Efficacy of Tele-CPASS Compared to In-person CPASS Therapy for Upper Extremity Motor Recovery

Inclusion Criteria: * Age 21 years or older * Neuroimaging-confirmed stroke within 40 days prior to enrollment * Persistent hemiparesis resulting in impaired upper extremity function, defined by a score of 0 to 3 on the NIH Stroke Scale motor arm item * Able to participate in all study-related activities, including 1-year follow-up * Short Blessed Memory Orientation and Concentration Scale score less than 8 * Able to follow 2-step commands * Montreal Cognitive Assessment (MoCA) score greater than 25 * No upper extremity injury or condition that limited upper extremity use prior to the stroke Exclusion Criteria: * Inability to provide informed consent * Persistent disabling neurologic condition, such as multiple sclerosis, Parkinsonism, amyotrophic lateral sclerosis, or dementia requiring medication * Clinically significant fluctuations in mental status within 72 hours prior to randomization * Active psychosis, psychosis within the prior 2 years, active substance abuse, or prior substance abuse * Dense sensory loss, defined by a score of 3 or 4 on the NIH Stroke Scale sensory item * Ataxia out of proportion to weakness in the affected arm, defined by a score greater than 1 on the NIH Stroke Scale ataxia item * Not expected to survive 12 months because of other illnesses * Pregnancy * Severe aphasia * Receipt of botulinum toxin or expectation of receiving botulinum toxin during the study period