A Rare Case of Alien Hand Syndrome Following Stroke: Rehabilitation Challenges and Strategies

Abstract

CASE DIAGNOSIS: Alien Hand Syndrome

CASE DESCRIPTION: A 62-year-old right-handed man developed moderate left hemiparesis after an ischemic stroke. During rehabilitation, he reported that his left hand often moved on its own, describing it as “possessed.” The paretic hand displayed spontaneous grasping of objects, levitation at rest, and intermanual conflict, such as knocking utensils from his right hand during feeding. These symptoms caused significant disability and distress for both patient and caregiver. Characteristic clinical features were consistent with Alien Hand Syndrome, independent of his residual weakness. Brain MRI showed infarction involving the right medial frontal and parietal regions. Rehabilitation focused on patient and caregiver education, occupation of the affected hand with a stress ball, use of a soft protective mitten to reduce sensory triggers, verbal cueing, and task-specific training. Psychological support addressed frustration and distress from involuntary movements. Within three months, he improved from severe to minimal pADL dependency, with a marked reduction in alien hand behaviors.

DISCUSSIONS: Alien Hand Syndrome is a rare post-stroke complication with no standardized treatment. Literature consists mainly of case reports, with limited evidence to guide rehabilitation. The syndrome creates both functional and psychological challenges that extend beyond motor impairment. In this case, early recognition and non-pharmacologic rehabilitation strategies were associated with reduced involuntary movements and improved participation in daily activities. Caregiver education further supported safety and adaptation in the home environment. Improvement without pharmacologic intervention highlights the role of structured rehabilitation in functional recovery.

CONCLUSION: This case demonstrates that Alien Hand Syndrome, although rare, can severely compromise independence after stroke. Practical rehabilitation measures, including sensory reduction, occupation of the affected hand, and consistent cueing, together with caregiver education, appeared to contribute to functional improvement and reduction of disability. Early recognition and individualized rehabilitation could support recovery toward greater independence.