Navigation ability in patients with acquired brain injury: A population-wide online study

Navigational difficulties after stroke: A systematic review and meta-analysis

OBJECTIVE

Navigation, the ability to find one's way from one place to another, is an important cognitive skill for maintaining autonomy in daily life. Several findings indicate that navigational ability can be impaired after stroke. However, navigation is rarely assessed in clinical practice, and evidence-based recommendations for suitable diagnostic tools are lacking. Furthermore, the scientific literature does not provide a meta-analytic estimation of the prevalence of post-stroke navigational impairments. This systematic review aims to provide an overview of the tools to assess navigational difficulties after stroke, including their psychometric properties, and determine the prevalence of post-stroke navigational difficulties.

METHOD

Three investigators independently and systematically searched publications performing assessments of navigation in the stroke population, with a fourth independent investigator consulted when discrepancies were present. References of the retrieved articles were hand searched for relevant articles.

RESULTS

The systematic review included 19 studies, reporting on 19 different approaches to assess objective and/or subjective navigation skills, each with different psychometric properties. The pooled effect size, using a random-effects model including data from a subset of 8 out of the 19 included studies, demonstrated a prevalence of post-stroke navigation impairments of 35% (95% CI: 0.29-0.42). However, this model was significantly heterogeneous.

CONCLUSIONS

Navigational difficulties are a common neuropsychological deficit after stroke. However, navigation is a broad construct and a subdivision to reduce heterogeneity in navigation ability is recommended, e.g. by categorizing navigation into landmark-, location-, and path-based navigation impairment. The inclusion of objective and subjective assessments of navigation is recommended in clinical practice.

REGISTRATION

The protocol was registered at the PROSPERO international prospective register of systematic reviews (PROSPERO ID: CRD42023491346).

Always Getting Lost: Defining Developmental Topographical Disorientation (DTD)-A Systematic Literature Review

Developmental topographical disorientation (DTD) refers to a condition of highly impaired navigation ability in healthy individuals. DTD often leads to severe consequences in daily life, affecting education and professional choices and limited everyday mobility. Since its first description in 2009, a substantial number of empirical studies on DTD have appeared, but a clear clinical definition of DTD that can be used to develop a behavioral assessment tool is not yet available. The aim of the current study was to shed more light on the precise behavioral characteristics of DTD by examining the empirical evidence available to date. Recent theoretical developments that enable the classification of navigation impairment in various populations are utilized in the current work. Through a systematic literature review, reported descriptions and criteria for DTD were identified. Furthermore, tests included and performance of people with DTD are classified in the different navigation domains relevant to navigation impairment (landmark knowledge; location knowledge, egocentric and allocentric; and path knowledge, route and survey). A total of 15 empirical papers were included in the analyses, each discussing performance of people with DTD in large-scale spatial tasks. Initial DTD descriptions focused on mental map quality, whereas later work adheres to a more general definition of impaired navigation. Performance patterns show that the navigation impairment in DTD is largely attributable to low mental map quality, as low performance is primarily found for tasks measuring allocentric location knowledge and path knowledge. In contrast, landmark knowledge remains largely unaffected and, if impaired, appears to also include face recognition impairment, suggesting a more general form of visual agnosia. Egocentric location knowledge is often not included in assessments. The outcomes support the initial focus on poor mental map quality as the key characteristic of DTD, combined with a landmark-focused navigation strategy. The current findings therefore provide relevant input to the development of a clinical characterization of DTD and the development of appropriate assessment tools.

A case of developmental topographical disorientation: impact on diagnostic trajectory and everyday life

Developmental Topographical Disorientation (DTD) refers to impaired ability to create and consult mental maps in the absence of neurological abnormalities. We present the case study of I.S. to explore diagnostic opportunities for DTD. I.S. showed a very specific impairment in the ability to visualize spatial environments. Impaired performance was found for map use, map recognition and spatial working memory. The interview and observations showed I.S.'s quality of life and life choices have been severely affected by her navigation complaints, which have most likely been misdiagnosed repeatedly. We highlight the importance of awareness of DTD in clinicians and provide clinical recommendations.

Wayfinding and path integration deficits detected using a virtual reality mobile app in patients with traumatic brain injury

The ability to navigate is supported by a wide network of brain areas which are particularly vulnerable to disruption brain injury, including traumatic brain injury (TBI). Wayfinding and the ability to orient back to the direction you have recently come (path integration) may likely be impacted in daily life but have so far not been tested with patients with TBI. Here, we assessed spatial navigation in thirty-eight participants, fifteen of whom had a history of TBI, and twenty-three control participants. Self-estimated spatial navigation ability was assessed using the Santa Barbara Sense of Direction (SBSOD) scale. No significant difference between TBI patients and a control group was identified. Rather, results indicated that both participant groups demonstrated 'good' self-inferred spatial navigational ability on the SBSOD scale. Objective navigation ability was tested via the virtual mobile app test Sea Hero Quest (SHQ), which has been shown to predict real-world navigation difficulties and assesses (a) wayfinding across several environments and (b) path integration. Compared to a sub-sample of 13 control participants, a matched subsample of 10 TBI patients demonstrated generally poorer performance on all wayfinding environments tested. Further analysis revealed that TBI participants consistently spent a shorter duration viewing a map prior to navigating to goals. Patients showed mixed performance on the path integration task, with poor performance evident when proximal cues were absent. Our results provide preliminary evidence that TBI impacts both wayfinding and, to some extent, path integration. The findings suggest long-lasting clinical difficulties experienced in TBI patients affect both wayfinding and to some degree path integration ability.