What if my left hand wants to grab a cookie but my right one disagrees? A single-case study on chronic anarchic hand syndrome rehabilitation.
Gaia Galluzzi, Fabiana Mogavero, Maddalena Boccia et al.
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Case in brief
A 26-year-old woman developed anarchic hand syndrome (AHS) after an intracerebral hemorrhage caused by rupture of an anterior communicating artery aneurysm. Neuropsychological assessment and brain lesion and tractography analyses were performed. Rehabilitation combined Mirror Box Treatment, targeting bottom-up mechanisms, with Verbal Order Treatment, targeting top-down mechanisms. Neuropsychological tests, structured interviews, and caregiver reports showed progressive improvement in motor and planning control, fewer AHS-related symptoms, and better quality of life; reported benefits persisted at follow-up. The single-case design did not permit direct comparison of the treatments’ efficacy.
What made this case unusual
The rehabilitation protocol paired mirror-box and verbal-order treatments to address both bottom-up and top-down mechanisms in chronic AHS, a syndrome for which the authors note that standardized rehabilitation treatments are lacking.
Diagnostic / clinical pearl
AHS can follow intracerebral hemorrhage from a ruptured anterior communicating artery aneurysm; assessment and caregiver reports can help track its effects on motor and planning control.
Why it matters
The case supports the feasibility of structured, multimodal rehabilitation for AHS, while not establishing the comparative efficacy of its components.