The Pathway Is Clear but the Road Remains Unpaved: a Scoping Review of Implementation of Tools for Early Detection of Cerebral Palsy

Abstract

Background/Objectives: International guidelines recommend the combined use of the General Movement Assessment (GMA), Hammersmith Infant Neurological Examination (HINE), and magnetic resonance imaging (MRI) to support early and accurate diagnosis of cerebral palsy (CP). However, their implementation remains inconsistent. This study aimed to map their reported global use and identify associated enablers and barriers. Methods: A scoping review was conducted following JBI and PRISMA-ScR guidelines. Systematic searches were performed in PubMed, Cochrane, PEDro, ProQuest, Web of Science, and Scopus. Eligible studies were charted and thematically analyzed, focusing on tools use and implementation factors at individual, organizational, and system levels. Results: Fourteen articles (seven surveys, seven implementation studies) from seven countries met the inclusion criteria. While awareness of GMA, HINE, and MRI was generally high, routine clinical use was limited—particularly outside structured implementation initiatives. Major barriers emerged at the system level (e.g., limited training access, time constraints, lack of standardized referral pathways) and social level (e.g., unclear leadership and coordination). Conclusions: The limited integration of GMA, HINE, and MRI into routine practice reflects a persistent “know–do” gap in early CP detection. Since implementation is shaped by the dynamic interplay of capability, opportunity, and motivation, bridging this gap demands sustained and equitable action—by addressing system-wide barriers, supporting professional development, and embedding early detection within national care pathways.