Current service delivery models limit treatment time and length of hospital stay during the period of post-ischemic heightened neuronal plasticity when intensive training may optimally affect recovery. Prioritization for rehabilitation of independence in transfers and ambulation, negatively impacts the provision of intensive hand and upper extremity therapy. Our pilot data show that we are able to integrate intensive, targeted hand therapy that uses robotics and a library of gaming activities into the routine of an acute rehabilitation setting. Our system has been specifically designed to deliver hand training when motion and strength are limited. The system uses adaptive algorithms to drive individual finger movement, gain adaptation and workspace modification, and haptic and visual feedback from mirrored movements. The data establishes a foundation for a future clinical trial to investigate the potential benefits of robot-assisted gaming during the early phase of recovery.