Virtual Occupational Therapy Application (VOTA) combines low-cost human motion tracking, commercial game engine technology, and evidence-based Occupational Therapy (OT) practice in a computer-based virtual world in which stroke patients practice activities of daily living (ADLs). The protocol investigates the efficacy of VOTA therapy for Upper Extremity (UE) motor recovery and assesses system usability and user acceptance.

Inclusion Criteria:

• Participant is a hemiparetic stroke survivor;
• Time since last stroke at least 3 months;
• Participant has antigravity strength at the elbow to at least 45 degrees of active flexion in the stroke affected arm;
• Participant has antigravity shoulder strength to at least 30 degrees each in active flexion, abduction/adduction, and 15 degrees in active rotation from an upright seated position in the stroke affected arm;
• Participant has visual acuity with corrective lenses of 20/50 or better;

Exclusion Criteria:

• Existing participation in an upper extremity stroke rehabilitation program or planned participation during the study period;
• Inability to understand and follow verbal directions;
• Determination that participation would result in over exertion or significant discomfort or pain;
• Determination that participation would result in significant agitation or elevated stress;
• Withholding or withdrawal of consent by the participant;
• Visual field deficit in either eye that impairs the ability to view the computer monitor;
• Hemispatial neglect that impairs the ability process and perceive visual stimuli provided through the computer monitor;