Infants and toddlers who experienced a stroke before or shortly after birth may benefit from a high-dose therapy that restricts use of the stronger arm while encouraging use of the affected limb, according to preliminary research presented at the American Stroke Association's International Stroke Conference 2026. The study, involving 167 children aged 8 months to 3 years with hemiparesis, found that those receiving six hours daily of I-ACQUIRE therapy for four weeks showed greater skill gains at six months post-treatment compared to those receiving moderate-dose or standard care.
Perinatal arterial ischemic stroke (PAIS) is the most common form of stroke in children, often leading to long-term motor impairment on one side of the body. Constraint-induced movement therapy (CIMT) has been used in older children and adults, but its effectiveness in very young children was not well established. This trial is the first to evaluate a specific CIMT protocol, I-ACQUIRE, delivered in home settings with a parent program. "Previously, parents and physicians relied on findings from a mixed group of mostly older children with cerebral palsy," said lead author Sharon Ramey, Ph.D., co-director of the Fralin Biomedical Research Institute Neuromotor Research Clinic. "Now, we confidently know that this treatment, at both dosages, was well-received, safe and produced measurable benefits."
Participants were randomly assigned to high-dose (six hours/day), moderate-dose (three hours/day), or usual care (about two hours of weekly therapy). Certified assessors blinded to treatment groups measured arm and hand skills before treatment, at treatment end, and six months later. At the end of treatment, both I-ACQUIRE groups gained a median of three new skills, significantly more than the usual care group (median one skill). However, at six months, the high-dose group showed larger gains than the moderate-dose or usual care groups. Parents also reported meaningful improvements in daily function for children in both I-ACQUIRE groups, including exploration, communication gestures, and self-help skills.
Unexpectedly, children in the usual care group also showed significant improvement at six months, though parent ratings did not reflect real-world functional gains. The researchers noted that the overall skill gains were smaller than anticipated, possibly due to variability in how children with PAIS respond. Identifying which children benefit most will be important for future treatment. The study, funded by the National Institute of Neurological Disorders and Stroke, highlights the potential for recovery after early stroke. As Ramey stated, "We think the potential for an infant to recover from an early stroke far exceeds what was once considered a fairly grim prognosis."
The findings are considered preliminary until published in a peer-reviewed journal. Additional information about the study is available at stroke.org.
