I have only a two‑hour clinic session and several wrist‑ and finger‑extensor devices; how should I structure therapy to restore active wrist extension?

Structuring a 2-Hour Clinic Session for Wrist Extension Recovery

Dedicate the majority of your 2-hour session to task-specific wrist extension practice combined with functional electrical stimulation (FES) applied directly to the wrist and forearm extensors, as this combination is the most effective intervention for restoring active wrist extension. 1, 2

Session Structure (120 minutes total)

Primary Component: FES + Task-Specific Practice (90 minutes)

• Apply FES to wrist and forearm extensor muscles throughout active practice sessions to cause controlled muscle contractions while the patient simultaneously attempts voluntary movement 1, 2
• Begin with supported wrist extension movements on a table surface for the first 30 minutes, progressing to unsupported movements as control improves 1, 2
• Practice functional activities that progressively challenge wrist extension with graded difficulty—start with simple reaching tasks, advance to object manipulation requiring wrist control 2, 3
• Use repetitive, goal-oriented activities that require active wrist use to promote neural reorganization 2

Secondary Component: Resistance Training (20 minutes)

• Start with low-intensity resistance at 40% of 1-repetition maximum (1-RM) with 10-15 repetitions targeting wrist extensors specifically 4, 1, 2
• Progress to moderate intensity (41-60% of 1-RM) with 8-10 repetitions only when 15 repetitions become somewhat difficult (Borg RPE 12-14) 4, 2
• Perform 2-3 sets with brief rest periods between sets 4

Tertiary Component: Flexibility Work (10 minutes)

• Perform static stretches of wrist flexors held for 10-30 seconds with 3-4 repetitions to address any compensatory tightness 4, 2
• Focus on improving joint mobility to prevent inward coiling patterns 2

Critical Management Principles: What NOT to Do

• Do NOT use splinting or immobilization during this recovery phase—this prevents restoration of normal movement and promotes learned non-use 1, 2, 3
• Avoid prolonged positioning of the wrist at end ranges, which exacerbates symptoms and impedes recovery 1, 2, 3
• Do not rely on passive range of motion alone—active motor practice is essential for recovery 2, 3
• Do not apply constraint-induced movement therapy (CIMT) until sufficient wrist extension has been restored through FES and task-specific training 3

Home Program Setup

• Provide video-format home exercises rather than paper handouts—patients utilize more exercises and have higher confidence with video instruction at subsequent time points 5
• Prescribe self-administered practice sessions of 105 minutes per week distributed across multiple days, as this duration has shown feasibility in chronic patients 6
• Include self-mobilization techniques and isometric exercises that can be performed independently 7

Expected Timeline

• Continue this intensive rehabilitation approach 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, 3

Common Pitfall

The presence of finger function without wrist extension represents an incomplete recovery pattern that will not spontaneously improve without structured resistance training and task-specific practice 1, 2, 3. Many clinicians mistakenly assume passive modalities or time alone will restore function—they will not.