Hi physios,

I need help.
I have recently started working in a hospital.I have a patient who developed stroke 4 months back, after which she develoved right hemiplegia.She recovered faster and now able to walk and also upper limb gained a little power.And I had started seeing her from past a month when she had already recovered partially.So I am treating her basically for her right arm paresis.she has full shoulder passive range of motion,mild adductor ,biceps and pectoral tightness.wrist and finger flexors are also tight with thenar and hypothenar wasting so grasp and release both are poor.(she has her middle finger PIP and DIP and DIP in ringer finger amputed because of which
tightness is moderate to severe in fingers) No subluxation of shoulder.no pain in shoulder.

I would like to know what is the best treatment approach for her.
I started with active assisted exercises for her one month back with which she improved active shoulder range but the pattern is very poor she includes upper trap and biceps for shoulder flexion and tends to forearm pronated.How do I work on the improvement of pattern.
And I have also included joint compression for shoulder joint and electrical stimulation for deltoid and supinators thenar hypothenar muscles.strtching of wrist and finger flexors.But I am not finding any improvement in her.Can you please help me with it.Is my treatment lacking somewhere?
I will be grateful if anyone can help me
Thanks a lot

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