ISC 2026 | Neuromotor rehabilitation in pediatric stroke: evidence from clinical trials
Warren Lo, MD, Nationwide Children’s Hospital, Columbus, OH, discusses neuromotor rehabilitation in children who have suffered a stroke, highlighting that high-intensity motor rehabilitation can improve motor function even years after the stroke occurred. Prof. Lo notes that various forms of therapy, such as constraint-induced movement therapy (CIMT) and bimanual therapy, have been shown to be effective in improving motor function in children with hemiplegic cerebral palsy, often caused by stroke. This interview took place at the 2026 International Stroke Congress (ISC), held in New Orleans, LA.
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Transcript
Children represent an excellent model because we know that they normally have neuroplasticity that occurs as part of normal development. There are skills that children will learn as they grow older, and it is important to be able to attract children who have had a stroke to identify if new impairments occur so that you can be able to address them appropriately. The studies that I’ve been involved with have concentrated on neuromotor rehabilitation...
Children represent an excellent model because we know that they normally have neuroplasticity that occurs as part of normal development. There are skills that children will learn as they grow older, and it is important to be able to attract children who have had a stroke to identify if new impairments occur so that you can be able to address them appropriately. The studies that I’ve been involved with have concentrated on neuromotor rehabilitation. And there’s abundant evidence in adults as well as children that high-intensity motor rehabilitation improves motor function even if it is delivered years after the child has suffered a stroke. There is a trial conducted by Adam Kirton and his colleagues that looked at the effects of high-dose motor rehabilitation, even delivered six to 18 years after the children had perinatal arterial ischemic stroke. His study demonstrated that there was a significant and sustained improvement in terms of motor function, and that was an important randomized clinical trial. We are involved in the I-ACQUIRE trial, and those results will be released in the appropriate time. However, there are other trials where children have had high-intensity motor rehabilitation. There are at least a couple of forms that are recognized. One is called constraint-induced movement therapy, where you constrain the less affected arm and you use a combination of high-dose, graduated movements of the affected limb using techniques called shaping, and then activities involving not only the affected limb, but also bilateral aspects of the body. This constraint-induced movement therapy, or CIMT, has been shown to be effective in children who have hemiplegic cerebral palsy, but they may have cerebral palsy from a variety of causes, but stroke is a very common cause. There is also evidence that children who have intensive therapy in a form called bimanual therapy also show gains in terms of motor function. So the point is that children have significant improvement in motor function when you deliver these high-dose motor rehabilitations, either with constraint or without. And that is similar to what has been found in adults.
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