NEW ORLEANS - February 6, 2026 - A new treatment combining restraint of the stronger arm with intensive, task-oriented physical therapy led to improved function and skill acquisition in infants and toddlers who had a stroke before birth or as a newborn, according to preliminary research presented today at the American Stroke Association’s International Stroke Conference 2026.
The study, the first to evaluate this form of constraint-induced movement therapy (CIMT) in children under 3 with perinatal arterial ischemic stroke (PAIS), found that those receiving a high dose of the therapy—six hours per day for five days a week over four weeks—showed larger gains in skills and daily function six months later compared to those receiving a moderate dose or usual care.
“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 older children with cerebral palsy; now we confidently know this treatment is safe and produces measurable benefits.”
Perinatal arterial ischemic stroke is the most common form of stroke in children, often causing hemiparesis—impaired motor control on one side of the body. CIMT aims to rewire the brain by restricting the stronger arm with a lightweight cast while engaging the impaired limb in intensive, goal-directed activities.
The phase 3 randomized clinical trial enrolled 216 children aged 8 to 36 months at 15 U.S. sites; outcomes from 167 confirmed PAIS cases were analyzed. Participants were assigned to high-dose I-ACQUIRE therapy (120 total hours), moderate-dose I-ACQUIRE therapy (60 total hours), or usual care (about 2.2 hours of weekly occupational and physical therapy).
Certified assessors blinded to group assignment measured arm and hand skills before treatment, at treatment end, and six months later. At the end of treatment, both dose groups gained a median of 3 new skills (mean 2.94 moderate, 3.30 high) compared to 1 skill in usual care—a statistically significant difference, though smaller than expected.
At six months, the high-dose group showed significantly larger skill gains than the moderate-dose or usual care groups. Parent ratings also indicated meaningful improvements in everyday functional use of the weaker arm for both I-ACQUIRE groups, including tasks like exploring toys, communicating gestures, and self-help skills.
Unexpectedly, children in usual care also showed clinically important improvement in arm and hand skills at six months, such as reaching, grasping, and using the impaired arm for balance and crawling. However, parents did not perceive real-world improvements in this group.
“We think the potential for an infant to recover from an early stroke far exceeds what was once considered a grim prognosis,” Ramey said. “Parents reported changes exceeding what they were told was likely, raising their expectations for their child’s future.”
The study was funded by the National Institute of Neurological Disorders and Stroke. Limitations include potential site selection bias and a reduced sample size due to unconfirmed PAIS diagnoses in some enrolled children. Full findings are considered preliminary until published in a peer-reviewed journal.
