A virtual reality extended neuropsychological assessment for topographical disorientation: a feasibility study
© Morganti et al; licensee BioMed Central Ltd. 2007
Received: 26 January 2007
Accepted: 11 July 2007
Published: 11 July 2007
Topographical disorientation represents one of the main consequences of brain injury. Up to now several methodological approaches have been used in the assessment of the brain injured patient's navigational abilities showing a moderate correlation with the impairments observed in everyday contexts.
We propose a combination of standardized neuropsychological tests and a more situated virtual reality-based assessment for the evaluation of spatial orientation in brain injured patients.
When tested with this virtual reality integrated procedure patients showed performance and execution times congruent with their neuropsychological evaluation. When compared to a control group, patients revealed significantly slower times and greater errors in solving virtual reality based spatial tasks.
The use of virtual reality, when combined with classical neuropsychological tests, can provide an effective tool for the study of topographical disorientation.
Topographical disorientation, when associated with a complex cognitive impairment, represents one of the main consequences of extended brain injury and occurs most frequently from damage in the parietal/temporal/occipital regions [1–5].
Patients with topographical disorientation revealed impairment in the capacity to orient oneself in and to cope with everyday environments. Despite this statement, up to now most of the evaluation tools for topographical disorientation introduced laboratory methodologies in order to understand how people explore three-dimensional spaces [6–12].
Laboratory evaluation does not support an immediate and direct interaction generally possible in the daily environment, and constitutes an important bias for the evaluation of spatial impairments in brain damage, often making clinicians desire a more ecological approach. Ecological methods, in fact, might help clinicians to observe the strategy used by a patient to explore a natural environment, and to understand the characteristics of the environment utilized to help in familiarization. On the other hand, the observation of a patient in daily contexts generates many questions about the reliability and interpretation of collected data. In order to avoid biases the design of an effective assessment tool that links a reliable evaluation methodology with a more situated observation of spatial behaviors appears to be still needed.
A promising way could be to integrate classical evaluation tools with computer-based interactive ones, such as virtual reality, in order to evaluate the navigational capacity of complex environments by neurological patients by observing the types of spatial representations that a patient is able to produce in order to adaptively interact with space within a given activity.
Virtual reality (VR) environments, in fact, constitute an interesting opportunity for the evaluation of topographical disorientation, providing a representation of a dynamic nature and interactive environments [13, 14]. In particular, we propose that from patients' active interaction with virtual reality simulations it is possible to clearly understand how the ability to organize spatial knowledge into a cognitive map is preserved.
The study of spatial cognition has provided evidence of how it can be represented in a cognitive map which can be of the "route" or "survey" type [15–18]. The "route" map is made up of representations of an egocentric nature. "Survey" maps, on the other hand, are representations of a higher level, organized according to an allocentric perspective. Studies in clinical neuropsychology showed how the processing of topographical information may be conducted within an egocentric or allocentric coordinate frame that are mainly comparable to route and survey knowledge organization [19, 20].
According to a particularly theoretical orientation, the capability of learning spatial relationships in a large scale environment, and of organizing them into "route" or "survey" types, is influenced not so much by a major familiarity with the environment, but by a series of characteristics of the specific environment, capable of assuming a functional role with the activities an agent performs or is going to perform inside it [21–23]. We propose an integrated evaluation method in which neuropsychological spatial ability evaluation will be extended with more situated computer based tools that allow the assessment of spatial orientation during the interaction with complex 3D environments.
In order to evaluate patients' spatial abilities with "paper and pencil" tests a neuropsychological assessment was performed. For general cognitive level identification Progressive Raven's Matrixes (PM47) were employed. Token test, Boston Naming test and phonemic and semantic Fluencies were used for verbal abilities evaluation. Memory ability was assessed through Digit and Corsi's span where attention and executive functions were evaluated through the Trial Making test, Attentive matrixes and the Tower of London test. Finally, spatial ability evaluation required the Rey's complex figure, Poppelreuter's test, Benton's line orientation test, Street's Completion test and the Elithorn's Perceptual Maze test.
We extended this evaluation by addition of the VR-Maze test and VR-Road Map. We developed these tools  to support the assessment of spatial orientation during the interaction with daily complex environments.
Four male patients with brain damage (mean age = 31.7 years, sd = 1.5 and mean years of school attendance = 16.7 years, sd = 2.5) were tested using paper and pencil neuropsychological evaluation and with the VR-integrated procedure. Patients' performance on VR-Maze test and VR-Road Map test were compared to a control group (10 male participants, with a mean age of 29.3 years, sd = 4.5 and 15.5 years of school attendance, sd = 2.6).
Discussion and Conclusion
Both in the VR-maze and in VR-Road Map tests, patients' execution times were higher than those of the control group. Moreover, patients' performance in the VR-maze and in the VR-Road Map tests were lower when compared to the control group.
These results underline how patients' performance and execution times in VR tests are congruent with their neuropsychological evaluation.
VR environments provide the possibility of an egocentric interaction that will highlight patient's difficulty in the translation of survey spatial knowledge into a route one. It could be considered the main feature of topographical disorientation disease.
The integration of virtual reality with traditional evaluation methods may provide an interesting alternative to paper and pencil-based approaches, thereby contributing to an improvement in the evaluation of topographical disorientation .
The observation of patients' performance allows an assessment of their difficulty in the translation of survey knowledge to route knowledge. In accordance with their impairment, they were able to memorize sequences of paths when provided in a top-view perspective (the survey one). This residual ability is usually assessed using classical neuropsychological evaluation since paper and pencil materials provide spatial relations mainly from a top-down view. In contrast, the integrated approach we have proposed allows an analysis of the survey-route translation of knowledge. In conclusion, the use of virtual reality appears to provide an effective and objective tool for the study of topographical disorientation when combined with classical neuropsychological tests.
This work was supported in part by the Italian MIUR FIRB programme, Project NEUROTIV – RBNE01W8WH
- De Renzi E: Disorders of space exploration and cognition. Chichester: Wiley; 1982.Google Scholar
- Paterson A, Zangwill OL: A case of topographical disorientation associated with a unilateral cerebral lesion. Brain 1945, 68: 188-212. 10.1093/brain/68.3.188View ArticlePubMedGoogle Scholar
- Whiteley AM, Warrington EK: Selective impairment of topographic memory: a single case study. J Neurol Neurosurg Psychiatry 1978, 41: 575-578.PubMed CentralView ArticlePubMedGoogle Scholar
- De Renzi E, Faglioni P, Villa P: Topographical amnesia. Journal of Neurology, Neurosurgery & Psychiatry 1977, 40: 498-505.View ArticleGoogle Scholar
- Barrash J: A historical review of topographical disorientation and its neuroanatomical correlates. Journal of Clinical and Experimental Neuropsychology 1998,20(6):807-827.View ArticlePubMedGoogle Scholar
- Lawton CA: Gender differences in way-finding strategies: Relationship to ability and spatial anxiety. Sex Roles 1994, 30: 765-779. 10.1007/BF01544230View ArticleGoogle Scholar
- Pazzaglia F, De Beni R: Strategies of processing spatial information in survey and landmark-centred individuals. European Journal of Cognitive Psychology 2001, 13: 493-508.View ArticleGoogle Scholar
- Juan-Espinosa M, Abad FJ, Colom R, Truchaud MF: Individual differences in large-space orientation: g and beyond? Personality and Individual Differences 2000, 29: 85-98. 10.1016/S0191-8869(99)00179-8View ArticleGoogle Scholar
- Just MA, Carpenter P: Cognitive coordinate systems: Accounts of mental rotation and individual differences in spatial ability. Psychological Review 1985, 92: 137-172. 10.1037/0033-295X.92.2.137View ArticlePubMedGoogle Scholar
- Casey MB: Understanding individual differences in spatial ability within females: A nature/nurture interactionist framework. Developmental Review 1996, 16: 241-260. 10.1006/drev.1996.0009View ArticleGoogle Scholar
- Denis M: Imagery and the description of spatial configurations. In Models of visuospatial cognition. Edited by: De Vegam M, Marschark M. New York: Oxford University Press; 1996:128-197.Google Scholar
- Colom R, Contreras MJ, Shih PC, Santacreu J: The Assessment of Spatial Ability with a Single Computerized Test. European Journal of Psychological Assessment 1994, 19: 92-100. 10.1027//1015-57184.108.40.206View ArticleGoogle Scholar
- Péruch P, Gaunet E: Virtual environments as a promising tool for investigating human spatial cognition. Current Psychology of Cognition 1998, 17: 881-899.Google Scholar
- Morganti F: Spatial cognition and virtual environments: How the interaction with 3D computer based environments could support the study of spatial abilities. Ricerche di Psicologia 2003, 26: 105-149.Google Scholar
- Golledge R: Cognition of physical and built environments. In Environment, Cognition and Action; a Multidisciplinary Integrative Approach. Edited by: Garling T, Evans G. New York: Oxford University Press; 1990.Google Scholar
- Golledge R: Wayfinding behavior: cognitive mapping and other spatial processes. Baltimore: John Hopkins University Press; 1999.Google Scholar
- Kitchin R, Freundschuh S: Cognitive Mapping: Past, Present and Future. London: Routledge; 2000.Google Scholar
- Taylor HA, Tversky B: Spatial mental models derived from survey and route descriptions. Journal of Memory and Language 1992, 31: 261-292. 10.1016/0749-596X(92)90014-OView ArticleGoogle Scholar
- Aguirre GK, D'Esposito M: Topographical Disorientation: A Synthesis And Taxonomy. Brain 1999, 122: 1613-1628. 10.1093/brain/122.9.1613View ArticlePubMedGoogle Scholar
- Barrash J, Damasio H, Adolphs V, Tranel D: The neuroanatomical correlates of route learning impairment. Neuropsychologia 2000, 38: 820-836. 10.1016/S0028-3932(99)00131-1View ArticlePubMedGoogle Scholar
- Tirassa M, Carassa A, Geminiani G: A theoretical framework for the study of spatial cognition. In Spatial Cognition. Edited by: O'Nuallain S. Amsterdam: Benjamins; 2000:19-31.View ArticleGoogle Scholar
- Gibson J: The ecological approach to visual perception. Boston: Houghton Mifflin; 1979.Google Scholar
- Morganti F, Carassa A, Geminiani G: Planning optimal paths: A simple assessment of survey spatial knowledge in virtual environments. Computers in Human Behavior, in press.Google Scholar
- Morganti F, Gaggioli A, Strambi L, Rusconi ML, Riva G: Computer-enhanced route and survey spatial knowledge assessment in clinical neuropsychology. IEEE International Workshop on Virtual Rehabilitation: August 2006; New York 2006, 110-115.View ArticleGoogle Scholar
- Wechsler D: Manual for the Weschsler Intelligence Scale – Revised (WISC-R). San Antonio, TX: Psychological Corporation; 1976.Google Scholar
- Money J, Alexander D, Walker HT: A Standardized Road-Map Test of Direction Sense. Baltimore: Johns Hopkins Press; 1967.Google Scholar
- Morganti F: Virtual interaction in cognitive neuropsychology. Studies in Health Technology and Informatics 2004, 99: 55-70.PubMedGoogle Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.