Inclusion Criteria:  stroke confirmed by history, physical examination and imaging having spastic elbow flexors MAS ≥ 2 full range of motion (ROM) of elbow from 0-150 degree Montreal cognitive assessment (MOCA) score ≥ 23 having had problem from spasticity age ≥ 18 years old given written informed consent to participate  Exclusion Criteria:  having been treated with Perfetti method previous soft tissue release of involved elbow flexor having wound or inflammation on treatment area unstable medical condition other conditions affecting tone of elbow flexor, e.g. nerve injury not willing to participate