Rehab Therapy Improves Motor Skills in Infants With Perinatal Stroke

High-dose constraint-induced movement therapy shows promise in early intervention for critical brain development window.

Published on Feb. 10, 2026

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A phase 3 study found that an intensive rehabilitation program focused on improving upper extremity skills produced measurable benefits and was well received and safe in infants with perinatal arterial ischemic stroke (PAIS). Babies who received the most intensive form of therapy, constraint-induced movement therapy (CIMT), and were most adherent achieved the best overall outcomes. This represents the first adequately powered trial of high-dose CIMT in infants and toddlers with perinatal stroke.

Why it matters

PAIS is a common form of ischemic stroke in children, but there has been a lack of evidence-based rehabilitation options for infants and toddlers with this condition. The study aimed to address this gap by testing CIMT during early development, a period of heightened neuroplasticity when intervention may have the greatest impact on long-term motor outcomes.

The details

The study included 167 infants with PAIS and hemiparesis, aged 8-36 months, across 15 US sites. Participants were randomly assigned to one of three groups: usual care, moderate-dose therapy (3 h/d, 5 d/wk for 4 weeks), or high-dose therapy (6 h/d, 5 d/wk for 4 weeks). The intervention involved task-oriented therapy delivered by trained occupational or physical therapists, typically in the home, to improve motor function, coordination, and functional independence. During most sessions, children wore a lightweight cast on the unimpaired arm and hand.

  • The study was conducted to address the lack of evidence-based rehabilitation options for infants and toddlers with PAIS.
  • Children typically begin to develop voluntary control of their arms and hands at around 6-8 months of age.
  • The trial, known as the I-ACQUIRE study, included children aged 8-36 months, a period of rapid brain development with high neuroplastic potential.

The players

Sharon Ramey

Professor, Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion School of Medicine, and professor, Fralin Biomedical Research Institute, Roanoke, Virginia.

Warren D. Lo

Co-investigator, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio.

Lauren Sansing

Professor of neurology at Yale School of Medicine in New Haven, Connecticut, and ISC Chair.

Bijoy Menon

Neurologist in Calgary, Alberta, Canada, and ISC Vice Chair.

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What they’re saying

“For the first time, we now have a protocol, a treatment, which produces benefits [for children with PAIS].”

— Sharon Ramey, Professor (Medscape Medical News)

“Once you have proof of principle that something like this potentially works, it opens up funding opportunities and new avenues of how this might actually be delivered.”

— Bijoy Menon, Neurologist (Medscape Medical News)

What’s next

The investigators plan to follow the children through 12 months and present additional findings at future meetings. They also want to identify clinical characteristics and biomarkers that may predict which children derive the greatest benefit from the intervention, as well as to examine which components of usual care were associated with the highest and lowest gains.

The takeaway

This study represents a significant step forward in addressing the lack of evidence-based rehabilitation options for infants and toddlers with perinatal stroke. The promising results of high-dose constraint-induced movement therapy suggest it could have a meaningful impact on long-term motor outcomes for this population during a critical window of brain development.