Enhancing Motor Outcomes Through Constraint-Induced Movement Therapy in Perinatal Arterial Ischemic Stroke: Sharon Ramey, PhD; Warren Lo, MD

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"This is an important trial, because typically we don't think of children developing stroke. However, ischemic stroke in the perinatal period, either at the time of birth or even perhaps occurring just before birth, is the most frequent form of ischemic stroke in children."

Perinatal arterial ischemic stroke (PAIS), the most common type of stroke in children, is associated with hemiparesis and impaired voluntary motor control on 1 side of the body. At the recently concluded 2026 International Stroke Conference (ISC), held February 4-6, in New Orleans, Louisiana, researchers presented preliminary late-breaking findings from a phase 3 trial assessing I-ACQUIRE, a constraint-induced movement therapy–based intervention, in young children. The study enrolled 216 infants and toddlers aged 8 to 36 months across 15 sites in the Unites States, with outcomes reported for 167 participants.¹

In the study, participants were randomized to moderate-dose therapy, high-dose therapy, both administered 5 days per week for 4 weeks with constraint of the less-affected limb, or to usual care consisting of community-based physical and occupational therapy. At the end of treatment, both I-ACQUIRE groups demonstrated greater gains in neuromotor skills compared with usual care. At 6 months, the high-dose group showed significantly greater skill gains. Parent-reported outcomes also indicated meaningful improvements in functional use of the affected limb, including gains in play, communication gestures, and self-help skills.

To learn more about the implications of the study’s findings, study authors Sharon Ramey, PhD, professor in the department of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine, and Warren Lo, MD, clinical professor of pediatrics and neurology at Nationwide Children’s Hospital, spoke with NeurologyLive^®. The duo discussed the rationale for early, intensive intervention in this population, the structure of the home-based treatment approach with caregiver involvement, and the broader clinical implications for motor recovery in early childhood stroke. They also addressed the therapy’s tolerability and its potential role in supporting functional development in affected infants.

Click here for more coverage of ISC 2026.

REFERENCES
1. Lo WD, Ramey SL, DeLuca S, et al. The I-ACQUIRE Trial of Constraint Induced Movement Therapy for Infants/Toddlers with Perinatal Arterial Ischemic Stroke. Presented at: International Stroke Conference; February 4-6, 2026; New Orleans, Louisiana. LB031.
2. High-dose therapy had lasting benefits for infants with stroke before or soon after birth. News release. American Heart Association. February 6, 2026. Accessed February 12, 2026. https://newsroom.heart.org/news/high-dose-therapy-had-lasting-benefits-for-infants-with-stroke-before-or-soon-after-birth