Eligible patients (study population)

Participants will be recruited from stroke services (Birmingham, Staffordshire and Norfolk) and will be followed up until 6 months after stroke wherever they are residing.

The inclusion criteria are

  • adults aged 18+ years;
  • 2-60 days after stroke when they provide informed consent. As brain recovery occurs mostly in the first 3 months after stroke participants will be within what is considered to be the critical time window for neural re-organisation;
  • a stroke in anterior cerebral circulation territory, cortical and/or subcortical, confirmed by clinical neuroimaging;
  • sufficient voluntary muscle contraction in the paretic upper limb to generate the beginning of prehension i.e score at least 11/33 for Motricity Index pinch section;
  • unable to complete the Nine Hole Peg Test (9HPT) in 50 seconds or less (maximum time for test);
  • no obvious spatial neglect as defined by a score of 0 or 1 on the Extinction and Inattention sub-scale of the NIH Stroke Scale;
  • have no obvious motor dyspraxia or communication deficits as assessed by ability to imitate action with the non-paretic upper limb. This will be assessed by the Research Therapist sitting alongside the potential participant. The Research Therapist will perform an upper limb activity 5 times and potential subjects will be asked to observe with intent to imitate and then perform the activities. This procedure will be repeated for four other upper limb activities. The accuracy of imitation of observed activity will be assessed on the 3-point scale used by Decety: 2 = correctly reproduced action; 1 = incorrectly reproduced action; 0 = not reproduced. Those scoring 8/10 or above will be considered to have the ability to imitate and therefore be included in this proposed trial;
  • were able, prior to the index stroke, to use the paretic upper limb to lift a cup and drink from it;