RESUMEN
A previously independent 66-yr-old right-handed man presented with right-sided weakness, preferring the lower limbs with additional impaired gait and dysarthria for 1-day duration. Imaging found a large left hemispheric anterior cerebral artery ischemic infarction with multiple lacunar infarcts. He exhibited frontal, callosal, and posterior variants of alien hand syndrome, which impeded activities of daily living. Though limited in evidence, a trial of clonazepam was initiated based on previous case reports describing suspected efficacy. Botulinum toxin A was not used given the patient's immediate need and limited hospital length of stay. Right upper limb constricting therapies improved intermanual conflict and spontaneous grasping and levitation (arm elevation in retroflexion) activity; however, concomitant left upper limb motor apraxia complicated task-oriented activities. The combination of pharmaceutical and therapeutic interventions improved the patient's quality of life as assessed by clinical observation, functional independence measures from 41 to 57, and patient reporting. This case report aims to increase awareness of a potential barrier to rehabilitation of a debilitating and rare condition and to discuss current assessment tools and treatment options supported by available evidence.
Asunto(s)
Fenómeno de la Extremidad Ajena/rehabilitación , Apraxias/rehabilitación , Actividades Cotidianas , Anciano , Fenómeno de la Extremidad Ajena/complicaciones , Apraxias/complicaciones , Humanos , Masculino , Calidad de VidaRESUMEN
Any injury of a hand more or less disintegrates the injured hand. The rehabilitation of an alienated hand is prolonged. How can the alienation of the own but injured hand and the involuntary and unconscious inhibition of its perception and use be diagnosed, explained, avoided and designated? Medical observations and interviews with patients and therapists on the occasion of rehabilitation of hand injuries resulted in the development of a new concept of biopsychosocial integrating rehabilitation and a creative hand therapy with the objective of integrating injured and alienated hands. DIAGNOSIS: The inhibition of the gesture of thinking has been the most revealing sign for the diagnosis of a disintegration of an injured hand. Explanation: The involuntary inhibition to recognize and use an injured hand causes and implicates the alienation of the rested hand. PREVENTION: Information by hand surgeons and hand therapists. Creative hand therapy guides the attention to complex and pleasing activities. In complex disintegrations after hand injuries the hand as well as the person need help. Designation: Hypotheses: Posttraumatic Proportionate Regional Disintegration while the tissues heal. Posttraumatic Complex Regional Disintegration, if the disintegration overruns the healing of tissues or if the person suffers. The Complex Regional Pain Syndrome is distinguished as a rare exception of a biopsychosocial disintegration. Posttraumatic regional disintegration seems to be proportionate while the tissues are healing. If the mentioned sensations of the patients and the visible signs of disintegration persist, the disorder spreads onto the biopsychosocial unit of the person. This disorder of hand and person may be designated as a complex disorder. The impact of a proportionate posttraumatic disintegration as well as the formation and exacerbation of a complex posttraumatic disintegration may be prevented by the facilitation of the integration of an injured hand. Scientific prove is needed for: the guiding impact of the healthy hand for physiotherapy; the impact of the gesture of thinking to diagnosis and treatment of disintegrations; the effectivity and the economic efficiency of a biowpsychosocial integrating rehabilitation and creative hand therapy.
Asunto(s)
Actividades Cotidianas/psicología , Fenómeno de la Extremidad Ajena/psicología , Fenómeno de la Extremidad Ajena/rehabilitación , Imagen Corporal , Traumatismos de la Mano/psicología , Traumatismos de la Mano/rehabilitación , Humanos , Comunicación Interdisciplinaria , Colaboración IntersectorialAsunto(s)
Fenómeno de la Extremidad Ajena/etiología , Infarto Encefálico/diagnóstico por imagen , Cuerpo Calloso/diagnóstico por imagen , Fenómeno de la Extremidad Ajena/diagnóstico , Fenómeno de la Extremidad Ajena/rehabilitación , Imagen de Difusión por Resonancia Magnética , Humanos , Persona de Mediana EdadRESUMEN
Disruption of motor control in the alien hand syndrome might result from a dissociation between intentions and sensory information. We hypothesized that voluntary motor control in this condition could improve by restoring the congruency between motor intentions and visual feedback. The present study shows that, in one patient with right alien hand syndrome, the use of a mirror box paradigm improved motor speed. We speculate that the visual feedback provided by the mirror increases the sense of congruence between intention and sensory feedback, leading to motor improvement.
Asunto(s)
Fenómeno de la Extremidad Ajena/rehabilitación , Retroalimentación Sensorial , Desempeño Psicomotor , Fenómeno de la Extremidad Ajena/complicaciones , Fenómeno de la Extremidad Ajena/psicología , Femenino , Humanos , Persona de Mediana Edad , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/psicología , Rehabilitación de Accidente CerebrovascularRESUMEN
Anarchic hand syndrome (AHS) is a rare disorder characterized by unwilled, but seemingly purposeful movements of the affected upper limb which are perceived by the patients not to be under their control. It often interferes with goal-directed movements and bimanual tasks. At present there is no effective method of treatment of AHS. We report here a case of AHS following resection of a frontal lobe tumor and describe its effects on the patient's functional activities. The patient used avoidance behavior and mental concentration to overcome the disabling effect of AHS. These strategies appear to be useful in the management of AHS.
Asunto(s)
Fenómeno de la Extremidad Ajena/etiología , Fenómeno de la Extremidad Ajena/psicología , Astrocitoma/cirugía , Neoplasias Encefálicas/cirugía , Lóbulo Frontal/cirugía , Complicaciones Posoperatorias/psicología , Actividades Cotidianas , Fenómeno de la Extremidad Ajena/rehabilitación , Astrocitoma/complicaciones , Neoplasias Encefálicas/complicaciones , Epilepsia Tónico-Clónica/etiología , Función Ejecutiva , Humanos , Imagen por Resonancia Magnética , Masculino , Memoria/fisiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Complicaciones Posoperatorias/rehabilitación , Escalas de Valoración Psiquiátrica , Tomografía Computarizada por Rayos X , Escalas de WechslerRESUMEN
BACKGROUND: Alien hand syndrome (AHS) is a neurological disorder in which movements are performed against conscious will. It is rare but significant due to its disability impact on everyday life. This case highlights the clinical features, recovery course and response to rehabilitation of a patient with a dominant anterior cerebral artery territory infarct. METHODS: Single case report. RESULTS: Clinical signs and symptoms included right hemiparesis, hemianesthesia, dysphagia, language and cognitive dysfunction, personification and autonomous movement of the affected limb; involuntary grasping of objects interfered with his activities of daily living (ADL). Education for diagnosis and compensatory strategies of AHS, including visualisation, distraction of affected limb and maintaining a slow/steady pace with activities decreased the frequency of his AHS movements from 10 times to twice a day. Over the course of 4 months the rehabilitation treatment targeted toward the specific needs of the patient, allowed improvement in his ADL. Commonly used upper extremity motor recovery outcome measures like the Chedoke McMaster Stroke Assessment cannot be considered as a sensitive tool for AHS. More sensitive outcome measures are needed to be determined for this condition. CONCLUSION: This case distinguishes the clinical findings and description to rehabilitation in a case of AHS.
Asunto(s)
Fenómeno de la Extremidad Ajena/rehabilitación , Accidente Cerebrovascular/complicaciones , Actividades Cotidianas , Fenómeno de la Extremidad Ajena/etiología , Evaluación de la Discapacidad , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Patients with anarchic hand (AH) syndrome exhibit involuntary but seemingly purposeful controlesional upper limb movements. Here we report on the case of a patient (AC) presenting with a right AH following a left medial frontal lesion. Previous literature indicated that endogenous movements, particularly in the presence of distractors, are impaired in AH, whereas exogenous movements are spared. In this study we examined exogenous and endogenous (or sequential) movements using a new experimental procedure. Our main aim was to investigate whether the ability to perform sequential movements improves under verbal command as anecdotally observed in patients with AH. Results showed that the performance of AC's right AH was impaired in sequential tasks and that this impairment was improved by verbal command. The observed reduction in errors in sequential tasks under external verbal command was coupled with a compensatory increase in response times.