Abstract
Neuropsychological studies on acquired topographical disorientation have provided useful insights into the contribution of different brain regions to human navigation. However, little is known about the possibility to restore navigational skills after brain damage. Here we describe the case of No Longer Lost (NLL), a 49-year-old man who complained of severe topographical disorientation following traumatic brain injury. Extensive neuropsychological evaluation at baseline revealed selective episodic memory deficits and topographical disorientation. NLL underwent 8-week imagery-based treatment (IBT) inspired by current cognitive models of human spatial navigation. After IBT, NLL improved topographical skills and episodic memory. From a clinical point of view, the present study describes a model-based intervention for topographical disorientation. From a theoretical point of view, it provides new insights into the cognitive models of human spatial navigation and straightforward evidence about common phylogenetic roots of brain mechanisms devoted to spatial navigation and memory.
Highlights
To orient themselves within the environmental space – namely, the space beyond the sensory horizon (Wolbers and Wiener, 2014) – individuals have to process “online” information about their own position and facing direction (Sulpizio et al, 2017, 2018), as well as to recall previously acquired “offline” information about the environment (Wolbers and Hegarty, 2010)
When No Longer Lost (NLL) came to our observation he was seriously worried about his topographical disorientation and memory impairment
After imagerybased treatment (IBT), NLL was able to learn and recall spatial positions within the environmental, vista, and reaching spaces, suggesting that the neuropsychological rehabilitation protocol we developed was able to restore the spatial mechanisms disrupted by traumatic brain injury
Summary
To orient themselves within the environmental space – namely, the space beyond the sensory horizon (Wolbers and Wiener, 2014) – individuals have to process “online” information about their own position and facing direction (Sulpizio et al, 2017, 2018), as well as to recall previously acquired “offline” information about the environment (Wolbers and Hegarty, 2010). Landmark recognition deficits are widely reported following lesions in the lingual gyrus: patients fail in recognizing and representing salient environmental stimuli, even in absence of perceptual deficits (Aguirre and D’Esposito, 1999) These neuropsychological findings provide important information about the unique and causal contribution of each specific node of the parieto-medial temporal lobe network of spatial navigation in humans. General Neuropsychological Assessment NLL performed well within the normal range in tests assessing attention, intelligence, executive functions, language, and working memory (Table 1). Learning of spatial positions within reaching and navigational vista spaces significantly improved, with an effectiveness of 89.79 and 82.97% on the CBT and the WalCT, respectively; after IBT performances on both tests were comparable with those of the control group (Table 2). After the IBT, NLL performed at ceiling on the Object Generation and Color subtests of the CVMIB, with an effectiveness of 100% in both subtests
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