Michiel H. G. Claessen

Navigation strategy training using virtual reality in six chronic stroke patients: A novel and explorative approach to the rehabilitation of navigation impairment

Recent studies have shown that navigation impairment is a common complaint after brain injury. Effective training programmes aiming to improve navigation ability in neurological patients are, however, scarce. The few reported programmes are merely focused on recalling specific routes rather than encouraging brain-damaged patients to use an alternative navigation strategy, applicable to any route. Our aim was therefore to investigate the feasibility of a (virtual reality) navigation training as a tool to instruct chronic stroke patients to adopt an alternative navigation strategy. Navigation ability was systematically assessed before the training. The training approach was then determined based on the individual pattern of navigation deficits of each patient. The use of virtual reality in the navigation strategy training in six middle-aged stroke patients was found to be highly feasible. Furthermore, five patients learned to (partially) apply an alternative navigation strategy in the virtual environment, suggesting that navigation strategies are mouldable rather than static. In the evaluation of their training experiences, the patients judged the training as valuable and proposed some suggestions for further improvement. The notion that the navigation strategy people use can be influenced after a short training procedure is a novel finding and initiates a direction for future studies.

Classification of navigation impairment: A systematic review of neuropsychological case studies

HighlightsNavigation impairment is often investigated in neuropsychological case studies.Current study provides a systematic inventory and interpretation of 58 case studies.We identified three main categories of navigation impairment.These categories are related to landmarks, locations, and paths.The model has implications for theory and clinical assessment of navigation ability. &NA; The neurocognitive architecture of navigation ability has been investigated by extensively studying the navigation problems of individual neurological patients. These neuropsychological case reports have applied highly variable approaches to establish navigation impairment in their patients. This review provides a systematic and up‐to‐date inventory of all relevant case studies and presents an analysis of the types of navigation impairments that have been described. The systematic literature search revealed 58 relevant papers reporting on 67 neurological patients. Close analysis of their patterns of navigation performance suggests three main categories of navigation impairments. These categories are related to three types of representations that are considered highly relevant for accurate navigation: knowledge of landmarks, locations, and paths. The resulting model is intended to serve both clinical and theoretical advances in the study of navigation ability and its neural correlates.

Computerization of the standard corsi block-tapping task affects its underlying cognitive concepts : A pilot study

The tablet computer initiates an important step toward computerized administration of neuropsychological tests. Because of its lack of standardization, the Corsi Block-Tapping Task could benefit from advantages inherent to computerization. This task, which requires reproduction of a sequence of movements by tapping blocks as demonstrated by an examiner, is widely used as a representative of visuospatial attention and working memory. The aim was to validate a computerized version of the Corsi Task (e-Corsi) by comparing recall accuracy to that on the standard task. Forty university students (Mage = 22.9 years, SD = 2.7 years; 20 female) performed the standard Corsi Task and the e-Corsi on an iPad 3. Results showed higher accuracy in forward reproduction on the standard Corsi compared with the e-Corsi, whereas backward performance was comparable. These divergent performance patterns on the 2 versions (small-to-medium effect sizes) are explained as a result of motor priming and interference effects. This finding implies that computerization has serious consequences for the cognitive concepts that the Corsi Task is assumed to assess. Hence, whereas the e-Corsi was shown to be useful with respect to administration and registration, these findings also stress the need for reconsideration of the underlying theoretical concepts of this task.

A Direct Comparison of Real-World and Virtual Navigation Performance in Chronic Stroke Patients.

OBJECTIVES An increasing number of studies have presented evidence that various patient groups with acquired brain injury suffer from navigation problems in daily life. This skill is, however, scarcely addressed in current clinical neuropsychological practice and suitable diagnostic instruments are lacking. Real-world navigation tests are limited by geographical location and associated with practical constraints. It was, therefore, investigated whether virtual navigation might serve as a useful alternative. METHODS To investigate the convergent validity of virtual navigation testing, performance on the Virtual Tubingen test was compared to that on an analogous real-world navigation test in 68 chronic stroke patients. The same eight subtasks, addressing route and survey knowledge aspects, were assessed in both tests. In addition, navigation performance of stroke patients was compared to that of 44 healthy controls. RESULTS A correlation analysis showed moderate overlap (r = .535) between composite scores of overall real-world and virtual navigation performance in stroke patients. Route knowledge composite scores correlated somewhat stronger (r = .523) than survey knowledge composite scores (r = .442). When comparing group performances, patients obtained lower scores than controls on seven subtasks. Whereas the real-world test was found to be easier than its virtual counterpart, no significant interaction-effects were found between group and environment. CONCLUSIONS Given moderate overlap of the total scores between the two navigation tests, we conclude that virtual testing of navigation ability is a valid alternative to navigation tests that rely on real-world route exposure.

Chapter 8 – Navigation Ability

Navigation ability is a function we rely on whenever we move around. In this chapter we discuss this part of spatial cognition, starting with an overview of basic spatial behavior and its neural underpinnings. Next we discuss different ways in which navigation ability can be structured; based on perspective taking, representations, types of tasks, and types of spatial knowledge used. In the second part of the chapter we focus on navigation impairment, or topographical disorientation. We provide an historic overview on the matter and discuss recent case studies to complement this overview. To end the chapter we discuss means of testing navigation ability and navigation impairment and how novel technologies such as virtual reality can be used as a testing tool.

Dissociating spatial and spatiotemporal aspects of navigation ability in chronic stroke patients.

OBJECTIVE The notion of distinguishable processing mechanisms for spatial and spatiotemporal information has largely been neglected in the context of navigation. Only a recent neuropsychological case study has provided initial evidence for the idea that these elements can be differentiated at a functional level. The aim of the current study was therefore to critically verify this double dissociation by adopting a systematic, large-scale approach. METHOD Sixty-five chronic stroke patients and 60 matched healthy controls watched a route through a realistic virtual environment. They were assessed on their knowledge of this route in 4 different tasks after the learning phase. Performance on the scene recognition and route continuation tasks was taken as an indication of knowledge of the spatial route aspects. By contrast, spatiotemporal knowledge of the route was assessed in the route order and route progression tasks. RESULTS Based on single case statistics, 6 patients showed an exceptionally large difference in their performance on the spatial and spatiotemporal tasks. Moreover, 2 patients satisfied formal criteria for a classical dissociation. CONCLUSIONS Our findings showed that spatial and spatiotemporal performance was closely associated in most patients. Nonetheless, the study also provided partial support for the notion of separate space- and time-based processing mechanisms in the context of navigation. This distinction is of particular relevance to the investigation into the cognitive structure underlying navigation behavior. (PsycINFO Database Record

The Wayfinding Questionnaire: A clinically useful self-report instrument to identify navigation complaints in stroke patients

ABSTRACT Post-stroke navigation complaints are frequent (about 30%) and intervention is possible, but there is no assessment instrument to identify patients with navigation complaints. We therefore studied the clinical validity of the Wayfinding Questionnaire (WQ) in a cross-sectional study with 158 chronic stroke patients and 131 healthy controls. Patients with low (more navigation complaints) versus normal WQ scores were compared for demographics, stroke characteristics, emotional and cognitive complaints, and health-related quality of life (HRQoL). Actual navigation performance of 78 patients was assessed in a virtual reality setting. Effect sizes (d) were calculated. WQ responses (22 items) of stroke patients were compared with those of controls (discriminant validity). Results showed that patients with a low WQ score (n = 49, 32%) were more often women (p = 0.013) and less educated (p = 0.004), reported more cognitive complaints (d = 0.69), more emotional problems (d = 0.38 and 0.52), and lower HRQoL (d = 0.40 and 0.45) and, last but not least, performed worse on the navigation ability tasks (d = 0.23–0.80). Patients scored lower than controls on 21/22 WQ items, predominantly with small to medium effect sizes (d = 0.20–0.51). We conclude that the WQ is valid as a measure of navigation complaints in stroke patients, and thus strongly advocate its use in stroke care.

A systematic investigation of navigation impairment in chronic stroke patients: Evidence for three distinct types

Objective: In a recent systematic review, Claessen and van der Ham (2017) have analyzed the types of navigation impairment in the single‐case study literature. Three dissociable types related to landmarks, locations, and paths were identified. This recent model as well as previous models of navigation impairment have never been verified in a systematic manner. The aim of the current study was thus to investigate the prevalence of landmark‐based, location‐based, and path‐based navigation impairment in a large sample of stroke patients. Method: Navigation ability of 77 stroke patients in the chronic phase and 60 healthy participants was comprehensively evaluated using the Virtual Tübingen test, which contains twelve subtasks addressing various aspects of knowledge about landmarks, locations, and paths based on a newly learned virtual route. Participants also filled out the Wayfinding Questionnaire to allow for making a distinction between stroke patients with and without significant subjective navigation‐related complaints. Results: Analysis of responses on the Wayfinding Questionnaire indicated that 33 of the 77 participating stroke patients had significant navigation‐related complaints. An examination of their performance on the Virtual Tübingen test established objective evidence for navigation impairment in 27 patients. Both landmark‐based and path‐based navigation impairment occurred in isolation, while location‐based navigation impairment was only found along with the other two types. Conclusions: The current study provides the first empirical support for the distinction between landmark‐based, location‐based, and path‐based navigation impairment. Future research relying on other assessment instruments of navigation ability might be helpful to further validate this distinction. HighlightsA recent literature review has identified three types of navigation impairment.These types are linked with deficits related to landmarks, locations, and paths.Navigation ability was extensively tested in stroke patients to verify these types.Both landmark‐based and path‐based navigation impairment occurred in isolation.Location‐based navigation impairment was found along with the other types.

Landmark Agnosia: Evaluating the Definition of Landmark-based Navigation Impairment

Objective Landmark agnosia is a rare type of navigation impairment, for which various definitions have been presented. From a clinical as well as theoretical perspective, consensus on the characteristics of landmark agnosia would be valuable. In the current study we review the literature concerning landmark agnosia and present a new case study. Existing literature highlights the importance of examining familiar as well as novel landmark processing and substantial variation in performance patterns of individual patients. Method We performed a case study with patient KS, a 53-year-old male, suffering from landmark agnosia, making use of elaborate neuropsychological screening and virtual reality-based tests of navigation ability. Results Our extensive examination of his impairment shows that landmark agnosia can be very narrow; in KS it is restricted to recognition of newly learned landmarks only. Also, he has no trouble recognizing familiar landmarks that are not part of a navigated route. Conclusions The literature review shows that the right temporal lobe, and the right hippocampus in particular are the main lesion sites for landmark agnosia. Furthermore, our case study substantiates that this disorder can occur for both familiar and novel landmarks, and can affect novel landmarks in isolation from familiar landmarks. Moreover, it can occur in isolation from problems with processing route information.

Neurocognitieve en klinische perspectieven op het navigatievermogen

SamenvattingHet navigatievermogen heeft grote invloed op het leven van de mens. Toch krijgt deze functie binnen de klinische neuropsychologie nog maar weinig aandacht. Het onderzoek naar de neurocognitieve architectuur van het navigatievermogen heeft door de technische ontwikkelingen van de afgelopen 20 jaar echter een enorme ontwikkeling doorgemaakt. Er zijn twee invloedrijke theoretische modellen ontstaan: het egocentrisch-allocentrisch model, dat onderscheid maakt tussen twee fundamenteel verschillende ruimtelijke perspectieven waarmee een omgeving geleerd en opgeslagen kan worden en het landmark-route-survey (LRS) model, dat drie verschillende typen kennis beschrijft, die bij het navigeren een rol spelen. Om de complexiteit van het navigatievermogen beter te begrijpen, lijkt niet alleen integratie van deze modellen zeer wenselijk, er moeten ook gegevens uit de klinische literatuur bij worden betrokken. In een systematische analyse van neuropsychologische casusstudies zijn recentelijk drie typen navigatiestoornissen geïdentificeerd, die zijn gerelateerd aan problemen met herkenningspunten, locaties en paden. Het onderscheid tussen deze typen navigatiestoornissen vormen een eerste aanzet tot integratie van het egocentrisch-allocentrisch en het LRS-model. Deze integratie is noodzakelijk voor een adequate beschrijving van het navigatievermogen vanuit meer fundamentele en klinische perspectieven.