Topographical disorientation in a patient who never developed navigational skills: the (re)habilitation treatment

Although many cases of topographical disorientation are described in the literature, very few attempts have been made to rehabilitate this deficit, most likely because it is a multi-faceted syndrome in which different patients are affected by different topographical deficits. Therefore, it is not easy to develop a single rehabilitation programme to improve all types of topographical disorders. We describe the rehabilitation of a young woman with selective and pervasive topographical disorientation who never developed navigational skills due to a cerebral malformation bilaterally involving the retrorolandic regions. During treatment, the patient was trained to explore her surroundings carefully, to orient herself and then to move in the environment using a language-based strategy. At the end of the treatment, the patient was able to navigate in the environment by adopting several cognitive strategies useful for orientation. This result was maintained at the one-year follow-up, at which time the patient was also able to reach locations she had never been to alone. These results suggest that even patients who have never developed the ability to orient themselves in the environment can still achieve very good functional recovery if they are accurately assessed and submitted to a specific rehabilitation intervention.