Intervention strategies for spatial orientation disorders in dementia: a selective review.

PURPOSE: This article provides a brief overview of the intervention strategies aimed at reducing spatial orientation disorders in elderly people with dementia. METHODS: Eight experimental studies using spatial cues, assistive technology programs, reality orientation training, errorless learning technique, and backward chaining programs are described. They can be classified into two main approaches: restorative and compensatory, depending on whether they rely or not on residual learning ability, respectively. RESULTS: A review of the efficacy of these intervention strategies is proposed. Results suggest that both compensatory and restorative approaches may be valuable in enhancing correct way-finding behavior, with various degrees of effectiveness. Some issues concerning (a) variability in participants' characteristics and experimental designs and (b) practicality of intervention strategies do not permit to draw a definite conclusion. CONCLUSIONS: Future research should be aimed at a direct comparison between these two strategies, and should incorporate an extensive neuropsychological assessment of spatial domain.

Assistive technology for promoting choice behaviors in three children with cerebral palsy and severe communication impairments.

A technology-based program to promote independent choice behaviors by three children with cerebral palsy and multiple disabilities was assessed. The program was based on learning principles and assistive technology (i.e., customized input devices/sensors, personal computers, screening of preferred stimuli according to a binomial criterion). The first purpose of the present study was to provide the participants with a new set-up of assistive technology and to allow them to choose among three categories (i.e., food, beverage and leisure), and to request a specific item out of four in each category, adopting a procedure that minimized (according to a conditional probability criterion) unintentional choices. The second aim of the study was to carry out the effects of the program on detectable mood signs (i.e., happiness index). The study was conducted according to an ABAB sequence with a subsequent post intervention check for each participant. The results showed an increase of engagement and of the happiness index during intervention phases. Psychological as well as educational implications were discussed.

Technology-based orientation programs to support indoor travel by persons with moderate Alzheimer's disease: impact assessment and social validation.

The present study (a) extended the assessment of an orientation program involving auditory cues (i.e., verbal messages automatically presented from the destinations) with five patients with Alzheimer's disease, (b) compared the effects of this program with those of a program with light cues (i.e., a program in which strobe lights were used instead of the verbal messages) with the same five patients, and (c) conducted a social validation assessment of the two programs with 70 university psychology students employed as social raters. Results confirmed the effectiveness of the program with auditory cues and showed an equally strong impact of the program with light cues with all five patients. The psychology students involved in the social validation assessment provided significantly higher scores for the program involving light cues on a six-item questionnaire. Those scores suggested that this program was perceived as a practically and socially preferable choice. The implications of the findings for daily contexts dealing with patients with Alzheimer's disease are discussed.

Reorientation deficits are associated with amnestic mild cognitive impairment.

BACKGROUND/AIMS: Spatial memory can be impaired in amnestic mild cognitive impairment (aMCI). The present study investigates categorical spatial memory deficits using a virtual navigation-based reorientation task. METHODS: Twenty-eight amnestic single domain and 23 amnestic multiple domain patients were compared with 53 healthy elderly controls on the performance of the virtual reorientation test (VReoT). RESULTS: The reorientation performance of participants in both aMCI groups was significantly worse than that of controls suggesting that VReoT detects spatial memory deficits. No significant difference emerged between the 2 groups of patients. A subsequent receiver-operating characteristic analysis showed that a score of 8 had a sensitivity of 80.4% and a specificity of 94.3% (area under the curve = 0.90). CONCLUSION: The VReoT seemed to be accurate in differentiating patients with aMCI from controls and may represent an evaluation supplement for spatial memory deficits in prodromal stages of Alzheimer's dementia.

Assessing human reorientation ability inside virtual reality environments: the effects of retention interval and landmark characteristics.

The purpose of the present study was to assess the navigational behaviour of adult humans following a disorientation procedure that perturbed their egocentric frame of reference. The assessment was carried out in a virtual reality (VR) environment by manipulating the disorientation procedure, the retention interval, the relative positions of target and landmark. The results of experiment I demonstrated that adding a physical rotation to a virtual disorientation procedure did not yield an additional decrease in searching performance. The results of experiment II showed that shortening the delay between study and test phase decreased the errors more markedly for geometric than landmark ones. An orientation specificity effect due to the manipulation of the relative position between target and landmark was discussed across the experiments. In conclusion, VR seemed to be a valuable method for studying human reorientation. Moreover, the virtual experimental setting involved here promoted knowledge of the relationship between working memory and spatial reorientation paradigm.