Eligibility Criteria

Inclusion Criteria

- diagnosis of stroke > 6 months
- moderate to severe arm impairment
- intact visual scanning and spatial orientation of the affected arm
- functional cognitive status
- medically stable

Exclusion Criteria

- concurrent occupational or physical therapy for the arm
- joint contractures at the wrist, forearm, elbow, or shoulder
- moderate to severe spasticity at the elbow or shoulder
- presence of other neurological conditions
- botulinum toxin injection in the affected arm < 3 months prior
- score of 0/5 on manual muscle test at the elbow or shoulder