Wayfinding in a virtual environment and Down syndrome: The impact of navigational aids

A profile of spatial abilities in people with Down syndrome

BACKGROUND

Spatial abilities are fundamental cognitive abilities, have direct applications in daily life, serve as a cognitive foundation for many other complex skills and are used in many specialty jobs. The current study aimed to systematically and comprehensively evaluate the spatial abilities of individuals with Down syndrome (DS) relative to mental ability-matched typically developing (TD) children based on Newcombe and Shipley's double-dimension theoretical framework for classifying spatial abilities.

METHODS

Forty adolescents and young adults with DS and 40 TD children completed a nonverbal intelligence test (Raven's), two measures of static-extrinsic skills (water-level task and cart task), two measures of static-intrinsic skills (figure ground and form completion), two measures of dynamic-extrinsic skills (three mountains task and dog task) and two measures of dynamic-intrinsic spatial skills (mental rotation task and block design task).

RESULTS

Participants with DS showed reduced performance on two dynamic-intrinsic tasks and one static-extrinsic task (i.e. cart task) relative to TD children. Performances were similar in two dynamic-extrinsic tasks and two static-intrinsic tasks. Analyses of composite accuracy for each spatial category further confirmed deficits in dynamic-intrinsic and static-extrinsic categories for people with DS relative to TD children.

CONCLUSIONS

Our results showed an uneven profile of spatial abilities in people with DS relative to ability-matched TD children with particular weaknesses in comprehending and manipulating dynamic-intrinsic and static-extrinsic spatial relations. Furthermore, our research has important clinical implications for more targeted interventions to improve spatial abilities in people with DS.

[Current status of requirements in the design of healthcare facilities to ensure accessibility for patients with disabilities]

BACKGROUND AND OBJECTIVE

People with disabilities are one of the groups that usually frequent healthcare centers, so it is essential to attend to their specific needs, especially from the point of view of universal accessibility, safety and healthcare quality. The aim of the study is to summarize the available evidence on the needs of groups of patients with some type of disability in access, navigation and stay during the reception of healthcare in various health centers and to identify successful solutions.

MATERIALS AND METHODS

A scoping review had been designed, based on a literature review without time limit in three databases (PubMed, WOS, and Embase).

RESULTS

Of the 2562 articles identified, 11 were included. Recommendations for improvement in the design of healthcare services focused on the following aspects: improving access to primary care centers; navigation, signage, and orientation in the hospital environment; elevator design; hospital room bathroom design; meeting the needs of wheelchair users; importance of the participation of the patient with a disability; involvement of stakeholders in the design process; and the need for appropriate policies to ensure accessibility to buildings.

CONCLUSIONS

The promotion of artistic programs in healthcare settings and the participation of people with disabilities in the design process of healthcare settings could provide beneficial solutions. More studies are needed, given the scarcity of evidence found, to ensure that care for this group is based on criteria of patient safety, universal accessibility, healthcare quality and humanization.

Bodily and Visual-Cognitive Navigation Aids to Enhance Spatial Recall in Mild Cognitive Impairment

Background

Individuals with mild cognitive impairment (MCI) syndrome often report navigation difficulties, accompanied by impairments in egocentric and allocentric spatial memory. However, studies have shown that both bodily (e.g., motor commands, proprioception, vestibular information) and visual-cognitive (e.g., maps, directional arrows, attentional markers) cues can support spatial memory in MCI.

Objective

We aimed to assess navigation cues for innovative spatial training in aging.

Methods

Fifteen MCI patients were recruited for this study. Their egocentric and allocentric memory recall performances were tested through a navigation task with five different virtual reality (VR) assistive encoding navigation procedures (bodily, vision only, interactive allocentric map, reduced executive load, free navigation without cues). Bodily condition consisted of an immersive VR setup to engage self-motion cues, vision only condition consisted of passive navigation without interaction, in the interactive allocentric map condition patients could use a bird-view map, in the reduced executive load condition directional cues and attentional markers were employed, and during free navigation no aid was implemented.

Results

Bodily condition improved spatial memory compared to vision only and free navigation without cues. In addition, the interactive allocentric map was superior to the free navigation without cues. Surprisingly, the reduced executive load was comparable to vison only condition. Moreover, a detrimental impact of free navigation was observed on allocentric memory across testing trials.

Conclusions

These findings challenge the notion of an amodal representation of space in aging, suggesting that spatial maps can be influenced by the modality in which the environment was originally encoded.

Visuospatial perspective taking in people with Down syndrome

Visuospatial perspective taking (VPT) refers to the process of mentally representing a viewpoint different from one's own. It is related to mental rotation and theory of mind and helps to support some complex spatial activities such as wayfinding. Despite research advances in spatial cognition, little is known about VPT in people with Down syndrome (DS). Here, we examined VPT in people with DS. A total of 38 individuals with DS (aged 12-25 years old) and nonverbal ability-matched typically developing (TD) children (aged 4-9 years old) participated. They completed two VPT tasks: the classic Piagetian Three Mountains Task and a modified version of the "Dog Task" (Newcombe & Huttenlocher, 1992). For both groups, the Three Mountains Task was more difficult than the Dog Task, implying the impact of task complexity on assessing VPT. However, the overall performance did not differ between the TD and DS groups in either VPT task. Implications of the results were discussed.

A Critical Review of Spatial Abilities in Down and Williams Syndromes: Not All Space Is Created Equal

Down syndrome (DS, Trisomy 21) and Williams syndrome (WS) are two neurodevelopmental disorders of genetic origin that are accompanied by mild to moderate intellectual disability but exhibit distinct cognitive profiles. In this review we discuss our recent work characterizing the real-world spatial learning and memory abilities of adult individuals with DS and WS. We used several different paradigms in which participants locomote freely and have access to coherent input from all sensory modalities to investigate their fundamental egocentric (body-centered or viewpoint-dependent) and allocentric (world-centered or viewpoint-independent) spatial abilities. We found unequivocal evidence that most individuals with DS exhibit low-resolution egocentric and allocentric spatial learning and memory abilities similar to typically developing (TD) children in the same mental age range. In contrast, most individuals with DS exhibit impaired high-resolution allocentric spatial learning and facilitated response learning as compared to TD children. In comparison, whereas most individuals with WS also exhibit facilitated response learning, their low-resolution allocentric spatial learning and memory abilities are severely impaired as compared to both TD children and individuals with DS. Together with work from other laboratories using real-world or virtual reality paradigms, these findings indicate that in order to navigate in their environment most individuals with DS may use either egocentric route learning that does not integrate individual landmarks, or a low-resolution allocentric spatial representation that encodes the relationships between different locations (i.e., cognitive mapping). In contrast, since most individuals with WS are unable to build or use a low-resolution allocentric or configural representation of the environment they may use visually and verbally encoded landmarks as beacons to learn routes. Finally, we discuss the main neural structures implicated in these different spatial processes and explain how the relative preservation or impairment of specific brain functions may engender the unique cognitive profiles observed in individuals with these neurodevelopmental disorders.

Path Integration and Cognitive Mapping Capacities in Down and Williams Syndromes

Williams (WS) and Down (DS) syndromes are neurodevelopmental disorders with distinct genetic origins and different spatial memory profiles. In real-world spatial memory tasks, where spatial information derived from all sensory modalities is available, individuals with DS demonstrate low-resolution spatial learning capacities consistent with their mental age, whereas individuals with WS are severely impaired. However, because WS is associated with severe visuo-constructive processing deficits, it is unclear whether their impairment is due to abnormal visual processing or whether it reflects an inability to build a cognitive map. Here, we tested whether blindfolded individuals with WS or DS, and typically developing (TD) children with similar mental ages, could use path integration to perform an egocentric homing task and return to a starting point. We then evaluated whether they could take shortcuts and navigate along never-traveled trajectories between four objects while blindfolded, thus demonstrating the ability to build a cognitive map. In the homing task, 96% of TD children, 84% of participants with DS and 44% of participants with WS were able to use path integration to return to their starting point consistently. In the cognitive mapping task, 64% of TD children and 74% of participants with DS were able to take shortcuts and use never-traveled trajectories, the hallmark of cognitive mapping ability. In contrast, only one of eighteen participants with WS demonstrated the ability to build a cognitive map. These findings are consistent with the view that hippocampus-dependent spatial learning is severely impacted in WS, whereas it is relatively preserved in DS.