Inclusion Criteria- Ischemic or hemorrhagic stroke at least 6 months prior study enrollment ;
- Moderate upper-extremity hemiparesis (initial score on the Upper Extremity Fugl-Meyer Assessment between 21 and 55 out of 66) ;
- Ability to extend at least 2 fingers in the affected hand 10 degrees at any joint with pain-free passive range of motion at least 50% in all joints below the elbow.
- Prospective subjects must have a computer and internet connection at home which they will use for the home-based therapy.
Exclusion Criteria- Cognitive impairment resulting to inability to follow instructions (MMSE < 23 and subject is able to follow the 3-Stage Command) and inability to sustain attention for more than 10 minutes;
- Current participation in upper-extremity therapy program;
- Treatment with Botox injections in the affected arm in the previous 6 months;
- Poor sitting balance (score <4 on item number 3 of the Berg Balance Test);
- Aphasia sufficient to limit comprehension and completion of the treatment protocol;
- No more than moderate impairments in paretic UE sensation, passive range of motion, and pain that would limit ability to engage in therapy;
- Increased muscle tone as indicated by score of >/= 3 on the Modified Ashworth Scale;
- Previous diagnosis of dementia;
- Previous diagnosis of neurological diseases other than stroke;
- Other conditions affecting function of the stroke affected upper limb;
- Severe pain in the stroke affected upper limb;
- Terminal diseases with expected survival <1 year.