Mirror Therapy Using Gesture Recognition for Upper Limb Function, Neck Discomfort, and Quality of Life After Chronic Stroke: A Single-Blind Randomized Controlled Trial.

BACKGROUND Mirror therapy for stroke patients was reported to be effective in improving upper-extremity motor function and daily life activity performance. In addition, game-based virtual reality can be realized using a gesture recognition (GR) device, and various tasks can be presented. Therefore, this study investigated changes in upper-extremity motor function, quality of life, and neck discomfort when using a GR device for mirror therapy to observe the upper extremities reflected in the mirror. MATERIAL AND METHODS A total of 36 subjects with chronic stroke were randomly divided into 3 groups: GR mirror therapy (n=12), conventional mirror therapy (n=12), and control (n=12) groups. The GR therapy group performed 3D motion input device-based mirror therapy, the conventional mirror therapy group underwent general mirror therapy, and the control group underwent sham therapy. Each group underwent 15 (30 min/d) intervention sessions (3 d/wk for 5 weeks). All subjects were assessed by manual function test, neck discomfort score, and Short-Form 8 in pre- and post-test. RESULTS Upper-extremity function, depression, and quality of life in the GR mirror therapy group were significantly better than in the control group. The changes of neck discomfort in the conventional mirror therapy and control groups were significantly greater than in the GR mirror therapy group. CONCLUSIONS We found that GR device-based mirror therapy is an intervention that improves upper-extremity function, neck discomfort, and quality of life in patients with chronic stroke.

Effects of an intensive Nordic walking intervention on the balance function and walking ability of individuals with Parkinson's disease: a randomized controlled pilot trial.

BACKGROUND: Parkinson's disease (PD) is associated with impairment in balance and postural control, accompanied by a progressive reduction in the speed and amplitude of movement. AIMS: The aim of our study was to evaluate the therapeutic effects of Nordic walking on a treadmill on the balance function and walking ability of individuals with PD. METHOD: Twenty participants with stage 1-3 PD in the Hoehn and Yahr scale were randomly allocated to the Nordic walking training (NWT) group and treadmill training (TT) group, with ten participants per group. Measured outcomes included: the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS-M), the Berg balance scale (BBS), the Timed Up-and-go test (TUG), the 10-meter walk test (10 MWT), and the 6-minute walk test (6 MWT). RESULTS: Improvement on all outcome measures was identified from pre-to-post intervention for both groups (p < 0.05). Post-intervention, there was a significant between-group difference on measured outcomes (p < 0.05). The NWT group exhibited greater improvement in the UPDRS-M (p = 0.006; 95 % CI 0.825-4.374), BBS (p = 0.002; 95 % CI 1.307-5.092), TUG (p = 0.048; 95 % CI 0.028-2.582), 10 MWT (p = 0.047; 95 % CI 0.108-2.306), and 6 MWT (p = 0.003; 95 % CI 20.302-42.097) compared to the TT group. CONCLUSIONS: Our outcomes provide evidence of the therapeutic benefit of Nordic walking on a treadmill to improve balance function and walking ability in individuals with PD.

Static balance according to hip joint angle of unsupported leg during one-leg standing.

[Purpose] This study aimed to determine static balance according to hip joint angle of the unsupported leg during one-leg standing. [Subjects and Methods] Subjects included 45 healthy adult males and females in their 20s. During one-leg standing on the non-dominant leg, the position of the unsupported leg was classified according to hip joint angles of point angle was class. Static balance was then measured using a force plate with eyes open and closed. The total length, sway velocity, maximum deviation, and velocity on the mediolateral and anteroposterior axes of center of pressure were measured. [Results] In balance assessment with eyes open, there were significant differences between groups according to hip joint angle, except for maximum deviation on the anteroposterior axis. In balance assessment with eyes closed, there were significant differences between total length measurements at 0° and 30°, 60° and between 30° and 90°. There were significant differences between sway velocity measurements at 0° and 30° and between 30° and 90°. [Conclusion] Thus, there were differences in static balance according to hip joint angle. It is necessary to clearly identify the hip joint angle during one-leg standing testing.

Postural control systems in two different functional movements: a comparison of subjects with and without chronic ankle instability.

[Purpose] The aim of this study was to evaluate postural control during two different movements of the Functional Movement Screen in patients with chronic ankle instability compared with healthy subjects. [Subjects] This study was a cross-sectional survey of 50 participants comprised of 25 chronic ankle instability patients and 25 healthy subjects. [Methods] All subjects were subjected to measurement of the Foot and Ankle Disability Index and center of pressure and Functional Movement Screen testing. The deep squat and hurdle step were performed for the lower extremities in Functional Movement Screen testing. Then, the center of pressure was measured with balance assessment software using a Nintendo Wii Balance Board. The center of pressure path length, velocity, and area of the 95% confidence ellipse and Functional Movement Screen scores were evaluated for all subjects. [Results] The results showed significant differences in center of pressure path length, velocity, and area of the 95% confidence ellipse between the groups for the hurdle step with the non-affected limb. However, there were no significant differences between groups for the deep squat and hurdle step with the affected limb. [Conclusion] The results of this study showed that there was a difference in the hurdle step with the non-affected limb in chronic ankle instability patients compared with normal subjects.

The effects of modified constraint-induced movement therapy combined with trunk restraint in subacute stroke: a double-blinded randomized controlled trial.

OBJECTIVE: To investigate the effects of a modified constraint-induced movement therapy (mCIMT) with trunk restraint in subacute stroke patients. DESIGN: Double-blind, randomized controlled trial. SETTING: Rehabilitation clinic. PARTICIPANTS: Eighteen subacute stroke patients with moderate motor impairment. INTERVENTIONS: The patients were treated with either mCIMT combined with trunk restraint or mCIMT for 5 days per week for 4 weeks. The mCIMT combined with trunk restraint group participated in structured intervention sessions for use of the more affected upper-extremity in task-oriented activities with trunk restraint for 1 hour per day, and with the less affected upper-extremity restrained for 5 hours per day weeks. The mCIMT group followed the same protocol without trunk restraint. MAIN OUTCOME MEASURES: The outcome measures included the action research arm test (ARAT), the Fugl-Meyer assessment (FMA), the modified Barthel index (MBI), the motor activity log (MAL) and the maximal elbow extension angle during reaching (MEEAR) were completed at baseline and post intervention. RESULTS: The mCIMT combined with trunk restraint group exhibited more improved in the ARAT, FMA, MBI, MAL and MEEAR compared with the mCIMT group. Statistical analyses showed significantly different in ARAT (P = 0.046), FMA (P = 0.008), MBI (P = 0.001), MAL-AOU (P = 0.024), MAL-QOM (P = 0.010) and MEEAR (P = 0.001) between groups. CONCLUSIONS: These results suggest that mCIMT combined with trunk restraint is more helpful to improve upper-extremity function than mCIMT only in subacute stroke patients with moderate motor impairment.

Validity of the lower extremity functional movement screen in patients with chronic ankle instability.

[Purpose] The purpose of this study was to provide evidence of construct validity for the lower extremity functional movement screen (LE-FMS) based on hypothesis testing in patients with chronic ankle instability (CAI). [Subjects] The subjects were 20 healthy subjects and 20 patients with CAI who had a history of ankle sprain with pain for more than 1 day. [Methods] All participants were measured using the Foot and Ankle Disability Index (FADI) and evaluated with the LE-FMS. The screen included the deep squat, the hurdle step (HS) and the in-line lunge (ILL). The symmetry ratios (RS) were accurately measured during the deep squat trial. [Results] Between the two groups, there were significant differences in scores on the LE-FMS, HS, ILL, RS, FADI, and FADI-sport. The FADI was strongly correlated with both LE-FMS score (r=0.807) and ILL score (r=0.896). There was a strong relationship (r=0.818) between LE-FMS score and FADI-sport. [Conclusion] These results suggest that the LE-FMS may be used to detect deficits related to CAI. Additionally, this instrument is reliable in detecting functional limitations in patients with CAI.

Comparison of the effect of weight-bearing and non-weight-bearing positions on knee position sense in patients with chronic stroke.

[Purpose] The purpose of this study was to investigate the knee joint proprioception in weight-bearing (WB) and non-weight-bearing (NWB) positions and to study the difference between the methods in chronic stroke patients. [Subjects and Methods] The subjects were 15 stroke patients who were randomly scheduled to perform both positions by a physical therapist not involved in the study. The subjects performed the positions (WB and NWB) based on a randomized controlled cross-sectional design. WB subjects were positioned in one-leg standing to assess the knee joint position sense. NWB subjects were instructed to sit comfortably in a chair and maintain the knees at 90° of flexion with the leg out of the plinth. [Results] The results revealed that the WB position showed a significant difference in knee position sense. The proprioception sense in the WB position was a higher than that in the NWB position. [Conclusion] The knee proprioception of chronic stroke patients differs between the weight-bearing and non-weight-bearing positions.

Effect of unstable surface training on walking ability in stroke patients.

[Purpose] The purpose of this study was to determine the effects of unstable surface training (UST) on walking ability in chronic stroke patients. [Subjects] The subjects were 12 stroke patients who were randomly divided into experimental (n1=6) and control (n2=6) groups. [Methods] The Subjects in both groups performed treadmill training for 30 minutes. The Subjects in the experimental group also performed UST after treadmill training, with the UST being performed for 10 minutes, five times per week, for four weeks. All subjects were evaluated with a 10-meter walk test, Timed Up and Go test and 6-minute walk test. The pared t-test was performed to test the significant differences between before and after the intervention. The independent t-test was conducted to test the significant differences between groups. [Results] Following the intervention, the experimental group showed significant differences in the Timed Up and Go test and 6-minute walk test. [Conclusion] The results of the study suggest that UST is an effective method for improvement of walking ability in chronic stroke patients.

Effect of training with whole body vibration on the sitting balance of stroke patients.

[Purpose] The purpose of this study was to determine the effects of task-oriented training with whole body vibration (WBV) on the sitting balance of stroke patients. [Subjects] The subjects were 30 stroke patients who were randomly divided into experimental (n1=15) and control (n2=15) groups. [Methods] Subjects in both groups received general training five times per week. Subjects in the experimental group practiced an additional task-oriented training program with WBV, which was performed for 15 minutes, five times per week, for four weeks. The center of pressure (COP) path length and average velocity were used to assess subjects static sitting balance, and the Modified Functional Reach Test (MFRT) was used to assess their dynamic sitting balance. The paired t-test was performed to test the significance of differences between before and after the intervention. The independent t-test was conducted to test the significance of differences between the groups. [Results] Following the intervention, the experimental group showed a significant change in MFRT. [Conclusion] The results of this study suggest that task-oriented training with WBV is feasible and efficacious for stroke patients.

Effects of Real-Time Feedback Methods on Static Balance Training in Stroke Patients: A Randomized Controlled Trial.

BACKGROUND: The purpose of this study was to investigate the effects of real-time feedback methods on static balance training in stroke patients. There are two types of real-time feedback methods, as follows: one is Knowledge of Result (KR), and the other is Knowledge of Performance (KP). METHOD: Thirty stroke patients participated in this study and were randomly assigned to the KR group (n = 15) or the KP group (n = 15). All of the groups underwent real-time feedback training for four weeks (30 min per session, five sessions per week). The primary outcomes were sway length, sway velocity, and area 95%, which were assessed before and after the intervention. The secondary outcomes included the Berg Balance Scale, the Fugl Meyer Assessment for Lower Extremity, the Postural Assessment Scale for Stroke Trunk Impairment Scale, and the Fall Efficacy Scale. A group × time interaction was assessed using two-way ANOVA with repeated measures. RESULT: There was a significant increase over time in all outcomes (p < 0.05). Significant differences were observed for a group × time interaction in sway length and area 95% (p < 0.05). CONCLUSIONS: Real-time feedback training for static balance enhanced stroke patients' static balance abilities, clinical outcome assessments, and promoted self-efficacy against falls.

The effects of action observational training on walking ability in chronic stroke patients: a double-blind randomized controlled trial.

OBJECTIVE: To investigate the effect of action observational training on walking ability with chronic stroke patients. DESIGN: A double-blind randomized controlled trial. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: Thirty chronic stroke patients. INTERVENTIONS: Patients in both groups underwent treadmill training for 30 minutes. The action observational training group (n = 15) watched a video of treadmill walking actions taken at various speeds before treadmill training for 10 minutes. The control group (n = 15) watched a nature video unrelated to gait training for the same amount of time. All participants received training five times a week for a period of four weeks. MAIN MEASURES: Timed up and go test, 10-metre walk test, 6-minute walk test and maximal flexed knee angle in the swing phase during walking. RESULTS: There were significant improvements in timed up and go test (-4.47 vs. -2.47 seconds), 10-m walk test (0.35 vs. 0.16 m/s), 6-minute walk test (93.13 vs. 32.53 m) and maximal flexed knee angle in the swing phase during walking (7.11 vs. 4.58 degrees) in the action observational training group compared with the control group (P < 0.05). Small to huge effect sizes of 1.27, 0.57, 2.34 and 0.37 were observed for timed up and go test, 10-m walk test, 6-minute walk test, and maximal flexed knee angle in the swing phase during walking, respectively. CONCLUSION: These results suggest that action observational training is an effective method for improvement of the walking ability in chronic stroke patients.

The effects of a warm whirlpool bath on pain and stiffness of patients with chronic stroke induced knee osteoarthritis.

[Purpose] This study set out to investigate the effects of leg immersion in warm water on pain, and stiffness of patients with stroke-induced chronic osteoarthritis. [Subjects] Forty-four patients with chronic stroke were randomly assigned to either the whirlpool group (n=24) or the control group (n=20). [Methods] Subjects in the whirlpool group immersed their legs in a whirlpool bath at 40 °C for 40 minutes 5 times a week for 8 weeks. The control group of patients was instructed to perform activities as usual without using a whirlpool bath. Pre-immersion and post-immersion measurements of the Western Ontario and McMaster University arthritis index (WOMAC)-pain and stiffness indexes were compared to determine the effects of the intervention. The paired t-test was performed to test the significance of differences before and after the experiment. The independent t-test was conducted in order to test the significance of differences between the whirlpool and control groups. Statistical significance was accepted for values of p<0.05. [Results] The WOMAC-pain score, and stiffness index were significantly lower after the intervention. [Conclusion] Immersion of the lower extremities in a whirlpool bath was beneficial for patients with chronic stroke-induced knee osteoarthritis.

Effect of an on-site physical therapy on pain, posture, function and composition, and work-related health status in workers in Korea.

BACKGROUND: The incidence of work-related musculoskeletal disease is increasing despite automated manufacturing processes. OBJECTIVE: To examine the effect of a customized on-site exercise program on pain, posture, body function, body composition, and work-related health status of workers at an auto-parts factory. METHODS: Fifty-six participants were randomly divided into one of two groups: experimental (EG), which received a customized exercise program that included manual and exercise therapy from physiotherapy at the workplace; and control (CG), which received customized exercise sheets for a self-directed program at home. The program was performed 3 times per week for 12 weeks. Assessments were performed according to numerical rating scale (NRS), Exbody, Selective Functional Movement Assessment (SFMA), InBody, Short-Form-12 version 2 (SF-12v2), and Work Ability Index (WAI), which were evaluated before and after the program. RESULTS: The EG exhibited significant within-group changes in NRS, Exbody, SFMA, SF-12v2, and WAI; the CG exhibited significant within-group changes only in NRS and SFMA (p < 0.05). There were significant between-group differences in NRS, Exbody, SFMA, and WAI (p < 0.05). CONCLUSIONS: An on-site program including manual and exercise therapy directed by a physiotherapist among workers at an auto-parts manufacturer was effective in improving pain levels, posture, body function, and work-related health status.

Effects of Vibrotactile Biofeedback Providing Real-Time Pressure Information on Static Balance Ability and Weight Distribution Symmetry Index in Patients with Chronic Stroke.

Training with visual and auditory biofeedback, in patients with stroke, improved balance ability and asymmetric posture. We developed a new biofeedback training device to prevent falls and improve balance ability in patients with stroke. This device corrects motion errors by collecting the pressure information of patients in real-time. This randomized crossover study aimed to investigate the effect of this biofeedback training on the static balance ability and weight distribution symmetry index in 24 patients with chronic stroke. Pressure sensor-based vibrotactile biofeedback, visual biofeedback providing posture information, and standing without biofeedback were randomly applied for 1 d each with 24 h washout intervals to minimize adaptation. The static balance ability was measured for each biofeedback training type, and the weight distribution symmetry index was calculated using the collected weight-bearing rate data. The static balance ability and weight distribution symmetry index differed significantly according to the type of biofeedback training used. Post-hoc analysis revealed significant differences in the order of newly developed vibrotactile biofeedback, visual biofeedback, and standing without biofeedback. These findings provide evidence that pressure sensor-based vibrotactile biofeedback improves static balance ability and weight support rates by proposing better intervention for patients with chronic stroke in the clinical environment.

Application of digital practice to improve head movement, visual perception and activities of daily living for subacute stroke patients with unilateral spatial neglect: Preliminary results of a single-blinded, randomized controlled trial.

BACKGROUND: Virtual reality (VR) based digital practice is an attractive way to provide a patient engagement, motivation and adaptable environment for stroke rehabilitation. However, clinical evidence of efficacy with VR-based digital practice is very limited. In this study, we investigated the effects of VR-based digital practice program on unilateral spatial neglect (USN) rehabilitation in patients with subacute stroke. METHODS: Twenty-four subacute stroke patients with USN were enrolled and randomly assigned to digital practice group (n = 12) and control group (n = 12). Patients in digital practice group received training programs with VR-based applications with leap motion environment. Control group received conventional USN specific training programs. All patients were underwent 4 week practice program (3 sessions/week, a half-hour/session). We analyzed training effects before and after training by assessing the line bisection test, Catherine Bergego Scale, modified Barthel index, Motor-Free Visual Perception Test Vertical Version (MVPT-V), and horizontal head movements (rotation degree and velocity during the VR-based applications), and compared the results between the two groups. RESULTS: Compared to control group, digital practice group showed significantly greater improvements in the line bisection test (P = .020), and visual perceptual tasks (MVPT-V, responded more on left visual task, P = .024; correctly respond more on both left and right visual tasks, P = .024 and P = .014, respectively; and faster response time, P = .014). Additionally, horizontal head movement of rotation degree and velocity during the VR based practice in the digital practice group were significantly increased more than control group (P = .007 and P = .001, respectively). CONCLUSIONS: VR-based digital practice program might be an affordable approach for visual perception and head movement recovery for subacute stroke patients with USN.

Effects of modified constraint-induced movement therapy with trunk restraint in early stroke patients: A single-blinded, randomized, controlled, pilot trial.

BACKGROUND: Reducing compensatory strategies during repetitive upper-limb training may be helpful in relearning motor skills. OBJECTIVE: To explore the effects of modified constraint-induced movement therapy (mCIMT), additionally modified by adding trunk restraint (TR), on upper-limb function and activities of daily living (ADLs) in early post-stroke patients. METHODS: Twenty-four participants with early stroke were randomly assigned to mCIMT combined with TR (mCIMT + TR) or mCIMT alone. Each group underwent twenty sessions (1 h/d, 5 d/wk for 4 weeks). Patients were assessed with the action research arm test (ARAT), the Fugl-Meyer Assessment-Upper extremity (FMA-UE), the Modified Barthel index (MBI), the Maximal elbow extension angle during reaching (MEEAR), and Motor Activity Logs (MAL-AOU and MAL-QOM). RESULTS: The mCIMT + TR group exhibited greater improvement in the ARAT, FMA-UE, MBI, MEEAR, and MAL-AOU, and MAL-QOM than the mCIMT group. Statistical analyses showed significant differences in ARAT (P = 0.003), FMA-UE (P = 0.042), MBI (P = 0.001), MEEAR (P = 0.002), and MAL-AOU (P = 0.005) between the groups. CONCLUSION: Modified CIMT combined with TR may be more effective than mCIMT alone in improving upper-limb function and ADLs in patients with early stroke.

Effects of Game-Based Constraint-Induced Movement Therapy on Balance in Patients with Stroke: A Single-Blind Randomized Controlled Trial.

OBJECTIVE: The aims of this work were to determine whether game-based constraint-induced movement therapy (CIMT) is effective at improving balance ability in patients with stroke, and to provide clinical knowledge of game-based training that allows application of CIMT to the lower extremities. DESIGN: Thirty-six patients with chronic stroke were randomly assigned to game-based CIMT (n = 12), general game-based training (n = 12), and conventional (n = 12) groups. All interventions were conducted 3 times a week for 4 weeks. The static balance control and weight-bearing symmetry were assessed, and the Functional Reach Test (FRT), modified Functional Reach Test (mFRT), and Timed Up and Go (TUG) test were performed to evaluate balance ability. RESULTS: All 3 groups showed significant improvement in anterior-posterior axis (AP-axis) distance, sway area, weight-bearing symmetry, FRT, mFRT, and TUG test after the intervention (P < 0.05). Post hoc analysis revealed significant differences in AP-axis, and sway area, weight-bearing symmetry of the game-based CIMT group compared with the other group (P < 0.05). CONCLUSIONS: Although the general game-based training and the game-based CIMT both improved on static and dynamic balance ability, game-based CIMT had a larger effect on static balance control, weight-bearing symmetry, and side-to-side weight shift.

Effects of robot-assisted gait training on spatiotemporal gait parameters and balance in patients with chronic stroke: A randomized controlled pilot trial.

BACKGROUND: Body weight-supported treadmill training assisted by a robotic gait orthosis is a helpful tool for restoring a symmetrical gait pattern in people with gait discrepancies. OBJECTIVE: This study's aim was to compare the effects of robot-assisted gait training (RAGT) versus treadmill gait training (TGT) on spatiotemporal gait parameters, balance, and activities-specific balance confidence with stroke patients. METHODS: Eighteen participants with stroke were randomly assigned to RAGT or TGT. Each group underwent twenty sessions (1 h/d, 5 d/wk for 4 weeks). Patients were assessed with gait parameters (gait speed, cadence, step length, and double limb support period) using the GAITRite, the Berg Balance Scale (BBS) score, and the activities-specific balance confidence (ABC) score before and after the intervention. RESULTS: Gait speed (P = 0.003), cadence (P = 0.002), step length (P = 0.004), the BBS score (P = 0.048), and the ABC score (P = 0.017) were significantly higher in the RAGT group than in the TGT group, while the double limb support period was significantly lower in the RAGT group (P = 0.043). CONCLUSION: RAGT using Lokomat may be more effective than TGT in improving waking ability, balance, and balance confidence in patients with chronic stroke.

Effects of hamstring stretch with pelvic control on pain and work ability in standing workers.

BACKGROUND: Hamstring tightness induces posterior pelvic tilt and decreased lumbar lordosis, which can result in low back painOBJECTIVE: We investigated effects of hamstring stretch with pelvic control on pain and work ability in standing workers. METHODS: One hundred adult volunteers from a standing workers were randomly assigned to pelvic control hamstring stretching (PCHS) (n = 34), general hamstring stretching (GHS) (n = 34), control (n = 32) groups. The control group was performed self-home exercise. All interventions were conducted 3 days per week for 6 weeks, and included in the hamstring stretching and lumbopelvic muscle strengthening. Outcomes were evaluated through the visual analog scale (VAS), straight leg raise test (SLR), sit and reach test (SRT), Oswestry disability index (ODI), and work ability index (WAI). RESULTS: Significant difference in VAS, SLR, SRT, ODI, and WAI were found in the PCHS and GHS groups. The control group was a significant difference only in ODI. The PCHS group showed a greater difference than the GHS group and control group in VAS, SLR, SRT, and ODI. CONCLUSIONS: The pelvic control hamstring stretch exercise would be more helpful in back pain reduction and improvement of work ability in an industrial setting.

Effects of modified constraint-induced movement therapy combined with trunk restraint in chronic stroke: A double-blinded randomized controlled pilot trial.

BACKGROUND: Reducing the compensatory mechanism by restraining the unnecessary movement may be helpful in relearning the upper-limb movement. OBJECTIVE: To investigate the effects of a modified constraint-induced movement therapy (mCIMT) with trunk restraint (TR) in chronic stroke patients with moderate impairment. METHODS: Eighteen participants with hemiparesis were randomly assigned to mCIMT + TR or mCIMT. Each group underwent 20 (1 h/d) intervention session (5 d/wk for 4 weeks). Patients were assessed with the action research arm test (ARAT), the Fugl-Meyer assessment upper extremity (FMA-UE), the modified Barthel index (MBI), and the motor activity log (MAL-AOU and MAL-QOM). RESULTS: The mCIMT combined with trunk restraint group exhibited greater changes in the ARAT, FMA, MBI, and MAL (MAL-AOU and MAL-QOM) compared with the mCIMT group. Statistical analyses showed significantly different in ARAT (Z = -2.17, P = 0.03), FMA-UE (Z = -2.49, P = 0.01), MBI (Z = -2.44, P = 0.02), MAL-AOU (Z = -2.17, P = 0.03), and MAL-QOM (Z = -2.17, P = 0.03) between groups. CONCLUSION: These finding suggest that mCIMT combined with trunk restraint is more helpful to improve upper-extremity function than mCIMT only in patient with chronic stroke.