Metamorphosis is a theory-driven occupational therapy program using telerehabilitation based on the concept of self-management of stroke (Warner et al., 2015), which emphasizes the crucial role of client adherence and engagement between formal therapy sessions to drive neuroplastic change. This program utilizes self-determination theory (Ryan & Deci, 2000) to cultivate the intrinsic motivation of individuals with chronic stroke to participate in evidence-based therapy from the home setting (Chemtob et al., 2019; Moore et al., 2016). Repetitious but interesting and engaging gamified therapy (Cramer et al., 2019; Proffitt & Lange, 2015; Thielbar et al., 2019) can lead to motor changes which are then translated into improvements in UL engagement during ADL guided by the Active Learning Program for Stroke (ALPS) (Fasoli & Adans-Dester, 2019), solidifying the motor changes by reducing learned non-use of the stroke-affected limb. Emotional support is provided through a moderated forum for stroke survivors (Owen et al., 2010) which can aid in continued translation of skills and motivation to participate in the program during a challenging time. / 2022-09-25T00:00:00Z