Eligibility CriteriaINCLUSION CRITERIA:
Twelve hemispheric patients (right or left) with residual arm function who had a single monohemispheric stroke (documented by CT or MRI) at least 12 months before, without severe proprioceptive deficits, independent of previous physical therapy will be included.
They should all be able to perform the training task.
Excluded from the study will be: patients with more than one stroke;
patients with large cortical, cerebellar or brainstem lesions;
Patients unable to extend metacarpophalangeal (MP) joints at least 10-20 degrees;
Patients unable to extend the wrist at least 20 degrees;
Patients with substantially recovered motor function;
Patients with severe depression, poor motivational capacity, or severe language disturbances, particularly of receptive nature;
Patients with severe spasticity/pain;
Patients with bilateral motor problems;
Patients with serious cognitive deficits (defined as equivalent to a mini-mental state exam score of 20 or less);
Patients severe uncontrolled medical problems (e.g. cardiovascular disease, severe rheumatoid arthritis, active joint deformity of arthritic origin, active cancer or renal disease, any kind of end-stage pulmonary or cardiovascular disease, or a deteriorated condition due to age, uncontrolled epilepsy or others);
Patients with respiratory failure;
Patients with friable plaques (class D disease) or a stenosis exceeding 70% in the internal carotid artery ipsilateral to the side of paresis (as assessed with ultrasonography).