Is it a good sign that my motor function has improved, allowing my index finger to push a 1 ml (milliliter) syringe intramuscularly, but I still have weakness in wrist motor function and finger extension and flexion, given my history of vascular issues and current age?

Motor Recovery Progress Assessment

Yes, this represents positive motor recovery progress, and you should continue intensive rehabilitation with specific focus on wrist strengthening and task-specific practice to maximize functional gains. 1, 2

Why This Is Good Progress

Your recovery demonstrates two critical positive prognostic indicators:

• Voluntary finger extension is present - This is specifically identified as a positive prognostic indicator for upper extremity motor recovery and suggests continued improvement is possible 1, 2, 3
• Functional strength has returned - The ability to push a 1 mL syringe intramuscularly demonstrates meaningful finger strength recovery, indicating significant motor recovery has already occurred 1

What You Must Do Now: Structured Rehabilitation Protocol

Task-Specific Wrist Practice (Primary Treatment)

The American Heart Association recommends intensive task-specific training as your primary intervention: 1, 2

• Focus on wrist extension and flexion movements with progressive difficulty 1
• Practice functional activities that challenge wrist control with graded resistance 1, 2
• Progress from supported (table-based) to unsupported wrist movements as control improves 1
• Incorporate activities requiring normal movement patterns with good alignment during functional tasks 1, 2

Resistance Training Protocol (Essential Adjunct)

The American College of Rehabilitation Medicine requires implementing resistance training: 1, 3

• Start: Low-intensity resistance at 40% of 1-repetition maximum with 10-15 repetitions 1, 2, 3
• Progress: Moderate intensity (41-60% of 1-RM) with 8-10 repetitions as tolerated 1, 2, 3
• Frequency: 2-3 times per week to allow adequate recovery between sessions 1, 3
• Increase resistance when 15 repetitions become only somewhat difficult 2

Functional Electrical Stimulation (Recommended Adjunct)

The World Stroke Organization and American Heart Association recommend FES for wrist motor impairment: 4, 1, 2

• Apply FES to wrist and forearm extensor muscles 1, 2
• Use FES in combination with task-specific training, not as standalone treatment 1, 2, 3
• FES leads to short-term increases in motor strength and motor control 4, 3

Flexibility Training

• Perform static stretches held for 10-30 seconds with 3-4 repetitions for each stretch 1, 2, 3
• Continue flexibility training 2-3 times per week in conjunction with resistance work 1, 3

Critical Warnings: What NOT to Do

The American Academy of Physical Medicine and Rehabilitation provides clear contraindications: 1, 2, 3

• Do NOT use splinting - This prevents restoration of normal movement and function 1, 2, 3
• Avoid prolonged positioning of the wrist at end ranges - This exacerbates symptoms and may impede recovery 1, 3
• Do not progress resistance too quickly - Start with very low intensity during initial sessions to avoid muscle damage 1, 3
• Do not rely on passive range of motion alone - Active motor practice is essential 1

Expected Timeline and Prognosis

• Continue rehabilitation for 9-12 months depending on functional goals for optimal recovery 1, 2, 3
• Most motor recovery gains occur within the first 6 months, making this a critical window for intensive rehabilitation 1
• Rapid relief of symptoms typically occurs within 3-4 months with structured rehabilitation, with maintenance of gains over 12 months 1

Key Point About Your Current Status

The absence of full wrist motor function represents incomplete recovery that will not spontaneously improve without structured resistance training and task-specific practice. 1 Your finger strength improvement demonstrates the nervous system's capacity for recovery, but persistent wrist weakness requires targeted intervention to achieve optimal functional outcomes.