When Playing Is a Problem: An Atypical Case of Alien Hand Syndrome in a Professional Pianist

Abstract

Alien hand syndrome (AHS) is a neurological illness characterized by limb movements which are carried out without being aware of it. Many patients describe these movements as aggressive and some perceive a strong feeling of estrangement and go so far as to deny ownership. The sense of body ownership is the perception that parts of one’s body pertain to oneself, despite it is moving or not and if movement is intentional or unintentional. These anomalous self-experiences may arise in patients with focal brain lesions and provide unique opportunities to disclose the neural components underlying self-body perception. The feeling of foreignness described in AHS is often observed in post-central cortical lesions in the non-dominant hemisphere and is typical of the “posterior alien hand variant”. We used Diffusion-Tensor magnetic resonance imaging (DT-MRI) in an unusual case of posterior AHS of the dominant hand in a professional pianist with corticobasal syndrome (CBS). The patient showed uncontrolled levitation with the right arm while playing the piano and perceived as if her hand had a “mind of its own” which prevented her from playing. MRI-scans show asymmetric brain atrophy, mainly involving left post-central regions and SPECT-Tc99m-ECD patterns of hypometabolism over the left parietal-occipital cortices. DT-MRI revealed extensive damage which comprised left fronto-temporal cortex and extends into the ipsilateral parietal cortex causing a disruption of corpus callosum (CC) projections from the rostrum to the splenium. Our case illustrates that posterior AHS may occur in the dominant hemisphere due to widespread damage, which exceed parietal cortex. The parietal lobe has been recognized as a multimodal association region that gets input from several networks and organizes motor output. We suggest that the disturbance to this pathway could result in disruption of motor output and associate an abnormal motor control and anomalous self-body perception.

A Critical Review of Alien Limb-Related Phenomena and Implications for Functional Magnetic Resonance Imaging Studies

“…The latter variant sometimes appeared misspelled in the literature as "diagnostic dyspraxia" (13,16), rather than the original "diagonistic" (12). However, this categorization appears to be not exhaustive, as parietal damage was found in patients presenting with limb levitation (20)(21)(22)(23), and thalamic acute lesions may present with features of the posterior variant of AL (i.e., levitation movement of the affected limb and sense of extraneousness), despite the preservation of parietal areas (24)(25)(26). Figure 1 shows relevant brain areas involved in AL.…”

Feature Extraction and Musical Personality Analysis of Piano Artistic Performances

“…Under the premise of the existence of commonality, piano art has realized the development of enduring and firmly occupies an extremely important position in musical art [13]. However, only commonality, any form of art can not realize the development of transcendence.…”

An empirical analysis of the evolution of piano performance skills based on big data

“…In the process of piano practice, it should mainly focus on several aspects such as pedal use, practice techniques and body skills, and then through repeated training from unfamiliar to familiar, mastering the basic skills of piano playing and transforming the playing process from technical to artistic, only in this way can practice making skill and skill make perfect [3][4]. In addition, it is necessary to cultivate the musical expression of the performer on this basis so that the performer has good physical and mental qualities in the process of playing so that he or she can skillfully play all the techniques of playing, proceed in the process of playing in an orderly manner and present the work perfectly to the audience [5][6]. Learners should be good at observing the playing techniques carefully when practicing piano and should not easily let go of any arc, detail or note in the process of playing, and at the same time must understand the meaning of each note during the performance, remember the position occupied by the phrase and divide the memory in a targeted way, which is the key and difficult point when practicing piano [7][8].…”