Gobbo Et Al Preprint RNN 2022

Restorative Neurology and Neuroscience xx (20xx) x–xx 1
DOI 10.3233/RNN-211234
IOS Press
1 The rehabilitation of object agnosia and

2 prosopagnosia: A systematic review
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3 Silvia Gobboa,∗ , Raffaella Calatib , Maria Caterina Silveric , Elisa Pinif and Roberta Dainid,e
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a Department of Psychology, University of Milan-Bicocca, Milan, Italy
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b Department of Adult Psychiatry, Nı̂mes University Hospital, Nı̂mes, France
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c Department of Psychology, Catholic University Milan, Italy
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d Milan Center for Neuroscience (Neuromi)
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e University Research Center in Optics and Optometry, Università di Milano-Bicocca (Comib), Milano, Italy
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f Neuroscience Department “Fondazione Poliambulanza” Hospital, Brescia, Italy
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10 Abstract.
11 Background: Agnosia for objects is often overlooked in neuropsychology, especially with respect to rehabilitation. Prosopag-
12 nosia has been studied more extensively, yet there have been few attempts at training it. The lack of training protocols may
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13 partially be accounted for by their relatively low incidence and specificity to sensory modality. However, finding effective
14 rehabilitations for such deficits may help to reduce their impact on the social and psychological functioning of individuals.
15 Objective: Our aim in this study was to provide clinicians and researchers with useful information with which to conduct
16 new studies on the rehabilitation of object agnosia and prosopagnosia. To accomplish this, we performed a systematic and
17 comprehensive review of the effect of neuropsychological rehabilitation on visual object and prosopagnosia.
18 Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. In addition,
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19 the Single-Case Experimental Design (SCED) and the Critical Appraisal Skills Programme (CASP) scales were used to
20 assess the quality of reporting.
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21 Results: Seven articles regarding object agnosia, eight articles describing treatments for prosopagnosia, and two articles
22 describing treatments for both deficits were included.
23 Conclusions: In the light of the studies reviewed, treatments based on analysis of parts seem effective for object agnosia, while
24 prosopagnosia appears to benefit most from treatments relying on holistic/configural processing. However, more attempts at
25 rehabilitation of face and object agnosia are needed to clarify the mechanisms of these processes and possible rehabilitations.
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26 Moreover, a publication bias could mask a broader attempt to find effective treatments for visual agnosia and leaving out
27 studies that are potentially more informative.
28 Keywords: Neuropsychological rehabilitation, cognitive treatment, agnosia, prosopagnosia, face perception, visual perception
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29 1. Introduction Riddoch and Humphreys (1987) developed a model 36

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distinguishing apperceptive and associative forms of 37
30 Visual agnosia is a neuropsychological deficit visual agnosia. The former refers to a lack of inte- 38
31 characterized by failure to recognize visually pre- gration of different sensory attributes in a complex 39
32 sented stimuli while vision, semantic knowledge of visual form, while the latter relates to an impair- 40
33 the stimulus, language, and general cognition are ment in the attribution of meaning to the content of 41
34 preserved (Farah, 2004; Zihl & Kennard, 2003). perception. 42
35 Following on from Lissauer’s classification (1890), Many forms of visual agnosia exist (Farah, 2004) 43
∗ Corresponding
but in this study we will focus on visual object agnosia 44
author: Silvia Gobbo, Tel.: +39 3473359479;
E-mail: s.gobbo6@campus.unimib.it. and prosopagnosia. 45
ISSN 0922-6028/$35.00 © 2022 – IOS Press. All rights reserved.

2 S. Gobbo et al. / Rehabilitating agnosias: A systematic review
46 1.1. Object agnosia of the stored knowledge of objects. Many standard- 97
ized tests evaluate such different object recognition 98
47 Object agnosia is a category of visual agnosia components, but their description is beyond the scope 99
48 that specifically refers to objects (Humphreys & of the present article. 100
49 Riddoch, 1993; Moscovitch, Wincour & Behrmann,

50 1997). As previously noted, object agnosia can occur 1.2. Prosopagnosia 101
51 in the apperceptive and its associative forms (Rid-

52 doch & Humphreys, 1987). Within the apperceptive The term prosopagnosia refers to the impairment 102
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53 form of visual agnosia, three further variants can of the ability to recognize both new and known 103
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54 be identified. These are, “Form agnosia”, which faces (Corrow, Dalrymple & Barton, 2016). It can 104
55 refers to an impaired analysis of the global config- be either a consequence of an acquired lesion (i.e., 105
56 uration of a stimulus despite preserved elaboration acquired prosopagnosia) or present since birth. For 106
57 of its single features, “Integrative agnosia”, which the latter condition, some authors prefer to use the 107
58 refers to an impairment in the integration of local term “congenital prosopagnosia” (Palermo, Willis, 108
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59 parts into a perceptual whole despite the preserved Rivolta, McKone, Wilson & Calder, 2011; Bentin, 109
60 ability to recognize them in isolation, and “Trans- DeGutis, D’Esposito & Robertson, 2007; Behrmann, 110
61 formational agnosia”, where the impairment is in Marotta, Gauthier, Tarr & McKeff, 2005; Carbon, 111
62 the transformation process in a 3D object which Grüter, Weber & Lueschow, 2007), with the aim of 112
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63 is independent from the observer’s view, necessary defining a disorder due to genetic account (e.g., Cat- 113
64 to identify the object from non-canonical perspec- taneo et al., 2016), but we will use “developmental 114
65 tives. Visual agnosia variants reflect a disruption at prosopagnosia” as a broader term referring both to 115
66 different visual object processing stages, yet mech- congenital prosopagnosia and a deficit with its onset 116
67 anisms subserving this process are still not fully in the first period of infancy, due to causes other than 117
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68 understood. Different models of object recognition genetic ones (Susilo & Duchaine, 2013). Original 118
69 have been proposed. An essential contribution in models of face recognition postulate that we process 119
70 this area was made by Elizabeth Warrington and faces in a sequential fashion (Bruce & Young, 1986). 120
71 Angela Taylor, who described patients having dif- After a primary analysis of facial visual features, 121
72 ficulties in naming objects photographed from an there is the so-called “structural encoding”, a phase 122
unconventional perspective (Warrington & Taylor, in which the information passes from a “viewer-
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73 123
74 1973) and in matching them with the same object centered” representation to a representation that is 124
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75 viewed from a conventional perspective (Warrington independent of the viewpoint. Once a “percept” is 125
76 & Taylor, 1978). Warrington and Taylor’s concept formed, the face recognition system compares it to 126
77 of conventional and unconventional perspectives was stored information about faces, the so-called “face 127
78 vital for describing the object-centered representa- recognition units”, which determines whether a face 128
79 tion of space in Marr’s model of object recognition is familiar or unknown. If a face is familiar, seman- 129
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80 (1982). According to Marr, the visual representa- tic information about that person can be accessed 130
81 tion of objects goes through a sequential process. through the “person identity node”. Prosopagnosia 131
82 There is a first viewer-centered representation where can result from a disruption in one of those mod- 132
83 the viewer encodes an object’s basic visual and ules. There can be problems in forming a percept, 133
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84 perceptual properties and a second object-centered in its association to memorized faces, and in access 134
85 representation, in which the object is fully repre- to semantic information. This can be due, as dis- 135
86 sented and thus recognized despite the perspective cussed above, both to an acquired brain lesion or the 136
87 of its view. Riddoch and Humphreys (1993) made a atypical development of one of the face recognition 137
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88 further step, developing a neuropsychological model subsystems (Susilo & Duchaine, 2013). 138
89 with the idea that it is crucial to evaluate the A longstanding debate in the literature concerns 139
90 various stages involved in object recognition selec- whether face processing is subserved by a specific 140
91 tively, while assessing visual perceptual disorders. system, different from that underlying object process- 141
92 Those stages are extraction of the basic dimensions, ing, or whether its apparent specificity is the result 142
93 figure-ground segmentation, recognition through dif- of our greater expertise with respect to faces com- 143
94 ferent points of view, representing what they define pared to other categories (Kanwisher, 2000; McKone, 144
95 as “pre-categorical” processing, independent from Kanwisher & Duchaine, 2007; Young & Burton, 145
96 knowledge of the object presented, and association 2018). On one hand, traditional domain-specific 146
S. Gobbo et al. / Rehabilitating agnosias: A systematic review 3
147 accounts of face processing claim the specificity of On the other hand, if face recognition results from 199
148 the Fusiform Face Area for face recognition (Kan- expertise with one category, it is likely that train- 200
149 wisher, McDermott & Chun, 1997), as part of a ing in the acquisition of expertise in a new category 201
150 face recognition system (Haxby, Hoffman & Gob- improves face recognition. 202
151 bini, 2000), as well as the existence of the ERP N170

152 component, which seems to be larger in response to 1.3. Rehabilitation of visual agnosia and 203
153 faces than to objects (Bentin, Allison, Puce, Perez prosopagnosia 204
154 & McCarthy,1996; Rossion et al., 2000; Carmel
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155 & Bentin, 2002). Neuropsychological data seem to Suitable visual recognition is fundamental to 205
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156 confirm this account because double dissociations many daily tasks (Zihl, 2011). Object agnosia is 206
157 of object agnosia and prosopagnosia deficits have a rare deficit (according to Zihl & Kennard, 2003 207
158 been documented (Moscovitch et al., 1997; Geskin 1–3% of brain-damaged patients) but it can be 208
159 & Behrmann, 2018; Riddoch, Johnston, Bracewell, often underestimated (Tikhomirov, Konstantinova, 209
160 Boutsen & Humphreys, 2008). Moreover, another Cirkova, Bulanov & Grigoryeva, 2019). Prosopag- 210
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161 account in favor of the specificity hypothesis is that nosia in its developmental form can be found in 211
162 faces, compared to objects, are processed in a holis- 2% of the population (Bowles et al., 2009; Ken- 212
163 tic way (Robbins & McKone, 2007). This appears to nerknecht, Ho & Wong, 2008), while difficulties in 213
164 be demonstrated by phenomena such as the inver- face recognition tests range from 21% to 80% of 214
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165 sion effect (i.e., a worsening of performance with brain lesion patients, depending on the test (Valen- 215
166 inverted compared with upright faces - Yin, 1969), tine, Powell, Davidoff, Letson & Greenwood, 2006). 216
167 the composite effect (i.e., the alignment of two half Difficulties in recognizing objects and faces can 217
168 faces belonging to different identities worsens per- impact negatively on social and daily life (Dalrymple 218
169 formance in judgment on the single halves compared et al., 2014), yet rehabilitation for visual-perceptual 219
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170 with misaligned trials - Young, Hellawell & Hay, disorders is still in its infancy. Many studies on 220
171 2013), and the part-whole effect (i.e., it is easier to dis- the topic are non-experimental in nature (Clarke & 221
172 criminate individual facial features presented within Bindschaedler, 2005; Anderson & Rizzo, 1995; Ray- 222
173 the entire face than without the rest of the face - mond, 1996; Burns, 2004). Therefore, it is difficult 223
174 Tanaka & Farah, 1993; Kanwisher, 2000). On the to draw conclusions about the generalization of the 224
other hand, supporters of the expertise hypothesis results to different patients and settings. The results
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175 225
176 brought evidence in favor of the increased activa- did not offer the numbers for quantitative analy- 226
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177 tion of the Fusiform Face Area and Occipital Face sis (i.e., meta-analysis), but the presented studies 227
178 Area not only for faces but also for objects for which can still direct future research towards promising 228
179 expertise has been acquired (Gauthier, Tarr, Ander- treatments. A recent review has been published on 229
180 son, Skudlarski & Gore, 1999; Gauthier, Skudlarski, the rehabilitation of visual agnosia and prosopag- 230
181 Gore & Anderson, 2000; Burns, Arnold & Bukach, nosia (Heutink, Indorf & Cordes, 2019). The authors 231
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182 2019). Moreover, the inversion effect has been found described both data on the rehabilitation of the 232
183 for non-face categories in which the participants were deficits and articles giving suggestions for treat- 233
184 experts (Diamond & Carey, 1986; Rezlescu, Chap- ment without displaying any data. They analyzed 234
185 man, Susilo & Caramazza, 2016), also in association the studies, dividing them into compensatory and 235
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186 with the N170 ERP component (Rossion et al., 2002). restorative approaches to rehabilitation (i.e., treat- 236
187 Additional accounts that favor the expertise hypoth- ments aimed at a compensation of the lost function 237
188 esis provide evidence for a better memory for faces through other functions versus treatments aimed 238
189 of the same race than for those of different races, at restoring the missing function), concluding that, 239
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190 explaining this as being due to greater experience even though the data are too scarce to allow any 240
191 with faces of the same race (Bukach, Gauthier & Tarr, conclusion, both these strategies seem to be use- 241
192 2006). Although this problem has not yet been solved, ful in the case of object agnosia, and compensatory 242
193 the debate raises important questions on the rehabil- approaches appear to work best for prosopagnosia. 243
194 itation of face and object recognition. For example, Moreover, the two previous reviews on the rehabilita- 244
195 one study claimed that rehabilitation of face recognition of prosopagnosia came to the same conclusions. 245
196 tion for impairment resulting from an acquired lesion Bate and Bennets (2014) stated that, for acquired 246
197 seems impossible due to the specificity of brain areas prosopagnosia, compensatory treatments appear to 247
198 subserving it (Coltheart, Brunsdon & Nickels, 2005). be more effective. However, they argue that under- 248
249 standing when restorative treatments are successful is be defined as restorative treatments, in other words 301
250 crucial as the benefits are greater. Concerning devel- those directly targeted at the rehabilitation of the 302
251 opmental prosopagnosia, the authors conclude that recognition function and not at potential compen- 303
252 there is not enough data to make inferences. DeGutis satory strategies. This choice was made for several 304
253 et al. reached a similar conclusion, and found no reasons. Very recently, Heutnik et al (2019) argued 305
254 evidence of the efficacy of restorative treatment on that compensatory strategies are beneficial in most 306
255 acquired prosopagnosia, while compensatory treat- cases, while restorative training has produced mixed 307
256 ments seem to be effective in certain cases (DeGutis, results. Nevertheless, restorative treatments can help 308
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257 Chiu, Grosso & Cohan, 2014). They pointed out the in recovering the function in an earlier phase and 309
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258 use of different successful approaches to treatment in change the neural organization (Raskin & Sohlberg, 310
259 acquired prosopagnosia, such as galvanic vestibular 2009). For this reason, they might be more prone 311
260 stimulation (Wilkinson, Nicholls, Pattenden, Kilduff to generalization. Finally, compensatory tools can 312
261 & Mildberg, 2008), and described rehabilitation of be added at any time and destroy the effect of the 313
262 developmental prosopagnosia, discussing evidence restorative treatments. 314
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263 of efficacy in both remedial and compensatory stud- Moreover, we think that reviewing studies on both 315
264 ies. the rehabilitation of face and object recognition could 316
265 We found these reviews inspiring and we have used be helpful in the comparison of the cognitive mecha- 317
266 them as a starting point for conducting the present nisms involved in processing faces and objects. It is 318
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267 work. However, we believe that one of the reasons for worth noting that a certain degree of uncertainty in 319
268 which solid conclusions were not reached in the pre- the degree of separation between object agnosia and 320
269 vious reviews could lie in the fact that there are several prosopagnosia still exists. Consequently, a thorough 321
270 methodological limits in the published studies on investigation of the rehabilitation of those functions 322
271 cognitive rehabilitation of agnosias. Namely, the fact could represent a new element in the understand- 323
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272 that the majority are single cases, different tests were ing of the mechanisms subserving them. Given the 324
273 used for assessment and assessment of improvement, scarcity of published studies on the topic and the lack 325
274 and that there was a lack of assessment of low-mid of standardized and controlled methods, the current 326
275 level visual perceptual functions. This motivated us review cannot provide guidelines for the treatment of 327
276 to perform a new systematic review. We aimed to help object agnosia and prosopagnosia. Its aim is that of 328
researchers and clinicians willing to perform rehabil- providing a starting point for researchers and clini-
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277 329
278 itation on patients with agnosia and prosopagnosia cians dealing with this type of patient in the hope of 330
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279 by providing them with useful information that can enhancing literature on the topic. 331
280 be used in conducting their studies. In order to do so,

281 unlike previous reviews, we decided to focus only
282 on original experimental studies addressing direct 2. Methods 332
283 cognitive rehabilitation of visual object agnosia and

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284 prosopagnosia. In referring to “experimental stud- 2.1. Search strategy 333
285 ies”, we mean those using quantitative methods to

286 assess the deficit and its improvement, with an exper- We followed the Preferred Reporting Items for 334
287 imental procedure as a treatment. This choice was Systematic reviews and Meta-Analyses (PRISMA) 335
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288 made because, in conducting the literature search, we guidelines (Page et al., 2021). The PsycINFO, Sci- 336
289 noticed that many studies present non-experimental enceDirect, and Pubmed databases were searched. 337
290 studies or data that had been used previously, making The search string that was used combined the 338
291 it difficult for clinicians and researchers to analyze, words “Rehabilitation” or “Treatment” or “Training” 339
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292 interpret, and replicate the results. We also chose or “Perceptual Learning”, with each of the terms 340
293 to include only studies performed on adults. This “Agnosia,” “Prosopagnosia,” “Visual Processing,” 341
294 is because rehabilitation is approached differently in “Visual Perceptual Disorders,” “Visual Agnosia,” 342
295 children and we wanted to include a population that “Object agnosia,” “Apperceptive Agnosia,” “Asso- 343
296 is as similar as possible in an attempt to make the ciative Agnosia,” “Integrative Agnosia,” and “Form 344
297 treatments uniform. Only by doing this, can we try agnosia.” The search for peer-reviewed publications 345
298 to be as specific as possible in reporting rehabilita- was conducted independently by two of the authors 346
299 tion procedures that could be generalized. In addition, (SG and EP). Articles were first screened for title, 347
300 by direct cognitive rehabilitation we mean what can then for abstract and finally the full test was assessed. 348
349 SG and EP discussed their choices after each of the Togher, Schultz & Savage, 2008) was used to 397
350 steps described. Any disagreement was solved by evaluate the quality of reporting. For the three 398
351 discussion and with the supervision of RD and RC. articles describing case-control studies, the Criti- 399
352 Studies from the inception up to February 2022 were cal Appraisal Skills Programme (CASP, available 400
353 included. The titles and abstracts of the results listed at https://casp-uk.net/casp-tools-checklists/) check- 401
354 were screened to identify the articles meeting the list was used (Ma, Wang, Yang, Huang, Weng & 402
355 inclusion criteria. If sufficient information was not Zeng, 2020). Two of the authors (SG and EP) inde- 403
356 obtained in the title and abstract, the full text of an arti- pendently rated each paper, giving a score of 1 if the 404
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357 cle was reviewed. The full texts of all articles meeting item was clearly present throughout the article and 0 405
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358 the criteria for inclusion were collected. The refer- if it was not; incongruencies were then discussed to 406
359 ence lists of the identified studies were also examined agree on a final score. The total score ranged from 407
360 to identify additional items. 0 to 10 (items 2 to 11): the higher the score, the 408
higher the quality of reporting. It must be noted that, 409
361 2.2. Study selection as mentioned specifically by the authors of the CASP 410
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scale, scores are indicative and must not be taken as 411
362 The established inclusion criteria were: a) studies a comprehensive evaluation of the article (Ma et al., 412
363 providing empirical evidence for cognitive rehabilita- 2020). 413
364 tion of visual agnosia and prosopagnosia; b) studies
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365 describing the impairment as part of a more global
366 deficit or in conjunction with other impairments (as 2.4. Risk of bias assessment 414
367 we expected the literature to be too scarce only

368 to consider “pure” impairments); c) articles pub- Risk of bias in the present review was addressed 415
369 lished in English. Exclusion criteria were: a) if the based on the Risk Of Bias In Systematic Reviews 416
(ROBIS) scale (Whiting et al., 2016). The ROBIS

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370 species studied was not human; b) if the deficit was
371 caused by a psychiatric disorder or a disorder in scale is a tool composed of three phases: the first 418
372 the autism spectrum; c) if the studies were exclu- phase is the “assessment of relevance” and is optional. 419
373 sively dealing with cognitive domains that were other The second consists of the “identification of concerns 420
374 than visuoperceptual; d) if the studies only treated in the review process”, and the third is to “judge the 421
reading difficulties; e) if the studies described the risk of bias”. 422

d
375
376 treatment of peripheral visual dysfunction, cortical

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377 blindness or visual field deficits; f) if non-cognitive

378 treatments were performed; g) if neurodegenerative 3. Results 423
379 diseases were treated; h) unpublished data; i) if com-

380 pensative strategies were adopted as a treatment j) The selection process led to the inclusion of 17 424
381 if studies considered children or subjects in their studies, 7 of which describe single case attempts 425
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382 developmental age. Although we aimed to include at rehabilitation of object agnosia, 8 describe train- 426
383 group studies such as randomized controlled trials, ing for acquired or developmental prosopagnosia, 427
384 in practice, most of those meeting our criteria used and 2 present the description of the rehabilitation of 428
385 single-case designs. A protocol for this study was not both object agnosia and prosopagnosia. The articles 429
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386 pre-registered. When missing data were encountered, selected were published between 1991 and 2019. Two 430
387 the authors were contacted in order to retrieve it. studies were retrieved by analyzing citations given in 431
388 Authors of three papers were contacted (Humphreys the other studies (Wilson, 1999; Davies-Thompson, 432
389 & Riddoch, 1994; Wilson et al., 1999; Zihl et al., Fletcher, Hills, Pancaroglu, Corrow & Barton, 2017). 433
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390 2011), two of which replied (Wilson et al., 1999; Zihl We describe and discuss the results relative to Object 434
391 et al., 2011), while one (Zihl et al., 2011) was able to Agnosia and Prosopagnosia separately below. 435
392 provide the necessary data.
393 2.3. Rating of quality of reporting 3.1. Risk of bias assessment 436
394 As most of the selected articles describe single- Risk of bias assessment revealed a low risk of bias 437
395 subject design studies, the Single-Case Experimental in the present review. For more details, please contact 438
396 Design (SCED) scale (Tate, McDonald, Perdices, the corresponding author. 439
440 3.2. Object agnosia associated with a head injury), known for producing 477
bilateral posterior cortical damage in the watershed 478
441 There are two tables presented that summarize areas, associated with frequent involvement of the 479
442 the results obtained on the rehabilitation of visual subcortical structures. 480
443 object agnosia. As all the studies are single cases and
444 patients present many differences, we compiled the
445 first table (Table 1) in order to summarize the localiza- 3.2.3. Studies description 481
446 tion and etiology (when reported) of the lesion of each A description of the studies that were included is 482
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447 patient and the second (Table 2) to summarise the presented in Table 2. Visual agnosia was assessed 483
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448 characteristics of the studies. For more information by utilizing a combination of standardized neuropsy- 484
449 on the characteristics of single patients, see supple- chological assessments, qualitative observations, and 485
450 mentary material. Each table is discussed separately ad hoc tests. Four studies describing five patients 486
451 below. (45%) (Behrmann et al., 2005; Lev 2015; Rosenthal 487
& Behrmann, 2006; Wilson, 1999) explicitly assessed 488
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the integrity of low-level visual processes. A control 489
452 3.2.2. Lesions localization condition was established in the treatment of 5 (45%) 490
453 Table 1 schematizes the location of the lesions of the patients described to address the possibility 491
454 when specified. For each patient, each box corre- that improvement was due to a spontaneous recovery. 492
455 sponds to a cerebral area (Temporal lobe, Parietal In two studies (18%) (Humpreys & Riddoch, 1994; 493
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456 lobe, Occipital lobe, Frontal lobe, Corpus Callosum, Rosenthal & Behrmann, 2006), a control group was 494
457 Basal Ganglia) of the right and left hemispheres. Four used as a baseline against which to compare the per- 495
458 patients (36%) underwent a Computerized Tomogra- formance of the patients. In one study describing two 496
459 phy (CT) scan (Behrmann et al., 2005; Rosenthal & patients (18%) (Wilson, 1999), spontaneous recov- 497
Behrmann, 2006; Rosselli, Ardila & Beltran, 2001, ery was checked for untrained items, and in another
460
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461 Polanowska, Mandat, Laudanski, 2003) and two study describing two patients (18%) (Zihl, 2011) 499
462 patients (18%) Magnetic Resonance Imaging (MRI) the author, after an initial assessment, introduced a 500
463 (Behrmann et al., 2005; Tanemura, 1999). Although waiting period of several weeks followed by another 501
464 heterogeneous with respect to the location and nature assessment to check whether recovery occurred in the 502
465 of the brain damage, the reported cases share common absence of any treatment. The treatments were all dif- 503
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466 traits, namely, the extent of the damage, which was ferent from each other. Given the nature of the studies, 504
467 generally bilateral. Four out of six patients in which we decided not to use the distinction between com- 505
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468 some details on lesion localization are reported had a pensatory and restorative rehabilitation. We divided 506
469 bilateral lesion and in one (P2 in Zihl, 2011), this was the studies into those in which a generic rehabilitation 507
470 expected (closed head injury and hypoxia). Patient was administered, a rehabilitation targeted to multi- 508
471 SM (Behrmann et al., 2005) was described as hav- ple cognitive functions (used for three patients (27%) 509
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472 ing right damage but the circumstances in which he (Rosselli et al., 2001; Seniow et al., 2003; Tane- 510
473 suffered the injury (severe head trauma in a motor mura, 1999), and those in which rehabilitation was 511
474 vehicle accident) do not exclude a bilateral hemi- specifically targeted at the visual perceptual deficit. 512
475 spheric involvement. Two patients (JW; P2 by Zhil The latter consisted of exercises specifically target- 513
2011) suffered from anoxic encephalopathy (in P2 ing low-level visual functions for one study (9%)
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476 514
Table 1
Localization of lesion in patients with object agnosia (when reported in the study): the asterisk indicates the damaged area
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Right hemisphere Left hemisphere Etiology

T P O F CC BG T P O F CC BG
SM (Bermann et al., 2005) * * * Head injury
JW (Rosenthal et al., 2006) * * * Anoxic encephalopathy
XX (Rosselli et al., 2001) * * * * Fat embolism
DE (Seniow et al., 2003) * * * * * Gunshot
YY (Tanemura, 1999) * * * * Stroke
P1 in: Zihl, 2011 * * * * Stroke
P2 in Zihl, 2011 Closed head trauma with severe chronic hypoxia; presumably frontal or
frontotemporal involvement for the trauma and biparietal involvement for hypoxia
abbreviations: T = temporal; P = parietal; F = Frontal; CC = Corpus Callosum; BG = Basal Ganglia.
Table 2
Studies description
Authors SCED Deficit(s) Control condition Treatment description/dependent Treatment Results of treatment Follow up (if
score variables of assessment duration present)
(0–10)
Behrmann et al. 7 Preserved: None for Specific treatment: 4 months Significant improvement for No follow up.
2005 - low-level visual processing; behavioral Categorization of unknown (twice a accuracy and RTs over session.
Patient SM - matching of objects from training. stimuli (Greebles). week). Generalization to untrained
Un different viewpoints or along a fMRI: 2 control Improvement: accuracy and RTs greebles and objects but
S. Gobbo et al. / Rehabilitating agnosias: A systematic review

foreshortened axis. groups matched for each session. worsening of performance with
Impaired performance in: for age and Generalization: accuracy for faces.
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- BNT1 ; education as the non-trained greebles, objects, and fMRI: face-selective voxels
- discrimination of exemplars baseline. faces. activated more by greebles and
within a single category; fMRI acquisition pre- and less by faces
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- recognition of photographs of a
famous individual;
- BFRT2 .
post-training.
Humphreys &
Riddoch 1994
Patient HJA
– Preserved:
- draw objects from memory;
- accurate descriptions of visual
cte For the first
experimental
condition: one
Specific treatment: grouping (1), Not fully
object identification (2), and
pattern recognition (3) tasks.
specified.
RT decrease (1); good
item-specific learning for line
drawings but not for photographs
No follow up.
d
attributes of objects. young and one Improvement: accuracy and RTs (2); learning specific to trained
Impaired: age-matched (1), test-stimuli created ad hoc items (3).
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- object recognition (object control subject. (2), accuracy (3).
decision task; Generalization: accuracy for
- semantic categorization; non-trained items.
- naming objects;
- situations where segmentation
of a stimulus from a complex
background is needed. tho
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Lev et al. 2015 5 Impaired: No control Specific treatment: contrast 9 months (3 Improvement in low, mid, and Follow up
Patient LG - low-level vision (visual acuity, condition. detection, lateral masking. times a week). partially high-level visual after 4 years:
crowding, lateral interactions, Improvement: pre- vs. functions. performance
roo
stereoacuity); post-treatment scores of within the
-mid-level vision (contour neuropsychological tests. norm in a
detection threshold, perceptual subset of
organization: L-POST); cognitive tests.
- high-level vision: BORB3 ,
VOSP4 , BFRT2 , HVOT5 .
f (Continued)
7
8
Table 2
(Continued)
(0–10)
Rosenthal et al. 5 Preserved: Four healthy Specific treatment: classification 2 months (8 Improved in learning to classify Follow up
2006 - visual acuity; controls matched learning of stripe stimuli. sessions). stimuli despite the persistent after 6
Patient JW - color-orientation adaptation; for gender, age, Improvement: accuracy in the deficit in perceiving the simple months: same
- coarse shape discrimination; and education. trained task. individual stimuli. results as post-
Un - color parallel search; Generalization: not assessed. treatment.

- object imagery and memory;
- binocular visual-motor
co
coordination.
Impaired:
- fine orientation discrimination;
rre
- contrast sensitivity;
- figure-ground segregation;
- shape segmentation;
- gestalt grouping;
- contour integration;
- symmetry judgement; cte
d
- object, faces and letter
recognition;
Au
- aspect ratio discrimination;
- fine shape discrimination;
- parallel search for orientation;
tho
- monocular visual-motor
coordination.
Rosselli et al. 4 Impaired: No control Generic treatment: eye 1 year (twice a Improvement, particularly for No follow up.
2001 - abilities involved in Balint’s condition. movements, convergence, word week). tests sensitive to scanning deficits
Unknown name
patient
syndrome;
- reading: alexia without agraphia
(letter reading, word reading); rP
reading, writing, visuokinetic
functioning, visual search, trail
making.
(TMT, word reading) and
measuring simultanagnosia
(ROCF-copy).
roo
- faces recognition (famous Improvement: pre- vs. Significant increase in the
people photographs); post-treatment scores of patient’s everyday life with his
- visual agnosia for neuropsychological tests. return to work.
schematized objects (recognition
of schematized figures,
recognition of overlapped
figures);
- memory capacity (WMS6 MQ).
f
Seniow et al. 2003 5 Impaired: No control Generic treatment: paper and 1 year (twice a Gradual improvement of No follow up.
- performance in non-verbal IQ condition. pencil exercises for visual week). performance in all affected
Patient DE of WAIS7 ; analysis and synthesis: computer cognitive domains.
- visual Perception and Memory: training for verbal memory,
BVRT8 . visuoperceptual, visuospatial,
and constructive functions;
occupational therapy.
Improvement pre- vs.
Un post-treatment scores of

neuropsychological tests and
GOS9 .
co
Tanemura 1999 2 Preserved (VPTA10 ) No control Generic treatment: Not specified. Improvement of performance for No follow up.
Unknown name - discrimination of shapes; condition. improvement of visual perception object agnosia, picture agnosia,
patient - naming colors. using the kinesthetic sense. and pure alexia but not for
rre
Borderline (VPTA10 ):
- selection of colored pencil;
- naming pictures.
Improvement: pre- vs.
post-treatment scores to
neuropsychological tests.
prosopagnosia.
Impaired (VPTA10 ):
- changes in visual experience;
- naming object and picture of cte
d
situations;
- familiar and unfamiliar face
Au
recognition.
Zihl 20111 4 Preserved: Visual agnosia Specific treatment in three steps 15 days (30 Improvement in the trained Follow up
Patient 1 - DS11 ; persisted in P1 for involving analysis of photographs sessions). object class. Generalization after 6 months:
- WAIS7 logical memory and
tho
Patient 2 15 weeks without of visual objects belonging to occurred for objects. further
logical reasoning; significant four visual categories. improvement
- AAT12 without visual items recovery. Improvement: accuracy. in object
Visual tests were not applied; Generalization: new visual recognition.
4
- sustained and focused attention
(behavioral level).
Preserved: Visual agnosia
rP
categories.
28 days (112
roo
- DS11 ; persisted in P2 for sessions).
- AAT12 without visual items. 22 months without
Impaired: significant
- WAIS7 logical memory. recovery.
f (Continued)
9
10
Table 2
(Continued)
(0–10)
Wilson 1999 4 Preserved: The patient was Specific treatment: line 6 months (10 Improvement in the trained No follow up
Patient Paula - visual field; checked for drawings were shown to the sessions). stimuli but no generalization to (Paula’s father
Patient Jenny - visual acuity; spontaneous patient and named once. Not the untrained ones nor to the wouldn’t let
- memory for Faces; recovery in labelled drawings served as alternative versions of the trained her).
Un
- auditory agnosia was excluded. non-trained items. control. stimuli.
Impaired: Improvement: accuracy.

- object recognition: better Generalization: alternative
co
performance with real objects examples of objects for which
(improved if objects were she had learned names.
rotated) than toy objects and
- GNT13 ;
rre
animals (lowest scores);
- Warrington and Taylor’s
cte
unusual views
- Oldfied Wingfield drawings.
6 Preserved: No control Specific treatment: naming 3 times a week Improvement in real object Duration of
d
- oral description of the visual condition. objects Jenny couldn’t identify, for one hour, recognition, pictures, and line follow up not
appearance of objects; copying the objects, visual one session drawings. Improvement in specified:
- pattern detection; analysis. with the everyday life perceptual abilities further
- visual matching;
- language (naming errors were
visual). Au
Improvement: accuracy.
Generalization: alternative
stimuli.
psychologist
(part of which
dedicated to
Generalization to other objects or
drawings provided these were
similar to those whose names had
improvement.
Impaired:
- visual field (slightly)
- Recognition of everyday objects tho object
recognition).
Sometimes
been given.
rP
(not helped by rotation nor touch) sessions
became 2 if
- Identification of photographs there also was
roo
and line drawings the memory
- WAIS7 picture completion, group running
- Reading (which she
- Face recognition attended for 9
f
- Memory weeks, 5 days
a week).
1 Boston Naming Test. 2 Benton Faces Test. 3 Birmingham Object Recognition Battery. 4 Visual Object Space Perception. 5 Hooper Visual Organization Test. 6 Wechsler Memory Scale. 7 Wechsler
Adult intelligence Scale. 8 Benton Visual Retention Test. 9 Glasgow Outcome Scale. 10 Visual Perception Test for Agnosia. 11 Digit Span. 12 Aachner Aphasie Test. 13 Graded Naming Test.
515 (Lev, 2015), visual perceptual abilities in one study the replication of the results (assessed across time for 566
516 (9%) (Humphreys & Riddoch, 1994), classification Rosenthal et al., 2006 and across patients Zihl 2011), 567
517 of simple (Rosenthal et al., 2006) and more com- and the second is the observation of evidence for gen- 568
518 plex (Behrmann et al., 2005) visual stimuli based on eralization of the results (assessed in Behrmann et al., 569
519 their visual features respectively in one study each 2005; Lev et al., 2015 and Paula from Wilson et al., 570
520 (9%), visual analysis of objects for two patients (18%) 1999). 571
521 (Zihl, 2011), and labelling of drawings for the two

522 remaining patients (18%) (Wilson, 1999). 3.3. Prosopagnosia 572
f
523 The duration of the treatment was not specified
roo
524 for two patients (18%) (Tanemura, 1999; Humphreys Three tables summarize the results obtained for 573
525 & Riddoch, 1994), and varied across the remain- prosopagnosia. Studies regarding acquired prosopag- 574
526 ing studies, ranging from a period of 15 days (P1 nosia and developmental prosopagnosia will be 575
527 from Zihl, 2001) to 1 year (Seniow, 2003). The out- discussed separately. The studies were classified as 576
528 come (improvement) of the training was measured perceptual or mnemonic treatments following the dis- 577
rP
529 by monitoring the accuracy of the task for seven tinction from Davies-Thompson et al. (2017), where 578
530 patients (64%) (Behrmann et al., 2005, Humphreys mnemonic treatments refer to interventions aimed 579
531 & Riddoch, 1994; Rosenthal & Behrmann, 2006; at associating faces to specific semantic information 580
532 Wilson, 1999; Zihl, 2011), or by administering the and perceptual treatments are based on the perceptual 581
tho
533 same neuropsychological tests used pre-treatment for analysis of faces. 582
534 the remaining four patients (36%) (Lev et al., 2015;

535 Rosselli et al., 2001; Seniow et al., 2003, Tanemura, 3.3.1.1. Acquired prosopagnosia. Table 3 presents 583
536 1999). Rehabilitation was effective for all studies. In the results from acquired prosopagnosic patients. The 584
537 those using specific stimuli that were created ad-hoc, observed deficit differs greatly from one study to 585
Au
538 generalization was evaluated and effective for three another. Two studies (29%) describe patients with 586
539 patients (27%) (Behrmann et al., 2005; P1 and P2 a semantic impairment together with prosopagnosia 587
540 from Zihl, 2011), while it was not effective in 2 cases (De Haan, Young & Newcombe, 1991; Francis, 588
541 (18%) (Paula from Wilson, 1999; Humphreys & Rid- Riddoch & Humphreys, 2002). Four studies (57%) 589
542 doch, 1994), and partially effective in one case (9%) describe patients having other visual perceptual 590
(Jenny from Wilson, 1999). A follow-up evaluation deficits besides prosopagnosia (De Haan et al., 1991;
d
543 591
544 was carried out for five patients (45%) (Lev et al., Francis et al., 2002; Behrmann et al., 2005; Zihl, 592
cte
545 2015; Rosenthal et al., 2006; P1 and P2 from Zihl, 2011). Finally, two studies (29%) present cases of 593
546 2011; Jenny from Wilson, 1999), all of which showed relatively “pure” prosopagnosia (Polster & Rapc- 594
547 consistency in results over time. sak, 1996; Davies-Thompson et al., 2017). A control 595
condition was included in four (57%) studies (Davies- 596
548 3.2.4. Quality of reporting Thompson et al., 2017; Francis et al., 2002; Powell, 597
rre
549 SCED scale scores are reported in Table 2. One Letson, Davidoff, Valentine & Greenwood, 2008; 598
550 study could not be evaluated due to insufficient infor- Zihl, 2011). Three studies (43%) describe per- 599
551 mation (Humphreys & Riddoch, 1994). Observing ceptual treatments (Davies-Thompson et al., 2017; 600
552 the assigned scores, we noted their heterogeneity. Behrmann et al., 2005; Zihl, 2011). Two studies 601
co
553 Among many other factors, this can be attributed to (29%) describe a mnemonic treatment (De Haan et 602
554 there being some information that was not present al., 1991; Francis et al., 2002). Finally, two studies 603
555 in the original articles. Despite that, in some cases, (29%) compare mnemonic and perceptual training 604
556 missing data could be retrieved from the authors (e.g., (Polster & Rapcsak, 1996; Powell et al., 2008). 605
Un
557 Zihl, 2011). Consequently, the results of the quality of Improvement appears poor for mnemonic treatments 606
558 reporting ratings are challenging to compare. A char- and better for perceptual training except for one case 607
559 acteristic that emerged from the articles is that the (Polster & Rapcsak, 1996). The duration of the treat- 608
560 authors did not account for inter-rater reliability in ment was specified for 5 studies (71%) and ranged 609
561 evaluating post-treatment scores, nor were the indi- from a period of approximately two weeks (Pow- 610
562 cators of eventual progress independent of the data ell et al., 2008; Zihl, 2011) to one of four months 611
563 used to assess the pre-treatment baseline. Two items (Behrmann et al., 2005). Follow-up evaluation was 612
564 that are relevant in our discussion of object agnosia reported in three studies (43%) (De Haan et al., 1991; 613
565 have different scores on the SCED scale. The first is Davies-Thompson et al., 2017; Francis et al., 2002), 614
12
Table 3
Studies description
Authors SCED/ Deficit Control Condition Treatment description/ dependent Treatment Results of treatment Follow-up
CASP variables of assessment duration
Polster & SCED: 5 Preserved: not specified Perceptual and mnemonic Not specified Improvement after personality No follow-up
Rapcsak, 1996 - verbal and semantic memory treatments: attention to facial traits judgements and learning of
N=1 - facial gender and emotional features; personality trait identity-specific semantic
expression discrimination judgements; attention to information These results did not
- identical faces matching distinctive features of the face; generalize to new views of faces
Un Impaired: learning of identity-specific

- famous faces recognition semantic information
- learning of new faces (WRMT1 ) Improvement measured through
co
- matching different views of a
face (BFRT2 )
accuracy Generalization to new
views of a face was assessed
De Haan, Young
& Newcombe,
1991
SCED: 4 Preserved:
rre
- visual acuity and colour
perception
not specified Mnemonic treatment: repeated
overt identification of familiar
faces and presentation of famous
Not specified No improvement for the repeated
overt identification of familiar
faces Little improvement for 5 of
Two months
later he had
returned to
N=1 Impaired:
cte
- Performance subtest (WAIS3 )
- Long term memory (WMS4 ,
faces in semantic categories
Improvement was measured
through accuracy
the 6 categories presented baseline on the
categories test
d
ROF5 )
- contrast sensitivity
Au
- emotional facial expression
recognition, race and gender
discrimination - face matching
tho
- recognition of familiar faces
- poor within class recognition
(e.g. flowers)
- object recognition
Davies-Thompson CASP: 7
et al., 2017
N = 10
Preserved:
- visual acuity - object
recognition and memory
Control task:
british television
series of their rP
Perceptual treatment: face
matching task
Improvement: same six online
11 weeks Improvement in the
discrimination of trained faces,
some benefits in daily life
Effects
persisted for at
least three
roo
Impaired: choice assessment tests used for initial Generalization to new views and months.
- subjective face recognition characterization + expressions and untrained faces
- famous faces recognition neuropsychological and although effects on
- at least one of CMFT6 or neuroimaging assessment neuropsychological tests were
WRM1 Generalization: to untrained
view, and to untrained expression
was evaluated within the six
assessment tests
minimal
f
Francis, Riddoch SCED: 5 Preserved: - Early perceptual Control task: no Mnemonic treatment: first treatment: face/name learning of familiar 1 week after
& Humphreys., abilities - BFRT2 - Executive treatment face/name learning of familiar seven people with recall of semantic the end of
2002 abilities (WCST8 ) people with recall of semantic two-hour information and imagery second
N=1 Impaired: - General Memory information and imagery; sessions of improved the number of treatment:
(WMS4 ) - Semantic memory - comparison of semantic treatment therapy second recognized faces; Improvement effect
Raven’s progressive matrices - with simple name retrieval or no treatment: five bigger after the semantic maintained
Picture naming test BORB7 - treatment Improvement was two hour condition with respect to the
Un Famous faces identification measured through accuracy sessions over a others

through vision fortnight
Powell et al., 2008 SCED: 5 Brain-injured patients: Control group: 12 Perceptual and mnemonic 4 one-hour Experimental group benefited for No follow-up
co
- Preserved screening tests of brain-injured treatments: 4 facesets in 4 sessions over a the 3 experimental conditions
N = 20 brain visual perception patients different conditions: simple period of two compared to the simple exposure;
injured patients - Impaired in face learning test comparable to the exposure, caricaturing, semantic weeks control group did not show
N = 1 Acquired
Prosopagnosic
rre
among other heterogeneous
cognitive impairments
Acquired prosopagnosic patient
20 tested were
used as a control
group: the same 4
association, part recognition
Improvement: measured through
accuracy of recognition of faces
differences between facesets.
Pure prosopagnosic patient
showed uniquely benefit of part
cte face sets as the

experimental
group were
presented with the above four
methods.
recognition training.
d
administered, all
in simple
Au
exposure task
Behrmann et al. SCED: 6 Preserved: None for Perceptual treatment: 4 months Worsening of performance with –
2005 - low-level visual processing; behavioral Categorization of unknown (twice a faces.
tho
- matching of objects from training. stimuli (Greebles). week). fMRI: face-selective voxels
different viewpoints or along a fMRI: 2 control Improvement: accuracy and RTs activated more by greebles and
foreshortened axis. groups matched for each session. less by faces
Impaired performance in: for age and Generalization: accuracy for
- BNT9 ;
- discrimination of exemplars
within a single category;
education as the
baseline. faces.
rP
non-trained greebles, objects, and
fMRI acquisition pre- and
roo
- recognition of photographs of a post-training.
famous individual;
- BFRT2 .
(Continued)
13
14
Table 3
(Continued)
Authors SCED/ Deficit Control Condition Treatment description/ dependent Treatment Results of treatment Follow-up
Zihl 20111 SCED: 4 P1: Preserved: Visual agnosia Perceptual treatment: analysis 15 days (30 Improvement in accuracy of age, –
N=2
Un - DS10 ; persisted in P1 for of visual features sessions). gender and discrimination.

- WAIS3 logical memory and 15 weeks without Improvement: accuracy. Improvement in familiar faces
logical reasoning; significant Generalization: not assessed for discrimination
co
- AAT11 without visual items
Visual tests were not applied;
recovery. faces.
rre
- sustained and focused attention
(behavioral level).
- identification of facial
expression
Impaired:
cte
- identification of gender and age
based on facial information
SCED: 4 P2. Preserved:
- DS10 ;
- AAT11 without visual items.
- identification of facial
expression
d Visual agnosia
persisted in P2 for
22 months without
significant
recovery.
Perceptual treatment analysis
of visual features
Au
Improvement: accuracy.
Generalization: not assessed for
faces.
28 days (112
sessions)
Improvement in accuracy of age,
gender and discrimination. Lack
of improvement with familiar
faces even after additional
training
–
tho
- visual field, treated
- colour discrimination, treated
Impaired:
- WAIS3 logical memory.
- identification of gender and age
based on facial information
- visual field, treated rP
1 Warrington
- colour discrimination, treated
roo
Recognition Memory Test. 2 Benton Facial Recognition Test. 3 Wechesler Adult Intelligence Scale. 4 Wechesler Memory Scale. 5 Rey-Osterrieth Figure. 6 Cambridge Memory Faces
Test. 7 Birmingham Object Recognition Battery. 8 Wisconsin Card Sorting Test. 9 Boston Naming Test. 10 Digit Span. 11 Aachner Aphasie Test.
f
Table 4
Localization of the lesion in the seven patients with acquired prosopagnosia
Right hemisphere Left hemisphere Etiology
T P O F CC BG T P O F CC BG
PH (DeHaan et al., 1991) * * * * trauma
NE (Francis, Riddoch & * Herpes Simplex
Humphreys, 2002)
WJ (Powell et al., 2008) * * * * stroke
RJ (Polster & Rapcsak, * * stroke
f
2008)
roo
SM (Behrman et al., * * stroke
2005)
P1 (Zihl, 2011) * * * * stroke
P2 (Zihl, 2011) Closed head trauma with severe chronic hypoxia; presumably frontal or
frontotemporal involvement for the trauma and biparietal involvement for
hypoxia
rP
615 and improvements were maintained in two studies replication, was reported in two studies (De Gutis, 650
616 (29%) (Davies-Thompson et al., 2017; Francis et al., Bentin, Robertson & D’Esposito, 2007; Behrmann 651
617 2002). et al., 2005), while replication across subjects was 652
tho
partially demonstrated in one study (Zihl, 2011). 653
618 3.3.1.2. Lesions localization. Table 4 presents the
619 location of the lesions in the acquired prosopagnosia 3.3.2.1. Developmental prosopagnosia. Diagnostic 654
620 cases described. As in the previous table reporting criteria for developmental prosopagnosia have not 655
621 object agnosia, for each patient, each box corre- been discussed until recently (Barton & Corrow, 656
Au
622 sponds to a cerebral area (Temporal lobe, Parietal 2016; Dalrymple & Palermo, 2016), and therefore, 657
623 lobe, Occipital lobe, Frontal lobe, Corpus Callosum, the inclusion criteria for the selected studies are not 658
624 Basal Ganglia) of the right and left hemispheres. homogeneous. A control condition was planned for 659
625 The right hemisphere is always involved, particu- each of the three studies selected. All studies describe 660
626 larly at the level of the temporal lobe (temporal lobe perceptual treatments. The duration of the training 661
d
627 involvement is assumed in P2, Zihl et al., 2011). In ranged from two weeks of effective training (De Gutis 662
628 six cases, the lesion also extends to the occipital lobe. et al., 2007) to eleven weeks (Corrow et al., 2019). 663
cte
629 In four out of seven patients, the damage is bilateral, Improvement occurred in all the studies described. 664
630 while temporo-occipital involvement is confirmed in Follow-up was carried out in two of the three studies 665
631 three. (De Gutis et al., 2014; Corrow, Dalrymple & Barton, 666
2019) but showed maintenance of improvement only 667
632 3.3.1.3. Ratings of quality of reporting. In the case in one case (Corrow et al., 2019). 668
rre
633 of acquired prosopagnosia, quality of reporting was

634 assessed using the SCED and CASP scale, depend- 3.3.2.2. Ratings of quality of reporting. The quality 669
635 ing on whether the design was a single case or not. of reporting in developmental prosopagnosia studies 670
636 It follows that the results cannot be compared with was evaluated as high. However, as happened with 671
co
637 each other. A factor that emerges when using the object agnosia and acquired prosopagnosia, inter- 672
638 CASP scale (Davies-Thompson et al., 2017) is that rater reliability and independence of assessors were 673
639 in the item relating to the evaluation of potential con- not evaluated. Generalization but not replication, 674
640 founding factors in the design and/or the analyses, assessed using the SCED scale, was reported in De 675
Un
641 the response is “can’t tell”. This is reflected in the Gutis et al., 2014. However, it must also be noted that 676
642 SCED items with respect to the inter-rater reliability both Corrow et al. (2019) and DeGutis et al. (2014) 677
643 and independence of assessors, always resulting in adapt a paradigm that had been used previously to a 678
644 a “no”. As in the case of object agnosia, the items new population. In this sense, we can consider that 679
645 relating to replication and generalization gave mixed these two articles represent a replication of previous 680
646 results. Neither replication nor generalization was results. Even though this specific item is not present 681
647 reported in four studies (Polster & Rapcsak, 1996; De in the CASP scale, it is important to note that gen- 682
648 Haan et al., 1991; Francis, Riddoch & Humphreys, eralization was also marginally present in Corrow et 683
649 2002; Powell et al., 2008). Generalization, but not al. (2019) and present for untrained stimuli and task 684
16
Table 5
Developmental prosopagnosia studies
Authors SCED/ Selection criteria Control Condition Treatment description/ dependent Treatment Results of treatment Follow - up
De Gutis et al., SCED: 7 Impaired: Control group: 6 Perceptual treatment: face - first training: Improvement in RT and accuracy Effects faded
2007 - famous faces days of the same discrimination task on the basis of one week; of face discrimination; ERP after several
N = 1 (MZ) recognition training in spacing among internal components - 105 days N170 normally selective to faces weeks. N170
- tests of visual memory participants with Improvement: RT and accuracy in the interval; differently from lacked face
Un
for faces but not for normal face training task, neuropsychological tests, - second before-treatment; no changes in selectivity

words recognition ERP N170 component and fMRI training: 1 face-selective regions measured after 90 days.
- unfamiliar face matching Generalization: faces were changed week; by fMRIchanges in coherence However,
co
each day of training - unsupervised between OFA and FFA; re-learning
training for generalization to was faster.
140 more days neuropsychological tests and
Corrow et al.,
2019
CASP:8
of:
rre
Impaired in at least two Control task:
british television
Perceptual treatment: face matching
task (same as Davies-Thompson 2017)
11 weeks
everyday life
Improvement in perceptual
sensitivity for faces;
Effects
persisted for at
cte
N = 10 - difference between series of their Improvement: same six online generalization to new views and least three
memory for faces and choice assessment tests used for initial new expressions of the trained months.
words (WRMT1 ) characterization + neuropsychological faces; several subjects reported
d
- impaired performance in and neuroimaging assessment improvement in everyday life;
CMFT2 Generalization: to untrained view, and marginal generalization to new
- impaired performance in to untrained expression was evaluated faces; modest improvements in
ONFT3
- impaired score in a
famous face recognition Au
within the six assessment tests neuropsychological tests.
DeGutis, Cohan & CASP: 9

Nakayama, 2014
test
Impaired:
- face recognition (self
Control group:
waiting period of tho
Perceptual treatment: face
discrimination task on the basis of
3 week Improvement in tests of
front-view face matching and
No follow-up
rP
N = 24 reported) 15 days spacing among internal components holistic face processing,
- impaired performance in (same as De Gutis 2007) generalization to different stimuli
CMFT2 Improvement and generalization: and task formats but not to
roo
online assessment test battery involving different view-point rotations;
front-view face discrimination, face improvement in self-reported
discrimination from different face recognition
view-points, holistic face processing, self
f
reported everyday improvement in face
processing
1 Warrington Recognition Memory Test. 2 Cambridge Memory Faces Test. 3 Old/New Faces Test.
f
roo
rP
tho
Au
Fig. 1. PRISMA flow diagram: Overview of the steps of the literature search (Page et al., 2020).
685 formats, although not for untrained views in DeGutis the studies are taken into consideration in the discus- 707
et al. (2014). sion of findings.

d
686 708
cte
4.1. Object agnosia 709
687 4. Discussion
Different possible treatments for visual agnosia 710
688 The purpose of the present article was to review emerged from the selected articles. We divided them 711
689 systematically all rehabilitation studies present in into generic and specific treatments, where generic 712
rre
690 the literature, providing experimental evidence for refers to those rehabilitation interventions that were 713
691 current cognitive rehabilitation treatments for visual not primarily aimed at the recovery of object recogni- 714
692 object agnosia and prosopagnosia. In particular, we tion, targeting several cognitive functions, and those 715
693 aimed at providing useful information for authors are which are specific directly target a cognitive func- 716
co
694 willing to perform a cognitive rehabilitation of visual tion (see Table 2). Even though not primarily aimed 717
695 object agnosia and prosopagnosia. We achieved this at a recovery in visual agnosia, generic treatments 718
696 by focusing on original studies performed on adults reflected an improvement in object recognition. This 719
697 using quantitative methods to assess the deficit and result has clinical validity, but it is challenging to 720
Un
698 its improvement and by using an experimental pro- interpret in terms of generalization to other patients 721
699 cedure as a treatment. Moreover, the present study as they targeted multiple cognitive functions. Conse- 722
700 aimed to concentrate on the cognitive mechanisms quently, the improvement of visual agnosia could be 723
701 subserving object agnosia and prosopagnosia, cur- attributed to many indivisible uncontrolled factors. 724
702 rently discussed in the literature. The PRISMA As far as specific treatments are concerned, the 725
703 method was used, and seven articles were included for authors of the remaining articles attempted to solve 726
704 object agnosia, eight articles describing treatments visual object recognition deficits in many ways. 727
705 for prosopagnosia, and two articles for both deficits. Patients impaired in low-level visual functions were 728
706 The results produced from the quality of reporting of treated with basic visual perceptual tasks and cat- 729
730 egorization of simple visual stimuli showing an which makes it challenging to identify the neural 782
731 improvement in the specific task (Rosenthal & basis of the neuropsychological disorder. One feature 783
732 Behrmann, 2006), which extended to visual object that needs to be pointed out is that damage is bilateral 784
733 recognition (Lev et al., 2015) and was maintained and mainly in posterior regions. Furthermore, brain 785
734 over time. When both low- and high-level visual lesions were generally not described in detail, and, 786
735 impairments occur, it is difficult to isolate the sin- above all, the possible relationship between lesion 787
736 gle contribution of the specific deficits. However, it localization and cognitive symptoms was not dis- 788
737 is likely that treating low-level visual functions leads cussed. Finally, neuroimaging techniques were less 789
f
738 to improvement in higher visual processes, not only advanced at the time when the cases were reported. 790
roo
739 because it trains low-level functions themselves, but Nevertheless, the observed lack of interest in the 791
740 also because it may trigger plasticity at a higher cor- lesion data is likely to reflect a more general “cogni- 792
741 tical level (Ahissar & Hochstein, 2004). Humphreys tive” approach to rehabilitation, with a lack of interest 793
742 and Riddoch (1994) combined different approaches in the neural correlates of cognitive impairment. 794
743 to find that grouping, object recognition, and pattern Finally, a developmental form of object agnosia has 795
rP
744 identification led to an improvement specific only to also been described (Germine, Cashdollar, Düzel & 796
745 the trained items. Wilson (1999) focused on naming Duchaine, 2011). As it was found that treatments that 797
746 line drawings (Paula) and, in addition to copying and were useful for developmental prosopagnosia were 798
747 visually analyzing them (Jenny), finding an improve- also suitable for use in the acquired cases, we sus- 799
tho
748 ment in the trained items (Paula and Jenny) and a pect that the same treatment used for acquired object 800
749 generalization to other similar objects (Jenny). These agnosia would also work in such cases. However, as 801
750 results were maintained over time (Jenny). Behrmann the literature available on this topic or on rehabili- 802
751 et al. (2005) carried out a rehabilitation based on cat- tation attempts is limited, it is difficult to draw any 803
752 egorizing unknown stimuli (i.e., greebles) differing definite conclusion. 804
Au
753 from each other for their internal features, which was
754 effective and generalized to object recognition. Zihl 4.2. Prosopagnosia 805
755 in 2011 treated two visual agnosic patients through

756 a visual analysis of photographs of objects, which In the case of prosopagnosia, both acquired and 806
757 resulted in an improvement in the trained stimuli and developmental prosopagnosics were described. 807
in a generalization to objects. The treatments these In acquired prosopagnosics, the pattern of brain
d
758 808
759 two authors performed are very different. Behrmann lesions always involved the right hemisphere. There- 809
cte
760 et al. (2006) used unknown stimuli, while Zihl fore, according to the brain imaging data reported 810
761 (2011) used known objects. Behrmann performed in the present review, right hemisphere damage 811
762 a categorization task, while Zihl was more focused appears to be the condition necessary for devel- 812
763 on visual analysis. Nevertheless, both rehabilitation oping prosopagnosia, more specifically, a lesion 813
764 tasks require a visual analysis of the object parts, and encompassing the right occipitotemporal regions 814
rre
765 in one case (Zihl, 2011) this is explicit, while in the and presumably including the right fusiform gyrus. 815
766 other (Behrmann et al., 2005) this is functional to the Although acquired prosopoagnosia is associated with 816
767 categorization. Using spared analysis of the object lesions confined to the occipito-temporal regions of 817
768 parts to rehabilitate object recognition is consistent the right hemisphere (De Renzi et al., 1994), a left- 818
co
769 with a study by Behrmann et al. (2006) describing two handed prosopoagnosic patient with a lesion in the 819
770 patients. One patient (S.M.) who was the same inte- left occipital and face areas (Barton, 2008) has been 820
771 grative agnosic patient receiving the rehabilitation also documented. It should be acknowledged, how- 821
772 with Greeble stimuli, was more impaired in detect- ever, that this patient, in addition to visuoperceptive 822
Un
773 ing the spatial arrangement between object parts than problems, also presented difficulties in accessing 823
774 a change of a single part. Hence, it is likely that an semantic -autobiographical information conveyed by 824
775 analysis of object parts accounts for the success of a name, generally of left hemispheric competence. 825
776 treatment based on feature discrimination, provided The author therefore concluded that the disorder 826
777 that the parts are not too numerous (Behrmann & of this patient reflects an abnormal lateralization of 827
778 Williams, 2007). visuoperceptive functioning, rather than reversed lat- 828
779 Because the localization of the lesion is involved, eralization. Different possible treatments for both 829
780 the patients who were reported with object agnosia acquired and developmental prosopagnosia emerged 830
781 suffered from widespread and severe brain damage, from the selected articles. Therefore, we divided them 831
832 into mnemonic and perceptual treatments (following pensate for the deficit as it has been present since birth 884
833 the distinction from Davies-Thompson et al., 2017). (Behrmann & Avidan, 2005). Yet, perceptual treat- 885
834 An entirely perceptual treatment was administered ments seem to be effective in both cases, despite the 886
835 to all congenital prosopagnosic patients described prosopagnosia subtype. 887
836 in the papers examined, and in four of the stud- Another issue emerging from this review is that 888
837 ies on acquired prosopagnosic patients. It consisted perceptual treatments require face-like stimuli to be 889
838 of an analysis of visual features (Zihl, 2011), face effective. The only authors who used non-face-like 890
839 matching (Davies-Thompson et al., 2017; Corrow stimuli to train an acquired prosopagnosic observed 891
f
840 et al., 2019), face discrimination (De Gutis et al., a worsening of the patient’s performance with faces 892
roo
841 2007, 2014), and categorization non-face stimuli (Behrmann et al., 2005). A possible interpretation of 893
842 (Behrmann et al., 2005). Perceptual treatment was the results, according to the authors, is of compe- 894
843 found to be adequate, but only when using face-like tition between objects of expertise. As the authors 895
844 stimuli. Moreover, it generalized to new faces and explained, it might be that both face and greeble pro- 896
845 views only when discrimination or matching tasks cessing rely on common psychological and neural 897
rP
846 were applied. The analysis of single features was not systems and, once greebles are trained, these mech- 898
847 found to be effective. anisms become less tuned to faces (Behrmann et al., 899
848 A pure mnemonic treatment was applied in two 2005). In fact, it has been observed that objects of 900
849 studies on acquired prosopagnosics with a slight expertise trigger holistic processing similar to the pro- 901
tho
850 improvement in one case (Polster & Rapcsak, 1996) cessing of faces (Gauthier, Curran, Curby & Collins, 902
851 and a clear improvement in the other (Francis et al., 2003). Thus, in this study, it is likely that, as greebles 903
852 2002). However, the latter describes a patient with became objects of expertise, they triggered holistic 904
853 prevalent mnemonic rather than perceptual impair- processing, and this competed with the processing 905
854 ment. of faces. On the other hand, as the authors sug- 906
Au
855 Eventually, a combination and comparison of the gested, it could be that greebles were not adequate 907
856 two types of treatment were applied in two stud- to trigger holistic processing but triggered part-based 908
857 ies on acquired prosopagnosics (Polster & Rapcsak, processing. Thus, it might be that stimuli capable 909
858 1996; Powell et al., 2008). In one case, there was of triggering holistic processing, if used, would be 910
859 a marginal improvement after mnemonic/semantic equally effective compared to faces as a treatment 911
treatment which, however, did not generalize to new of prosopagnosia. However, it is still not clear what
d
860 912
861 views of faces (Polster & Rapcsak, 1996), while the these stimuli might be. 913
cte
862 other the prosopagnosic patient only benefited from a

863 perceptual analysis of the single parts (Powell et al.,
864 2008). 5. General discussion 914
865 In summary, perceptual treatments consisting of

866 discrimination or matching faces seem effective, Visual object agnosia and prosopagnosia are debil- 915
rre
867 while mnemonic treatment was effective in a patient itating cognitive deficits that can lead to life-changing 916
868 with evident mnemonic impairment (Francis et al., consequences (Riddoch & Humphreys, 1987). Yet, 917
869 2002). It must be considered that both acquired protocols involving their neuropsychological reha- 918
870 and developmental prosopagnosia can be mani- bilitation are missing, leaving such patients forced 919
co
871 fested through apperceptive, associative, or amnesic to live with their visual recognition impairment. This 920
872 deficits (Davies-Thompson, Pancaroglu & Barton, may be partially accounted for by the fact that cog- 921
873 2014). Thus, the efficacy of mnemonic or percep- nitive mechanisms on the basis of object and face 922
874 tual treatments inevitably depends on the nature of recognition are still not fully understood. This review 923
Un
875 prosopagnosia and the presence of associated deficits. was aimed at providing a critical discussion of the 924
876 Therefore, tests to understand prosopagnosia sub- cognitive mechanisms of face and object recognition. 925
877 types better are vital in order to address treatments Moreover, it aimed to guide clinicians dealing with 926
878 tailored to specific patients. agnosic patients and, at the same time, address future 927
879 An initial consideration addresses the fact that sim- research on the topic. Referring to recent reviews 928
880 ilar treatments were effective for both acquired and on the rehabilitation of agnosia or prosopagnosia 929
881 developmental prosopagnosics. People with develop- (Heutink et al., 2019; Bate & Bennets, 2014; De Gutis 930
882 mental prosopagnosia, different from patients with its et al., 2014), we performed a new review uniquely 931
883 acquired form, are likely to have found a way to com- selecting the original experimental studies on adults 932
933 on the rehabilitation of visual object agnosia and this light, we could also explain the competition that 985
934 prosopagnosia to obtain a comparison between the was observed between greebles and faces. It might 986
935 approaches towards these two deficits. be the case that greebles were never processed holis- 987
936 The definition of “associative agnosia” involves a tically, and thus their learning did not train the type 988
937 wide variety of deficits (Farah, 2004). It appears that of perceptual processing needed for faces. 989
938 treatments using semantic memory result in improve- On the other hand, Bukach et al. (2012) trained 990
939 ment in patients with an associative/semantic deficit an acquired prosopagnosic (L.R.) with greebles and 991
940 (e.g., De Haan et al., 1991; Wilson, 1999), while found that the patient could learn to classify them 992
f
941 perceptual training does not (De Haan et al., 1991). (Bukach et al., 2012). However, he needed more 993
roo
942 On the other hand, when the deficit is more pro- sessions than the controls, and the authors inter- 994
943 nounced for perceptual tests, perceptual treatments preted this result as an abnormal processing strategy. 995
944 are more effective (e.g., Powell et al., 2008). How- They concluded that his face recognition impair- 996
945 ever, as it is challenging to consider semantic and ment was derived from a more general difficulty with 997
946 mnemonic treatments of the agnosic deficit, and given object recognition. Both developmental and acquired 998
rP
947 the scarcity of the material, we did not focus on prosopagnosia are often reported in concomitance 999
948 semantic nor mnemonic treatments of both object with a more general object processing deficit (Geskin 1000
949 agnosia and prosopagnosia. & Berhmann, 2018), and patients with both acquired 1001
950 As far as perceptual treatments are concerned, the object agnosia and prosopagnosia were found to 1002
tho
951 first question that arises is regarding the differences share abnormal crowding (Strappini, Pelli, Di Pace 1003
952 between object and face processing. Understanding & Martelli, 2017; Sand, Robotham, Martelli & Star- 1004
953 mechanisms subserving these two processes could rfelt, 2018). Thus, a clear dissociation between the 1005
954 be fundamental to addressing specific treatments and two deficits and their respective rehabilitations were 1006
955 vice versa. Treatments could help patients and also rather difficult. Therefore, more rehabilitation studies 1007
Au
956 clarify the underlying cognitive mechanisms. are required. 1008
957 On one hand, there is still no agreement in the lit- Independently from the ongoing specificity- 1009
958 erature as to whether faces are stimuli on which we expertise debate, it appears from the present review 1010
959 are experts because of their relevance in our lives, that face and object recognition benefit from dif- 1011
960 or if they are stimuli that we process in a way that ferent types of training. Holistic training of face 1012
is always different and separate from other objects processing resulted in improved face recognition
d
961 1013
962 (Young & Burton, 2018). If the former interpreta- abilities (DeGutis et al., 2007; DeGutis et al.; 1014
cte
963 tion is true, as expertise with faces results from our Davies-Thompson et al., 2017; Corrow et al., 2019). 1015
964 exposure to faces in our lifetime, we would expect Moreover, it seems that eyes, eyebrows, and to a lesser 1016
965 a prosopagnosic to have trouble learning to dis- extent the mouth, are the most important regions 1017
966 criminate exemplars belonging to any new category for face discrimination, and that prosopagnosics rely 1018
967 for which he/she acquires expertise. This was not quantitatively less on them with respect to poor rec- 1019
rre
968 observed in the study by Duchaine et al. (2004) where ognizers (Tardif et al., 2019). This can be attributed 1020
969 a severe prosopagnosic learned to recognize greebles to the fact that the eyes themselves and the mouth 1021
970 within ten sessions (Duchaine, Dingle, Butterworth to a lesser extent represent configurations (Caldara, 1022
971 & Nakayama, 2004). Schyns, Mayer, Smith, Gosselin & Rossion, 2005; 1023
co
972 The same happened with two acquired prosopag- DeGutis, Cohan, Mercado, Wilmer & Nakayama, 1024
973 nosics in a study by Rezlescu et al. (2014) that 2012). Conversely, object recognition seems to ben- 1025
974 showed improved greebles but not face learning efit from part-based training (Behrmann et al., 2005; 1026
975 (Rezlescu, Barton, Pitcher & Duchaine, 2014). While Zihl, 2011). An exception to this distinction is repre- 1027
Un
976 Rezlescu et al. (2014) interpreted their results in terms sented by the study of Powell et al. (2008). 1028
977 of domain specificity hypothesis, Duchaine et al. While analyzing the articles used in this review, 1029
978 (2004) maintained that greebles did not elicit exper- it became clear that there are several aspects to 1030
979 tise, and the improvement of the patient could be consider in planning future rehabilitative studies on 1031
980 explained by using intact object-recognition mech- visual object agnosia and prosopagnosia to guide 1032
981 anisms. This interpretation is consistent with the researchers and clinicians. Firstly, the lack of a 1033
982 results of Behrmann et al. (2005). Their patient unitary account that explains the deficits reflects 1034
983 (S.M.) learned to classify greebles, which reflected a variegated clinical assessment. Patients are often 1035
984 an improvement in object recognition mechanisms. In described from an anecdotal point of view or through 1036
1037 qualitative observations. We believe that it is vital the condition of peripheral vision. Peripheral vision 1089
1038 to assess visual recognition impairment systemati- of complex images is constrained by the phenomenon 1090
1039 cally. We believe it is crucial for an assessment to of visual crowding, defined by the authors as “the fail- 1091
1040 take into account low-level visual disturbances to ure to identify a simple object (like a letter) because 1092
1041 exclude the possibility that the recognition deficit is of surrounding clutter.” The authors hypothesize that 1093
1042 secondary to peripheral visual deficits (Bauer, 2006) crowding drives object recognition difficulties in a 1094
1043 or low and middle vision deficits. Only at that point domain-general fashion. We believe that confronting 1095
1044 can a specific and detailed assessment of visual object classic and emerging theories on visual object agnosia 1096
f
1045 agnosia and prosopagnosia be carried out (e.g., Rid- and prosopagnosia by implementing different assess- 1097
roo
1046 doch & Humphreys, 1993; Vancleef et al., 2015; ment tools and rehabilitation programs may shed light 1098
1047 Warrington & James, 1991). As far as prosopagnosia on the mechanisms underlying this deficit that are still 1099
1048 is concerned, object recognition capacity must be being debated. 1100
1049 evaluated. This could allow us to observe whether In conclusion, two typologies of treatments spe- 1101
1050 some treatments are more effective in patients show- cific for object agnosia were effective. One involved 1102
rP
1051 ing both deficits with respect to only prosopagnosic categorization of greebles (based on their parts) while 1103
1052 patients. An additional consideration that needs to be the other a part-based analysis of objects. Thus, it 1104
1053 made on neuropsychological assessment is the urge to appears that a task that involves an analysis of object 1105
1054 specify whether patients suffer from an apperceptive parts might be the best choice in the rehabilitation of 1106
tho
1055 or an associative deficit. In the studies reviewed here, object agnosia. As far as apperceptive prosopagnosia 1107
1056 due to the hetherogeneity of evaluations, this distinc- is concerned, treatments involving holistic percep- 1108
1057 tion could not be made. We believe it could be crucial tual processing (categorization or matching) of faces 1109
1058 for readers to know which rehabilitation worked on seem to be the most effective and can be generalized 1110
1059 which specific subsample of patients. Moreover, it is to new views and perspectives of faces. Therefore, 1111
Au
1060 important to find a condition that serves as a con- it seems that a holistic analysis of face-like stim- 1112
1061 trol, otherwise it becomes difficult to know whether uli is effective for both acquired and developmental 1113
1062 the improvement was due to spontaneous recovery or prosopagnosia. However, the literature on object 1114
1063 rehabilitation. agnosia and prosopagnosia rehabilitation is still lim- 1115
1064 Another issue that should be considered is general- ited and new studies addressing the topic are required. 1116
ization. The aim of neuropsychological rehabilitation

d
1065
1066 should be that the patient improves not only in the

cte
1067 trained tasks but also in extending the improvement to Supplementary material 1117
1068 other tasks (Humphreys & Riddoch, 1994) and, ulti-
1069 mately, to everyday life. Consequently, it is essential The supplementary material is available in the 1118
1070 to assess the patient’s generalization and daily func- electronic version of this article: http://dx.doi.org/ 1119
1071 tioning to assess the efficacy of the treatment and, 10.3233/RNN-211234
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1120
1072 for the same reason, it is crucial to plan a follow-
1073 up evaluation and determine whether the progress is
1074 maintained over time.
1075 As emerged from the current literature analysis, References 1121
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Restorative Neurology and Neuroscience xx (20xx) x–xx 1

1 The rehabilitation of object agnosia and

29 1. Introduction Riddoch and Humphreys (1987) developed a model 36

distinguishing apperceptive and associative forms of 37

34 preserved (Farah, 2004; Zihl & Kennard, 2003). perception. 42

ISSN 0922-6028/$35.00 © 2022 – IOS Press. All rights reserved.

46 1.1. Object agnosia of the stored knowledge of objects. Many standard- 97

ized tests evaluate such different object recognition 98

49 Riddoch, 1993; Moscovitch, Wincour & Behrmann,

51 in the apperceptive and its associative forms (Rid-

151 bini, 2000), as well as the existence of the ERP N170

154 & McCarthy,1996; Rossion et al., 2000; Carmel

262 developmental prosopagnosia, discussing evidence restorative treatments. 314

280 be used in conducting their studies. In order to do so,

283 cognitive rehabilitation of visual object agnosia and

284 prosopagnosia. In referring to “experimental stud- 2.1. Search strategy 333

285 ies”, we mean those using quantitative methods to

higher the quality of reporting. It must be noted that, 409

363 providing empirical evidence for cognitive rehabilita- 2020). 413

364 tion of visual agnosia and prosopagnosia; b) studies

367 we expected the literature to be too scarce only

(ROBIS) scale (Whiting et al., 2016). The ROBIS

reading difficulties; e) if the studies described the risk of bias”. 422

376 treatment of peripheral visual dysfunction, cortical

377 blindness or visual field deficits; f) if non-cognitive

379 diseases were treated; h) unpublished data; i) if com-

392 provide the necessary data.

bilateral posterior cortical damage in the watershed 478

& Behrmann, 2006; Wilson, 1999) explicitly assessed 488

Right hemisphere Left hemisphere Etiology

S. Gobbo et al. / Rehabilitating agnosias: A systematic review

Un - color parallel search; Generalization: not assessed. treatment.

S. Gobbo et al. / Rehabilitating agnosias: A systematic review

S. Gobbo et al. / Rehabilitating agnosias: A systematic review

S. Gobbo et al. / Rehabilitating agnosias: A systematic review

- Warrington and Taylor’s

521 (Zihl, 2011), and labelling of drawings for the two

534 the remaining four patients (36%) (Lev et al., 2015;

condition was included in four (57%) studies (Davies- 596

Un Impaired: learning of identity-specific

S. Gobbo et al. / Rehabilitating agnosias: A systematic review

Un Famous faces identification measured through accuracy sessions over a others

S. Gobbo et al. / Rehabilitating agnosias: A systematic review

cte face sets as the

fMRI acquisition pre- and

Un - DS10 ; persisted in P1 for of visual features sessions). gender and discrimination.

S. Gobbo et al. / Rehabilitating agnosias: A systematic review

2019) but showed maintenance of improvement only 667

633 of acquired prosopagnosia, quality of reporting was

S. Gobbo et al. / Rehabilitating agnosias: A systematic review

DeGutis, Cohan & CASP: 9

et al. (2014). sion of findings.

4.1. Object agnosia 709

755 in 2011 treated two visual agnosic patients through

835 to all congenital prosopagnosic patients described prosopagnosia subtype. 887

862 other the prosopagnosic patient only benefited from a

865 In summary, perceptual treatments consisting of

1048 is concerned, object recognition capacity must be being debated. 1100

1063 rehabilitation. agnosia and prosopagnosia rehabilitation is still lim- 1115

ization. The aim of neuropsychological rehabilitation

1066 should be that the patient improves not only in the

1298 Neuropsychological Rehabilitation, 29(10), 1489-1508. 105906. 1357

1417 Visual crowding in pure alexia and acquired prosopagnosia.