A treatment combining restriction of the stronger arm with intensive task-oriented physical therapy has demonstrated lasting benefits for infants and toddlers who experienced stroke before birth or as newborns, according to preliminary research presented at the American Stroke Association's International Stroke Conference 2026. The study focused on children with perinatal arterial ischemic stroke (PAIS), the most common form of stroke in children, which causes functional impairment and limited voluntary motor control on one side of the body, a condition known as hemiparesis.
The research involved 167 stroke survivors younger than 3 years old with marked impairment in using one arm, who were randomly assigned to one of three treatments: high-dose I-ACQUIRE therapy, moderate-dose I-ACQUIRE therapy, or continuation of their usual care. I-ACQUIRE is a form of constraint-induced movement therapy (CIMT) specifically designed for very young children, delivered in the child's home or natural settings and including a parent program. This approach helps rewire the brain after injury by restricting use of the stronger arm and hand with a lightweight cast while providing intensive motor therapy focused on task-oriented activities.
Six months after treatment, children who received the high-dose therapy showed larger gains in skills and daily function compared to those in the moderate-dose or usual care groups. The high-dose treatment consisted of six hours of therapy with constraint of the less-affected arm and hand five days a week for four consecutive weeks, totaling 120 hours of therapist-delivered treatment. The moderate dose involved three hours daily for the same period, while usual care typically involved about one hour of physical therapy and one hour of occupational therapy each week from community therapists.
"This research fills a knowledge gap," said study author Sharon Ramey, Ph.D., co-director of the Fralin Biomedical Research Institute Neuromotor Research Clinic. "Previously, parents and physicians relied on findings from a mixed group of mostly older children with cerebral palsy and hemiparesis to make treatment recommendations; however, these findings lacked sufficient data about benefits for this clinical population of infants and toddlers." The study represents the first evaluation of this specific form of CIMT for this age group following perinatal strokes.
At the end of treatment, both dose groups showed improvements in neuromotor skills, with children gaining a median of 3 new skills compared to the usual care group's median gain of 1 skill. Parents' ratings indicated that children in both I-ACQUIRE groups gained meaningful improvement in everyday functional use of their weaker arm and hand, including exploring and manipulating toys, communication gestures, and self-help skills. Unexpectedly, children in the usual care group also showed clinically important improvement in their arm and hand skills at six months, though parent ratings did not indicate they saw real-world improvements in everyday use of the more-impaired limb.
The findings are particularly significant given that stroke is now the #4 leading cause of death in the U.S., according to the American Heart Association's 2026 Heart Disease and Stroke Statistics available at https://www.stroke.org. The research addresses a critical need for evidence-based interventions for this vulnerable population, as the potential for infant recovery from early stroke may exceed what was once considered a fairly grim prognosis. Researchers noted that identifying which children benefit most from this treatment will be important for future clinical applications, as responses varied among participants. The study's design and implementation demonstrate that such intensive interventions can be conducted carefully with proper monitoring and family participation, offering new hope for improving outcomes in children affected by perinatal stroke.
