Mapping independence

Neurologist Krish Sathian directs the Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA Medical Center.
Neurologist Krish Sathian directs the Center for Visual and Neurocognitive Rehabilitation at the Atlanta VA Medical Center.

 

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After diabetic retinopathy turned everything blurry, Ralph Potter had reluctantly given up his car keys.

The three-dimensional model of the hospital was a little like his grandson's globe, but instead of mountains and lakes, the raised parts were hallways and doors.

As his vision continued to deteriorate, the 75-year old Korean War veteran gave up leaving the house unless his wife went with him. One day, while waiting for Ralph at the Atlanta VA Medical Center (VAMC), Potter's wife picked up a brochure describing various research studies under way. Two days later, Potter was undergoing an intensive assessment by neurologist Krish Sathian and his team in the Center for Visual and Neurocognitive Rehabilitation. Potter was already being treated for hypertension, high cholesterol, and diabetes, but the test also showed mild cognitive impairment, probably exacerbating Potter's growing isolation.

You used to navigate from place to place, using maps in your head, Sathian told Potter, maps you unconsciously built using visual cues. Now that you don't see as well, we need to teach you different strategies to build maps like that. We'll start, he said, by teaching you how to find your way around the VAMC. But what you learn will help you build maps to get from any point A to point B.

Potter was dubious. He had been to the VAMC many times. He couldn't picture himself getting anywhere in that shadowy maze without his wife. But on the computer-generated, three-dimensional tabletop model of the hospital, he could feel the route. It was like his grandson's globe, but instead of mountains and lakes, the raised parts were hallways and doors. And he could hear where he was going. Running his hand down the map activated sounds. A voice counting 20 footsteps from the door. Echoes in a big space—a lobby?—of people talking as they moved about. Elevator buttons ringing. After a number of “walk-throughs” with the table map, he did the real thing accompanied by a therapist. And did it again and again, until to his surprise there did seem to be a map in his head, guiding him with previously unnoticed distances and sounds.

It won't happen overnight, Sathian told him, but you are rebuilding your map-making ability. The next step for Potter was to get back into his own neighborhood.

The center Sathian leads has 20 investigators, mostly Emory faculty, with others from Georgia Tech and Georgia State University. The map-building study is one of many to help visually or cognitively impaired veterans function better and re-integrate into society.

   
   
 
 

Since their partnership began in 1946, Emory and the Atlanta VAMC have shared both a backyard and a mission to care for veterans. Because many patients are elderly, care and research focus on memory problems, low vision, diabetes, cancer, and other aging-related disorders.

 

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