A self-training program for sensory substitution devices.

Sensory Substitution Devices (SSDs) convey visual information through audition or touch, targeting blind and visually impaired individuals. One bottleneck towards adopting SSDs in everyday life by blind users, is the constant dependency on sighted instructors throughout the learning process. Here, we present a proof-of-concept for the efficacy of an online self-training program developed for learning the basics of the EyeMusic visual-to-auditory SSD tested on sighted blindfolded participants. Additionally, aiming to identify the best training strategy to be later re-adapted for the blind, we compared multisensory vs. unisensory as well as perceptual vs. descriptive feedback approaches. To these aims, sighted participants performed identical SSD-stimuli identification tests before and after ~75 minutes of self-training on the EyeMusic algorithm. Participants were divided into five groups, differing by the feedback delivered during training: auditory-descriptive, audio-visual textual description, audio-visual perceptual simultaneous and interleaved, and a control group which had no training. At baseline, before any EyeMusic training, participants SSD objects' identification was significantly above chance, highlighting the algorithm's intuitiveness. Furthermore, self-training led to a significant improvement in accuracy between pre- and post-training tests in each of the four feedback groups versus control, though no significant difference emerged among those groups. Nonetheless, significant correlations between individual post-training success rates and various learning measures acquired during training, suggest a trend for an advantage of multisensory vs. unisensory feedback strategies, while no trend emerged for perceptual vs. descriptive strategies. The success at baseline strengthens the conclusion that cross-modal correspondences facilitate learning, given SSD algorithms are based on such correspondences. Additionally, and crucially, the results highlight the feasibility of self-training for the first stages of SSD learning, and suggest that for these initial stages, unisensory training, easily implemented also for blind and visually impaired individuals, may suffice. Together, these findings will potentially boost the use of SSDs for rehabilitation.

Tactile to visual number priming in the left intraparietal cortex of sighted Braille readers.

Numbers can be presented in different notations and sensory modalities. It is currently debated to what extent these formats overlap onto a single representation. We asked whether such an overlap exists between symbolic numbers represented in two sensory modalities: Arabic digits and Braille numbers. A unique group of sighted Braille readers underwent extensive Braille reading training and was tested in an fMRI repetition-suppression paradigm with tactile Braille digit primes and visual Arabic digit targets. Our results reveal cross-modal priming: compared to repetition of two different quantities (e.g., Braille "5" and Arabic "2"), repetition of the same quantity presented in two modalities (e.g., Braille "5" and Arabic "5") led to a reduction of activation in several sub-regions of the Intraparietal Sulcus (IPS), a key cortical region for magnitude processing. Thus, in sighted Braille readers, the representations of numbers read by sight and by touch overlap to a degree sufficient to cause repetition suppression. This effect was modulated by the numerical prime-probe distance. Altogether this indicates that the left parietal cortex hosts neural assemblies that are sensitive to numerical information from different notations (number words or Arabic digits) and modalities (tactile and visual).

Visual-to-auditory sensory substitution alters language asymmetry in both sighted novices and experienced visually impaired users.

Visual-to-auditory sensory substitution devices (SSDs) provide improved access to the visual environment for the visually impaired by converting images into auditory information. Research is lacking on the mechanisms involved in processing data that is perceived through one sensory modality, but directly associated with a source in a different sensory modality. This is important because SSDs that use auditory displays could involve binaural presentation requiring both ear canals, or monaural presentation requiring only one - but which ear would be ideal? SSDs may be similar to reading, as an image (printed word) is converted into sound (when read aloud). Reading, and language more generally, are typically lateralised to the left cerebral hemisphere. Yet, unlike symbolic written language, SSDs convert images to sound based on visuospatial properties, with the right cerebral hemisphere potentially having a role in processing such visuospatial data. Here we investigated whether there is a hemispheric bias in the processing of visual-to-auditory sensory substitution information and whether that varies as a function of experience and visual ability. We assessed the lateralization of auditory processing with two tests: a standard dichotic listening test and a novel dichotic listening test created using the auditory information produced by an SSD, The vOICe. Participants were tested either in the lab or online with the same stimuli. We did not find a hemispheric bias in the processing of visual-to-auditory information in visually impaired, experienced vOICe users. Further, we did not find any difference between visually impaired, experienced vOICe users and sighted novices in the hemispheric lateralization of visual-to-auditory information processing. Although standard dichotic listening is lateralised to the left hemisphere, the auditory processing of images in SSDs is bilateral, possibly due to the increased influence of right hemisphere processing. Auditory SSDs might therefore be equally effective with presentation to either ear if a monaural, rather than binaural, presentation were necessary.

Multiprofessional care for delirium patients in intensive care: integrative review. / Cuidados multiprofissionais para pacientes em delirium em terapia intensiva: revisão integrativa.

OBJECTIVE: To describe the multiprofessional care for the management of critical patients in delirium in the ICU from the evidences found in the literature. METHODS: This integrative review was carried out in the period from February 1 to June 30, 2016 through searches on PubMed, Scopus, Web of Science, and CINAHL, with the following descriptors: delirium, critical care e intensive care units, which brought up 17 original papers. RESULTS: A bundle and a guideline, two systematic reviews, evidence 1a and four clinical trials, evidence 1b and 2b, cohort and observational studies were found. The multiprofessional care was presented to better understand the diagnosis of delirium, sedation pause, early mobilization, pain, agitation and delirium guidelines, psychomotor agitation, cognitive orientation, sleep promotion, environment and family participation. CONCLUSION: The care for delirium is wide and not specific, which determines its multifactorial aspect.

Cuidados multiprofissionais para pacientes em delirium em terapia intensiva: revisão integrativa / Cuidados multiprofesionales para pacientes en delirium en la terapia intensiva: revisión integrativa / Multiprofessional care for delirium patients in intensive care: integrative review

Resumo OBJETIVO Descrever os cuidados multiprofissionais para manejo de pacientes críticos em delirium na UTI a partir das evidências encontradas na literatura. MÉTODOS Trata-se de uma revisão integrativa realizada no período de 1º de fevereiro a 30 de junho de 2016 através de busca nas bases de dados PubMed, Scopus, Web of Science e CINAHL com os descritores delirium, critical care e intensive care units que finalizou com 17 estudos originais. RESULTADOS Foram encontrados um bundle e uma diretriz, duas revisões sistemáticas, evidência 1a e quatro ensaios clínicos, evidência 1b e 2b, os demais estudos de coorte e observacionais. Os cuidados multiprofissionais foram apresentados para melhor entendimento em diagnóstico de delirium, pausa de sedação, mobilização precoce, diretrizes para dor, agitação e delirium, agitação psicomotora, orientação cognitiva, promoção do sono, ambiente e participação da família. CONCLUSÃO Os cuidados para delirium são abrangentes e pouco específicos, determinando seu aspecto multifatorial.

Resumen OBJETIVO Se objetivó describir los cuidados multiprofesionales para manejo de pacientes críticos en delirium en la UTI a partir de las evidencias encontradas en la literatura. MÉTODOS Se trata de una revisión integradora realizada en el período del 1 de febrero al 30 de junio de 2016 a través de búsqueda en PubMed, Scopus, Web of Science, and CINAHL con descriptores delirium, critical care e intensive care units que finalizó 17 estudios originales. RESULTADOS Fueron encontrados un bundle, una directriz, dos revisiones sistemáticos, evidencia 1a, cuatro ensayos clínicos, evidencia 1b y 2b, los demás estudios de cohorte y observacionales. Los cuidados multiprofesionales fueron presentados para mejor entenderse el diagnóstico de delirium, pausa de sedación, movilización temprana, directrices para dolor, agitación, y delirium, agitación psicomotora, orientación cognitiva, promoción de sueño, ambiente y participación de la familia. CONCLUSIÓN Los cuidados para delirium son más amplio y poco específicos, determinando su aspecto multifactorial.

Abstract OBJECTIVE To describe the multiprofessional care for the management of critical patients in delirium in the ICU from the evidences found in the literature. METHODS This integrative review was carried out in the period from February 1 to June 30, 2016 through searches on PubMed, Scopus, Web of Science, and CINAHL, with the following descriptors: delirium, critical care e intensive care units, which brought up 17 original papers. RESULTS A bundle and a guideline, two systematic reviews, evidence 1a and four clinical trials, evidence 1b and 2b, cohort and observational studies were found. The multiprofessional care was presented to better understand the diagnosis of delirium, sedation pause, early mobilization, pain, agitation and delirium guidelines, psychomotor agitation, cognitive orientation, sleep promotion, environment and family participation. CONCLUSION The care for delirium is wide and not specific, which determines its multifactorial aspect.

Designing sensory-substitution devices: Principles, pitfalls and potential1.

An exciting possibility for compensating for loss of sensory function is to augment deficient senses by conveying missing information through an intact sense. Here we present an overview of techniques that have been developed for sensory substitution (SS) for the blind, through both touch and audition, with special emphasis on the importance of training for the use of such devices, while highlighting potential pitfalls in their design. One example of a pitfall is how conveying extra information about the environment risks sensory overload. Related to this, the limits of attentional capacity make it important to focus on key information and avoid redundancies. Also, differences in processing characteristics and bandwidth between sensory systems severely constrain the information that can be conveyed. Furthermore, perception is a continuous process and does not involve a snapshot of the environment. Design of sensory substitution devices therefore requires assessment of the nature of spatiotemporal continuity for the different senses. Basic psychophysical and neuroscientific research into representations of the environment and the most effective ways of conveying information should lead to better design of sensory substitution systems. Sensory substitution devices should emphasize usability, and should not interfere with other inter- or intramodal perceptual function. Devices should be task-focused since in many cases it may be impractical to convey too many aspects of the environment. Evidence for multisensory integration in the representation of the environment suggests that researchers should not limit themselves to a single modality in their design. Finally, we recommend active training on devices, especially since it allows for externalization, where proximal sensory stimulation is attributed to a distinct exterior object.

Designing Media for Visually-Impaired Users of Refreshable Touch Displays: Possibilities and Pitfalls.

This paper discusses issues of importance to designers of media for visually impaired users. The paper considers the influence of human factors on the effectiveness of presentation as well as the strengths and weaknesses of tactile, vibrotactile, haptic, and multimodal methods of rendering maps, graphs, and models. The authors, all of whom are visually impaired researchers in this domain, present findings from their own work and work of many others who have contributed to the current understanding of how to prepare and render images for both hard-copy and technology-mediated presentation of Braille and tangible graphics.

Low-vision service provision by optometrists: a Canadian nationwide survey.

PURPOSE: To document the degree to which Canadian optometrists are involved in the provision of low-vision (LV) care and their referral patterns. To investigate the barriers to providing optometric low-vision services (LVS). METHODS: Practicing optometrists across Canada were randomly sampled and invited to participate in a questionnaire that included questions on personal profile, primary practice profile, levels of LV care offered, patterns of referral, and barriers to provision of LV care. Questions included a combination of multiple choice and open-ended formats, and included hypothetical cases. RESULTS: A total of 459 optometrists responded (response rate, 24.8%). Optometrists estimated that 1% (range, 0 to 100%) of their patients were LV patients yet also estimated that 10% of their patients had acuity equal to or worse than 20/40. Thirty-five percent of respondents indicated that their primary practice offered LV care, 75.6% would manage a patient with minimum disability and simple goals themselves, whereas 10.7% would manage a patient with more than minimal visual disability who needed more specialized LV devices (e.g., telescopes, electronic aids, and custom-designed microscopes); 84.3% of optometrists would assess for basic magnification and lighting in a hypothetical patient with early age-related macular degeneration, whereas 15% would undertake full LV rehabilitation in advanced age-related macular degeneration. Optometrists commonly referred to CNIB (formerly the Canadian National Institute for the Blind), yet only 10.7% of respondents almost always received a written report after referral. Those who would not undertake LV assessment stated that they lacked the knowledge, equipment, or experience; that LV assessment is too time consuming; and that the cost is too prohibitive. CONCLUSIONS: This is the first comprehensive study of LVS provision by optometrists in Canada. In order for optometrists to become more involved in LVS, there is a need for more LV education, provincial health coverage of optometric LVS, and better collaboration communication between LV providers.

Música: un recurso psicofisiológico para el ejercicio físico y deporte / Music: a psychophysiological aid to physical exercise and sport

El uso de la música se ha identificado como un auxiliar ergogénico potencial que ayuda a mejorar el rendimiento en el ejercicio. La música ha sido clasificada como una ayuda ergogénica psicológica y ha despertado el interés principalmente por sus efectos encontrados en estudios con un enfoque en el rendimiento durante, antes y después del ejercicio, En este contexto, el objetivo de este estudio fue revisar la literatura sobre los principales efectos de la música sobre el rendimiento y sus posibles mecanismos, cubriendo nuevas perspectivas sobre el tema. El método consistió en la búsqueda, selección y estratificación de los artículos originales de grandes bases de datos (Medline, Sport Discuss, Scopus, Web of Science and Scielo) que utilizan los descriptores: música, ejercicio, rendimiento y fatiga. Se consideraron todos los modelos y tipos de ejercicio y música. Estos artículos indican que el uso de la música como un auxiliar ergogénico podría ser eficaz para mejorar el rendimiento; disminuir la tasa de percepción de esfuerzo y es capaz de ofrecer mejores sensaciones con el ejercicio, de acuerdo con el tiempo de aplicación, la condición física de los sujetos, el tipo de ejercicio y componentes musicales, respetando algunas recomendaciones y orientaciones para la inserción. Los principales mecanismos de acción propuestos por los efectos ergogénicos de la música se basan en la hipótesis de comportamiento y se siguen discutiendo; tampoco hay evidencias suficientes para descartar cualquiera de ellos, lo que demuestra la necesidad de estudios futuros en un intento por aclarar tales efectos en el sistema nervioso central. Para resumir todo esto, proponemos algunas orientaciones de uso en el ejercicio submáximo y máximo, permitiendo que los entrenadores y atletas aplicar esta técnica en sus métodos de entrenamiento (AU)

The use of music has been identified as a potential ergogenic aid that helps to improve performance in exercise. Music has been classified as a psychological ergogenic aid and has attracted interest mainly for its effects found in studies with a focus on performance during exercise, pre-task and post-task. In this context, the objective of this study was to review the literature about the main effects of music on performance and their possible mechanisms, covering new perspectives about the theme. The method consisted of search, selection and stratification of the original articles of major databases (Medline, Sport Discuss, Scopus, Web of Science and Scielo) using the descriptors music, exercise, performance and fatigue. We considered all models and types of exercise and music. These articles suggest that the use of music as an ergogenic aid could be efficient to improve performance; decrease rate perceived of exertion and is capable to bring better feelings to exercise, according to time of application, physical fitness of subjects, type of exercise and musical components, respecting some recommendations and orientations to insertion. The main proposed mechanisms of action for the music ergogenic effects are based on behavioral hypothesis and are still being discussed; also there are not enough evidences to discard any of them, demonstrating the need for future studies in attempt to clarify such effects in central nervous system. To sum it all up, we propose some orientations of use in submaximal and maximal exercise, allowing coaches and athletes apply this technique in their methods of training (AU)

The evolution of a visual-to-auditory sensory substitution device using interactive genetic algorithms.

Sensory substitution is a promising technique for mitigating the loss of a sensory modality. Sensory substitution devices (SSDs) work by converting information from the impaired sense (e.g., vision) into another, intact sense (e.g., audition). However, there are a potentially infinite number of ways of converting images into sounds, and it is important that the conversion takes into account the limits of human perception and other user-related factors (e.g., whether the sounds are pleasant to listen to). The device explored here is termed "polyglot" because it generates a very large set of solutions. Specifically, we adapt a procedure that has been in widespread use in the design of technology but has rarely been used as a tool to explore perception-namely, interactive genetic algorithms. In this procedure, a very large range of potential sensory substitution devices can be explored by creating a set of "genes" with different allelic variants (e.g., different ways of translating luminance into loudness). The most successful devices are then "bred" together, and we statistically explore the characteristics of the selected-for traits after multiple generations. The aim of the present study is to produce design guidelines for a better SSD. In three experiments, we vary the way that the fitness of the device is computed: by asking the user to rate the auditory aesthetics of different devices (Experiment 1), and by measuring the ability of participants to match sounds to images (Experiment 2) and the ability to perceptually discriminate between two sounds derived from similar images (Experiment 3). In each case, the traits selected for by the genetic algorithm represent the ideal SSD for that task. Taken together, these traits can guide the design of a better SSD.

'Visual' acuity of the congenitally blind using visual-to-auditory sensory substitution.

Sensory Substitution Devices (SSDs) convey visual information through sounds or touch, thus theoretically enabling a form of visual rehabilitation in the blind. However, for clinical use, these devices must provide fine-detailed visual information which was not yet shown for this or other means of visual restoration. To test the possible functional acuity conveyed by such devices, we used the Snellen acuity test conveyed through a high-resolution visual-to-auditory SSD (The vOICe). We show that congenitally fully blind adults can exceed the World Health Organization (WHO) blindness acuity threshold using SSDs, reaching the highest acuity reported yet with any visual rehabilitation approach. This demonstrates the potential capacity of SSDs as inexpensive, non-invasive visual rehabilitation aids, alone or when supplementing visual prostheses.

Safe trajectory estimation at a pedestrian crossing to assist visually impaired people.

The aim of this paper is to present a service for blind and people with low vision to assist them to cross the street independently. The presented approach provides the user with significant information such as detection of pedestrian crossing signal from any point of view, when the pedestrian crossing signal light is green, the detection of dynamic and fixed obstacles, predictions of the movement of fellow pedestrians and information on objects which may intersect his path. Our approach is based on capturing multiple frames using a depth camera which is attached to a user's headgear. Currently a testbed system is built on a helmet and is connected to a laptop in the user's backpack. In this paper, we discussed efficiency of using Speeded-Up Robust Features (SURF) algorithm for object recognition for purposes of blind people assistance. The system predicts the movement of objects of interest to provide the user with information on the safest path to navigate and information on the surrounding area. Evaluation of this approach on real sequence video frames provides 90% of human detection and more than 80% for recognition of other related objects.

Audible vision for the blind and visually impaired in indoor open spaces.

In this paper we introduce Audible Vision, a system that can help blind and visually impaired users navigate in large indoor open spaces. The system uses computer vision to estimate the location and orientation of the user, and enables the user to perceive his/her relative position to a landmark through 3D audio. Testing shows that Audible Vision can work reliably in real-life ever-changing environment crowded with people.

Seeing with sound? exploring different characteristics of a visual-to-auditory sensory substitution device.

Sensory substitution devices convert live visual images into auditory signals, for example with a web camera (to record the images), a computer (to perform the conversion) and headphones (to listen to the sounds). In a series of three experiments, the performance of one such device ('The vOICe') was assessed under various conditions on blindfolded sighted participants. The main task that we used involved identifying and locating objects placed on a table by holding a webcam (like a flashlight) or wearing it on the head (like a miner's light). Identifying objects on a table was easier with a hand-held device, but locating the objects was easier with a head-mounted device. Brightness converted into loudness was less effective than the reverse contrast (dark being loud), suggesting that performance under these conditions (natural indoor lighting, novice users) is related more to the properties of the auditory signal (ie the amount of noise in it) than the cross-modal association between loudness and brightness. Individual differences in musical memory (detecting pitch changes in two sequences of notes) was related to the time taken to identify or recognise objects, but individual differences in self-reported vividness of visual imagery did not reliably predict performance across the experiments. In general, the results suggest that the auditory characteristics of the device may be more important for initial learning than visual associations.

Persons with multiple disabilities use orientation technology to find room entrances during indoor traveling.

These two studies assessed adapted orientation technology for promoting correct direction and room identification during indoor traveling by persons with multiple (e.g., sensory, motor and intellectual/adaptive) disabilities. In Study I, two adults were included who had severe visual impairment or total blindness and deafness and used a wheelchair for traveling. In Study II, two adults participated who had visual impairment or total blindness but were ambulatory. All participants were to travel to different rooms located along a hallway to carry out small activities. The orientation technology ensured that the participants received (a) a verbal instruction to go to their right or left and/or a vibratory cue to the right or left side of their body as soon as they exited a room to orient their travel within the hallway and (b) a similar verbal instruction and/or vibratory cue to turn and enter when they reached the next target room entrance. Results of both studies showed that the participants on wheelchairs and those able to ambulate were successful in using the technology, orient their travel, and find the appropriate room entrances. The findings are discussed in relation to the importance of independent indoor traveling and the impact of the new technology.

Visual experiences in the blind induced by an auditory sensory substitution device.

In this report, the phenomenology of two blind users of a sensory substitution device - "The vOICe" - that converts visual images to auditory signals is described. The users both report detailed visual phenomenology that developed within months of immersive use and has continued to evolve over a period of years. This visual phenomenology, although triggered through use of The vOICe, is likely to depend not only on online visualization of the auditory signal but also on the users' previous (albeit distant) experience of veridical vision (e.g. knowledge of shapes and visual perspective). Once established, the sensory substitution mapping between the auditory and visual domains is not confined to when the device is worn and, thus, may constitute an example of acquired synaesthesia.

Two persons with multiple disabilities use orientation technology with auditory cues to manage simple indoor traveling.

This study was an effort to extend the evaluation of orientation technology for promoting independent indoor traveling in persons with multiple disabilities. Two participants (adults) were included, who were to travel to activity destinations within occupational settings. The orientation system involved (a) cueing sources only at the destinations (i.e., a single sound source per destination), (b) a newly developed electronic control device that allowed the participants to easily manage the activation of the sources at the destinations, and (c) the provision of approval or encouragement messages. Both participants were successful in using the system and performed their travels to the destinations fairly correctly and in relatively short amounts of time within (a) the occupational setting used for the intervention and (b) a similar occupational setting used for checking generalization effects. The findings are discussed in relation to the importance of independent indoor traveling and the impact of the new technology.

Retinal neurostimulator for a multifocal vision prosthesis.

A neurostimulator application-specific integrated circuit (ASIC) with scalable circuitry that can stimulate 14 channels, has been developed for an epi-retinal vision prosthesis. This ASIC was designed to allow seven identical units to be connected to control up to 98 channels, with the ability to stimulate 14 electrodes simultaneously. The neurostimulator forms part of a vision prosthesis, designed to restore vision to patients who have lost their sight due to retinal diseases such as retinitis pigmentosa and macular degeneration. For charge balance, the neurostimulator was designed to stimulate with current sources and sinks operating together, and with the ability to drive a hexagonal mosaic of electrodes to reduce the electrical crosstalk that occurs when multiple bipolar stimulation sites are active simultaneously. A hexagonal mosaic of electrodes surrounds each stimulation site and has been shown to effectively isolate each site, increasing the ability to inject localized independent charge into multiple regions simultaneously.

Enhanced sensory recovery after median nerve repair using cortical audio-tactile interaction. A randomised multicentre study.

The "Sensor Glove System" offers an alternate afferent inflow from the hand early after nerve repair in the forearm, mediated through the hearing sense, implying that deprivation of one sense can be compensated by another sense. This sensory "by-pass" was used early after repair of the median nerve with the intention of improving recovery of functional sensibility by maintaining an active sensory map of the hand in the somatosensory cortex during the deafferentation period. In a prospective multicentre clinical study, one group (n=14) started early after surgery with sensory re-education using the Sensor Glove System and the control group (n=12) received conventional sensory re-education, starting 3 months postoperatively. The patients were checked regularly during a 1-year period, with focus on recovery of tactile gnosis. After 12, months, tactile gnosis was significantly better in the Sensor Glove System group. This highlights the timing for introduction of training after nerve repair, focusing on the importance of immediate sensory re-learning.

Impact of visual impairment on service and device use by individuals with age-related macular degeneration (AMD).

PURPOSE: To assess the patient-reported use of services, supplements, and devices among individuals with age-related macular degeneration (AMD) and evaluate the impact of visual impairment level on this use. METHOD: Data for this study were collected using two instruments, the AMD Health and Impact Questionnaire and the Daily Living Tasks Dependent on Vision questionnaire (DLTV). Both questionnaires were mailed to members of the Macular Degeneration Partnership. The study was approved by an IRB and respondents provided consent before participating. Respondents' visual acuity (VA) was estimated using scores from the DLTV, while use of services and devices was collected from the AMD Questionnaire. De-identified data were analysed in SAS. RESULTS: Of 803 respondents, 56% were male and the mean age was 73 years. Use of services (e.g., counseling, rehabilitation), and devices significantly increased as VA decreased. Using standard US costs, costs for services, supplements, and devices ranged from 506-1619 US dollars depending on VA. CONCLUSION: There are substantial differences in service and device use with increased AMD severity. Delaying progression of AMD could result in considerable cost savings.