"ok!!!!!let me describe him in detail, physiotherapy taken previously only for 1 month at the time when he got stroke since then no physio!!!!! was instead taking taditional chinese medicine and accupuncture......
left side stroke:- UE Non functional with severe contractures
LE no hip control,no quads,Plantar flexors
grade 2
Right side Non affected side both upper and....."
OK, let us get something sorted out. This patient has not got an unaffected side!!!
The left side in this patient, even if it had better muscle control than you have described would possibly not function well as this is often seen in left sided (rightside brain) hemiplegia.Using the BETTER side to pull up by force for ages tends to reinforce disuse and wrong movement patterns on the affected side and also produces increased tone on the BETTER side. Have you tried to do anything with the UE left side or have you left it? This person must have massive changes in the body picture represented in the brain, possibly severe neglect. Patients with neglect do not know what is wrong with the affected side as they don't really know it's there! In neuro courses we constantly hear the phrase "if you don't use it you lose it". How is the tone in trunk/UE/LE increased/decreased ? Does this person sit straight or slanted to one side ? Are there structural changes in the trunk as well as UE?
I think you have to go back to looking and improving trunk posture and control in sitting on a suitable plinth with support, try and get both feet with "good" alignment on the ground. It may need towels serving as wedges to lift one pelvic side to get the trunk straight; and support with pillows for the contracted left arm in a position comfortable (contractures will need some work on too...) but if possible in some AB. With you maybe behind the patient or at one side, with your hands on sternum and Thorax its possible through slight compresion then "lift" of the thorax to lead the patient thro trunk flex/ext/latflex/rotation movements in a small range. You can also have your hands laterally on the thorax, depends on the state of the patient. Maybe you need two therapists or a relative to help.
The left foot gets input in standing, but it is possible in sitting to start reeducation in sitting by rolling the foot over your thigh(you are kneeling on the floor then) and also mobilising dorsal and plantar flexion and also the bones of the foot. Heel thumping on the floor (or also in bed when in crook lying) helps stimulate extensor activity. Extensor and abduction activity in hip and knee can be asked for with onesided bridging type exs in supine. The choice of postural positioning for various exs depends on what the hyper or hypo-tone situation is like.
Improvement depends on maany factors; age and state of patient; ammount of medication taken or other pathologies; cooperation; maybe cultural expectations in your country etc. I can't give you a complete overview of theBobath Concept on this website, but I would advise you to find suitable up to date books on Bobath. Of course you need quadriceps, but it won't be easy and there is an immense amount of work to do in order to try and improve the patient that has been left for so long. You must also look at the upper limb, scapula etc.
Fortunately we have Neuroplasticity, we can often see improvment a long time after the cerebral insult BUT neuroplasticity allso develops in negative direction with inefficient wrong movemant patterns.
I hope I've got the message over to you, not just quadriceps!
Good Luck!