High-Dose Therapy Boosts Arm and Hand Skills in Infants After Stroke

New treatment combining constraint and intensive therapy led to greater gains in function compared to standard care

Feb. 6, 2026 at 11:31pm

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In a clinical trial, infants and toddlers who had a stroke before birth or as a newborn showed improved arm and hand skills after receiving a new treatment that combined restricting the use of their stronger arm with intensive, task-oriented physical therapy. The high-dose version of this therapy, called I-ACQUIRE, led to significantly larger gains in skills and daily function compared to moderate-dose or usual care at six months post-treatment.

Why it matters

This study provides important new evidence that a specialized rehabilitation approach can benefit very young children who have experienced a perinatal stroke, which is the most common form of stroke in children. The findings suggest this treatment may help rewire the brain and improve motor function on the affected side, exceeding what was previously thought possible for this population.

The details

The clinical trial enrolled 216 children ages 8 months to 36 months who had experienced a perinatal stroke. They were randomly assigned to one of three groups: high-dose I-ACQUIRE therapy (6 hours per day, 5 days per week for 4 weeks), moderate-dose I-ACQUIRE therapy (3 hours per day, 5 days per week for 4 weeks), or usual care (about 1 hour each of physical and occupational therapy per week). The I-ACQUIRE therapy involved restricting use of the stronger arm to encourage use of the affected arm and hand, combined with intensive, task-oriented motor therapy. Assessors blind to the treatment groups measured the children's arm and hand skills before, after, and 6 months post-treatment.

  • The clinical trial was conducted from 2023 to 2026.
  • Outcomes from 167 children were included in the presentation at the American Stroke Association's International Stroke Conference 2026 held February 4-6 in New Orleans.

The players

Sharon Ramey, Ph.D.

The study author, co-director of the Fralin Biomedical Research Institute Neuromotor Research Clinic, a distinguished scholar and professor at the Fralin Biomedical Research Institute, and professor in the department of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine in Roanoke, Virginia.

I-ACQUIRE

A specialized form of constraint-induced movement therapy (CIMT) designed for infants and toddlers who have had a stroke, involving restricting use of the stronger arm to encourage use of the affected arm and hand, combined with intensive, task-oriented physical therapy.

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What they’re saying

“This research fills a knowledge gap. 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. Now, we confidently know that this treatment, at both dosages, was well-received, safe and produced measurable benefits.”

— Sharon Ramey, Study author (Mirage News)

“We think the potential for an infant to recover from an early stroke far exceeds what was once considered a fairly grim prognosis. 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. In turn, when they saw these improvements, they increased their own expectations for the future and their child's likely success in participating in a wider range of age-typical activities at home and in the community.”

— Sharon Ramey, Study author (Mirage News)

What’s next

The researchers plan to further analyze the data to identify which children benefited the most from the high-dose I-ACQUIRE therapy, as the response appeared to vary across the study participants.

The takeaway

This study demonstrates that a specialized rehabilitation approach combining constraint therapy and intensive, task-oriented physical therapy can significantly improve arm and hand function in infants and toddlers who have experienced a perinatal stroke, providing new hope for recovery and improved quality of life for this vulnerable population.