This study aims to better understand how occupational therapists provide rehabilitation for adults recovering from stroke or spinal cord injury (SCI), with a focus on improving arm and hand function. Using video recordings of real outpatient therapy sessions, researchers will identify the key elements of treatment, such as the types of activities, the therapist's techniques, and how patients respond. The study will use the Rehabilitation Treatment Specification System (RTSS), a framework designed to clearly describe rehabilitation methods. By analyzing these sessions, the research team will develop a practical toolkit to help therapists and researchers deliver and study more effective rehabilitation treatments in the future.

Occupational Therapy Inclusion Criteria:

• Must be a licensed OT practitioner (occupational therapist or occupational therapy assistant),
• The OT practitioner must treat at least one adult stroke or spinal cord injury patient with UE sensorimotor impairment per month
• The OT practitioner must be willing to be video recorded while treating their enrolled stroke or SCI patients.

Stroke Patients Inclusion Criteria:

• Must have a medical diagnosis of ischemic or hemorrhagic stroke
• Must be ≥ 18 years old
• Must have at least one OT goal related to UE hemiparesis
• Must have at least one remaining OT treatment session after enrollment
• The patient's OT must be enrolled in the study.

Spinal Cord Injury (SCI) Patients Inclusion Criteria:

• Must have a medical diagnosis of cervical spinal cord injury
• Must be ≥ 18 years old
• Must have at least one OT goal related to UE sensorimotor impairment
• Must have at least one remaining OT treatment session after enrollment
• The patient's OT must be enrolled in the study.

A purposive sample of OT practitioners working in an outpatient rehabilitation at OSUWMC will be recruited for this study.

A purposive sample of stroke patients receiving OT at an OSU outpatient rehabilitation clinic will be recruited for this study.

A purposive sample of SCI patients receiving OT at an OSU outpatient rehabilitation clinic will be recruited for this study.