Topographical disorientation: Toward an integrated framework for assessment

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Topographical disorientation Toward an
integrated framework for assessment

• Brunsdon R, Nickels L, Coltheart M
• NEUROPSYCHOLOGICAL REHABILITATION 2007

Speaker Kuang-chi Chen Advisor Ming-chi
Pai Date 2007.8.22
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INTRODUCTION

• Topographical Disorientation (TD)
• Unable to navigate or find their way around
  large-scale environments
• Arise from a number of different underlying
  impairments

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INTRODUCTION

• No more than a general description associated
  neuropsychological impairments and/or
  neuroanatomical correlates

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INTRODUCTION

• Relatively few studies have investigated
• Complexity visual field loss, visual agnosia,
  prosopagnosia, visuo-spatial disturbance, visual
  memory impairments and/or constructional
  difficulties
• Limitations in assessment of TD lacked
  theoretical structure, inconsistent across
  studies, failed to employ functionally relevant
  assessment methods

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COGNITIVE NEUROPSYCHOLOGY

• Visual perception and recognition, spatial
  processing, memory, and imagery
• No widely accepted cognitive theoretical
  framework

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This Article

• Framework of topographical cognition
• Providing comprehensive clinical assessment of TD
• Theories proposed by Riddoch and Humphreys
  (1989), Farah (1984), and Kosslyn (1980)

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Specific Disorder

• Case impaired processing of topographical
  information but intact recognition and/or memory
  for faces and objects

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Specific Disorder (Case MS)

• General visual perceptual and visual spatial
  abilities were intact
• New learning and recognition memory for faces and
  words fell within normal limits
• Naming of famous landmarks was impaired
• Unable to describe highly familiar routes

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Specific Disorder
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Specific Disorder

• Double dissociation between recognition and
  memory
• Case familiar environments no longer look
  familiar, intact memory for the spatial layout
• Case recognize familiar landmarks relatively
  well but cannot navigate between them
  successfully

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Specific Disorder
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Specific Disorder (Case GN)

• Recognize familiar landmarks
• Unable to recognize critical scenes along each
  route

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Specific Disorder

• Separable mechanisms for encoding new information
  when compared to recall of old information

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Specific Disorder

• Case recognition of landmarks is relatively
  intact and route descriptions are intact, but
  they have TD in real-life settings because
  landmarks fail to convey directional information

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Specific Disorder (Case TY)

• Able to identify single objects, sets of objects
  and house
• Able to draw a complete plan of her house and
  local environment and describe routes
• When asked to point to the standpoint from which
  the photo was taken, able to do so for
  non-topographic objects, but not for photos of
  her own house

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Specific Disorder

• Relatively distinct processing
• Recognition topographical stimuli
  scenes/buildings
• Memory encoding/ retrieval

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Visual Imagery

• Difficulty with revisualisation or internal
  representation of spatial environments
• Dissociation has been proposed between imagery of
  visual and spatial topographical information

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Specific Disorder (Case EP)

• Able to describe visual characteristics of famous
  monuments
• Unable to describe spatial relations between
  familiar streets and squares

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Specific Disorder (Case RM)

• Difficulty describing visual characteristics of
  famous buildings
• Able give an adequate description of the route
  from his home town to Paris

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Visual Imagery
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Map Reading Skills

• Case1 cannot navigate environments in daily life
  but can draw and/or follow maps successfully
• Case2 topographognosia, perform normally in
  real situations but cannot place themselves on or
  draw a map or plan

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Map Reading Skills
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Summary

• Integration of a number of relatively independent
  cognitive functions
• Visuospatial perceptual and memory impairments
• Double dissociation between recognition and
  memory
• Dissociation between topographical orientation in
  real life and general topographic

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THEORETICAL PROPOSALS

• DeRenzis (1985)
• Disorders of space exploration
• Disorders of space perception and cognition
• Disorders of space memory
• Final level would cause TD topographical
  amnesia

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THEORETICAL PROPOSALS

• Aguirre and DEsposito (1999)

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THEORETICAL PROPOSALS

• Visual attention
• Visual object recognition
• Working memory
• Visual/spatial memory and imagery

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Visual Imagery

• Short term memory representations that lead to
  the experience of seeing with the minds eye
• Drawing maps (or floor plans) of familiar
  environments, describing well-known routes,
  describing familiar landmarks
• Recognition of landmarks, scenes and maps

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Visual Imagery

• Kosslyns (1980)
• Long-term visual memory structure
• Visual memory buffer

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Visual Imagery

• Generate process retrieves the visual image
  from long-term memory and represents its parts in
  the visual memory buffer
• Inspect process converts the pattern of
  activation in the visual buffer into an organized
  coherent percept of an object
• Transform process allows for manipulations of
  the image including transformations and rotations

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Visual Imagery

• Farahs (1984) adds three new components
• Describe for question and answer tasks that
  require inspection of the image in the visual
  buffer
• Copy for drawings or constructions that are
  created following an inspection of visual buffer
• Detect which refers to tasks in which an
  image is simply detected but not inspected or
  processed

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Visual Imagery

• Farahs (1984) adds two sensory processes
• Visual encoding process which encodes stimuli
  into the buffer
• Recognition process which matches the contents
  of the visual buffer with long-term memories

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Topographical Cognition

• Visual and spatial perceptual skills depth,
  spatial location, spatial relationship
• Spatial working memory updating and planning
• Attentional processes
• Long-term stored memories loss, difficulty with
  retrieving it

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Summary

• Riddoch and Humphreys (1989)
• Impairments in viewpoint-dependent
  representations
• Impairments in perceptual integration
• Problems in representing and using spatial
  information in working memory
• Disorders of long-term topographical memory

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INTEGRATEDCOGNITIVE FRAMEWORK
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INTEGRATEDCOGNITIVE FRAMEWORK
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INTEGRATEDCOGNITIVE FRAMEWORK
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ASSESSMENT

• Past
• General observation and/or recording of client
  reports
• Neuropsychological table-top tests
• Photos
• Small-scale maps or plans
• Videos
• Virtual reality

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ASSESSMENT

• Problems
• Inconsistent
• Incomplete
• Lacked sensitivity to the specific topographical
  deficits
• Failed to assess real-life topographical
  functioning in large-scale spaces

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INTEGRATED FRAMEWORK

• Perception
• Spatial processing
• Memory
• Imagery
• Specific topographical skills route finding and
  map following

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Level 1 Perception of single objects

• Early visual analysis and figure ground formation
• Subtests 26 from the Birmingham Object
  Recognition Battery, BORB

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Level 2 Perception of multiple objects in
the visual field

• Include tests of single object perception from
  unusual views (e.g., subtests 7 and 8 from the
  BORB)
• Perception of topographical landmarks and scenes
  from different viewpoints (e.g., using
  photographs)

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Level 2 Perception of multiple objects in
the visual field

• Perception and/or discrimination of relative
  spatial location and spatial orientation (e.g.,
  subtests 67 from the Visual Object and Space
  Perception Battery, VOSP
• Multiple stimuli (even a photo of a visual scene)
  with task demands such as indicating which
  stimulus is higher than another or which is
  closer to a target, or which of two stimuli is
  further away from the viewer

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Level 3 The core of topographical
cognition

• Recognition, new learning and memory
• Visual and spatial short-term memory, and
  encoding and long-term retrieval of visual and
  spatial information
• Wechsler Memory Scales
• Childrens Memory Scale
• Test of Memory and Learning
• Benton Visual Retention Test

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Level 3 The core of topographical
cognition

• Recognition, new learning and memory
• Recognition and memory for specific topographical
  material should also be assessed
• New learning of routes and landmarks
• Retrieval of well-learned topographical
  information

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Level 3 The core of topographical
cognition

• Imagery
• Individual fails to describe visual appearance of
  famous landmarks from memory, but able to
  describe and recognize visually presented
  pictures of landmarks, is likely to have a
  deficit in image generation
• Individual can describe visually presented
  landmarks or routes but cannot recognize them or
  describe them from memory, is likely to have a
  deficit in long-term visual memory

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Level 3 The core of topographical
cognition

• Executive and semantic processing
• Assessment of route finding in large-scale space
• Assessed in a multidimensional way percentage of
  routes failed, percentage of incorrect steps or
  turns, number of hesitations and time taken
• Analyses of both quantitative and qualitative
  aspects of route finding

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Map Reading

• Map-following skills
• Working memory, executive, attention and spatial
  skills in combination and in practice

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FINAL COMMENTS

• It is hoped that the current framework will
  stimulate further research in this area
• More cases studies of topographical
  disorientation that include a comprehensive
  theoretically based assessment
• Hopefully leading to a more widely accepted
  cognitive neuropsychological model of normal
  topographical cognition in the future

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Thanks for your attention!!