A groundbreaking study presented at the American Stroke Association’s International Stroke Conference 2026 reveals that high-dose constraint-induced movement therapy (CIMT) can produce lasting improvements in arm and hand function for infants and toddlers who suffered a stroke before or shortly after birth. The research, published as a late-breaking abstract, is the first large-scale trial to specifically evaluate this therapy in very young children with perinatal arterial ischemic stroke (PAIS), the most common form of stroke in children.
The study, led by Sharon Ramey, Ph.D., co-director of the Fralin Biomedical Research Institute Neuromotor Research Clinic, enrolled 216 children aged 8 to 36 months across 15 U.S. universities and hospitals. Of these, 167 children with confirmed PAIS and marked impairment in one arm were randomly assigned to three groups: high-dose I-ACQUIRE therapy (six hours per day for five days a week over four weeks), moderate-dose I-ACQUIRE therapy (three hours per day for five days a week over four weeks), or usual care (about one hour of physical therapy and one hour of occupational therapy per week).
The I-ACQUIRE treatment combines constraint of the less-affected arm with a lightweight cast and intensive, task-oriented motor therapy delivered in the child’s home or natural settings. The goal is to encourage use of the stroke-affected arm and hand, promoting neuroplasticity. Certified assessors blinded to treatment groups measured children’s arm and hand skills before treatment, at the end of treatment, and six months later. Parents also rated their child’s functional performance in daily activities.
At the end of treatment, both I-ACQUIRE dose groups showed significantly greater gains in neuromotor skills compared to usual care, with median gains of three new skills in the moderate-dose group and 3.3 in the high-dose group versus one skill in the usual care group. However, the most striking findings emerged at the six-month follow-up: children in the high-dose group had significantly larger skill gains than those in the moderate-dose or usual care groups. These differences were even more pronounced for children whose treatment closely adhered to the protocol.
Parent ratings corroborated the benefits, indicating that children in both I-ACQUIRE groups showed meaningful improvements in everyday functional use of their weaker arm, including skills like exploring toys, communication gestures, and self-help tasks. Unexpectedly, children in the usual care group also demonstrated clinically important improvements in arm and hand skills at six months, such as reaching, grasping, and using the impaired arm for balance. However, their parents did not perceive real-world improvements at either time point.
“This research fills a knowledge gap,” said Ramey. “Previously, parents and physicians relied on findings from older children with cerebral palsy. Now, we confidently know that this treatment, at both dosages, was well-received, safe, and produced measurable benefits.” The study authors noted that the smaller-than-expected skill gains may reflect variability in individual responses, highlighting the need to identify which children benefit most.
The study was funded by the National Institute of Neurological Disorders and Stroke, part of the National Institutes of Health. It underscores the potential for significant recovery after early stroke, with many parents reporting improvements that exceeded their expectations. “We think the potential for an infant to recover from an early stroke far exceeds what was once considered a fairly grim prognosis,” Ramey added.
The findings are considered preliminary until published in a peer-reviewed journal. Additional information is available at www.stroke.org and the abstract can be accessed via the American Stroke Association International Stroke Conference 2026 Online Program Planner.
