Releasing forced grasp reflex by use of concomitant imitation behaviour during rehabilitation of a stroke patient

An 80-year-old woman had a stroke during treatment for diffuse large B cell lymphoma. She exhibited left hemispatial inattention, forced grasping with her left hand and moderate left hemiplegia. She always grasped the guard rail of the bed with her left hand, which prevented her from standing up and performing activities of daily living (ADL) centred on move and transfer operations. During a medical examination, she showed an imitation behaviour (IB), mimicking gestures visually presented by the examiner, such as holding up. By using her IB in rehabilitation training, flexor-dominated posture of the upper arm was gradually reduced and performance of ADL improved. Her brain lesion was localised in the right middle frontal gyrus. Based on our experience of concomitant appearance of forced grasping and IB in this case, the pathophysiological involvement of the lesion was discussed.