Understanding and assisting difficulties with everyday spatial navigation

Spatial navigation is a fundamental component of our daily lives, from retracing a familiar journey to work through to exploring a city that we are visiting for the first time. Effective navigation requires a complex synthesis of psychological abilities, including our perception of the environment, directing our attention to useful parts of it, and our ability to remember those features for future journeys. Because of this complexity, it is no surprise that people can experience difficulty with navigation, and this can take a great toll on quality of life, psychological well-being, and employability. Whilst many people experience difficulty at some point in their lives, such as old age or when receiving chemotherapy, other people experience lifelong impairments, and their needs are rarely recognised or met. In this project we will provide a full understanding of individual differences in navigational ability, in both typical adults and a vulnerable population. We will also test new methods to assist people experiencing difficulties with daily wayfinding.

We will first recruit a representative sample of adults with Hydrocephalus, a common condition associated with an excess of fluid in the brain. This condition is anecdotally known to have a very large impact on navigational ability which, in turn, adversely affects the daily lives of people and their carers. However, scientists have not produced a full account of this issue, nor have they characterised the underlying cognitive abilities responsible. Participants will complete a battery of experimental tasks designed to assess a broad range of navigational abilities. Importantly, the tests will take place both in the laboratory and the real world. Performance across these tasks will be related to basic cognitive abilities, which will enable us to understand both the variety of strengths and weakness present in this group, along with the basic cognitive skills that underlie them.

Difficulties with everyday navigation are not confined to vulnerable groups - there are great individual differences within the typical population. The scientific literature currently lacks a comprehensive and contemporary study of normative individual differences in navigational abilities, which can pave the way to understanding and assisting difficulties across populations. A large representative sample of typical adults (N=200) will complete the same battery of tasks as the individuals with hydrocephalus. This will provide a full characterisation of strengths and weaknesses, alongside a greater understanding of the skills that underlie them.

Finally, we will develop and test new cognitive methods to assist people experiencing difficulty. No such methods currently exist, and while much effort is being devoted to the development of navigational aids based on GPS guidance, psychological research has demonstrated that this method can actually impair navigational performance in users. We will invite people from both of the preceding stages who had the most difficulty on our tasks, and they will take part in a study that compares two different methods. These strategies will be compared to a general mindfulness strategy, and we will assess which have the most positive effect on route-learning a week later. We will later follow-up participants' daily navigational experiences, along with their quality of life, to assess the longer-term benefits of intervention.

Together, this work will provide an important step-change in our understanding of a fundamental daily behaviour, in both typical adults and a sizeable vulnerable population. It will also spearhead an evidence-based approach to rehabilitation that can improve the daily experiences of individuals experiencing navigational difficulties. This will pave the way to a future programme of interventions that will be applicable to a broad variety of groups whose lives are affected by wayfinding problems.

PATIENTS AND CARERS: This work is aimed at improving daily quality of life for people experiencing navigational difficulty. At this stage, the clearest impact will be through our focus on people with hydrocephalus. Navigation is fundamental to independent living, and impairments have a large impact upon quality of life, wellbeing, independence, and employability. By providing a broader and more detailed account of the cognitive sequelae of hydrocephalus we can help patients and carers towards a greater understanding the condition. Moreover, if we are able to successfully identify an effective rehabilitation strategy to assist with route learning then patients and carers will be able to directly improve their daily experiences. The benefits can not only affect day-to-day living but can also improve more general prospects: helping patients to become more independent will affect their employability and also the provision of care that is required to assist their daily living, thus providing economic as well as societal benefits. A representative sample of the user group will initially be engaged through testing, and later through an informal workshop, providing a forum for dissemination, discussion, and feedback. We will also meet with the Shine Adult Members Council, a representative group of adult members, to work on a strategy for broader dissemination through events and social networking. Throughout the project, a larger sample will be reached through quarterly project updates via Shine's 'Together' magazine.

HEALTHCARE PROFESSIONALS: Hydrocephalus is a common condition, accounting for almost 30% of paediatric neurosurgical admissions. There are many staff devoted to the diagnosis, treatment, and care of people with the condition across the UK alone. By producing a comprehensive account of the spatial difficulties associated with the condition, healthcare professionals will be able to draw from a greater wealth of knowledge when assessing and treating patients. In particular, outpatient care will be informed by a greater awareness of cognitive components that can affect daily living. In addition, an evidence-based rehabilitation technique will be of great use to practitioners in their attempts to ensure that patients enjoy a fulfilling and independent life. We will personally engage practitioners through research workshops, held at the Chelsea & Westminster clinic, where we will present and discuss the ongoing project, the findings, and their broader clinical ramifications. Practitioners will also be engaged through regional Shine meetings (East Midlands and London), through publications in academic and charity-based texts, and also through presentations at clinically-related conferences, such as IFSBH and SRHSB.

PUBLIC SECTOR, EDUCATION, & INDUSTRY: This broad group will also be reached through media dissemination of our findings. Greater knowledge and awareness of common impairments will be of great importance to employers in the workplace and individuals that play a role in local communities (e.g. social workers). It will also be of primary importance to education professionals working with children with hydrocephalus, or other conditions that affect spatial ability (e.g. autism). This will ensure that people have an informed awareness of the needs and abilities of people, which can inform understanding and assistance in a variety of everyday circumstances, and can also ensure that they are able to play a meaningful and economically viable role in society. Particularly important issues will relate to transitional stages (e.g. the move from secondary to tertiary education) and employment. Through Shine, we will work towards producing fact-sheets to add to their series that provide information about hydrocephalus, treatment, complications, outcomes and research, for a variety of different audiences and contexts. We will also pilot a more general leaflet for broader sections of society experiencing difficulty.