Assessment and treatment of childhood topographical disorientation: A case study

1. Assessment and treatment of childhood topographical disorientation: A case study Jennifer Touse

2. Background • CA • 6 ½ year old male • Suffered an intraventricular hemorrhage when he was 8 days old • Large amounts of blood entered the right lateral ventricle • Extended to the 3rd and 4th ventricles and the left lateral ventricle

3. Subsequent tests at age 6 • EEG: • Slowing of the right hemisphere with frequent sharp wave discharges from the occipital regions • CT Scan: • Softened brain tissue in the right frontal lobe, asymmetry of the lateral ventricles, and prominence of the fourth ventricle

4. Psychological Assessment • Overall functioning was mildly delayed • Semantic knowledge and language skills were intact • CA had mild to moderate visual agnosia • CA’s ability to learn and remember spatial information was severely impaired • CA responded more accurately to verbal questions than to spatial situations

5. Topographical Skills • Knowledge of topographical information was virtually nonexistent • Could not remember the position of landmarks on a map or use a map to navigate around the lab • Could not place pictures of his furniture in their correct location on a house plan • Could not describe routes in his house or follow pre-determined routes in a lab setting • Could navigate routes if he received the instructions verbally and if they did not involve directions

6. CA’s case supports the general progression of topographical processing He is most accurate at noting spatial features of a single object He is less accurate at comparing multiple objects It is virtually impossible for CA to complete the real-world tasks of the third level Brunsdon’s assessment framework

7. Outlook • There has been one study completed about possible treatments of adult topographical disorientation • No previous studies have addressed treating childhood topographical disorientation • CA did manage to learn a few topographical routes from repeated exposure • Took him years to learn routes in his most familiar settings • Not a feasible solution to his everyday problems

8. Proposed Treatment • Train CA to recognize school buildings and landmarks using photographs • Teach CA verbal route instructions involving those landmarks • Practice following the verbal instructions twice a day • Results: The treatment significantly improved CA’s memory for new routes

9. Questions that still need to be answered • Did CA actually have impairments in his executive functioning? Why couldn’t the researchers test that? • The study did not sufficiently explain why CA was able to perform certain tasks but not others • E.g., Why can CA identify color and shape but not size?