Navigation ability after stroke

When one is not able to navigate properly, this can have a severe impact on
one*s autonomy and psychosocial wellbeing. Approximately 25 % of stroke
patients report such navigation problems. However, current standardized
neuropsychological tests are insufficient to identify such navigation problems
in an objective manner. The implementation of appropriate diagnostic tests and
treatment could increase autonomy in such patients as well as reduce secondary
psychosocial problems. The proposed study is aimed at developing a
rehabilitation programme that incorporates virtual reality navigation
exercises.

Primary objective: To create diagnostic and treatment tools for navigation
ability in stroke patients, that can be used in clinical practice.
Secondary objective: To increase knowledge about the cognitive structure and
neuroanatomical correlates of navigation ability in humans

A large sample of stroke patients will be screened by means of a navigation
questionnaire. Those who show impairment on the questionnaire and a subset of
the patients that do not show impairment will be included in a behavioural
screening session. In this session, all main aspects of navigation ability will
be tested with a computer task that includes virtual environments. A comparable
task will also be performed in a real environment, along with some standardized
neuropsychological tests. Patients who objectively show impairment in
navigation ability will be included in the training program. This group of
patients will be split in half and randomly assigned to the training condition
or the alternative training condition. Training entails explicit instructions
for and feedback on performance. During those training sessions patients will
practice navigation tasks in virtual environments, presented on a regular
computer. The alternative training condition serves as a control for repeated
testing and the individual attention provided during training. The potential
long term effects of the training will be measured by sending out the
navigation questionnaire six months after participation in the training.

Participation includes filling out four questionnaires (duration approximately
30 minutes), performing a behavioural screening session, including navigation
in a virtual and a real environment (approximately 2.5 hours), and enrolment
in the training program. The training program includes 3 sessions of 60 minutes
each. During training subjects will be placed in front of a large, regular
computer screen on which a virtual environment is presented. Responses will be
given verbally or with a computer keyboard and mouse. Prior to participation,
explicit permission of the patient after informed consent is warranted, and
participation will be voluntary and can be terminated without any consequences
for the participants.