Novel Arm Therapy May Shift Stroke Rehab Focus

Ipsilesional arm training improves motor function in chronic stroke survivors with severe paresis

Published on Feb. 13, 2026

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A small randomized clinical trial found that targeted therapy of the ipsilesional, or 'good' arm, improved motor function, including control and speed, in chronic stroke survivors with severe contralesional arm weakness. This is the first study to use a rigorous design to investigate ipsilesional limb training in this population, challenging the traditional rehabilitation focus on the contralesional arm.

Why it matters

Individuals with severe contralesional paresis depend almost entirely on their ipsilesional arm for daily activities, yet these impairments remain amenable to improvement even years after a stroke. This study suggests that targeting the ipsilesional arm could lead to sustained motor improvements and more efficient activities of daily living for chronic stroke survivors with severe hemiparesis.

The details

The phase 2 randomized clinical trial included 53 participants with chronic stroke and severe contralesional arm weakness. The ipsilesional therapy group received virtual reality-based motor training and real-world dexterity exercises focused on speed, accuracy, and coordination. The contralesional therapy group received traditional approaches like proximal strength training and mirror therapy. At the first post-treatment assessment, the ipsilesional group completed a standardized dexterity test 5.87 seconds faster than the contralesional group, a 12% improvement from baseline. These gains were sustained at 3-week and 6-month follow-ups.

  • The study was published online on February 2, 2026 in JAMA Neurology.
  • Participants were assessed before the start and end of the 5-week, 15-session trial, as well as 3 weeks and 6 months after the trial concluded.

The players

Carolee Winstein

Professor emerita and adjunct faculty, Division of Biokinesiology and Physical Therapy, University of Southern California, in Los Angeles, and study co-author.

Robert Sainburg

Dorothy F. and J. Lloyd Huck Distinguished Chair in Kinesiology and Neurology at Penn State in University Park, Pennsylvania, and study co-author.

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What they’re saying

“This is the first project to use a rigorous randomized clinical trial design to investigate the use of ipsilesional limb training — training the less-impaired arm — in chronic stroke survivors with severe paresis.”

— Carolee Winstein, Professor emerita and adjunct faculty, Division of Biokinesiology and Physical Therapy, University of Southern California (News release)

“We're changing the function of the less-impaired hand so that their activities of daily living can be more efficient.”

— Robert Sainburg, Dorothy F. and J. Lloyd Huck Distinguished Chair in Kinesiology and Neurology at Penn State (News release)

What’s next

Future research should explore integration of ipsilesional training with home-based practice and combined bilateral approaches that optimize recovery and independence.

The takeaway

This study suggests that targeting the ipsilesional, or 'good' arm, could lead to sustained motor improvements and more efficient daily activities for chronic stroke survivors with severe hemiparesis, challenging the traditional rehabilitation focus on the contralesional arm.