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Background and purpose: Recovery of early voluntary finger extension is an important predictor of recovery of upper extremity (UE) function, but the intensity of UE rehab is reported to be low during the acute stage post stroke. This may be the period of greatest neuroplasticity, where intensive rehabilitation may have greater gains. The aim of this study was to examine the feasibility of implementing an intensive evidence-based UE rehabilitation program in the first four weeks post stroke.Methods: Twenty participants were recruited to the study 5 ± 4 days after a first-ever stroke. All participants received usual physical and occupational therapy. Those randomly allocated to the intervention group received a supplementary program based on an evidence-based algorithm, which was monitored and progressed weekly by an experienced physiotherapist. Participants were asked to perform this for 60 mins/day for four weeks, supervised and assisted as necessary by a carer or therapy assistant. Accelerometers were used to measure changes in real-world use of the affected UE, in addition to the Action Research Arm Test and Motor Activity Log to record arm activity. Interviews were conducted to explore acceptability for participants and their carers.Results: Two patients were withdrawn due to medical issues, but there were no adverse events from the intervention. All measures improved significantly over time, with no between-group difference. Accelerometry measures correlated strongly with the ARAT, at baseline and post-intervention (e.g. use ratio and ARAT post-intervention, Pearson’s r = 0.86, P < 0.001).Conclusion: Additional evidence-based therapy was feasible and acceptable in the acute setting, but there was no superior effect in this pilot group. This study confirms the strong relationship between objective measures of acceleration and self-reported and clinical measures of UE activity in the acute setting post-stroke.