Stroke Care Management: Alien Hand Syndrome

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Published: 16 August 2015

Being groped or grabbed by a patient while carrying out work duties is not okay in any clinical setting.

Yet, a Monash University study found that 70% of surveyed nurses reported being physically assaulted in the workplace. The patient was identified as being the perpetrator in many of these assaults (ANMF 2015).

The challenge for nurses is that they are caring for patients who may be aggressive due to an acute or untreated medical condition such as dementia, delirium or brain injury. One such medical condition that may lead to incidents of physical assault is Alien Hand Syndrome (AHS), which may occur in patients recovering from stroke due to disruption of the anterior cerebral artery (ACA) blood supply.

alien hand syndrome

AHS is a phenomenon involving the involuntary motor activity of a limb in conjunction with the feeling of estrangement from that limb. In many instances, patients speak about their limb in the third person and as having a will of its own.

Research has provided evidence to support the theory of there being two variants - posterior (PV) and anterior (AV), with the later having a further two subtypes - frontal (AVF) and callosal (AVC). Each variant and subtype presents in a clinically different manner and there have also been reported cases of mixed variants.

The AVF subtype presents with the disinhibited groping and reaching for objects that are within arm's reach without the patient's will or control. If the object happens to be the arm or another body part of the nurse, this may be upsetting for both patient and nurse. Particularly distressing is if the patient's grip tightens as the patient and nurse try to release the affected hand's grip.

Purposeful hand movement signals originate from the frontal lobe where the movement is planned and organised. A message is then sent through to the motor strip also located in the frontal lobe to move the limb. Alien hand movement signal originates in the motor strip itself due to the location of the lesion and does not involve the frontal lobe. There is no conscious decision for movement, nor is there any planning or organising of the movement, hence the alienness of the limb movement.

Management of Alien Hand Syndrome

alien hand syndrome management

Protecting the patient in addition to the staff is an important component of care management. Providing education to the patient, family and staff is the first and most important step in promoting safety and optimising functional recovery.

Protective strategies that can be considered include:

  • Keeping the affected hand occupied (e.g. with a stress or tennis ball) when working in close proximity to the patient;
  • Ensuring the environment is clutter-free and objects are not in reach of the affected hand (reduces the risk of minor spilling accidents or use of objects as weapons);
  • Creating a calm and stress-free environment (i.e. accommodating the patient in a single room, which also promotes sleep hygiene);
  • Using visualisation tactics such as positioning the affected hand within the patient's visual field and encouraging the patient to mentally practise functional tasks using both limbs;
  • Providing reassurance to the patient and family that AHS generally resolves as recovery occurs;
  • Minimising distractions for the patient when providing care or therapy; and
  • Managing fatigue by scheduling therapy and care throughout the day dependent upon patient fatigue levels.

In the event of a situation wherein a patient grips or gropes a staff member, patience is required in managing the incident. If required, release the patient's grip gently by prising off the little and ring fingers followed by the remaining fingers. Pulling away or forcing the release will in many instances only increase the force of the grip. Panic will increase anxiety for both the staff member and the patient, which could exacerbate the situation further.

Conclusion

Raising awareness of Alien Hand Syndrome (AHS) post-stroke and providing information on how to minimise the effects should decrease gripping and groping incidents attributed to AHS occurring within the workplace.


References

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