What is Alien Hand Syndrome and why does it occur? Discuss in relation to one or more case studies.
Alien hand syndrome is an intermittent involuntary disorder whereby the hand acts of its ‘own free will’. However, alien hand syndrome is not consistently or precisely defined. Alien hand syndrome describes complex, goal-directed activity in one hand that is not voluntarily initiated by the individual but is well executed (Mark, 2007). This syndrome is an extremely puzzling phenomenon experienced by brain-damaged patients whereby their limb performs purposeful actions without the intention of the patient (Biran, et al., 2006). The patient is unable to explain the exact source of movement from the hand and may actually consider the hand to have a mind of its own (Mark, 2007).
It is caused by lesions to the frontal lobes and corpus callosum (Banks et al., 1989) and generally follows acute focal cerebral injury. The most common causes are cerebral hemispheric stroke, severe brain damage or damage to the corpus callosum such as in surgery, which is used to treat severe epilepsy. The corpus callosum connects the two hemispheres, therefore surgery to this area of the brain can lead there to be less or no communication between the hemispheres which can lead to limbs acting of their own accord. Alien hand syndrome can also be seen in patients who suffer from a variety of degenerative, dementing cerebral disorders such as Alzheimer’s (Mark, 2007). Due to the numerous different causes of alien hand syndrome there are many variations of the condition. Therefore, it has been that alien hand syndrome is an umbrella term for a heterogeneous set of symptoms (Chokar et al., 2014).
There have been reports of patients who were unable to stop their alien hand from grabbing and seizing nearby objects without any willing from their body (Kumral, 2001). This can be seen by the study of patient JC, a 56 year old man who had suffered from a left hemispheric stroke, with damage extending to the corpus callosum. Four weeks after his stroke he complained of peculiar uncontrolled movements of his hand. His hand would do things “as though it has a mind of its own” such as playing with light switches, grasping and holding things. In many situations the patient found themselves in the situation where the right hand opposed the left hand without the patient choosing to do so. Furthermore, the alien hand caused the patient difficulty in eating because of the opposing behaviour of the right and left hand (Biran, Giovannetti, Buxbaum, & Chatterjee 2006).
Often, a patient has to use their other willing hand to prise open their fingers and release the object which the alien hand has grasped (Kumral, 2001). Patients observe and experience their own limbs carrying out purposeful behaviours over which they have no or very little control. In one case it was noted that a patient had picked up a pencil and begun scribbling with the right hand. She indicated she had not initiated the action with the right arm, she experienced a feeling of dissociation from the actions of the right arm, stating that `it will not do what I want it to do’ (Goldberg et al.1981).
This alien limb may disrupt movements of the other limb that is actually responding to the intentions of the patient (Akelaitis, 1944-45). Patients can experience their limbs acting without being guided by their own will (Bogen, 1993, fisher, 2000). Bogen, J. E. (1993) found his alien hand undoing the buttons of his shirt even as his “healthy” limb tried to button the shirt. The errant limb is known to not even rest during sleep in some cases and patients with alien hand syndrome have woken up to find their alien limbs choking them (Banks et al, 1989). In one case the patient’s `left hand would tenaciously grope for and grasp any nearby object, pick and pull at her clothes, and even grasp her throat during sleep . . . . She slept with the arm tied to prevent nocturnal misbehaviour.’ However, she never denied that her hand belonged to her (Banks et al. 1989). This is an important part of this syndrome; that the patient does not deny responsibility for the hand or the behaviour that it carries out.
Two types of behaviour are displayed with this syndrome, repetitive involuntary grasping and unilateral goal-directed limb behaviour. Patients clearly recognize that there is a discrepancy between what the hand is doing and their desired actions. The patients are upset by the actions of the hand and will often try to prevent it from moving by grasping it firmly with the other hand (Frith, 2000). MP was a patient who had an operation to repair a ruptured aneurysm of the anterior communication artery. Within two years she was unable to live independently with her family due to the way in which the alien hand syndrome was affecting her life (Sala, 1998).
An alien hand sufferer can feel normal sensation in the hand, but believes that the hand, while still part of their body, behaves in a manner that is totally distinct from them. They feel that they have no control over the movements of their alien hand but that, instead, the hand has the capability of acting independent of their conscious control. Alien hands can perform complex acts such as removing clothing which can be seen from examples above. Sometimes the sufferer will not be aware of what the hand is doing until it is brought to his or her attention. Patients frequently report astonishment and frustration at these errant limbs.
Overall, alien hand syndrome is difficult to explain as there are many different causes and symptoms that can be described as this condition. However, one symptom that is apparent throughout the many case studies is that the alien hand acts against the willing of the patient. The condition is extremely complex and even though many causes are symptoms are known there is still a lot to learn about it. Further research is therefore required.
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