Participants will receive 24 one-hour rehabilitation sessions with a licensed occupational therapist trained in stroke recovery and with the VR system. Each therapy session will include range of motion and general strengthening activities as well as 20-30 minutes of the intervention (ADL-focused upper-limb virtual reality training). The goal is to complete rehabilitative training in 12 weeks, with each participant training two times per week.

The virtual reality (VR) training tool simulates cooking, an activity of daily living (ADL). The layout of VR environments intentionally place ingredients, tools, and the recipe book far away from the user to require gross upper-limb physical movements. Successful step completion requires reaching to obtain ingredients or turn book pages, grabbing to hold or release objects, and chopping, scooping, stirring, and pouring motions to prepare food items. The VR tool includes three versions of varying graphical complexity: Simple, Standard, and Complex.

Complexity is controlled by stimuli count and detail level. For example, Simple features an empty room with monotone colors, basic shapes, and no extra features. In contrast, Complex resembles a fully-fledged kitchen with color patterns, textures, background details, and sounds.

The Fugl-Meyer Assessment (FMA) is a physical performance impairment index that evaluates motor recovery.

Domains of motor function, sensation, balance, range of motion, and pain are measured on a 3-point ordinal scale.

The upper extremity (UE) section score ranges from 0 to 66, with higher scores indicating less impairment.

The Stroke Impact Scale (SIS) holistically evaluates quality of life after a stroke. The SIS-16 version is a self-report questionnaire that assesses the ability to perform daily physical activities on a 5-point Likert scale.

Score ranges from 0 to 100, with higher scores indicating better capacity and milder stroke impact.

The Mini-Mental State Examination (MMSE) is an 11-question cognitive performance assessment that evaluates orientation, understanding, language, attention, and memory.