A treatment combining constraint 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 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.
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 usual care. The I-ACQUIRE treatment, delivered in the child's home or natural settings, included a parent program and was designed to increase use of the more-affected arm and hand through intensive motor therapy guided by learning principles.
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. Parents of children in both the high and moderate-dose groups reported meaningful improvement in everyday functional use of the 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 real-world improvements for those receiving standard care. The usual care group received an average of 2.2 hours of weekly therapy, with most children seeing both an occupational therapist and physical therapist every week for about an hour each.
"We think the potential for an infant to recover from an early stroke far exceeds what was once considered a fairly grim prognosis," said study author Sharon Ramey, Ph.D., co-director of the Fralin Biomedical Research Institute Neuromotor Research Clinic. "We repeatedly heard from parents that the many changes they saw in their children exceeded what they had been told was likely for their child."
The study represents the first evaluation of this form of Constraint-Induced Movement Therapy specifically for infants and toddlers after perinatal strokes, filling a knowledge gap where parents and physicians previously relied on findings from mostly older children with cerebral palsy and hemiparesis. According to the American Heart Association's 2026 Heart Disease and Stroke Statistics, stroke is now the fourth leading cause of death in the U.S., making this research particularly significant for improving outcomes in vulnerable pediatric populations.
Study limitations include that the 15 U.S. sites may not represent all places where children with PAIS receive care, and researchers enrolled a small number of children whose parents stated the child had PAIS without independent specialist confirmation. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal, as abstracts presented at the Association's scientific meetings are not peer-reviewed. The study received funding from the National Institute of Neurological Disorders and Stroke, an institute in the National Institutes of Health.
