Pilot Study to Assess the Feasibility and Initial Efficacy of Therapist-as-consultant, Game-based CI Therapy

Inclusion Criteria: * Provide signed and dated informed consent form * Willing to comply with all study procedures and be available for the duration of the study * Male or female aged \> 17 * Preserved ability to comprehend English and participate in basic elements of the therapy * Community-dwelling * Experienced mild to moderate hemiparesis at least six months prior * Can independently operate the gaming system (those with severe cognitive impairments can usually achieve this) * Corrected vision of at least 20/70 as assessed by their ability to identify game objects on the monitor from 5 feet away Exclusion Criteria: * concurrent participation in other experimental upper extremity trials * concurrent participation in other outpatient rehabilitation for their upper extremity * Botox within the last 3 months (confound) * near-normal motor function (9-hole Peg Test score above the 10th percentile of a normative sample) * minimal nonuse (Motor Activity Log at baseline \>2.5, Accelerometry \> 60%) * major medical issues that would interfere with study treatments or make intensive rehabilitation difficult to tolerate