Human click-based echolocation: Effects of blindness and age, and real-life implications in a 10-week training program.

Understanding the factors that determine if a person can successfully learn a novel sensory skill is essential for understanding how the brain adapts to change, and for providing rehabilitative support for people with sensory loss. We report a training study investigating the effects of blindness and age on the learning of a complex auditory skill: click-based echolocation. Blind and sighted participants of various ages (21-79 yrs; median blind: 45 yrs; median sighted: 26 yrs) trained in 20 sessions over the course of 10 weeks in various practical and virtual navigation tasks. Blind participants also took part in a 3-month follow up survey assessing the effects of the training on their daily life. We found that both sighted and blind people improved considerably on all measures, and in some cases performed comparatively to expert echolocators at the end of training. Somewhat surprisingly, sighted people performed better than those who were blind in some cases, although our analyses suggest that this might be better explained by the younger age (or superior binaural hearing) of the sighted group. Importantly, however, neither age nor blindness was a limiting factor in participants' rate of learning (i.e. their difference in performance from the first to the final session) or in their ability to apply their echolocation skills to novel, untrained tasks. Furthermore, in the follow up survey, all participants who were blind reported improved mobility, and 83% reported better independence and wellbeing. Overall, our results suggest that the ability to learn click-based echolocation is not strongly limited by age or level of vision. This has positive implications for the rehabilitation of people with vision loss or in the early stages of progressive vision loss.

Light therapy for seasonal affective disorder in visual impairment and blindness - a pilot study.

OBJECTIVE: Seasonal and non-seasonal depression are prevalent conditions in visual impairment (VI). We assessed the effects and side effects of light therapy in persons with severe VI/blindness who experienced recurrent depressive symptoms in winter corresponding to seasonal affective disorder (SAD) or subsyndromal SAD (sSAD). RESULTS: We included 18 persons (11 with severe VI, 3 with light perception and 4 with no light perception) who met screening criteria for sSAD/SAD in a single-arm, assessor-blinded trial of 6 weeks light therapy. In the 12 persons who completed the 6 weeks of treatment, the post-treatment depression score was reduced (p < 0.001), and subjective wellbeing (p = 0.01) and sleep quality were improved (p = 0.03). In 6/12 participants (50%), the post-treatment depression score was below the cut-off set for remission. In four participants with VI, side effects (glare or transiently altered visual function) led to dropout or exclusion. CONCLUSION: Light therapy was associated with a reduction in depressive symptoms in persons with severe VI/blindness. Eye safety remains a concern in persons with residual sight.

Surgical outcomes of macular hole and epimacular membrane treatment in patients with intraoperative amaurosis under sub-Tenon's anesthesia.

OBJECTIVE: Some patients have been found to develop intraoperative amaurosis under sub-Tenon's anesthesia. We explored whether these patients have poor surgical outcomes during mid- to long-term postoperative follow-up. METHODS: In this case series, 74 of 85 patients with macular diseases who underwent phacoemulsification combined with vitrectomy under sub-Tenon's anesthesia developed intraoperative amaurosis. The surgical outcomes at the 2- and 4-month follow-ups in these patients were investigated and compared with the outcomes in patients without amaurosis using best-corrected visual acuity (BCVA), optical coherence tomography (OCT), and pattern visual evoked potential (PVEP). RESULTS: Both BCVA and the OCT-based macular structure in patients with intraoperative amaurosis showed significant postoperative improvement comparable with that of patients without amaurosis. The presence of intraoperative amaurosis was not associated with either macular hole closure or macular edema regression. PVEP revealed no significant changes in the wave latency or amplitude before and after surgery. CONCLUSION: Intraoperative amaurosis following sub-Tenon's block is commonly seen but does not predict a poor surgical prognosis. When a patient develops amaurosis during surgery, the surgeon should increase patient comfort through verbal communication rather than perform an additional intervention to help relieve the patient's anxiety.

Investigating the Effect of Visual Imagery and Learning Shape-Audio Regularities on Bouba and Kiki.

This article presents a protocol for investigating the role of visual imagery in the bouba/kiki-effect, whether training in noticing the bouba/kiki shape-audio regularities affects the bouba/kiki-effect and the recognition of individual bouba and kiki shapes, and finally what mental images these regularities produce. To generate bouba/kiki shape-audio regularities, there were two types of shapes (filled; outlined) and two types of audio (word; non-word sound). Three groups of individuals participated in three experiments: Blind, blindfold, and vision. The experiments were conducted in fixed order across participants, with no break between them. In Experiment 1 (pre-test-post-test design with three repeated within-group measures) the participants were asked to pick out the shape they associated with the auditory bouba/kiki; in Experiment 2 (within-subject design), to name one shape and some audio (sometimes congruous; sometimes incongruous) as 'bouba' or 'kiki;' and in Experiment 3 (post-test only design), to draw the shape they associated with the auditory bouba/kiki. The results suggest that the blindfold-group draw upon visual imagery to solve new problems, but not long term; that training in noticing bouba/kiki shape-audio regularities affects the bouba/kiki-effect and the recognition of individual bouba and kiki shapes, but differently in each experimental group; and that all experimental groups create mental images of the most characteristic shape feature of bouba (curve) and kiki (angle). In fact, the effect of visual imagery is robust across tasks, but not long term; the effect of learning shape-audio regularities is robust long term, but not across tasks. The presented protocol is appropriate for investigating the effect of visual imagery and learning shape-audio regularities, when they occur and how robust they are; in specific individuals and groups of individuals. This protocol is unique in that it keeps under control both the visual imagery and the sensory information during training and testing.

Effect of blindness on mismatch responses to Mandarin lexical tones, consonants, and vowels.

According to the hypothesis of auditory compensation, blind listeners are more sensitive to auditory input than sighted listeners. In the current study, we employed the passive oddball paradigm to investigate the effect of blindness on listeners' mismatch responses to Mandarin lexical tones, consonants, and vowels. Twelve blind and twelve sighted age- and verbal IQ-matched adults with normal hearing participated in this study. Our results indicated that blind listeners possibly had a more efficient pre-attentive processing (shorter MMN peak latency) of lexical tones in the tone-dominant hemisphere (i.e., the right hemisphere); and that they exhibited greater sensitivity (larger MMN amplitude) when processing phonemes (consonants and/or vowels) at the pre-attentive stage in both hemispheres compared with sighted individuals. However, we observed longer MMN and P3a peak latencies during phoneme processing in the blind versus control participants, indicating that blind listeners may be slower in terms of pre-attentive processing and involuntary attention switching when processing phonemes. This could be due to a lack of visual experience in the production and perception of phonemes. In a word, the current study revealed a two-sided influence of blindness on Mandarin speech perception.

Bouba or kiki with and without vision: Shape-audio regularities and mental images.

95% of the world's population associate a rounded visual shape with the spoken word 'bouba', and an angular visual shape with the spoken word 'kiki', known as the bouba/kiki-effect. The bouba/kiki-effect occurs irrespective of familiarity with either the shape or word. This study investigated the bouba/kiki-effect when using haptic touch instead of vision, including the role of visual imagery. It also investigated whether the bouba/kiki shape-audio regularities are noticed at all, that is, whether they affect the bouba/kiki-effect itself and/or the recognition of individual bouba/kiki shapes, and finally what mental images they produce. Three experiments were conducted, with three groups of participants: blind, blindfold, and vision. In Experiment 1, the participants were asked to pick out the tactile/visual shape that they associated with the auditory bouba/kiki. Experiment 1 found that the participants who were blind did not show an instant bouba/kiki-effect (in Trial 1), whereas the blindfolded and the fully sighted did. It also found that the bouba/kiki shape-audio regularities affected the bouba/kiki-effect when using haptic touch: Those who were blind did show the bouba/kiki-effect from Trial 4, and those who were blindfolded no longer did. In Experiment 2, the participants were asked to name one tactile/visual shape and a segment of audio together as either 'bouba' or 'kiki'. Experiment 2 found that corresponding shape and audio improved the accuracy of both the blindfolded and the fully sighted, but not of those who were blind - they ignored the audio. Finally, in Experiment 3, the participants were asked to draw the shape that they associated with the auditory bouba/kiki. Experiment 3 found that their mental images, as depicted in their drawings, were not affected by whether they had experienced the bouba/kiki shapes by haptic touch or by vision. Regardless of their prior shape experience, that is, tactile or visual, their mental images included the most characteristic shape feature of bouba and kiki: curve and angle, respectively, and typically not the global shape. When taken together, these experiments suggest that the sensory regularities and mental images concerning bouba and kiki do not have to be based on, or even include visual information.

A quality of life survey in patients with long-term silicone oil or phthisis bulbi.

AIM: The aim of this study is to determine whether there is any difference in the quality of life of patients with a blind eye with long-term silicone oil compared to without. METHOD: Patients with either long-term silicone oil in situ (N = 17), defined as a period greater than 6 months duration with no plan for future removal, or those with a phthisical, non oil-filled eye were identified (N = 13). Two validated questionnaires (NEI VFQ-25 and the FACE-Q) that cover indicators for visual function, pain and cosmesis were sent to all patients in the two cohorts. RESULTS: There was no significant difference found in quality of life outcomes between the two groups in terms of visual function, pain or cosmesis. CONCLUSION: The results of this study support a holistic approach to the consent process before vitreoretinal surgery. Patients that may need to undergo multiple vitreoretinal procedures, where the endstage result is a long-term silicone oil fill, should be informed that their functional outcome may be similar to having no surgical intervention.

Conveying facial expressions to blind and visually impaired persons through a wearable vibrotactile device.

In face-to-face social interactions, blind and visually impaired persons (VIPs) lack access to nonverbal cues like facial expressions, body posture, and gestures, which may lead to impaired interpersonal communication. In this study, a wearable sensory substitution device (SSD) consisting of a head mounted camera and a haptic belt was evaluated to determine whether vibrotactile cues around the waist could be used to convey facial expressions to users and whether such a device is desired by VIPs for use in daily living situations. Ten VIPs (mean age: 38.8, SD: 14.4) and 10 sighted persons (SPs) (mean age: 44.5, SD: 19.6) participated in the study, in which validated sets of pictures, silent videos, and videos with audio of facial expressions were presented to the participant. A control measurement was first performed to determine how accurately participants could identify facial expressions while relying on their functional senses. After a short training, participants were asked to determine facial expressions while wearing the emotion feedback system. VIPs using the device showed significant improvements in their ability to determine which facial expressions were shown. A significant increase in accuracy of 44.4% was found across all types of stimuli when comparing the scores of the control (mean±SEM: 35.0±2.5%) and supported (mean±SEM: 79.4±2.1%) phases. The greatest improvements achieved with the support of the SSD were found for silent stimuli (68.3% for pictures and 50.8% for silent videos). SPs also showed consistent, though not statistically significant, improvements while supported. Overall, our study shows that vibrotactile cues are well suited to convey facial expressions to VIPs in real-time. Participants became skilled with the device after a short training session. Further testing and development of the SSD is required to improve its accuracy and aesthetics for potential daily use.

The Spatial Musical Association of Response Codes does not depend on a normal visual experience: A study with early blind individuals.

Converging evidence suggests that the perception of auditory pitch exhibits a characteristic spatial organization. This pitch-space association can be demonstrated experimentally by the Spatial Musical Association of Response Codes (SMARC) effect. This is characterized by faster response times when a low-positioned key is pressed in response to a low-pitched tone, and a high-positioned key is pressed in response to a high-pitched tone. To investigate whether the development of this pitch-space association is mediated by normal visual experience, we tested a group of early blind individuals on a task that required them to discriminate the timbre of different instrument sounds with varying pitch. Results revealed a comparable pattern in the SMARC effect in both blind participants and sighted controls, suggesting that the lack of prior visual experience does not prevent the development of an association between pitch height and vertical space.

The detection of 'virtual' objects using echoes by humans: Spectral cues.

Some blind people use echoes to detect discrete, silent objects to support their spatial orientation/navigation, independence, safety and wellbeing. The acoustical features that people use for this are not well understood. Listening to changes in spectral shape due to the presence of an object could be important for object detection and avoidance, especially at short range, although it is currently not known whether it is possible with echolocation-related sounds. Bands of noise were convolved with recordings of binaural impulse responses of objects in an anechoic chamber to create 'virtual objects', which were analysed and played to sighted and blind listeners inexperienced in echolocation. The sounds were also manipulated to remove cues unrelated to spectral shape. Most listeners could accurately detect hard flat objects using changes in spectral shape. The useful spectral changes for object detection occurred above approximately 3 kHz, as with object localisation. However, energy in the sounds below 3 kHz was required to exploit changes in spectral shape for object detection, whereas energy below 3 kHz impaired object localisation. Further recordings showed that the spectral changes were diminished by room reverberation. While good high-frequency hearing is generally important for echolocation, the optimal echo-generating stimulus will probably depend on the task.

Burst Out of the Dead Land by the Help of Spirituality: A Case Study of Living with Blindness and Cancer.

Blindness is one of the most complex problems related to health throughout the world. The condition is worse when such stress is accompanied with cancer. The aim of this case study was to introduce a patient with both these conditions who could come over her problems well. A phenomenological hermeneutic approach influenced by Ricoeur was used to explore the experience of the patient. Data were collected through unstructured and deep interview and by checking patient medical records. The patient is an Iranian 58-year-old teacher residing in Kerman who became blind at age 32 due to bloodshed inside the eye and was affected by breast cancer at age 52. The patient could come over these divine tests through the help of spirituality so that she believed blindness and cancer was the best events in her life. Spirituality is one of the human aspects that give meaning and purposes to life. Health care providers are suggested to implement spiritual strategies such as instructional workshops for increasing spirituality in settings, such as oncologic wards for patients to pass stages of adaptation to such great stresses easily and rapidly.

Blind people are more sensitive than sighted people to binaural sound-location cues, particularly inter-aural level differences.

Blind people use auditory information to locate sound sources and sound-reflecting objects (echolocation). Sound source localization benefits from the hearing system's ability to suppress distracting sound reflections, whereas echolocation would benefit from "unsuppressing" these reflections. To clarify how these potentially conflicting aspects of spatial hearing interact in blind versus sighted listeners, we measured discrimination thresholds for two binaural location cues: inter-aural level differences (ILDs) and inter-aural time differences (ITDs). The ILDs or ITDs were present in single clicks, in the leading component of click pairs, or in the lagging component of click pairs, exploiting processes related to both sound source localization and echolocation. We tested 23 blind (mean age = 54 y), 23 sighted-age-matched (mean age = 54 y), and 42 sighted-young (mean age = 26 y) listeners. The results suggested greater ILD sensitivity for blind than for sighted listeners. The blind group's superiority was particularly evident for ILD-lag-click discrimination, suggesting not only enhanced ILD sensitivity in general but also increased ability to unsuppress lagging clicks. This may be related to the blind person's experience of localizing reflected sounds, for which ILDs may be more efficient than ITDs. On the ITD-discrimination tasks, the blind listeners performed better than the sighted age-matched listeners, but not better than the sighted young listeners. ITD sensitivity declines with age, and the equal performance of the blind listeners compared to a group of substantially younger listeners is consistent with the notion that blind people's experience may offset age-related decline in ITD sensitivity.

Visual cortical prosthesis with a geomagnetic compass restores spatial navigation in blind rats.

Allocentric sense is one of the major components that underlie spatial navigation. In blind patients, the difficulty in spatial exploration is attributed, at least partly, to the deficit of absolute direction perception. In support of this notion, we announce that blind adult rats can perform spatial tasks normally when externally provided with real-time feedback of their head directions. Head-mountable microstimulators coupled with a digital geomagnetic compass were bilaterally implanted in the primary visual cortex of adult rats whose eyelids had been sutured. These "blind" rats were trained to seek food pellets in a T-shaped maze or a more complicated maze. Within tens of trials, they learned to manage the geomagnetic information source to solve the mazes. Their performance levels and navigation strategies were similar to those of normal sighted, intact rats. Thus, blind rats can recognize self-location through extrinsically provided stereotactic cues.

Retrieval and phenomenology of autobiographical memories in blind individuals.

Although visual imagery is argued to be an essential component of autobiographical memory, there have been surprisingly few studies on autobiographical memory processes in blind individuals, who have had no or limited visual input. The purpose of the present study was to investigate how blindness affects retrieval and phenomenology of autobiographical memories. We asked 48 congenital/early blind and 48 sighted participants to recall autobiographical memories in response to six cue words, and to fill out the Autobiographical Memory Questionnaire measuring a number of variables including imagery, belief and recollective experience associated with each memory. Blind participants retrieved fewer memories and reported higher auditory imagery at retrieval than sighted participants. Moreover, within the blind group, participants with total blindness reported higher auditory imagery than those with some light perception. Blind participants also assigned higher importance, belief and recollection ratings to their memories than sighted participants. Importantly, these group differences remained the same for recent as well as childhood memories.

Mid-latency auditory evoked potential response revealed as an evidence of neural plasticity in blinnd individuals.

There is a general impression that visually blind individuals show an exceptionally better perception of other sensory modalities such as hearing, touch and smell sensations. In this study, we intended to compare the mid-latency auditory evoked potential response (MLAEP) or Middle latency Response (MLR) to get an idea of the activity pattern of auditory thalamus and cortex between 30 visually handicapped subjects and 30 normal sighted subjects. The results showed a decrease in many of the MLR wave latencies, but highly significant for the wave Pa (P value <0.002). This fact can be reflected as an evidence of existence of cross-modal neuroplasticity. We also inferred that there are significant gender differences with latencies shorter in males than females (P value <0.02) in the blind subjects group which could be attributed to their rehabilitation training.

Touching words is not enough: how visual experience influences haptic-auditory associations in the "Bouba-Kiki" effect.

Since Köhler's experiments in the 1920s, researchers have demonstrated a correspondence between words and shapes. Dubbed the "Bouba-Kiki" effect, these auditory-visual associations extend across cultures and are thought to be universal. More recently the effect has been shown in other modalities including taste, suggesting the effect is independent of vision. The study presented here tested the "Bouba-Kiki" effect in the auditory-haptic modalities, using 2D cut-outs and 3D models based on Köhler's original drawings. Presented with shapes they could feel but not see, sighted participants showed a robust "Bouba-Kiki" effect. However, in a sample of people with a range of visual impairments, from congenital total blindness to partial sight, the effect was significantly less pronounced. The findings suggest that, in the absence of a direct visual stimulus, visual imagery plays a role in crossmodal integration.

Brain systems mediating voice identity processing in blind humans.

Blind people rely more on vocal cues when they recognize a person's identity than sighted people. Indeed, a number of studies have reported better voice recognition skills in blind than in sighted adults. The present functional magnetic resonance imaging study investigated changes in the functional organization of neural systems involved in voice identity processing following congenital blindness. A group of congenitally blind individuals and matched sighted control participants were tested in a priming paradigm, in which two voice stimuli (S1, S2) were subsequently presented. The prime (S1) and the target (S2) were either from the same speaker (person-congruent voices) or from two different speakers (person-incongruent voices). Participants had to classify the S2 as either a old or a young person. Person-incongruent voices (S2) compared with person-congruent voices elicited an increased activation in the right anterior fusiform gyrus in congenitally blind individuals but not in matched sighted control participants. In contrast, only matched sighted controls showed a higher activation in response to person-incongruent compared with person-congruent voices (S2) in the right posterior superior temporal sulcus. These results provide evidence for crossmodal plastic changes of the person identification system in the brain after visual deprivation.

Improvement in spatial imagery following sight onset late in childhood.

The factors contributing to the development of spatial imagery skills are not well understood. Here, we consider whether visual experience shapes these skills. Although differences in spatial imagery between sighted and blind individuals have been reported, it is unclear whether these differences are truly due to visual deprivation or instead are due to extraneous factors, such as reduced opportunities for the blind to interact with their environment. A direct way of assessing vision's contribution to the development of spatial imagery is to determine whether spatial imagery skills change soon after the onset of sight in congenitally blind individuals. We tested 10 children who gained sight after several years of congenital blindness and found significant improvements in their spatial imagery skills following sight-restoring surgeries. These results provide evidence of vision's contribution to spatial imagery and also have implications for the nature of internal spatial representations.

The role of whiskers in compensation of visual deficit in a mouse model of retinal degeneration.

Sensory deprivation in one modality can enhance the development of the remaining modalities via mechanisms of synaptic plasticity. Mice of the C3H strain suffer from RD1 retinal degeneration that leads to visual impairment at weaning age. We examined a role of whiskers in compensation of the visual deficit. In order to differentiate the contribution of the whiskers from other mechanisms that can take part in the compensation, we investigated the effect of both chronic and acute tactile deprivation. Three-month-old mice were used. We examined motor skills (rotarod, beam walking test), gait control (CatWalk system), spontaneous motor activity (open field) and CNS excitability to an acoustic stimulus for assessment of compensatory changes in auditory system (audiogenic epilepsy). In the sighted mice, the only effect was a decline in their rotarod test performance after acute whisker removal. In the blind animals, chronic tactile deprivation caused changes in their gait and impaired the performance in motor tests. Some other compensatory mechanisms were involved but the whiskers are essential for the compensation as it emerged from more marked change of gait and the worsening of the motor performance after the acute whisker removal. Both chronic and acute tactile deprivation induced anxiety-like behaviour. Only a combination of blindness and chronic tactile deprivation led to an increased sense of hearing.

Acoustic and articulatory analysis of French vowels produced by congenitally blind adults and sighted adults.

In a previous paper [Ménard et al., J. Acoust. Soc. Am. 126, 1406-1414 (2009)], it was demonstrated that, despite enhanced auditory discrimination abilities for synthesized vowels, blind adult French speakers produced vowels that were closer together in the acoustic space than those produced by sighted adult French speakers, suggesting finer control of speech production in the sighted speakers. The goal of the present study is to further investigate the articulatory effects of visual deprivation on vowels produced by 11 blind and 11 sighted adult French speakers. Synchronous ultrasound, acoustic, and video recordings of the participants articulating the ten French oral vowels were made. Results show that sighted speakers produce vowels that are spaced significantly farther apart in the acoustic vowel space than blind speakers. Furthermore, blind speakers use smaller differences in lip protrusion but larger differences in tongue position and shape than their sighted peers to produce rounding and place of articulation contrasts. Trade-offs between lip and tongue positions were examined. Results are discussed in the light of the perception-for-action control theory.