To examine the preliminary effects of meta-cognitive strategy training for individuals with acute stroke. Pre-post non-randomized comparison study. Inpatient rehabilitation units within the same academic health center. We recruited participants who demonstrated cognitive impairment (Executive Interview>4 and Symbol Digit Modalities Test >1 standard deviation below norms) after acute stroke. We excluded individuals with severe aphasia (Boston Diagnostic Aphasia Examination < 2), pre-morbid diagnoses of dementia, current major depressive or bipolar disorder, recent alcohol/drug abuse, or psychosis. We administered either a meta-cognitive strategy training (Cognitive Orientation to daily Occupational Performance, CO-OP) or an attention control session (discussion group, AC) every weekday of the length of stay, in addition to usual inpatient rehabilitation. Since we expected that CO-OP might influence the rest of the usual inpatient rehabilitation in a given unit, participants on one unit received CO-OP (n=4) and participants on the other unit received AC (n=5). To describe the sample, we administered measures of cognitive function (Repeatable Battery of Neuropsychological Status, Delis Kaplan Executive Functioning System), motor function (Chedoke McMaster Assessment Impairment Inventory), and mood (Hamilton Depression Rating Scale, Apathy Evaluation Scale). To measure outcomes, we administered the Functional Independence Measure (FIM) at rehabilitation admission and discharge. Mean FIM admission scores were similar between groups, but there was greater variability in the AC group (CO-OP: M=64.5, SD=9.7; AC: M=65.6, SD=22.5). Mean FIM change scores differed between groups (CO-OP: M=25.8, SD=9.1; AC: M=15.0, SD=8.3) and although this difference was not statistically significant (Mann Whitney U=4.0; p=.14), it was associated with a moderate effect size (Cohen's d=.5). Meta-cognitive strategy training is feasible in acute stroke and is associated with promising preliminary outcomes (FIM) among individuals with cognitive impairment engaged in inpatient rehabilitation.