More than 6000 Veterans each year have an ischemic stroke that often results in some level of hemiplegia. Poor outcomes in stroke therapy leave the Veteran less able to participate in follow- up therapy post-discharge, reduces ability to complete activities of daily living, and contributes to an average cost of care three times the typical Veteran. Current protocols for therapy on a rehabilitation unit call for intensive rehabilitation composed of high intensity, long duration therapy. Evidence from brain healing and animal research, along with motor learning principles suggest that a treatment program composed of short duration therapy sessions distributed throughout the day may provide better rehabilitation outcomes for stroke patients. Such a program can be implemented using constraint-induced therapy in which the Veteran is provided with opportunities to use the affected limb while participating in a video game and completing complementary tasks in therapy. Additionally, rehabilitation outcomes may improve if Veterans are provided with regular opportunities to participate in gaming therapy at home after discharge from the hospital rather than having to travel to a clinic or receive limited or no follow-up in rural areas. This project will develop a therapeutic model for applying constraint-induced therapy via a video gaming environment that has movements paired with motor retraining performed in therapy sessions. A small group of patients will participate in a question and answer session about preferences for activities which make up transfer tasks. Transfer tasks are paired with movement performed while playing the video game. Patients will also receive automated reminders to use the impaired arm throughout the day. Ten Veterans will be recruited annually from the inpatient Stroke Specialty Program. Five patients will be assigned to the Treatment group and receive the intervention. The remaining five will receive the current standard of care. Outcome measures will include motor function tests that evaluate upper extremity function. Preliminary results will be presented at a major conference with project results submitted to a relevant peer-reviewed journal. Norms from this project will serve as the basis for a larger, multi-site Merit grant proposal. We believe this project will lead to substantive change in the treatment of acute stroke that will lead to improved functional outcomes for Veterans and reduced care costs for the VA.