TRANSCRIPT - Assessing Spatial Dysfunction in O&M and the Classroom Ð 2/13/23 >>Dr. Deverell: Today we're going to be talking about what spatial cognition is and how we recognize spatial dysfunction in O&M, which is my particular interest and how I got to meet Ian. Ian, though, is the neuropsychologist who is going to be telling us more about what's happening in the brain when someone has difficulty making sense of space and learning orientation. There are good questions in there about Braille because not all of the action happens outside the classroom or out in the community. Teachers have a lot to do with the classroom in learning assessment and we'll touch base on that and how to make decisions around learning maybe your assessment when someone seems to have spatial fragmentation. Then we'll talk about the 3D block construction test and assessing with the Stuart Tactile Maps. Lastly, we'll finish up with getting around in the community, wayfinding, without having to use mental mapping. So, what is spatial cognition? This is your first chance to write some things into the chat. And as you have a look at those things, perhaps, Kaycee, you could read them out for us. What does it involve? No ideas so far. >>Kaycee: Knowing where you are in space. >>Dr. Deverell: Uh-huh. Yep. It's pretty much the summary of it. You know, it's a sense of where we are in relation to other things. So, making sense of space, getting your bearings, continually updating once you step out and move. You might make a mapping head of where things are in relation to yourself, so object relationships, and also object-to-object relationships. And all of that comes together as a sense of orientation. This is really important for a orientation and mobility specialist because it's half the things we do but you really don't do one without the other, so there's always an element of navigational wayfinding with any kind of mobility. And in order to manage that from a mental mapping point of view, understanding spatial relationships deeply, there's a whole of things involved. So, what we need to do is be aware that any spatial cognition, any thinking about space, really depends on our fundamental sense of lines, whether they're straight, curved, or crooked and then how lines come together in angles to make two dimensional and three-dimensional shapes. In this concept of how they align, so parallel, perpendicular, adjacent, and diagonal. I love the tessellation. We have a place in Tasmania where a place has split in very brick-like fashion. So, you've got what looks like it's been neatly tiled but it's naturally a geological formation. You get an idea of how they fit together or nest in each other or creating layers. There's left, right, and contralaterality, clockwise, anti-clockwise, and awesome those position concepts. There's also longer, shorter, bigger, and smaller and these are concepts that have to do with space in different dimensions. Of course, our surveyors use triangulation with three points measuring places on the Earth to understand how they relate to each other and any maps that surveyors create made of triangulation networks. But we do that kind of thing in our head as well when we make meant maps. Then there's this idea of dead reckoning. A lot of this means that when you're a long way from home you have this internal sense of which direction to go in ahead of time. And some people have that and some people are completely mystified by that and head out in another direction. When I'm working with people in orientation and mobility there's a lot of ways I recognize spatial dysfunction and they're kind of my unwritten professional knowledge that comes from experience in the field but I've also had the chance to compare people's results on Ian's tactile maps test. Not particularly that those people didn't perform well and had spatial dysfunction and then go back and look at their functional orientation and mobility to find out what was particular about their style of moving through the world. And here's what I saw. When they're reaching for things in tabletop or say standing at the kitchen bench looking in the cupboard. People who were accurate with mental mapping could just put their hands straight on the handle of the door. There's a lot more groping and hand trailing with people who have spatial dysfunction in areas. When they're on their feet, people with poor mental mapping find it very difficult to walk accurately to where things are because they don't have a mental map that says where things are. So, they walk generally in the right direction. Walking to something, feel their way around it and if there are familiar things nearby, then they might get busy at that place but if they don't find something familiar they'll ricochet and head another way. They get easily disoriented, they veer, do foot shuffling and they are uncertain at turns. I find they're not as fluent and graceful as travelers but there's not that elegance to their movement because it lacks precision. Things that go haywire when I'm teaching O&M, the client tends to be quite vague or wrong about directions so they can't point in the direction that, you know, they need to be going, necessarily. They can have difficulty following route instructions and trouble learning new routes. It's going to take a lot of time to learn new orientation to new places, a lot of structure, training, and route practice. There's almost always difficulty or impossibility if a person veers in doing the old 180-degree turn and then retracing steps or reversing a route. And typically, these people hate maps. They can't make sense of a body map on the hand or on the back. Tactile maps, you know, producing maps like this can be a waste of our time. And a cause of frustration because you're watching the person's face trying to be obliging but not really understanding what I'm talking about from a mapping point of view. Then when it comes to life choices, I find that people with poor spatial cognition always prefer accompanied travel, even if they're not hanging on, they like traveling in social places where help is available. They like live assistance apps like Ira where they can point the camera at something and have the person on the other end explain what's in view. They tend to stick closer to home and like familiar places and a limited life-space. And this is a surprising one that I noticed that often these people aren't anxious about being lost because it's normal for them and it's very different from a person who is used to being oriented and then gets lost, which can be quite distressing. So, Ian, I'm going to hand over to you because we're going to look at what's happening in the brain and then go into more detail. So, whenever I come across someone who has poor spatial cognition, I really like to get a second opinion. And so, I've been going to Ian for 30 years. Thank you, Ian. Who was a consultant neuropsychologist at the agency where I worked. And Ian has a very deep understanding of what's happening in the brain. So, to look at these on the left side of the brain, Ian. >>Dr. Stuart: Well, as people probably know, the brain is divided into the two sides and speech and language is generally on the left and generally on the right side of the brain is all types of spatial activity. But there are some spatial activities in the language area, particularly related to writing and things like that where some sort of minimal understanding of space is needed. So, you have this sort of division and the two really working together. >>Dr. Deverell: And it's often been the case that when I've had people with really dramatically poor mental mapping skills, sometimes they're really clever. There's lots of witty reporte. >>Dr. Stuart: That's right. You can get people who present themselves as being highly capable and intelligent from a language point of view but not very competent from the spatial point of view. So, the difference is often -- >>Dr. Deverell: When you dealt with the things, the way standard intelligence scales look at, you're looking at fragmentation on the right side of the brain. If a person's got some vision you can use some of those visual tests, can't you? Like the Rey Complex figure -- and we'll have a look at that in a moment. >>Dr. Stuart: There's also a bit of an issue because when you have some sort of cortical blindness or when you have people with some limited, just very small amounts of vision, it's never quite clear how much they're using. And even if you do get that from observing them closely. >>Dr. Deverell: So, Ian has some visual tests that he uses to look for spatial fragmentation but most of these tests of spatial cognition have been visual spatial tests, we recognized in the '80s that what we need is tests anyone can do with no vision, whether you have sight or not. So, he created the 3D block construction test and the Stuart Tactile Maps test and we're going to look at those in more detail in a moment. But in the meanwhile, that question about Braille never quite goes away when you're dealing with children and needing to do Learning Media Assessment. So, there are language centers in the left brain and they may need to connect what's happening in space on the right side of the brain. >>Dr. Stuart: Well, as you can imagine, it's basically a spatial class and each one of those has to link up, something in the left side of the brain that has the language. So, when someone's reading, obviously they're reading with their hands and the information is being transferred to the left side of the brain as well. >>Dr. Deverell: So, this is cross-hemispheric. If someone has a disordered on the left side of the brain, they might have trouble with Braille? >>Dr. Stuart: It's actually quite a common thing to see people who have quite poor language but really a high level of spatial functioning. You see that in people who are really highly competent in their activities of daily living. And their daily activities are really done well and with confidence. Whereas sometimes their language might even make you think they can be retarded. Whereas this may not be the case at all. >>Dr. Deverell: We're appreciating that IQ is a much more complex thing than just expecting people to be the same on every subtest. And so similarly if someone has spatial dysfunction but their language is okay, they're not necessarily going to be able to get Braille. So a question for those of you who are working in the classroom and looking at literacy and Learning Media Assessments, just as I gave a list of indicators in orientation and mobility that there might be spatial dysfunction, I'm interested in what your experience is of recognizing spatial dysfunction when you're doing Learning Media Assessment, if you're wondering about if someone is on the cusp between reading print, for example, and going for tactile options like Braille or going for audio. How do you recognize spatial dysfunction? What kind of age does it come up? And, you know, what questions have come up for you that you might want to ask Ian as we proceed through. >>Dr. Stuart: I did -- the first study that I did on this kind of thing with blind children, I actually used two tests of Braille learning as well as all the tests of spatial functioning and language functioning. It was apparent with some of those children had quite severe problems with their Braille learning. And the issue that really comes up is what you find is they might -- they might even be unable to learn Braille at all but the teachers feel that they must learn. They want them to read normal Braille but they need at least some sort of -- what would you call them? Survival Braille. It's quite a complicated problem but it's all related to the spatial issues as well. So, where we talk about spatial dysfunction and difficulty finding your way, it raises the question of the possibility of some Braille difficulties as well. >>Dr. Deverell: So, we'll keep that in mind and, Kaycee, I wonder where the people have put any indicators into the chat yet on spatial dysfunction. >>Kaycee: We got a couple of questions come in. So, would a genesis of the Corpus colosum, would they have spatial dysfunction? >>Dr. Stuart: There's not a communication between the left and the right side of the brain. A Genesis is a difficult question. But generally, what you're saying is the two hemispheres are separated. But not only that, the -- if you find some sort of agenesis you're looking at a person with a congenital disorder of some sort and that raises the question of other difficulties. A really -- to understand a person with agencies of the corpus Callosum you need all language and spatial functioning. >>Dr. Deverell: For those of us who aren't neurological geniuses, just to clarify, agenesis -- >>Interpreter: It's different from acquired. It's a congenital condition and there are a lot of these congenital conditions of the spatial abilities. You'll see that as we go through further on in this talk. >>Dr. Deverell: One more, Kaycee? >>Kaycee: Yes. We had someone ask about how dyslexia -- how this relates to dyslexia in Braille readers and someone shared their O&M students with dyslexia struggle with spatial processing. As far as the indicators that you asked for, difficulty with understanding tactile graphics and math graphics and charts. And then there was a question. If you see this in individuals who have O&H. >>Dr. Stuart: What's that? >>Kaycee: Optic nerve hypoplasia. >>Dr. Deverell: I'm going to shut the door because the birds are annoying. >>Dr. Stuart: We've got magpies outside the house. In my study I found that out of 31 children there was probably about six or seven children with very severe Braille reading difficulties. I would call that a Braille dyslexia. So, I think that if you've got a dyslexia arising from spatial dysfunction, that is truly a Braille dyslexia. You can also get a dyslexia coming from the language side of things. So, people who are not making the connections between the left and the right side of the brain probably may find it difficult and they might present with a dyslexia which is more of a verbal language-related dyslexia. >>Dr. Deverell: And a comment about optic nerve hyperplasia >>Dr. Stuart: As we know it is a congenital condition but in the study I did there were a lot of children with the optic nerve displassia and many of those had cognitive deficits. One of the issues about these things is that I tend to work on the assumption that everyone who's -- who I see in the normal course of events has got normal intelligence and normal capacities. But sometimes we find that some of these people, some of these children, say with the optic nerve hyperplasia will have difficulties of various sorts. I think I lost my -- >>Dr. Deverell: That's all right. So, there was a prevalence of -- a relation between -- >>Dr. Stuart: I think what I was trying to say is it's one thing to talk about an acquired brain injury, which comes from a head injury, but we also talk about brain injury that arises from other things. And the congenital abnormalities in the brain are associated with difficulties with cognition and they all relate to some form of brain injury or brain damage. And I guess what I'm saying is that I found at times quite a resistance to this idea of people don't seem to see congenital blindness in the same way as they see other forms of brain injury. In the early days there was a lot of blaming of parents because they had children who were having difficulties, say, with spatial orientation. They couldn't find their way. And the parents were often told that it was because they were overprotected. Overprotection was considered to be quite a cause of this sort of difficulty. Whereas, in reality these children were going with a brain injury. >>Dr. Deverell: It was never going to work, even if their parents took them all kinds of amazing places to learn about space. If that part of the brain that deals with it is not functioning well, that's not going to happen. >>Dr. Stuart: What was surprising to me was what a relief it was for many parents to be told, look, your child has a difficulty that really is not your fault. It's a difficulty that is associated with blindness and we can work our way around it and take account of the difficulties, but it's not something that was caused by parental neglect or something like that. >>Dr. Deverell: And important that you say it's associated with blindness but not caused by blindness. Because that's an important distinction, as we keep going. We'll move forward because it's helpful to know a little bit about how the world of neuropsychology has learned about spatial dysfunction and through the work of Oliver Zangwill. >>Dr. Stuart: Yes, one of my early influences in this area was a paper by Oliver Zangwill in 1944, which there are disorders of space perception associated with the right hemisphere. What this neurologist was doing was he was investigating men who had been in World War II and who came back from the war with various forms of brain damage. And what he found was that damage to the right parietal lobe was associated with quite a range of spatial difficulties. So, these people with right parietal damage were often unable to find their way in space. They had difficulty with constructional tests and they had -- there was another condition called neglect, which is also associated with hemmianopia. He drew attention to this sort of difficulty -- and what's the next one? And so, in my study, in the study -- I started off the study as a PhD study. Oliver Zangwill was very concerned with problems in what he described as a fragmentation in the sense of space. That is people, when they had to draw common things like if you had to draw a plan of a house or if you had to draw a bicycle, the parts wouldn't be related one to the other. And I adapted -- at least I used this test, which is called the Rey Complex Figure Test. It's simple visually and people have to make a copy of that figure that you see in the middle of the screen. It's well within the range of most people. But what you find is that people who have a fragmented sense of space, damage to the right parietal area, they show an inability to relay one part of the figure to the other. So, if you look at these diagrams here, perhaps looking at the one that's underneath. >>Dr. Deverell: On the bottom right? >>Dr. Stuart: In the center. What you see is that all of the elements of the figure, they're all roughly put in the correct position but you can see that the small elements of this figure, the circle, triangle, squares are not directly related to each other in a coherent manner. And you see that also, if you look at the figure on the left side, if you notice you'll also see that some of these -- the drawings show signs of neglect of the space. But I'm not particularly concerned about that. If we look to the right and we look at the figure above there, that figure was drawn by a person who had damage on the right side of the brain in the right parietal area but also on the left side of the brain. So, the left side of the brain has some language, which as I said before is related to writing and speech. What you see in this figure, not only do we have the fragmented sense of space, but those small elements of the figure have all been disturbed and they can't even reproduce those very clearly. On the bottom right you see another pretty characteristic drawing where there's fragmentation but also some neglect in the left side. >>Dr. Deverell: So pretty interesting drawings. I like them because they're pretty. >>Dr. Stuart: Well, I number the colors in order to say which order the person commenced drawing figures. >>Dr. Deverell: On the top right we have hot pink. They saw that and went from there and ended up with the black. Yeah. So, there's two important parts of this and we really helped to clarify this, in my mind, when we're looking at what's happening in the brain because you've explained to me that it's a two-step process. First of all, with the parietal lobes. There's not a lot of action there. There's not going to be a lot of joy with mental mapping, is there? So, with the left parietal lobe, as Ian says this spatial integration and if there's damage on the left parietal lobe, then the person gets written deficits. In the right, that's where the spatial happens and -- it might just be a spatial deficit. It's really important to point out here that the loss might be associated with spatial deficit but you can equally meet congenitally blind people who are brilliant meant mappers so the two are not automatically connected. >>Dr. Stuart: Can I just add one thing to what we've been saying? I've been talking in this very fluent fashion about these difficulties. But what I think is important from an O&M point of view is that in talking about this kind of spatial deficits and spatial -- we're using a language that is unfamiliar -- was unfamiliar to me and I had to learn that language. And you can become fluent in it. But what I think is important from an O&M point of view is to recognize that you have to become -- to understand what's going on in these things, you have to actually learn a new language. You have to learn what the concepts are and you don't -- and it's important not to be discouraged by feelings that this is too complicated. Because it's not actually complicated but it appears that way because the language is not familiar to us. >>Dr. Deverell: And when we've looked -- you know, Ian and I diving into the literature, it's this developmental topographical disorientation or is this just getting lost? And they can both be words for the same thing. So, in light of this parietal deficit, you've looked at 3D block constructions as a way to test that. I think the real learning for me is this two-handed block construction is a way of testing someone's spatial perceptions in realtime. They're not having to remember anything about spatial mapping because they're able to compare what they find with one hand with what they find with another in the moment rather than try and remember it and carry learning across. So, with the 3D block constructions, Ian actually developed four models as part of his original study in the 1980s, although he's only showing three of them there. One has a simple three-block construction and we go for something that has like a T-bar on top and something that looks like you might built it up as a log cabin. Perhaps my imagination goes in all kind of places. The rules are the same for each of them. We give the person the fixed model and they need to make, from that model, their own replica with the same loose blocks. So, we'll look at what that is like, comparing a person with good spatial cognition and a person with poor spatial cognition. >>Dr. Stuart: Just go back, if you don't mind. What I would say about these figures is that the idea of those was to develop a test that was done by touch and not by vision. So even though one is using blocks and the other is copying that complicated figure, the aim of these tests is to identify that fragmentation in space and it's to be seen in the placement of the blocks as well as the placement of the elements of Rey figure. So, the argument that I would forward is that if you have a fragmented sense of space you would find it difficult to do the Rey figure but you would also find it difficult to place these blocks in correct spatial relationships to each other. But we'll show you that -- from the point of view of two congenitally blind people, one of whom has normal spatial function and one of whom has a fragmented sense of space. >>Dr. Deverell: Actually, the first one had a retinal problem. She used to be able to see but she's now, you know -- might be blinded by the light if I turn the light on right in her eyes. So, neither of them is wearing a blindfold but if anyone has any sense of vision whatsoever, that might be useful in the task if everyone wears a blindfold for that. We'll look at this video. We'll turn our sound off and if you have questions or comments, please put them in the chat. >>We're comparing good mental mapping skills. See if you can use the same loose blocks to copy the fixed one. Mel picks up the fixed block model and rotates it in her hands to feel it from different angles. Then she puts it back on the table. Feels for the loose blocks, lays the base flat. With one hand on the fixed model and the other on the loose blocks, she moves between the two with her left hand and places the other two blocks precisely in position. Checking again with the model. Job done. >>Okay. We've got this one. >>Yes. >>And then there's two. >>Yes. >>And then there's obviously -- >>A third one. >>Which is three. Yes, that's well done. >>We call it the base. >>That's exactly right. >>Obviously you'll need to -- >>Just side by side. >>Okay. Right. >>Not necessary on top. Just put them -- >>All right. >>Perhaps across to the side here. >>Okay. >>Let me put this here. Now, if you do it there -- >>Yep, thank you. >>There we go. Now, just put them together there. That's right. Check with the other if you want to. >>Okay. Yes. Right. It might help. >>Yeah. >>Do you feel comfortable with that? Is it not getting there? Okay. Tell me when you feel as though it's reasonably. >>Okay. So -- now I think here. >>Okay. >>Okay. >>We're comparing good mental mapping skills and spatial dysfunction. They are separated and there are two more parallel rods adjacent to them and the whole thing makes a square. She sufficiently feels her way around the original model and sets about building up from the base. Notice the rod that should go on top is missing and she suggests we use a pen, which she puts precisely in place. >>How are you going there? >>There's a rectangle up top. >>Yes. A rectangle up top. >>Then it's the usual sides are smaller. What we've got is a bigger rectangle at the bottom than at the top. >>Yes. So, Christian, you used the words to describe it very well, don't you? >>Yes. >>And you wouldn't have done that in the past. And the other blocks on your left. Just see what you can do with them. >>All right. Yes. You never know until you try, do you? >>I think this one is quite difficult. It's got more blocks in it and their position. >>Ah! >>That's actually quite hard. >>I would imagine so. I imagine that. >>Now from your point of view, this one is -- it's hard to get a picture of it. >>Well, that's right. And, again, we don't know until we find out. >>We'll leave it at that. >>That's all right. [ End of video] >>Dr. Deverell: So, you might be wondering, well, what can I do with this at home? I watched Ian do these assessments for about 20 years before it really occurred to me, gee, could I do this at home? For my own PhD project, I asked Ian and he handed over some of his originals from the 1980s. Along the way I wondered how can we make this kind of task accessible to O&M specialists to be able to explore these ideas about the spatial dysfunction in relation to the block models. So Ian and I got some commercial blocks last week and we had a look at what we could do with them and we found that just in buying a bucket of blocks from our local office supply shop we were able to do some kind of replica with three blocks that just focused on the keyboard kind of thing and went in the same direction with the base block and an upper sitting along top of it and an upper along is side of it. That's the simplest of Ian's models. But then the other ones are excited about creating other things with shapes available. So just again focusing on right angles and keeping it pretty simple but getting the craft wood out to fix these blocks together and giving them the loose blocks to see if they can construct the same sort of thing. Comments, Ian? >>Dr. Stuart: No, no. >>Dr. Deverell: Okay. >>Kaycee: We did have a couple of questions. Do you guys want to take questions from the video? >>Dr. Deverell: Fire away >>Kaycee: Is it always that obvious of a difference like there was between those two videos? >>Dr. Deverell: It's true we have chosen pretty stark contrasts but with those blocks, Ian, I think you said to me if someone is going to have difficulty with that first simple one they're going to have difficulty all the way through, aren't they? >>Dr. Stuart: Yes, I think either you can do them or you can't. I think if your sense of space is fragmented, what it means is you're unable to apply any geometric concepts at all. >>Dr. Deverell: It leads on to the second part, which is a basic principle that you can't remember what you could never make sense of in the first place. So that's why we've said this right parietal functioning and testing it with the two-handed construction in realtime is the first part of your functional assessment. Because if the person can't make sense of these geometric spatial relationships then they haven't got anything to remember. Everything is just fragmented in their mind. >>Dr. Stuart: I would say you could use as blocks, as a memory test as well. I avoided that. I didn't want to use them -- I wanted them to be memory free. But you could actually say to a person, well, look, I want you to remember this in half an hour and we'll come back to it. And you could be testing memory in that way. So, you can adapt them but the question of memory is something that we'll be looking at in a different way -- >>Dr. Deverell: In a moment. So, with that memory issue, I noticed with Mel that she wasn't having to go back and have one hand on the model in order to place some of the blocks precisely in place. Clearly, she recalled and created a mental map of where those things were. Whereas Christian was thinking that pressing harder on the blocks would make it go into the right position. Unfortunately, that one doesn't work. So, with these examples that we've used with commercial blocks, as Ian said you could wait half an hour and then give the person the loose blocks and see if they could remember with the model how they constructed that model half an hour ago. But sometimes that spatial memory is actually evident in the precision during the construction of the models. So, the second phase of what needs to happen -- we've really slowed down brain function, haven't we? We noticed in the right parietal lobe, all those spatial relationships. Then the hippocampus does the work of remembering those spatial relationships. So, if you've got brain damage in the hippocampus then even if you could make sense of those relationships in realtime, you can't put it down as a tactile map or mental map. So, someone who can do the block instruction might not necessarily still be able to make mental maps. >>Dr. Stuart: Go back. What I would say about this diagram here, what we're identifying is this sort of -- that brown color is the hippocampus and there's one on each side. And these are the structures that are responsible for making things retain their memory. So, these are -- the first discovery or the early discoveries about this came about because someone was operated on for epilepsy and both of these hippocampus on the left and on the right were removed. And what they found was a shocking discovery. One of the most important discoveries that's ever been made in neurology, which was that the removal of the hippocampus on both sides caused the person to be unable to learn or memorize or retain anything, anything new. >>Dr. Deverell: From the time of the surgery. >>Dr. Stuart: From the time of the surgery. The man who had the surgery was called HM and he never, over the next 30 years, he never learned anything new at all. He remembered all his previous knowledge, his previous information, the people he knew, what he did, but he never learned anything new. >>Dr. Deverell: And so that's how we learned how important the hippocampus is in embedding things down in memory. Ian, you translated that need to separate and noticing spatial relationships from the business of learning spatial relationships as a mental map by creating this second test. And a lot of people have said to me why can't we let people have two-handed exploration of the Stuart Tactile Maps. It's about controlling exposure to the maps so that you can count how many repetitions it takes, how many practice runs it takes for someone to get it down, basically. >>Dr. Stuart: Well, let me -- I'd like to take this one back a bit. If you look at this test, the way that it works is that I had created some wire shapes and what the person does is they run their finger over the shape a number of times, three times, and then they are asked to draw the shape. Now, it's quite a simple idea that if you -- and it comes -- well, it didn't actually come from this idea but one aspect of it is that if you're an O&M instructor you very commonly will -- if you want a person to walk down a corridor and you want them to turn right, you can demonstrate that to them by taking their hand and saying walk down this way, and you demonstrate the movement of that in the arm. And then you move the arm to the right and you've created in their brain a very small mental or cognitive map. And that can guide the person's walking. So, they then follow the corridor down and turn right. So, they've created a mental map of their own. And that's what you see in that first one of these, level one of the diagrams. What you'll also see, on further turns so that the pathway becomes much more complex. It can be as complex as you like. I've got three levels there. And what you find, what I found with sighted children was that the average 6 or 7-year-old child -- maybe 7 to 8-year-old child was able to learn these figures without any difficulty. The most complicated figure could be learning two or three trials and remember without any difficulty. That's the level of difficulty that we're working with in these figures. >>Dr. Deverell: So, we'll look at a bit of video again. >>The Stuart Tactile Maps test involves guided exposure to a map to assess how much repetition is needed for spatial learning. >>One, two, three, four, five. Now, we'll do it again and one, two, three, four, five. And one more time and then I'll get you to draw it. One, two, three, four, five. Okay. Well done. >>Here we go. >>Oh, yes. That's right. >>That's got a bend in it. >>Okay. >>Trace out the shape. >>Oh, right. >>Once more. >>Here it comes. >>And after we finish -- >>Yep. >>I'll get you to draw this shape. >>Ah, right. >>One, two, three, four, five. Okay. So... >>Trace the shape with your finger. >>One, two, three, four, five. >>Okay. So, here's a pencil. >>Ah, nice! >>See if you can draw that same shape. >>Do I do it on this? >>On that page. >>Thank you. So, let me see. At the top. One, two, three, four, five. >>Okay. Now let me go through it again. >>Okay. I'll put the pen down. Oh, here it is. >>You ready? >>Yes, I am. One, two, three, four, five. >>And again. >>And one, two, three, four, five. >>And one more time. >>One. >>One, two, three, four, five. >>Trace that with your finger. >>Okay. One, two, three, four, five. And again? One, two, three, four, five. >>Okay. And again. >>One, two. >>You can trace that on the page. >>Okay. Here we go. So, one, two. One, two. >>Just draw. >>Okay. Thank you. One -- one, two. One, two. >>All right. >>Dr. Deverell: He's learning the directions and angles through his whole arm movement in relation to his body. On the most difficult map he was hesitant after three exposures, not wanting to try and fail. He asked, can I have another go? After another three guided exposures, he had learned the most difficult map and drew it with minor self-correction just halfway through. That gave him a score of 8 out of 9 for the Stuart Tactile Maps test. The Stuart Tactile Maps test -- >>Dr. Deverell: So, the Stuart Tactile Maps test is a little bit harder to make yourself at home. I tried initially using pictures but it took me eight years to hit on the right person who had the backyard skills to make the small run, really, of commercial-quality maps that could be used in research. I have done that now and they're available through my website, www.lildeverell.net or you can make your own out of the dimensions that Ian has given. He has made them free and available since the 1990s but I just think this test is so good because it clarifies how many repetitions it takes for a person to learn at those different levels, which has such immediate translation into our work in trying to orient people in O&M. So, in summary, we've got the right parietal lobe, which understands the spatial relationships, and that's what the 3D blocks test does. The hippocampus glues the information together -- I love your glue analogy there, Ian. If the person has got some understanding of spatial relationships and some glue then they might learn a spatial map. But if there's no understanding, because the blocks aren't working and no glue from the hippocampus -- and that's tested with the spatial mapping test -- then the person can't learn a spatial map and we need to not set them up to fail and expect them to learn from directional, distance, and angle instruction but unravel that complexity and give people a sequence of what they need in O&M. We've got a short list which I'll pop on the screen in a moment, that looks at alternatives to mental mapping without expecting them to remember mental mapping. >>Dr. Stuart: I would like to adjust one other thing. From the O&M instructor's point of view, I found a lot of the instructors feel physical their student is not learning O&M skills, that it's somehow a fault of the instruction. I have seen people being -- when I first started out there was an instructor who had given something like 70 actually daily instructions in wayfinding without any success whatsoever. It's useful to say when you have to call it a day. >>Dr. Deverell: Yes, and having those tests can actually reduce the wondering time, how best to work with people. This list of wayfinding strategies without mental mapping. I keep popping it up, so that's very accessible in the information that you can download. And if you want to contact either of us, we are very happy to be contacted by e-mail. We can set up a Zoom if you want a further conversation with the team that you're working with. We're very happy to continue this conversation about spatial functioning. Back to you, Kaycee.