Virtual Reality-Based Orienteering Training Improves Spatial Memory in College Students with Operationally Defined DTD-like Navigational Difficulties: fNIRS Correlates of Training-Related Cortical Adaptation

Background: Developmental topographical disorientation (DTD)-like navigational difficulties can impair everyday orientation and spatial information processing. Objective: We examined whether 8-week virtual reality (VR) orienteering training improves performance on a laboratory spatial memory task in college students with operationally defined DTD-like navigational difficulties and examined task-related cortical changes. Methods: In a randomized controlled trial, 96 students were assigned to VR orienteering, VR exercise, or control groups (n = 32/group). The exercise groups trained twice weekly for 45 min for 8 weeks at moderate intensity (64–76% HRmax). Before and after the intervention, all participants completed a delayed visuospatial recognition task designed to assess spatial-memory-related processing, while functional near-infrared spectroscopy measured hemodynamic changes in prefrontal and sensorimotor cortices. The post-test session was conducted 48 h after the final scheduled session, with no immediate post-exercise assessment. Results: VR orienteering produced greater improvement in spatial-memory-task accuracy and reaction time than the other groups. After BH-FDR correction across eight ROIs, training-specific reductions in task-related activation were observed in the right primary motor cortex and left frontopolar area. Within the VR orienteering group, pre-to-post change in left orbitofrontal activation was negatively associated with change in spatial-memory-task accuracy, Pearson r(30) = −0.819, 95% CI [−0.908, −0.658], p < 0.001, R2 = 0.670; the association remained significant after eight-ROI BH-FDR correction (adjusted p < 0.001). Conclusions: VR orienteering improved performance on the laboratory spatial memory task and was accompanied by reduced task-related cortical recruitment. Greater reductions in L-OFC activation were linked to greater improvements in accuracy, identifying L-OFC activation change as a neural correlate of training-related spatial-memory improvement.