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

Anarchic Hand Syndrome (AHS) is a rare neurological disorder characterized by uncontrollable yet seemingly purposeful limb movements, profoundly affecting daily life. Despite its clinical impact, no standardized rehabilitative treatments currently exist due to the syndrome's rarity and symptom variability. This study describes the case of No Longer (an) Enemy (NLE), a 26-year-old woman who developed AHS following an intracerebral hemorrhage due to a ruptured anterior communicating artery aneurysm. The patient underwent an extensive neuropsychological assessment; brain correlates were assessed by using lesion mapping and atlas-based tractography, as well. To address her symptoms, we implemented a rehabilitation protocol combining two distinct treatments targeting both bottom-up and top-down mechanisms: Mirror Box Treatment (MB-T) and Verbal Order Treatment (VO-T). Outcome measures included neuropsychological testing, structured interviews, and caregiver reports. Results indicate a progressive improvement in motor and planning control, reduction of AHS-related symptoms, and enhanced quality of life, with benefits persisting at follow-up. While the study design does not allow for a direct comparison of treatment efficacy, findings support the feasibility of structured, multi-modal rehabilitation approaches for AHS.