Article

This paper describes the rehabilitation process of a patient with severe
topographical disorientation. The study demonstrates the sustained effects of a
tailor-made, meticulous rehabilitation programme based on the gradual development
of compensatory strategies. The patient (RB) had a memory impairment specific to
environmental landmarks. He was able to recognise objects in his environment, but
was unable to identify any salient object as a landmark and was also unable to
derive any directional information from a chosen landmark. As such, his
topographical disorientation syndrome was complex in that he had elements of both
landmark agnosia and a heading disorientation, as described by Aguirre and
D'Esposito (1999). Because of this dual damage to the exocentric framework, the
tools and methods used in RB's rehabilitation programme were all based on his
intact egocentric frame of reference. Remarkable training effects were found for
routes he used frequently. After years of training he could walk these routes
without the aid of the written information he had used previously, which can be
interpreted as a form of implicit learning. In the 12 years we followed this
patient some transfer occurred, as the patient was ultimately able to identify
his own landmarks. However, RB remains dependent on other people to construct new
routes for him on the basis of these landmarks.

Langue : ANGLAIS