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Tuesday, November 08, 2005

Alien Hand Syndrome

நாங்கள் Psychology class இல் செய்த ஒரு செயற்பாட்டை இங்க போட்டிருக்கிறன்...யாருக்கும் interest இருந்தா வாசிச்சிட்டுச் எப்பிடி இருக்கு என்று சொல்லுங்கோ.
Understanding Alien Hand Syndrome (AHS)

The purpose of project one was to develop our research and communication skills with regards to psychological readings and writings. More specifically, these skills were used and applied to a particular case that had arisen in the study of psychology. We were hoping to familiarize ourselves with a variety of psychological sources and finally, to collect and summarize our findings and procedures.

Our topic of interest was Alien Hand Syndrome. We were provided with basic information regarding this case and from that we began a more thorough investigation into the topic using both old and new research skills. A summary of our trigger is as follows:
The subject of interest is a sixty-eight year old grandmother who loves working with her hands to accomplish her day-to-day activities, such as knitting. Eventually, her left arm begins to act up by not cooperating with what she wants it to do. It is almost as if her arm has a mind of its own. It levitates without command and she often has to restrain it with her right arm so that it will stop moving. Interestingly enough, when blindfolded she is unable to tell if her right hand is holding her own left arm or another person’s.

In order to come up with a plan of action, our group had to meet before we could individually set out and research. Our first meeting consisted of discussing our topic and our thoughts about it prior to reading about it. We then brainstormed a few starter questions so that everyone was thinking in the same frame of mind. At the end of that meeting we had decided that we would, individually, do some general research on Alien Hand Syndrome before we were to meet again. We also decided upon what methods of research we were all going to focus on. We wanted to stay away from unreliable Internet sources as much as possible but it turned out that most of us found the Internet and its electronic library more useful with regards to our topic, rather than going to actual libraries on campus. After visiting the libraries and the World Wide Web, we found that the electronic libraries carried information more specific to our topic. After we each did our share of research, we met up again and pooled our resources together. It turned out that a lot of our information overlapped and we could see this becoming a bit of a problem since there was not a lot of information out there to begin with. With that set aside, our group generated the first set of questions that we wanted to investigate to see if they would lead us to the information we would need to produce this paper.

For the most part, our first set of questions was too specific to generate any information needed to complete the research process. This was because we did not have enough understanding on the patient’s case. We did not find this to be a waste of time because it helped us to understand just how difficult a research process could be. We then decided to do a bit more research on the case, re-word, and in some cases change the questions to adapt to the information accessible to us in our resources. We found this tiresome and at times very frustrating because we weren’t sure if there was even enough information out there for us to write a proper report with. It seemed to be that we were researching a topic that, as of yet, little is known about. Staying in a positive frame of mind, we realized that this was a crucial part of the learning process. Coming up with questions that nobody has investigated before and coming up with many sets of questions is an important tool of inspection. It isn’t about how much information you write down, it’s about the strategies used to get there, both mental and physical. It only takes one well thought out question to write a good research paper. Every time a new set of questions was formed, we were able to see which questions kept appearing within every set. This allowed us to derive one last and final set of questions that we believed were more specific to what we felt was important to research. Each of these questions was one that a member of the group wanted to individually research. We realized that there is no point in researching something that doesn’t strike you as interesting because chances are, other people won’t find it interesting either and your research will be lost. This is why we let everyone pick a question of his or her choice from the list.

Final Set of Questions:

1. When was Alien Hand Syndrome first researched and who were the first people affected by
it?
2. What might have caused this?
3. What are the symptoms?
4. Are people who are affected by other diseases affected by this syndrome too? (Are there any
relations between AHS and other diseases?)
5. Are there any treatments available for a person who suffers from Alien Hand Syndrome?
6. Is Alien Hand Syndrome only isolated to the hand?

Of course, we realized that we needed qualified resources in order to obtain the appropriate answers to these questions but our search in Mills, Thode and the Health Science libraries at Mcmaster University landed us with very little information. That is when we decided we would focus our research to PubMed journals online. As much as we would have liked to include a broader range of resources, there was just too little published about Alien Hand Syndrome to satisfy that. In fact, we were not able to answer, in depth, or find significant information relating to some of our questions possibly because some of those answers are unknown as of now.
The following is a summary of the information we found regarding our final list of questions.
The History and Facts About Alien Hand Syndrome

The phenomenon of alien hand syndrome is the most extraordinary and remarkable wonder ever seen in clinical practice, (Moore, 2004). Kurt Goldstein first described it in 1908 using a 57-year old woman who suffered a stroke and later explained her hand as being possessed by an “evil spirit.” She stated that it did not belong to her (Scepkowski, 2003). In the American Journal of Psychiatry, Akelaitis published an article in 1941 about patients who had epilepsy and had undergone a removal of a section of the corpus callosum for control over the attacks. The corpus callosum is a thick band of nerve fibers that connect the two hemispheres of the brain (see Fig.1 app. A). He used the name “diagnostic dysphasia,” to describe it but this name did not gain popularity (Moore, 2004). In 1972 researchers Brion and Jedynak introduced the term Alien Hand Syndrome (AHS). This term was used to describe patients experiencing denial of ownership to one of their own hands due to a midline brain tumor. A unique trait of this syndrome was that the patient could not control his or her own hand and could not even perform simple day to day tasks, such as writing (Scepkowski, 2003).

The main critical point of alien hand syndrome is damage of one sort or another to the corpus callosum (Moore, 2004). The corpus callosum enables the communication between the right and left hemisphere of the brain (Day, 2005). The left hemisphere normally controls the activity in the right hemisphere, but if the corpus callosum is destroyed, the right hemisphere is now able to act autonomously (Moore, 2004). In a further explanation, the patient loses their conscious sense of control over their contradictive movements. This is somewhat like losing a sense of the limb belonging to them (Doody, 1992). The Alien hand syndrome appears normally after trauma to the brain that is caused after brain surgery, stroke or an infection of the brain (Medicine Net, 2000).

Symptoms Of Alien Hand Syndrome

There are many symptoms exhibited by Alien Hand Syndrome (AHS) patients. These symptoms include (a) intermanual conflict, in which one hand acts at different from the other; (b) mirror movements in, for example, writing, in which one hand imitates the movements of the other hand; (c) enabling synkinesis, in which one hand can execute an action on in agreement with the other; “(d) grasp reflex; (e) impulsive groping toward objects; or, in Denny Brown’s (1958) term, magnetic paraxial, in which the affected hand reaches toward and grasps objects as if drawn to them by a magnet, and release of the object is difficult;” and (f) utilization behavior, or compulsive manipulation of tools,” (Scepkowski, 2003, p 262). Patients will not possess and may not experience all the characteristics of Alien Hand Syndrome.
In most, if not all, cases some kind of event triggers this unusual disorder. In particular, different types of brain injuries seem to cause different types of "Alien Hand." For example, injuries sustained in the Corpus Callosum may result in "purposeful" movements of the non-dominant hand, which could be explained as due to lack of communication between the brain’s two hemispheres (Mundell, 2000), (Grohol), (Marey-Lopez). Injury to the Frontal Lobe can trigger "grasping" or compulsive manipulation in the dominant hand, or the hand opposite to the affected hemisphere (Mundell, 2000), (Grohol), (Marey-Lopez). In addition, injury to the Cerebral Cortex (the outer layer of the brain responsible for all forms of conscious experience, thoughts, emotions and perceptions) can cause "aimless" or "non-purposeful" movements; like levitation of either hand. Brain tumors, infection, aneurysm or stroke may trigger more complex movements, such as the unbuttoning of a blouse (Mundell), (Grohol), (Marey-Lopez).
Generally, "alien hands" do not behave as though they belong to the same person, even though the patient retains sensation in that affected limb (Mundell), (Cullari), (Grohol). In addition, patients have trouble distinguishing between their own hand and the hand of another person when they are placed in the patient’s "good" hand (and the hands are not viewable by the patient - ex. behind their back) (Wang, 2004), (Marey-Lopez). People with AHS often feel that the affected limb is not part of their own body, and they tend to deny ownership of it (Mundell), (Grohol). Sometimes, patients are not even aware that the limb is moving, and if they are, they can only watch its unpredictable movements helplessly as it appears to have a life of its own (Cullari), (Wang).

Sources tell us that patients are not always in control of one of their hands, and that AHS can affect any of the limbs (but is most common in the hand) (Cullari, 2005). This resulted in the assumption that they can regain control of the alien hand when it ceases to act out and that it mostly affects only one hand or limb, as opposed to both hands and both feet simultaneously. Sources also tell us that AHS can last for only a brief period, as reported in some epileptic patients that underwent Corpus Callosum operations to relieve severe seizures (Cullari, 2005). This information allows us to conclude that once alien hand symptoms appear they can either remain with the patient for the rest of their lives, or they go away after significant time has passed.

In conclusion, symptoms of AHS include an array of movements and behaviors. Many of these are determined by the injuries or infections sustained by the brain and, in most cases, patients are unable to predict when the limb will spontaneously act out and are unable to prevent them from doing so. A patient’s incapability of distinguishing their own hand from someone else’s hand is typical, and symptoms can persist for only brief periods of time.

Alien Hand Syndrome and Brain Diseases

As said before, many common brain diseases can result in AHS. Alien had Syndrome (Also known as Alien Hand Sign, Alien Limb Sign and Alien Hand Phenomena) is a significant syndrome in some of brain diseases such as in epilepsy, seizures, Creutzfeldt-Jakob disease (CJD), and Corticobasal Ganglionic Degeneration (CBGD). There have also been cases where AHS has been linked to diseases such as acute cerebral vascular diseases, herpes viral encephalitis, and Alzheimer’s disease (Wang, 2004).

Creutzfeldt-Jakob disease:

CJD is a slow-viral infection of the brain.
Symptoms: Personality and emotional changes, anxiety, depression, inappropriate euphoria, language difficulties, memory disorders, visual disorders, involuntary movements and ataxia.
Case Study: A 70-year-old right-handed man with CJD has been reporting symptoms of Alien Hand Syndrome, such as his hand moving against his will. If someone asks him why he raised his hand while he was talking to him or her then he would say that he does not know what his hand was doing at that moment. Later he was affected by grossly ataxic and he was unable to walk also he could not do his daily activities; he died few weeks later. People with CJD often had memory disorder (Inzelberg, 2000).

Corticobasal Ganglionic Degeneration (CBGD):

Corticobasal ganglionic degeneration (CBGD) is a neurodegenerative dementia characterized by asymmetric Parkinsonism, ideomotor apraxia, myoclonus, dystonia, and the alien hand syndrome (Mendez MF). Many of CBGD patients are identified as having AHS. A group of UK universities’ did an experiment to examine the task of visual and tactile information in a Dyspraxic patient who had CBGD. The patient had been asked to present actions with his right hand and his hand sometimes went to his pocket without his knowledge or other times it rubbed the top of his head (Graham, 1996).

Case Studies: Patients with Alien Hand Syndrome

Symptoms of AHS can also appear suddenly, as reported in some cases; in one particular case, a 54 year-old patient was just sitting down when he suddenly detected a difference in feeling in his one hand; if he didn’t see his hand, he was unable to distinguish between his own hand, and a stranger’s. In addition, the hand would also try to imitate his "good" hand with respect to its movements (Suwanwela, 2002). This proved to be a case of AHS.
Other symptoms can also be associated with Alien Hand Syndrome as reported in the following case: The movements of the alienated hand of a 64-year-old woman were "inaccurate in trajectory and irregular in speed and amplitude”(Marey-Lopez, 2002). In other words, her hand was unsteady and jerky in its maneuvers. It would begin to move slowly and smoothly, and then it would become fitful and rapid. The hand sometimes froze or underwent episodes of levitation (Marey-Lopez, 2002).
In all the studied cases, patients were over 50 years old.

Treatment

It seems that Alien Hand Syndrome is not fully enhanced. All the articles and papers written about this syndrome give the impression that doctors and neurologists are still unaware of the causes, symptoms, and anatomy of AHS. Therefore, it is difficult to conclude a treatment for and unknown cause.
Although there is little known about treatment for AHS, there are ways to reduce the hassles of it. In these cases, uncontrollability of the hand can be settled down by using a wrist restraint or by putting a mitten on the hand, (Moore, 2004). With other patients, keeping the hand busy by making the affected hand hold an object can help control the spontaneous movements (Medicine Net, 2000).

Follow-up:

Even though we were able to find a decent amount of sufficient information with regards to Alien Hand Syndrome we found that it was very repetitive. This was definitely a reoccurring obstacle in our process.

As a group, we decided that if we had the chance to follow up on this case we would want to compare it in depth to a number of other reported cases and see, more specifically, the effects of this disorder both long and short term. Our report may have only stated a portion of the knowledge we obtained and only answered in detail a select few of our questions, we believe that it was suitable for the nature of this paper.

In general, this report turned out to be quite an interesting process. The knowledge we acquired in order to understand our trigger would prove to be beneficial in our future reports. We were forced to look at the problem with varying degrees of questions, each building on the one before. We found that the initial questions were not too general but rather too specific. This taught us to extend our perceptions on the problem and take into account many different possibilities of questioning that could be used as an approach to write this report. This gave way to a number of questions that were not possible to answer because we could not find the information needed to support them without raising even more questions. The information we did use to answer our questions was carefully picked from recent and credible sources so we felt that we were using the best knowledge we could possibly attain at this time. Having everyone research his or her own question proved to be a good tool because each person was able to answer their question in their own style giving the report a more diverse style. The hardest part of this report was the final product. It was quite difficult collecting everyone’s information and combining it into one product that flowed in a uniform and progressive manner. We decided to meet before the final product and go through everyone’s information so that everybody had an input on what was written. This eliminated any discrepancies in the information presented.
As for recommendations, we definitely recommend getting together more often as a group so that the final product is easier to put together and flows in a better way. Something that worked well for us was everyone researching his or her own questions. At first it seemed like we would come up with information that did not relate to each other’s but in reality we came back with very similar information from many different sources. Once we were finished it turned out that our information was well intertwined. We believe that we approached this paper with the right frame of mind and we were successful in producing a well-written and well-read paper.

Bibliography

Biran, I. MD and Chatterjee, A. MD (2003). Alien Hand Syndrome. Neurological Sciences: Official Journal of the Italian Neurological Society and the Italian Society of Clinical Neurophysiology. 24 (4) p252-257.

Cullari, S (2005). Is the alien hand syndrome something that still goes on today. Mad Science Web Site. Oct. 2, 2005.< http://www.madsci.org/posts/archives/2000- 12/976183734.Ns.r.html>.

Doody RS, Jankovic J. The alien hand and related signs. J Neurol Neurosurg Psychiatry 1992;55:806-810.

Dr. Day, Richard (2005). Psychology 1A03: The Basics and Beyond & CD. Hamilton: Custom Publishing Solutions.

Google Images. Retrieved on Oct. 17, 2005
Grohol, J. (2005). Alien hand syndrome. Oct. 2, 2005. <http://psychcentral.com/psypsych/Alien_hand_syndrome>.

Inzelberg,R., P.Nisipeanu, and S.C.Blumen,R.L Carasso.,(2000), Alien hand sign in Creutzfeldt-Jakob disease. Journal of Neurology, Neurosurgery, and Psychiatry . 68(1) pg103-104.
Marey-Lopez, J., E. Rubio-Nazabal, L. Alonso-Magdalena, and S. Lopez-Facal (2002). Posterior Alien Hand Syndrome. British Medical Association.

Medicine.net (2000). Alien hand syndrome definition. U.S. Board Certified Physicians and Allied Health Professionals, Oct 9, 2005, Available from: <http://www.medterms.com/script/main/art.asp?articlekey=12655>.

Mendez MF (2000). Corticobasal ganglionic degeneration with Balint's syndrome. The Journal of Neuropsychiatry and Clinical Neuroscience, 12 (2) pg 273-275.
Moore, David P and James W. Jefferson (2004). Alien Hand Syndrome. Handbook of Medical Psychiatry, 2nd Ed. retrieved Oct. 5, 2005 electronic online.

Mundell, E, J (2000). Alien Hand Syndrome Turns Limbs Monstrous. Journal of Neurology, Neurosurgery, and Psychiatry. Retrieved October 1, 2005, from: <http://home.mdconsult.com/das/book/body/410293079/1243.html?printing=true>.
Graham, Naida L., Adam Zeman, Andrew W Young, Karalyn Patterson, and John R Hodges (1999) The role of visual and tactile inputs to action, Journal of Neurology, Neurosurgery, and Psychiatry .67:334-344

Scepkowski, Lisa A., and Alice Cronin (2003). The Alien Hand: Cases, Categorizations, and Anatomical Corrleates. Behavioural and Cognitive Neuroscience Reviews. 45 (2), 261-262.
Suwanwela, N. C. and N. Leelacheavasit (2002). Isolated Corpus Callosal Infarction secondary to Pericallosal Artery Disease presenting as Alien Hand Syndrome. J ournal of Neurology, Neurosurgery and Psychiatry. 72 (4) 533.

Wang XP, Fan CB, Zhou JN (2004). Alien hand syndrome: Contradictive movement and disorder of color discrimination. Neurol India 52 (1), 109-110.
Group Members
Crislee
Lauren
Jalajah
May
Laura
Christina

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