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Case report

Rehabilitation of a patient with alien hand syndrome: A case report of a 61-year old man

Inge Bru, Lisa Verhamme, Pascal De Neve, Hanne Maebe
Department of Physical and Rehabilitation Medicine, BZIO Oostende, Oostende, Belgium: E-mail: inge.bru@bzio.be
DOI: 10.2340/20030711-1000050

Abstract

Objective: Alien hand syndrome is a rare neurological disorder in which the patient makes seemingly purposeful movements of one hand, which are dissociated from any conscious intent. These abnormal movements are very annoying, and can be disabling, for the patient. There is no established effective treatment for alien hand syndrome.
Methods: Report of a case of a 61-year old man with frontal variant of alien hand syndrome following ischaemic stroke.
Results: During therapy, the patient unwittingly grabbed objects with his right hand and could not voluntarily release his grip. Multidisciplinary rehabilitation was started, with learning of compensation strategies and a focus on bimanual tasks. Follow-up after 5 months showed a major improvement in the Functional Index Measure (FIM) score, an improvement from 36 to 79 on 126 scored items.
Conclusion: It is important to recognize this rare syndrome because of its disabling character. Evidence about the best treatment for alien hand syndrome is scarce. There is an important role for specific exercises and patient education. During rehabilitation of the patient, most improvement occurred with bimanual tasks and different colours (black, white and other bright colours) to navigate the subject's attention more to one side. Another exercise strategy was letting the alien hand catch a cube, after which the patient was able to perform more exercises with the other hand during one – handed training. In the current case, the alien hand syndrome resolved following specific and multidisciplinary rehabilitation.

Lay Abstract

A 61-year-old man presented with specific difficulties after an ischaemic stroke. During rehabilitation for ischaemic stroke, he unwittingly grabbed objects with his right hand and could not voluntarily release his grip. His hand had become an "alien hand", which he could no longer control voluntarily. This is a very disabling condition for the patient (and his family) and treatment options are limited. It is therefore important to draw attention to this condition and share learning in order to improve rehabilitation techniques.

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