Hand is stuck open after stroke and resists movement in BOTH directions spasticity, co-contraction, or weakness?

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My mother had a stroke about 2 months ago. The stroke mainly affected her hand/upper limb. Her leg was not significantly affected. Her main remaining problem is her affected hand.

What is particularly confusing to me is how her hand has changed over time.

During the first month after the stroke, her affected hand was relatively relaxed, and she was able to make a full or nearly full fist.

Around 40 days after the stroke, the hand gradually became much stiffer and more difficult to control. She is now approaching 2 months post-stroke, and her hand is usually held open. She can move her fingers voluntarily, but she can no longer make a proper fist.

There is resistance and sometimes pain in both directions:

When I gently try to flex her fingers to make a fist, there is significant resistance and discomfort.

When I extend the fingers in the opposite direction, there is also resistance and discomfort.

After gentle massage, her hand becomes noticeably more relaxed and easier to move, and this improvement can sometimes last for about an hour before the stiffness returns.

She has also developed a drooping shoulder / shoulder subluxation (“drop shoulder”) on the affected side.

I am trying to understand whether this pattern could represent:

spasticity of the flexors, spasticity of the extensors, co-contraction of both muscle groups, weakness of the finger flexors, muscle/tendon shortening or contracture, or a combination of these.

One thing that makes me especially confused is that her hand is open, yet she cannot make a fist. At the same time, there seems to be resistance when moving the fingers in either direction.

I live in Iraq, and unfortunately access to specialized post-stroke neurological rehabilitation is very limited where I live. Many people offering “rehabilitation” have a general physical-education/sports background rather than specialized neurological rehabilitation training. Because of this, I am trying to understand the problem as accurately as possible so I can make better decisions about her rehabilitation.

I would really appreciate input from stroke survivors, caregivers, occupational therapists, physical therapists, neurologists, or other clinicians experienced in post-stroke hand rehabilitation.

How would you distinguish clinically between spasticity, co-contraction, weakness, and contracture in this situation?

And regarding NMES/FES, would stimulation of the finger flexors to facilitate grasp ever be appropriate in a hand like this, or could stimulating the extensors be more appropriate? Should the specific muscles involved be assessed first before using electrical stimulation?

Also, is it common for a hand to be relatively relaxed and functional during the first few weeks after a stroke and then develop significant spasticity around 4–6 weeks later?

Any advice on what should specifically be assessed during a neurological hand examination would be extremely helpful.