Walking on the Number Line: A Playful and Embodied Group Intervention for People with Acquired Number Deficits (Acalculia)

Abstract

Highlights What are the main findings? Group-intervention for acalculia can be effective and acceptable to users. Playful and embodied activities are acceptable and effective in supporting the rehabilitation of stroke survivors. What are the implications of the main findings? Support for stroke survivors with acalculia that incorporate sensory-motor tasks into numerical activities may support the development of a ‘number sense’ rather than address specific numerical deficits. Future work should systematically examine the effectiveness of group support across multiple domains (wellbeing, cognitive, physiological and functional). Abstract Numbers-skills are affected in as many as 65% of cases following a stroke or a brain-injury, a condition termed ‘acalculia’. Post-stroke numerical skills interventions have to-date focused on using intense repetitions (‘drill’), in one-to-one settings. However, while ‘drill’ is needed, there is increasing evidence that learning (and re-learning) of numerical skills may be enhanced by additional techniques, informed by current educational and cognitive neuroscience theories. We report on a mixed-methods feasibility study examining the acceptability and impact of the first reported group intervention for acalculia, that is based on the principles of embodied learning, playfulness, and enriched social environment. Four brain-injury survivors took part in six-weekly 45-min group sessions involving games with numbers, accompanied with congruent movements. Following a 4-week break, n = 3 took part in additional three sessions. Performance on number skills (theoretical and functional) was collected before the intervention (T0), after six weeks (T1) and after further three weeks (T2) using validated batteries. Qualitative data were collected 3-months post intervention using semi-structured interviews with two patients. Results show improvements on all measures at both T1 and T2, including far-transfer to untrained problems. Qualitative findings emphasised the importance of group-settings, and the impact of playful learning on cognition, engagement, learning, confidence and wellbeing. We conclude that playful group therapy integrating modern educational theories is feasible and can be effective for improving numerical skills and speculate on the possible neural mechanisms that may facilitate these findings. Future work should evaluate the impact of combining multi-sensory, movement and cognitive rehabilitation in improving patients’ linguistic, physiological, and wellbeing outcomes.