I-ACQUIRE Rehabilitation Intervention Shows Promising Short-Term Outcomes for Pediatric Stroke Patients

Late-breaking data from a large-scale, phase 3 study (NCT03910075) showed that high doses of I-ACQUIRE, a constraint-induced movement therapy (CIMT), led to clinically important gains in toddlers with perinatal arterial ischemic stroke (PAIS), a group that accounts for 80% of infant strokes. At 6 months after the conclusion of treatment, exploratory findings showed higher Infant Motor Activity Log parent ratings for I-ACQUIRE groups than usual treatment, supporting future analyses and next steps.

Presented at the 2026 International Stroke Conference (ISC), held February 4-6 in New Orleans, Louisiana, I-ACQUIRE was a study that randomly assigned children aged 8-36 months with PAIS to 3groups across 15 sites: usual care, moderate-dose I-ACQUIRE, and high-dose I-ACQUIRE. Those in the moderate dose group experienced treatment for 3 hrs/day, for 5 days/week, over a 4-week span, while those on high-dose I-ACQUIRE were on the intervention for 6 hrs/day, 5 days/week, for the same 4-week time period.

Led by Warren D. Lo, MD, a clinical professor of pediatrics and neurology at Nationwide Children’s Hospital, and others, the blinded study used the 30-item Emerging Behaviors Scale (EBS) scale as the primary outcome, with favorable outcomes considered at least a 7-point gain at both post-treatment time points. Within the modified intent-to-treat (mITT) group (n = 167), results showed that at the end of treatment, both the moderate-dose I-ACQUIRE (between-group differences, 1.82; 95% CI, 0.35-3.29) and high-dose I-ACQUIRE dosed groups (between-group differences, 2.27; 95% CI, 0.81-3.72) outperformed usual treatment.

Despite the improvements, only the high-dose I-ACQUIRE group separated from usual treatment at 6 months post-treatment. At this time point, there were differences of 0.02 (95% CI, –1.47 to 1.51) for moderate dose vs usual treatment, 1.29 (95% CI, –0.20 to 2.78) for high-dose vs usual treatment, and 1.27 (95% CI, –0.20 to 2.74) for high vs moderate dose I-ACQUIRE groups, favoring the higher dosage.

I-ACQUIRE, a CIMT approach, is a structured, motor rehabilitation program originally designed for children with unilateral cerebral palsy or hemiparesis. It builds on principles of neuroplasticity and motor learning, emphasizing repetitive, task-specific, goal-directed practice of the affected upper extremity. Some of the key components of this approach are the natural setting, bimanual activities, parent program, therapy log, and transfer package.

READ MORE: Precision Antithrombotic Therapy After Stroke: Interpreting the OCEANIC-STROKE Results

In the study, at end-of-treatment, there were substantial differences between the I-ACQUIRE groups and usual treatment on Bayley-4 Fine Motor Scale/Paretic side. While these differences shrunk during the 6-months post-treatment, those in both the moderate and high-dose ACQUIRE groups showed better overall outcomes on this scale than the usual treatment group.

Overall, better outcomes were observed in the per-protocol (PP) sample, which remained highly compliant to treatment. Within the PP sample, investigators recorded EBS score differences of 1.77 (95% CI, 0.22-3.33) for the high-dose group vs usual treatment, and 2.29 (95% CI, 0.66-3.92) for the high vs moderate dose groups, at 6 months.

In terms of next steps, the study authors noted that it would be important to identify whether clinical characteristics and biomarkers can predict which children benefit the most and least from I-ACQUIRE. In addition, the authors mentioned that future analyses should consider how to balance blinded objective outcomes and parent ratings when evaluating outcomes. The hope is that following this study, these data may inform future pediatric rehabilitation trials for children with other types of stroke, delivered across wide age ranges.

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REFERENCE
1. Ramey S, Lo W, DeLuca S, et al. The I-ACQUIRE Trial of Constraint Induced Movement Therapy for Infants/Toddler s with Perinatal Arterial Ischemic Stroke. Presented at: 2026 ISC Conference; February 4-6; New Orleans, LA. LB031.