Understanding Spatial Navigation Challenges After Stroke

Erica Barhorst-Cates Headshot

To find the offices at Moss Rehabilitation Research Institute (MRRI), take the elevator to thethird floor. Once you exit the elevator, turn left, then right down the first hallway, then left through the conference room. Turn right, then left, and the office is the third door on your right. Got that? Okay, now head back to the elevator the way you came. Make sure not to bump into any of the obstacles in your way, and make sure you still pay attention to what the research assistant is saying as you go.

Spatial navigation, or the way we find our way around an indoor or outdoor space while remembering important landmarks or routes, is a complicated activity that many of us take for granted. It requires attention, memory, language, and, often, physical requirements such as the ability to walk or control a wheelchair. Spatial navigation involves various brain regions, including the temporal and parietal lobes. Even many neurotypical individuals have difficulty with navigation; some of us forget where the exit is in the local Target or have no idea which way is north.

Stroke can make the act of spatial navigation even more challenging, because lesions in different parts of the brain can impair different aspects of navigation. MRRI researchers Drs. Erica Barhorst-Cates, PhD, Aaron Wong, PhD, and Laurel Buxbaum, PsyD, are conducting research to better understand how stroke can affect navigation abilities, and in what situations. While one individual might have an excellent “mental map” of the environment, she may have difficulty walking and become distracted by the need to avoid an obstacle in the environment. This distraction may make her temporarily forget where she is, thus affecting her navigation ability. Another individual may walk normally but have impaired working memory ability, thus making it hard for him to remember a list of directions. Depending on where an individual’s stroke occurred in the brain, different abilities might be affected. There is no one-size-fits-all navigation impairment.

In their ongoing study funded by the Albert Einstein Society, Dr. Barhorst-Cates and colleagues are asking participants with stroke and a group of neurotypical participants to navigate around the MRRI building and learn the location of “landmarks” in the hallways. Much of the prior research on navigation after stroke has used computer based virtual reality tasks, where participants are seated and stationary. The task used in this study is more similar to how navigation occurs in the real world, thus allowing the researchers to more accurately understand the various challenges. They are testing participants’ memory for the object locations and the traveled routes using a series of measures that they have adapted for use for individuals with stroke. In addition to this navigation task, participants also complete a series of tests aimed at understanding their physical and mental abilities. The researchers have currently run 30 participants through the study out of our goal sample size of 55. We hope to use the results from these tests to understand more about which types of patients might be affected in terms of their navigation abilities.

Ultimately, the results from this study may help inform development of therapies to improve navigation abilities for individuals who suffer a stroke. In the meantime, which way is south?

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