Cardiac-Sympathetic Contractility and Neural Alpha-Band Power: Cross-Modal Collaboration during Approach-Avoidance Conflict.

As evidence mounts that the cardiac-sympathetic nervous system reacts to challenging cognitive settings, we ask if these responses are epiphenomenal companions or if there is evidence suggesting a more intertwined role of this system with cognitive function. Healthy male and female human participants performed an approach-avoidance paradigm, trading off monetary reward for painful electric shock, while we recorded simultaneous electroencephalographic and cardiac-sympathetic signals. Participants were reward sensitive but also experienced approach-avoidance "conflict" when the subjective appeal of the reward was near equivalent to the revulsion of the cost. Drift-diffusion model parameters suggested that participants managed conflict in part by integrating larger volumes of evidence into choices (wider decision boundaries). Late alpha-band (neural) dynamics were consistent with widening decision boundaries serving to combat reward sensitivity and spread attention more fairly to all dimensions of available information. Independently, wider boundaries were also associated with cardiac "contractility" (an index of sympathetically mediated positive inotropy). We also saw evidence of conflict-specific "collaboration" between the neural and cardiac-sympathetic signals. In states of high conflict, the alignment (i.e., product) of alpha dynamics and contractility were associated with a further widening of the boundary, independent of either signal's singular association. Cross-trial coherence analyses provided additional evidence that the autonomic systems controlling cardiac-sympathetics might influence the assessment of information streams during conflict by disrupting or overriding reward processing. We conclude that cardiac-sympathetic control might play a critical role, in collaboration with cognitive processes, during the approach-avoidance conflict in humans.

The dissociating effects of fear and disgust on multisensory integration in autism: evidence from evoked potentials.

Background: Deficits in Multisensory Integration (MSI) in ASD have been reported repeatedly and have been suggested to be caused by altered long-range connectivity. Here we investigate behavioral and ERP correlates of MSI in ASD using ecologically valid videos of emotional expressions. Methods: In the present study, we set out to investigate the electrophysiological correlates of audiovisual MSI in young autistic and neurotypical adolescents. We employed dynamic stimuli of high ecological validity (500 ms clips produced by actors) that depicted fear or disgust in unimodal (visual and auditory), and bimodal (audiovisual) conditions. Results: We report robust MSI effects at both the behavioral and electrophysiological levels and pronounced differences between autistic and neurotypical participants. Specifically, neurotypical controls showed robust behavioral MSI for both emotions as seen through a significant speed-up of bimodal response time (RT), confirmed by Miller's Race Model Inequality (RMI), with greater MSI effects for fear than disgust. Adolescents with ASD, by contrast, showed behavioral MSI only for fear. At the electrophysiological level, the bimodal condition as compared to the unimodal conditions reduced the amplitudes of the visual P100 and auditory P200 and increased the amplitude of the visual N170 regardless of group. Furthermore, a cluster-based analysis across all electrodes revealed that adolescents with ASD showed an overall delayed and spatially constrained MSI effect compared to controls. Conclusion: Given that the variables we measured reflect attention, our findings suggest that MSI can be modulated by the differential effects on attention that fear and disgust produce. We also argue that the MSI deficits seen in autistic individuals can be compensated for at later processing stages by (a) the attention-orienting effects of fear, at the behavioral level, and (b) at the electrophysiological level via increased attentional effort.

Menstrual cycle-driven hormone concentrations co-fluctuate with white and gray matter architecture changes across the whole brain.

Cyclic fluctuations in hypothalamic-pituitary-gonadal axis (HPG-axis) hormones exert powerful behavioral, structural, and functional effects through actions on the mammalian central nervous system. Yet, very little is known about how these fluctuations alter the structural nodes and information highways of the human brain. In a study of 30 naturally cycling women, we employed multidimensional diffusion and T1-weighted imaging during three estimated menstrual cycle phases (menses, ovulation, and mid-luteal) to investigate whether HPG-axis hormone concentrations co-fluctuate with alterations in white matter (WM) microstructure, cortical thickness (CT), and brain volume. Across the whole brain, 17ß-estradiol and luteinizing hormone (LH) concentrations were directly proportional to diffusion anisotropy (µFA; 17ß-estradiol: ß1 = 0.145, highest density interval (HDI) = [0.211, 0.4]; LH: ß1 = 0.111, HDI = [0.157, 0.364]), while follicle-stimulating hormone (FSH) was directly proportional to CT (ß1 = 0 .162, HDI = [0.115, 0.678]). Within several individual regions, FSH and progesterone demonstrated opposing relationships with mean diffusivity (Diso) and CT. These regions mainly reside within the temporal and occipital lobes, with functional implications for the limbic and visual systems. Finally, progesterone was associated with increased tissue (ß1 = 0.66, HDI = [0.607, 15.845]) and decreased cerebrospinal fluid (CSF; ß1 = -0.749, HDI = [-11.604, -0.903]) volumes, with total brain volume remaining unchanged. These results are the first to report simultaneous brain-wide changes in human WM microstructure and CT coinciding with menstrual cycle-driven hormone rhythms. Effects were observed in both classically known HPG-axis receptor-dense regions (medial temporal lobe, prefrontal cortex) and in other regions located across frontal, occipital, temporal, and parietal lobes. Our results suggest that HPG-axis hormone fluctuations may have significant structural impacts across the entire brain.

Reorganization of sensorimotor representations of the intact limb after upper but not lower limb traumatic amputation.

It is becoming increasingly clear that limb loss induces wider spread reorganization of representations of the body that are nonadjacent to the affected cortical territory. Data from upper extremity amputees reveal intrusion of the representation of the ipsilateral intact limb into the former hand territory. Here we test for the first time whether this reorganization of the intact limb into the deprived cortex is specific to the neurological organization of the upper limbs or reflects large scale adaptation that is triggered by any unilateral amputation. BOLD activity was measured as human subjects with upper limb and lower limb traumatic amputation and their controls moved the toes on each foot, open and closed each hand and pursed their lips. Subjects with amputation were asked to imagine moving the missing limb while remaining still. Bayesian pattern component modeling of fMRI data showed that intact ipsilateral movements and contralateral movements of the hand and foot were distinctly represented in the deprived sensorimotor cortex years after upper limb amputation. In contrast, there was evidence reminiscent of contralateral specificity for hand and foot movements following lower limb amputation, like that seen in controls. We propose the cortical reorganization of the intact limb to be a function of use-dependent plasticity that is more specific to the consequence of upper limb loss of forcing an asymmetric reliance on the intact hand and arm. The contribution of this reorganization to phantom pain or a heightened risk of overuse and resultant maladaptive plasticity needs investigating before targeting such reorganization in intervention.

Decision heuristics in contexts integrating action selection and execution.

Heuristics can inform human decision making in complex environments through a reduction of computational requirements (accuracy-resource trade-off) and a robustness to overparameterisation (less-is-more). However, tasks capturing the efficiency of heuristics typically ignore action proficiency in determining rewards. The requisite movement parameterisation in sensorimotor control questions whether heuristics preserve efficiency when actions are nontrivial. We developed a novel action selection-execution task requiring joint optimisation of action selection and spatio-temporal skillful execution. State-appropriate choices could be determined by a simple spatial heuristic, or by more complex planning. Computational models of action selection parsimoniously distinguished human participants who adopted the heuristic from those using a more complex planning strategy. Broader comparative analyses then revealed that participants using the heuristic showed combined decisional (selection) and skill (execution) advantages, consistent with a less-is-more framework. In addition, the skill advantage of the heuristic group was predominantly in the core spatial features that also shaped their decision policy, evidence that the dimensions of information guiding action selection might be yoked to salient features in skill learning.

Contingent negative variation to tactile stimuli - differences in anticipatory and preparatory processes between participants with and without blindness.

People who are blind demonstrate remarkable abilities within the spared senses and compensatory enhancement of cognitive skills, underscored by substantial plastic reorganization in relevant neural areas. However, little is known about whether people with blindness form top-down models of the world on short timescales more efficiently to guide goal-oriented behavior. This electroencephalography study investigates this hypothesis at the neurophysiological level, focusing on contingent negative variation (CNV) as a marker of anticipatory and preparatory processes prior to expected events. In sum, 20 participants with blindness and 27 sighted participants completed a classic CNV task and a memory CNV task, both containing tactile stimuli to exploit the expertise of the former group. Although the reaction times in the classic CNV task did not differ between groups, participants who are blind reached higher performance rates in the memory task. This superior performance co-occurred with a distinct neurophysiological profile, relative to controls: greater late CNV amplitudes over central areas, suggesting enhanced stimulus expectancy and motor preparation prior to key events. Controls, in contrast, recruited more frontal sites, consistent with inefficient sensory-aligned control. We conclude that in more demanding cognitive contexts exploiting the spared senses, people with blindness efficiently generate task-relevant internal models to facilitate behavior.

Hand choice is unaffected by high frequency continuous theta burst transcranial magnetic stimulation to the posterior parietal cortex.

The current study used a high frequency TMS protocol known as continuous theta burst stimulation (cTBS) to test a model of hand choice that relies on competing interactions between the hemispheres of the posterior parietal cortex. Based on the assumption that cTBS reduces cortical excitability, the model predicts a significant decrease in the likelihood of selecting the hand contralateral to stimulation. An established behavioural paradigm was used to estimate hand choice in each individual, and these measures were compared across three stimulation conditions: cTBS to the left posterior parietal cortex, cTBS to the right posterior parietal cortex, or sham cTBS. Our results provide no supporting evidence for the interhemispheric competition model. We find no effects of cTBS on hand choice, independent of whether the left or right posterior parietal cortex was stimulated. Our results are nonetheless of value as a point of comparison against prior brain stimulation findings that, in contrast, provide evidence for a causal role for the posterior parietal cortex in hand choice.

Reinforcement learning with associative or discriminative generalization across states and actions: fMRI at 3 T and 7 T.

The model-free algorithms of "reinforcement learning" (RL) have gained clout across disciplines, but so too have model-based alternatives. The present study emphasizes other dimensions of this model space in consideration of associative or discriminative generalization across states and actions. This "generalized reinforcement learning" (GRL) model, a frugal extension of RL, parsimoniously retains the single reward-prediction error (RPE), but the scope of learning goes beyond the experienced state and action. Instead, the generalized RPE is efficiently relayed for bidirectional counterfactual updating of value estimates for other representations. Aided by structural information but as an implicit rather than explicit cognitive map, GRL provided the most precise account of human behavior and individual differences in a reversal-learning task with hierarchical structure that encouraged inverse generalization across both states and actions. Reflecting inference that could be true, false (i.e., overgeneralization), or absent (i.e., undergeneralization), state generalization distinguished those who learned well more so than action generalization. With high-resolution high-field fMRI targeting the dopaminergic midbrain, the GRL model's RPE signals (alongside value and decision signals) were localized within not only the striatum but also the substantia nigra and the ventral tegmental area, including specific effects of generalization that also extend to the hippocampus. Factoring in generalization as a multidimensional process in value-based learning, these findings shed light on complexities that, while challenging classic RL, can still be resolved within the bounds of its core computations.

What makes somatosensory short-term memory maintenance effective? An EEG study comparing contralateral delay activity between sighted participants and participants who are blind.

Somatosensory short-term memory is essential for object recognition, sensorimotor learning, and, especially, Braille reading for people who are blind. This study examined how visual sensory deprivation and a compensatory focus on somatosensory information influences memory processes in this domain. We measured slow cortical negativity developing during short-term tactile memory maintenance (tactile contralateral delay activity, tCDA) in frontal and somatosensory areas while a sample of 24 sighted participants and 22 participants who are blind completed a tactile change-detection task where varying loads of Braille pin patterns served as stimuli. Auditory cues, appearing at varying latencies between sample arrays, could be used to reduce memory demands during maintenance. Participants who are blind (trained Braille readers) outperformed sighted participants behaviorally. In addition, while task-related frontal activation featured in both groups, participants who are blind uniquely showed higher tCDA amplitudes specifically over somatosensory areas. The site specificity of this component's functional relevance in short-term memory maintenance was further supported by somatosensory tCDA amplitudes first correlating across the whole sample with behavioral performance, and secondly showing sensitivity to varying memory load. The results substantiate sensory recruitment models and provide new insights into the effects of visual sensory deprivation on tactile processing. Between-group differences in the interplay between frontal and somatosensory areas during somatosensory maintenance also suggest that efficient maintenance of complex tactile stimuli in short-term memory is primarily facilitated by lateralized activity in somatosensory cortex.

Spatial Binding Impairments in Visual Working Memory following Temporal Lobectomy.

Disorders of the medial temporal lobe (MTL) adversely affect visual working memory (vWM) performance, including feature binding. It is unclear whether these impairments generalize across visual dimensions or are specifically spatial. To address this issue, we compared performance in two tasks of 13 epilepsy patients, who had undergone a temporal lobectomy, and 15 healthy controls. In the vWM task, participants recalled the color of one of two polygons, previously displayed side by side. At recall, a location or shape probe identified the target. In the perceptual task, participants estimated the centroid of three visible disks. Patients recalled the target color less accurately than healthy controls because they frequently swapped the nontarget with the target color. Moreover, healthy controls and right temporal lobectomy patients made more swap errors following shape than space probes. Left temporal lobectomy patients, showed the opposite pattern of errors instead. Patients and controls performed similarly in the perceptual task. We conclude that left MTL damage impairs spatial binding in vWM, and that this impairment does not reflect a perceptual or attentional deficit.

Habituation of the stress response multiplex to repeated cold pressor exposure.

Humans show remarkable habituation to aversive events as reflected by changes of both subjective report and objective measures of stress. Although much experimental human research focuses on the effects of stress, relatively little is known about the cascade of physiological and neural responses that contribute to stress habituation. The cold pressor test (CPT) is a common method for inducing acute stress in human participants in the laboratory; however, there are gaps in our understanding of the global state changes resulting from this stress-induction technique and how these responses change over multiple exposures. Here, we measure the stress response to repeated CPT exposures using an extensive suite of physiologic measures and state-of-the-art analysis techniques. In two separate sessions on different days, participants underwent five 90 s CPT exposures of both feet and five warm water control exposures, while electrocardiography (ECG), impedance cardiography, continuous blood pressure, pupillometry, scalp electroencephalography (EEG), salivary cortisol and self-reported pain assessments were recorded. A diverse array of adaptive responses are reported that vary in their temporal dynamics within each exposure as well as habituation across repeated exposures. During cold-water exposure there was a cascade of changes across several cardiovascular measures (elevated heart rate (HR), cardiac output (CO) and Mean Arterial Pressure (MAP) and reduced left ventricular ejection time (LVET), stroke volume (SV) and high-frequency heart rate variability (HF)). Increased pupil dilation was observed, as was increased power in low-frequency bands (delta and theta) across frontal EEG electrode sites. Several cardiovascular measures also habituated over repeated cold-water exposures (HR, MAP, CO, SV, LVET) as did pupil dilation and alpha frequency activity across the scalp. Anticipation of cold water induced stress effects in the time-period immediately prior to exposure, indexed by increased pupil size and cortical disinhibition in the alpha and beta frequency bands across central scalp sites. These results provide comprehensive insight into the evolution of a diverse array of stress responses to an acute noxious stressor, and how these responses adaptively contribute to stress habituation.

Ventromedial Prefrontal Cortex Activity and Sympathetic Allostasis During Value-Based Ambivalence.

Anxiety is characterized by low confidence in daily decisions, coupled with high levels of phenomenological stress. Ventromedial prefrontal cortex (vmPFC) plays an integral role in maladaptive anxious behaviors via decreased sensitivity to threatening vs. non-threatening stimuli (fear generalization). vmPFC is also a key node in approach-avoidance decision making requiring two-dimensional integration of rewards and costs. More recently, vmPFC has been implicated as a key cortical input to the sympathetic branch of the autonomic nervous system. However, little is known about the role of this brain region in mediating rapid stress responses elicited by changes in confidence during decision making. We used an approach-avoidance task to examine the relationship between sympathetically mediated cardiac stress responses, vmPFC activity and choice behavior over long and short time-scales. To do this, we collected concurrent fMRI, EKG and impedance cardiography recordings of sympathetic drive while participants made approach-avoidance decisions about monetary rewards paired with painful electric shock stimuli. We observe first that increased sympathetic drive (shorter pre-ejection period) in states lasting minutes are associated with choices involving reduced decision ambivalence. Thus, on this slow time scale, sympathetic drive serves as a proxy for "mobilization" whereby participants are more likely to show consistent value-action mapping. In parallel, imaging analyses reveal that on shorter time scales (estimated with a trial-to-trial GLM), increased vmPFC activity, particularly during low-ambivalence decisions, is associated with decreased sympathetic state. Our findings support a role of sympathetic drive in resolving decision ambivalence across long time horizons and suggest a potential role of vmPFC in modulating this response on a moment-to-moment basis.

Late attentional processes potentially compensate for early perceptual multisensory integration deficits in children with autism: evidence from evoked potentials.

Sensory processing deficits and altered long-range connectivity putatively underlie Multisensory Integration (MSI) deficits in Autism Spectrum Disorder (ASD). The present study set out to investigate non-social MSI stimuli and their electrophysiological correlates in young neurotypical adolescents and adolescents with ASD. We report robust MSI effects at behavioural and electrophysiological levels. Both groups demonstrated normal behavioural MSI. However, at the neurophysiological level, the ASD group showed less MSI-related reduction of the visual P100 latency, greater MSI-related slowing of the auditory P200 and an overall temporally delayed and spatially constrained onset of MSI. Given the task design and patient sample, and the age of our participants, we argue that electro-cortical indices of MSI deficits in ASD: (a) can be detected in early-adolescent ASD, (b) occur at early stages of perceptual processing, (c) can possibly be compensated by later attentional processes, (d) thus leading to normal MSI at the behavioural level.

Sympathetic involvement in time-constrained sequential foraging.

Appraising sequential offers relative to an unknown future opportunity and a time cost requires an optimization policy that draws on a learned estimate of an environment's richness. Converging evidence points to a learning asymmetry, whereby estimates of this richness update with a bias toward integrating positive information. We replicate this bias in a sequential foraging (prey selection) task and probe associated activation within the sympathetic branch of the autonomic system, using trial-by-trial measures of simultaneously recorded cardiac autonomic physiology. We reveal a unique adaptive role for the sympathetic branch in learning. It was specifically associated with adaptation to a deteriorating environment: it correlated with both the rate of negative information integration in belief estimates and downward changes in moment-to-moment environmental richness, and was predictive of optimal performance on the task. The findings are consistent with a framework whereby autonomic function supports the learning demands of prey selection.

Early sensitivity of evoked potentials to surface and volumetric structure during the visual perception of three-dimensional object shape.

This study used event-related potentials (ERPs) to elucidate how the human visual system processes three-dimensional (3-D) object shape structure. In particular, we examined whether the perceptual mechanisms that support the analysis of 3-D shape are differentially sensitive to higher order surface and volumetric part structure. Observers performed a whole-part novel object matching task in which part stimuli comprised sub-regions of closed edge contour, surfaces or volumetric parts. Behavioural response latency data showed an advantage in matching surfaces and volumetric parts to whole objects over contours, but no difference between surfaces and volumes. ERPs were analysed using a convergence of approaches based on stimulus dependent amplitude modulations of evoked potentials, topographic segmentation, and spatial frequency oscillations. The results showed early differential perceptual processing of contours, surfaces, and volumetric part stimuli. This was first reliably observed over occipitoparietal electrodes during the N1 (140-200 ms) with a mean peak latency of 170 ms, and continued on subsequent P2 (220-260 ms) and N2 (260-320 ms) components. The differential sensitivity in perceptual processing during the N1 was accompanied by distinct microstate patterns that distinguished among contours, surfaces and volumes, and predominant theta band activity around 4-7 Hz over right occipitoparietal and orbitofrontal sites. These results provide the first evidence of early differential perceptual processing of higher order surface and volumetric shape structure within the first 200 ms of stimulus processing. The findings challenge theoretical models of object recognition that do not attribute functional significance to surface and volumetric object structure during visual perception.

Electro-cortical correlates of multisensory integration using ecologically valid emotional stimuli: Differential effects for fear and disgust.

Multisensory integration (MSI) is crucial for human communication and social interaction and has been investigated in healthy populations and neurodevelopmental disorders. However, the use of stimuli with high ecological validity is sparse, especially in event-related potential (ERP) studies. The present study examined the ERP correlates of MSI in healthy adults using short (500 ms) ecologically valid professional actor-produced emotions of fear or disgust as vocal exclamation or facial expression (unimodal conditions) or both (bimodal condition). Behaviourally, our results show a general visual dominance effect (similarly fast responses following bimodal and visual stimuli) and an MSI-related speedup of responses only for fear. Electrophysiologically, both P100 and N170 showed MSI-related amplitude increases only following fear, but not disgust stimuli. Our results show for the first time that the known differential neural processing of fear and disgust also holds for the integration of dynamic auditory and visual information.

Now and then: Hand choice is influenced by recent action history.

Action choices are influenced by recent past and predicted future action states. Here, we demonstrate that recent hand-choice history affects both current hand choices and response times to initiate actions. Participants reach to contact visible targets using one hand. Hand choice is biased in favour of which hand was used recently, in particular, when the biomechanical costs of responding with either hand are similar, and repeated choices lead to reduced response times. These effects are also found to positively correlate. Participants who show strong effects of recent history on hand choice also tend to show strong effects of recent history on response times. The data are consistent with a computational efficiency interpretation whereby repeated action choices confer computational gains in the efficiency of underpinning processes. We discuss our results within the framework of this model, and with respect to balancing predicted gains and losses, and speculate about the possible underlying mechanisms in neural terms.

The neural basis of hand choice: An fMRI investigation of the Posterior Parietal Interhemispheric Competition model.

The current study investigates a new neurobiological model of human hand choice: The Posterior Parietal Interhemispheric Competition (PPIC) model. The model specifies that neural populations in bilateral posterior intraparietal and superior parietal cortex (pIP-SPC) encode actions in hand-specific terms, and compete for selection across and within hemispheres. Actions with both hands are encoded bilaterally, but the contralateral hand is overrepresented. We use a novel fMRI paradigm to test the PPIC model. Participants reach to visible targets while in the scanner, and conditions involving free choice of which hand to use (Choice) are compared with when hand-use is instructed. Consistent with the PPIC model, bilateral pIP-SPC is preferentially responsive for the Choice condition, and for actions made with the contralateral hand. In the right pIP-SPC, these effects include anterior intraparietal and superior parieto-occipital cortex. Left dorsal premotor cortex, and an area in the right lateral occipitotemporal cortex show the same response pattern, while the left inferior parietal lobule is preferentially responsive for the Choice condition and when using the ipsilateral hand. Behaviourally, hand choice is biased by target location - for targets near the left/right edges of the display, the hand in ipsilateral hemispace is favoured. Moreover, consistent with a competitive process, response times are prolonged for choices to more ambiguous targets, where hand choice is relatively unbiased, and fMRI responses in bilateral pIP-SPC parallel this pattern. Our data provide support for the PPIC model, and reveal a selective network of brain areas involved in free hand choice, including bilateral posterior parietal cortex, left-lateralized inferior parietal and dorsal premotor cortices, and the right lateral occipitotemporal cortex.

Effects of caffeine on reaction time are mediated by attentional rather than motor processes.

BACKGROUND: Caffeine has a well-established effect on reaction times (RTs) but the neurocognitive mechanisms underlying this are unclear. METHODS: In the present study, 15 female participants performed an oddball task after ingesting caffeine or a placebo, and electroencephalographic data were obtained. Single-trial P3b latencies locked to the stimulus and to the response were extracted and mediation models were fitted to the data to test whether caffeine's effect on RTs was mediated by its effect on either type of P3b latencies. RESULTS: Stimulus-locked latencies showed clear evidence of mediation, with approximately a third of the effect of caffeine on RTs running through the processes measured by stimulus-locked latencies. Caffeine did not affect response-locked latencies, so could not mediate the effect. DISCUSSION: These findings are consistent with caffeine's effect on RTs being a result of its effect on perceptual-attentional processes, rather than motor processes. The study is the first to apply mediation analysis to single-trial P3b data and this technique holds promise for mental chronometric studies into the effects of psychopharmacological agents. The R code for performing the single trial analysis and mediation analysis are included as supplementary materials.

Multisensory stimulation in hemianopic patients boosts orienting responses to the hemianopic field and reduces attentional resources to the intact field.

PURPOSE: Lateralised lesions can disrupt inhibitory cross-callosal fibres which maintain interhemispheric equilibrium in attention networks, with a consequent attentional bias towards the ipsilesional field. Some evidence of this imbalance has also been found in hemianopic patients (Tant et al., 2002). The aim of the present study was to reduce this attentional bias in hemianopic patients by using multisensory stimulation capable of activating subcortical structures responsible for orienting attention, such as the superior colliculus. METHODS: Eight hemianopic patients underwent a course of multisensory stimulation treatment for two weeks and their behavioural and electrophysiological performance was tested at three time intervals: baseline 1 (before treatment), control baseline 2 (two weeks after baseline 1 and immediately before treatment as a control for practice effects) and finally after treatment. RESULTS: The results show improvements on various clinical measures, on orienting responses in the hemianopic field, and a reduction of electrophysiological activity (P3 amplitude) in response to stimuli presented in the intact visual field. CONCLUSIONS: These results suggest that the primary visual deficit in hemianopic patients might be accompanied by an ipsilesional attentional bias which might be reduced by multisensory stimulation.