Wayfinder: Assessing the effectiveness of a navigation rehabilitation training

Spatial navigation is a complex cognitive ability that is essential to our
daily functioning. Twenty-nine percent of mild stroke patients report
navigation problems. Recent literature shows that navigation impairments are
not limited to stroke patients, but can occur as a result of many types of
brain injuries. Despite the severity and prevalence of navigation impairments
no standardized rehabilitation treatment is currently available. We have
developed a novel navigation rehabilitation training aimed at tackling the
multifaceted nature of navigation impairments. Performance on subcomponents of
navigation is assessed to identify the nature of an individual*s navigation
impairments. Using combination of psycho-education and virtual reality eHealth
software, patients are trained to develop compensatory navigation strategies.
In this study we will investigate the effectiveness of the navigation
rehabilitation training. It is hypothesized that navigation impairment
complaints of patients will be reduced after engaging in the training.

The primary objective of this study is to determine whether self-reported
spatial navigation impairment complaints in acquired brain injury patients are
reduced as a result of engaging in a behavioural navigation rehabilitation
training. The secondary objective is to determine whether objective navigation
performance improves as a result of the training.

Single-blind randomized control trail employing a control and experimental
group.

The navigation rehabilitation training consists of a psycho-education session
and individual training sessions using the Wayfinder software, a
serious-gaming eHealth application which is installed on and used from a
patient*s home computer. The Wayfinder software is designed to train patients
in the use of compensatory navigation strategies using game-like assignments in
virtual environments. Participants will receive a single psycho-education
session at the university (30 minutes) and engage in 12 individual training
sessions using the Wayfinder software over a period of 6 weeks. (30 minutes per
session, 2 sessions per week ).

A potential risk of participation is the experience of simulation sickness
during exposure to Wayfinder software. Simulation sickness is a side effect of
interaction with virtual environments. Symptoms of simulation sickness include
in dizziness, headaches and nausea. The symptoms are minor, short-lived and
can be easily controlled by stepping away from the computer. We consider the
risks of simulation sickness to be negligible as no instances of simulation
sickness have been reported in a prior feasibility study with 43 healthy
participants and a usability study with 27 acquired brain injury patients.
Patients engage in the training program for six consecutive weeks, in which
patients use the application for one hour per week. To reduce the burden, game
components are included in the training such as achievements and motivational
rewards.
The potential benefits of participation are considerable. Aside from the
potential positive effects which might result from the navigation
rehabilitation training intervention in this study, participants will receive
psycho-education on spatial cognition and navigation. Psycho-education will
help participants to identify the nature of their impairments and give insight
into their disabilities.