Inclusion Criteria:

• Acute ischemic stroke with moderate to severe hemiparesis
• Functional independence in activities of daily living without requiring nursing care before the index stroke.
• Consent process by participant or proxy, with reconsent provision.
• Age ≥ 45 to ≤ 80 years of age (inclusive) on the date of randomization
• Sufficient attention, comprehension, and cooperation to carry out instructions

Exclusion Criteria:

• Pre-existing motor deficit prior to index stroke
• Posterior circulation ischemic stroke
• Lacunar stroke
• Qualifying brain imaging demonstrating intracranial hemorrhage, malignant middle cerebral artery (MCA) infarct with edema, or bilateral/multifocal infarcts, clinically significant vascular malformation, brain tumor, or other central nervous system (CNS) pathology
• Recent major surgery or trauma (<30 days)