Randomized trial of intensive arm movement therapy using a telerehab system. Being done at Moss Rehab. To refer patients, contact: Tejaswini.Sudhakar@Jefferson.edu. More info at tr2trial.com.

Inclusion Criteria

• Age 18-85 years at the time of randomization
• Ischemic stroke or intracerebral hemorrhage (ICH) seen on imaging within 3-9 months of randomization
• Arm weakness but with ability to hold and lift a spoon
• Informed consent and behavioral contract signed by the subject (i.e., no surrogate consent)

Exclusion Criteria

• A diagnosis (apart from the index stroke) that substantially affects paretic arm function
• Severe depression
• Significant cognitive impairment, defined as Montreal Cognitive Assessment score <22 [a lower score is permitted if due to aphasia and allowed by the site PI]
• Deficits in communication that interfere with reasonable study participation
• Severe UE spasticity, defined as presence of contracture or modified Ashworth Scale score=4 in either biceps or pectoralis
• Modified Rankin Scale score was >2 prior to the index stroke
• A new symptomatic stroke has occurred since the index stroke, or a separate stroke occurred within 30 days prior to the index stroke
• Lacking visual acuity, with or without corrective lens, of 20/50 or better in at least one eye
• Life expectancy < 9 months
• Botulinum toxin to the paretic arm: received in the prior 3 months OR expected by the 8-Month Visit
• Subject lacks sufficient English or Spanish to comply with study procedures and TR instructions
• Contraindication to MRI