Lay summary
Stroke is the second leading cause of death and the third leading cause of disability among adults worldwide. Motor impairment is common after stroke, affecting around 80% of patients and recovery of movement is crucial to regaining independence. However, all major trials of movement rehabilitation interventions since 2011 have been negative. There is a great need to develop new approaches for rehabilitation of the upper limb after stroke. Our position is that stroke rehabilitation research needs to be different in order to make a difference, with greater contrast between experimental interventions and standard care, and principled selection of trial participants using biomarkers. We propose to conduct a Phase IIa trial to achieve both of these things.