The purpose of this randomized controlled study is to

1. Examine the feasibility of a home Mirror therapy (MT) program in the NYC metropolitan area;

2. Evaluate the effectiveness of home MT versus traditional home exercise program; and

3. Evaluate the superiority of unimanual or bimanual MT intervention protocols for chronic stroke subjects with moderate hand deficits. Subjects from occupational therapy at the Ambulatory Care Center of NYU Langone Center with a diagnosis of cerebral vascular accident (CVA) or stroke will be divided into three (3) groups:

   • Control Group subjects will participate in standard occupational therapy rehabilitation protocol plus a traditional home based exercise program.
   • Experimental group 1 subjects will participate in standard rehabilitation protocol plus unimanual home based mirror therapy program
   • Experimental group 2 subjects will participate in standard rehabilitation protocol plus bimanual home based mirror therapy program.

Inclusion Criteria:

• First time unilateral stroke > 3 months post stroke.
• Cognitively be able to follow direction
• Cognitively be able to consent to participation in research study
• Moderate/severe deficits as per the Fugl-Meyer assessment score from 10-50 and the ability to grasp and release a small towel or washcloth.

Exclusion Criteria:

• Complex medical problems, that would render the subject unable to participate in an extensive home program
• History of pre-existing neurological or psychiatric diseases, orthopedic conditions of the upper limbs, or peripheral nerve injuries that render the subject unable to sit or to move either upper limb
• Hearing and vision impairments which may impede subjects participation in the home program
• Perceptual deficits such as apraxia, neglect, or agnosias as per clinical evaluation which may impede subjects participation in the home program
• Botox injection in affected arm/hand within 3 months
• Global aphasia that may interfere with understanding instruction for testing or home exercise program.

Participants included in the study will be those referred to outpatient occupational therapy at the Ambulatory Care Center of NYU Langone Center with a diagnosis of cerebral vascular accident (CVA) or stroke.