Stephanie DeLuca, PhD, discusses choosing the right approach for UCP

In a clinical discussion regarding infants with unilateral cerebral palsy (UCP), Stephanie DeLuca, PhD, an associate professor at the Fralin Biomedical Research Institute Neuromotor Research Clinic, emphasizes that choosing between high-dose interventions such as constraint-induced movement therapy (CIMT) and bimanual therapy depends significantly on family goals and the child’s developmental stage.

For infants who do not yet recognize their paretic side, CIMT may be preferred to encourage focus on that limb. Conversely, if a child is already incorporating the paretic hand into daily activities but lacks coordination, bilateral intensive therapy is often just as effective.

Addressing the logistical burden of a regimen requiring 3 hours per day, 5 days a week for 4 weeks, DeLuca notes that while intensive, the success-oriented nature of the therapy provides rapid, visible changes. This immediate progress serves as a primary support mechanism for parents, offering a sense of accomplishment that is often missing from traditional distributed practice models. Practical support from extended family and pediatricians who acknowledge these positive changes further aids adherence.

Regarding the study’s finding that the CIMT/full-time cast group showed surprisingly larger gains on the nonparetic side compared with the bimanual group, DeLuca suggests a potential neurological mechanism involving developmental differentiation. In children aged 6 to 24 months, the brain is naturally differentiating the control of both arms. The constraint may provide a “push” for the development of even the nonparetic limb during this critical window of neuroplasticity.

Looking at long-term outcomes, DeLuca highlights that early high-dose interventions aim to alter the lifelong neuromotor trajectory by establishing robust neural pathways. Beyond physical skills, these therapies provide children with the confidence to tackle difficult tasks. While there is a need for more longitudinal studies, current anecdotal evidence from grown participants indicates lasting benefits to both functional ability and well-being.

Finally, in a real-world setting, DeLuca supports pairing intensive therapies with interventions such as botulinum toxin for older children, though she notes it is unusual for infants younger than 24 months. Clinical application aims to maximize the physiological benefits of the toxin through task-oriented practice.

DeLuca concludes that the choice of therapy is not “either-or” but rather a conversation centered on evolving goals at different points in a child’s development.

No relevant disclosures.

Reference

DeLuca SC, Landesman Ramey S, Darragh AR, et al. Comparative efficacy RCT of 3 intensive infant/toddler therapies for unilateral cerebral palsy. Pediatr Open Sci. Published online February 20, 2026. doi:10.1542/pedsos.2025-000676