Rehabilitation of topographical disorientation: An experimental single case study

Patients with topographical disorientation characteristically have difficulty in finding their way from one location to another, despite intact basic visual processes. Topographical disorientation can be a feature of diffuse cognitive impairment (e.g. in dementia) or it can have a focal presentation, with other neuropsychological functions relatively intact. The present study examines the effects of a rehabilitation programme on the topographical functioning of a 46-year-old female patient, KL, who presented with relatively isolated symptoms of topographical disorientation of recent onset. According to recent research, such symptoms may result from the breakdown of a single neuropsychological process or from the combined effects of several impairments. The latter appears to be the case for KL, whose topographical symptoms appeared to be related to impairment of some aspects of both memory and space perception/cognition. Intervention focused only on KL's difficulty in acquiring new topographical information, as she considered this symptom to be the most disabling in daily life. She was taught simple mnemonic techniques designed to increase the meaningfulness and association of the selected material (the names and locations of 14 streets in the central business district of her town). Using the technique, KL showed significant improvement in her recall of the names and locations of the selected streets, and she retained this information well even at a delayed post-test conducted two months after the conclusion of treatment. Qualitative data indicated that she successfully applied this knowledge in daily living, negotiating her way accurately and confidently in this part of town. However, there was no evidence of spontaneous generalisation of her mnemonic technique to other locations. The study highlights one of the basic strengths of the cognitive neuropsychological approach to rehabilitation, namely, that simple intervention strategies can be highly effective and efficient if they are founded on a sound understanding of the patient's cognitive strengths and deficits, allowing the intervention to be precisely targeted.