Positive Outcomes of Early Task-Specific Training and Action Observation Mirror Therapy Following Infarction of Hand Knob Area: A Case Report

Traumatic nerve damage or compression neuropathy is the most common cause of unilateral weakness in an upper extremity. Rarely, a central nervous system lesion may cause syndromes that initially appear to indicate peripheral nerve injury. The most well known of these is pseudoperipheral hand palsy, which is typically brought on by a minor brain lesion in the contralateral motor cortex. The term "hand knob" refers to a restricted area in the posterior frontal lobe's precentral gyrus, a lesion that causes isolated weakness in the upper extremity that mimics injury to peripheral nerves. The majority of the time, an embolic infarction is the cause of this uncommon condition. We present a case of a 52-year-old female who presented to the medicine outpatient department with sudden onset of acute pure motor paresis of the right hand. She also complained of clumsiness in her hand and several episodes of generalized headache in the parieto-occipital region in the past two weeks. Following an initial evaluation by a physician, she was advised for MRI of the head and neck, which reported occlusion in the petrous part of the left internal carotid artery, and referred to physiotherapy for further management. She was assessed and a task-specific training protocol was made for the patient, which also included physiotherapy techniques like grip exercises, mirror therapy, and strengthening. There was an improvement in the patient within a few weeks that was evident with the outcome measures post-rehabilitation. This case study is really a good case not only in regards to peculiarities and clinical presentation but also in promoting rarely implementation of rehabilitation to get patients back to their previous functional status.