Visual perceptual remediation for individuals with schizophrenia: Rationale, method, and three case studies.

OBJECTIVE: Few studies have evaluated the effects of visual remediation strategies in schizophrenia despite abundant evidence of visual-processing alterations in this condition. We report preliminary, case-study-based evidence regarding the effects of visual remediation in this population. METHOD: We describe implementation of a visual-perceptual training program called ULTIMEYES (UE) and initial results through 3 brief case studies of individuals with schizophrenia. UE targets broad-based visual function, including low-level processes (e.g., acuity, contrast sensitivity) as well as higher level visual functions. Three inpatients, recruited from a research unit, participated in at least 38 sessions 3 to 4 times per week for approximately 25 min per session. Contrast sensitivity (a trained task), as well as acuity and perceptual organization (untrained tasks), were assessed before and after the intervention. Levels of progression through the task are also reported. RESULTS: UE was well tolerated by the participants and led to improvements in contrast sensitivity, as well as more generalized gains in visual acuity in all 3 participants and perceptual organization in 2 participants. Symptom profiles were somewhat different for each participant, but all were symptomatic during the intervention. Despite this, they were able to focus on and benefit from training. The adaptive nature of the training was well suited to the slower progression of 2 participants. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These case studies set the stage for further research, such as larger, randomized controlled trials of the intervention that include additional assessments of perceptual function and measures of cognition, social cognition, and functional outcomes. (PsycINFO Database Record

The Benefits and Challenges of Implementing Motivational Features to Boost Cognitive Training Outcome.

In the current literature, there are a number of cognitive training studies that use N-back tasks as their training vehicle; however, the interventions are often bland, and many studies suffer from considerable attrition rates. An increasingly common approach to increase participant engagement has been the implementation of motivational features in training tasks; yet, the effects of such "gamification" on learning have been inconsistent. To shed more light on those issues, here, we report the results of a training study conducted at two Universities in Southern California. A total of 115 participants completed 4 weeks (20 sessions) of N-back training in the laboratory. We varied the amount of "gamification" and the motivational features that might make the training more engaging and, potentially, more effective. Thus, 47 participants trained on a basic color/identity N-back version with no motivational features, whereas 68 participants trained on a gamified version that translated the basic mechanics of the N-back task into an engaging 3D space-themed "collection" game (Deveau et al. Frontiers in Systems Neuroscience, 8, 243, 2015). Both versions used similar adaptive algorithms to increase the difficulty level as participants became more proficient. Participants' self-reports indicated that the group who trained on the gamified version enjoyed the intervention more than the group who trained on the non-gamified version. Furthermore, the participants who trained on the gamified version exerted more effort and also improved more during training. However, despite the differential training effects, there were no significant group differences in any of the outcome measures at post-test, suggesting that the inclusion of motivational features neither substantially benefited nor hurt broader learning. Overall, our findings provide guidelines for task implementation to optimally target participants' interest and engagement to promote learning, which may lead to broader adoption and adherence of cognitive training.

Applying perceptual learning to achieve practical changes in vision.

Research of visual perceptual learning has illuminated the flexibility of processing in the visual system and provides insights into therapeutic approaches to remediating some components of low vision. A key observation from research of perceptual learning is that effects of training are often highly specific to the attributes of the trained stimuli. This observation has been a blessing to basic research, providing important constraints to models of learning, but is a curse to translational research, which has the goal of creating therapies that generalize widely across visual tasks and stimuli. Here we suggest that the curse of specificity can be overcome by adopting a different experimental framework than is standard in the field. Namely, translational studies should integrate many approaches together and sacrifice mechanistic understanding to gain clinical relevance. To validate this argument, we review research from our lab and others, and also present new data, that together shows how perceptual learning on basic stimuli can lead to improvements on standard vision tests as well as real world vision use such as improved reading and even improved sports performance. Furthermore, we show evidence that this integrative approach to perceptual learning can ameliorate effects of presbyopia and provides promise to improve visual function for individuals suffering from low vision.

Broad-based visual benefits from training with an integrated perceptual-learning video game.

Perception is the window through which we understand all information about our environment, and therefore deficits in perception due to disease, injury, stroke or aging can have significant negative impacts on individuals' lives. Research in the field of perceptual learning has demonstrated that vision can be improved in both normally seeing and visually impaired individuals, however, a limitation of most perceptual learning approaches is their emphasis on isolating particular mechanisms. In the current study, we adopted an integrative approach where the goal is not to achieve highly specific learning but instead to achieve general improvements to vision. We combined multiple perceptual learning approaches that have individually contributed to increasing the speed, magnitude and generality of learning into a perceptual-learning based video-game. Our results demonstrate broad-based benefits of vision in a healthy adult population. Transfer from the game includes; improvements in acuity (measured with self-paced standard eye-charts), improvement along the full contrast sensitivity function, and improvements in peripheral acuity and contrast thresholds. The use of this type of this custom video game framework built up from psychophysical approaches takes advantage of the benefits found from video game training while maintaining a tight link to psychophysical designs that enable understanding of mechanisms of perceptual learning and has great potential both as a scientific tool and as therapy to help improve vision.

How to build better memory training games.

Can we create engaging training programs that improve working memory (WM) skills? While there are numerous procedures that attempt to do so, there is a great deal of controversy regarding their efficacy. Nonetheless, recent meta-analytic evidence shows consistent improvements across studies on lab-based tasks generalizing beyond the specific training effects (Au et al., 2014; Karbach and Verhaeghen, 2014), however, there is little research into how WM training aids participants in their daily life. Here we propose that incorporating design principles from the fields of Perceptual Learning (PL) and Computer Science might augment the efficacy of WM training, and ultimately lead to greater learning and transfer. In particular, the field of PL has identified numerous mechanisms (including attention, reinforcement, multisensory facilitation and multi-stimulus training) that promote brain plasticity. Also, computer science has made great progress in the scientific approach to game design that can be used to create engaging environments for learning. We suggest that approaches integrating knowledge across these fields may lead to a more effective WM interventions and better reflect real world conditions.

The therapeutic benefits of perceptual learning.

The modern field of perceptual learning addresses improvements of sensory and perceptual functioning in adult observers and provides powerful tools to ameliorate the effects of neurological conditions that involve a sensory or attentional deficit. While the sensory systems were once thought to be plastic only during early development, modern research demonstrates a great deal of plasticity in the adult brain. Here we discuss the value of perceptual learning as a method to improve sensory and attentional function, with a brief overview of the current approaches in the field, including how perceptual learning can be highly specific to the training set, and also how new training approaches can overcome this specificity and transfer learning effects to untrained tasks. We discuss these in the context of extant applications of perceptual learning as a treatment for neurological conditions and how new knowledge mechanisms (including attention, exposure based learning, reinforcement learning and multisensory facilitation) that allow or restrict learning in the visual system can lead to enhanced treatment approaches. We suggest new approaches that integrate multiple mechanisms of perceptual learning that promise greater learning and more generalization to real world conditions.