Rehabilitation of arithmetic fact retrieval via extensive practice: a combined fMRI and behavioural case-study.

The present study investigates the effects of a training of arithmetic fact retrieval in a patient suffering from particular difficulties with multiplication facts. Over a period of four weeks simple multiplication facts were trained extensively. The outcome of the training was assessed behaviourally and changes in cerebral activation patterns were investigated using fMRI. The training led to a change in calculation strategies: Prior to training, the patient used predominantly time-consuming back-up strategies, after training he relied increasingly on the direct retrieval of arithmetic facts from long-term memory. Regarding the fMRI results, prefrontal activations were observed for untrained problems, which can be attributed to the application of back-up strategies strongly relying on fronto-executive functions. Interestingly, significant foci of activation for both trained and untrained items were found in the angular gyrus of the right hemisphere, which, however, differed in their exact localisation. For the trained condition, activations were observed in anterior parts of the angular gyrus which may be related to the training-based automatisation in fact retrieval. Activations in the untrained condition were found in a more posterior portion of the angular gyrus, that might be attributable to one of the patient's back-up strategies, namely to recite a whole multiplication row to get to the correct answer.