Multisensory training improves the development of spatial cognition after sight restoration from congenital cataracts.

Spatial cognition and mobility are typically impaired in congenitally blind individuals, as vision usually calibrates space perception by providing the most accurate distal spatial cues. We have previously shown that sight restoration from congenital bilateral cataracts guides the development of more accurate space perception, even when cataract removal occurs years after birth. However, late cataract-treated individuals do not usually reach the performance levels of the typically sighted population. Here, we developed a brief multisensory training that associated audiovisual feedback with body movements. Late cataract-treated participants quickly improved their space representation and mobility, performing as well as typically sighted controls in most tasks. Their improvement was comparable with that of a group of blind participants, who underwent training coupling their movements with auditory feedback alone. These findings suggest that spatial cognition can be enhanced by a training program that strengthens the association between bodily movements and their sensory feedback (either auditory or audiovisual).

Clinical assessment of the TechArm system on visually impaired and blind children during uni- and multi-sensory perception tasks.

We developed the TechArm system as a novel technological tool intended for visual rehabilitation settings. The system is designed to provide a quantitative assessment of the stage of development of perceptual and functional skills that are normally vision-dependent, and to be integrated in customized training protocols. Indeed, the system can provide uni- and multisensory stimulation, allowing visually impaired people to train their capability of correctly interpreting non-visual cues from the environment. Importantly, the TechArm is suitable to be used by very young children, when the rehabilitative potential is maximal. In the present work, we validated the TechArm system on a pediatric population of low-vision, blind, and sighted children. In particular, four TechArm units were used to deliver uni- (audio or tactile) or multi-sensory stimulation (audio-tactile) on the participant's arm, and subject was asked to evaluate the number of active units. Results showed no significant difference among groups (normal or impaired vision). Overall, we observed the best performance in tactile condition, while auditory accuracy was around chance level. Also, we found that the audio-tactile condition is better than the audio condition alone, suggesting that multisensory stimulation is beneficial when perceptual accuracy and precision are low. Interestingly, we observed that for low-vision children the accuracy in audio condition improved proportionally to the severity of the visual impairment. Our findings confirmed the TechArm system's effectiveness in assessing perceptual competencies in sighted and visually impaired children, and its potential to be used to develop personalized rehabilitation programs for people with visual and sensory impairments.

Effects of audio-motor training on spatial representations in long-term late blindness.

Vision plays a pivotal role in the development of spatial representation. When visual feedback is absent, complex spatial representations are impaired and temporal properties of auditory information are used by blind people to build spatial maps. Specifically, late blind (LB) adults that have spent more than 20 years without vision (i.e., long-term LB) represent space based on temporal cues. In the present study, we investigate whether audio-motor training based on body feedback modifies the way in which long-term LB adults create spatial representations of the environment. Three long-term LB adults performed a battery of spatial tasks before and after four weeks of training, while three long-term LB adults performed the same tasks before and after four weeks without attending any training. Tasks included: i) an EEG recording during a spatial bisection task with coherent or conflicting spatiotemporal information, ii) auditory vertical and horizontal localization paradigms where participants indicated the final position of a moving sound source, iii) proprioceptive-motor paradigms where participants discriminated the end point of arm movements. The training consisted of specific exercises based on upper-limb movements with auditory feedback from a bracelet device and auditory paths. Our findings suggest that training produces a beneficial effect on some spatial competencies and tends to induce a cortical reorganization of occipital areas sensitive to spatial instead of temporal coordinates of sounds.

Feasibility of audio-motor training with the multisensory device ABBI: Implementation in a child with hemiplegia and hemianopia.

Spatial representation is crucial when it comes to everyday interaction with the environment. Different factors influence spatial perception, such as body movements and vision. Accordingly, training strategies that exploit the plasticity of the human brain should be adopted early. In the current study we developed and tested a new training protocol based on the reinforcement of audio-motor associations. It supports spatial development in one hemiplegic child with an important visual field defect (hemianopia) in the same side of the hemiplegic limb. We focused on investigating whether a better representation of the space using the sound can also improve the involvement of the hemiplegic upper limb in daily life activity. The experimental training consists of intensive but entertaining rehabilitation for two weeks, during which a child performed ad-hoc developed audio-motor-spatial exercises with the Audio Bracelet for Blind Interaction (ABBI) for 2 h/day. We administered a battery of tests before and after the training that indicated that the child significantly improved in both the spatial aspects and the involvement of the hemiplegic limb in bimanual tasks. During the assessment, ActiGraph GT3X+ was used to measure asymmetry in the use of the two upper limbs with a standardized clinical tool, the Assisting Hand Assessment (AHA), pre and post-training. Additionally, the study measured and recorded spontaneous daily life activity for at least 2 h/day. These results confirm that one can enhance perceptual development in motor and visual disorders using naturally associated auditory feedback to body movements.

Visual Function and Neuropsychological Profile in Children with Cerebral Visual Impairment.

Cerebral Visual Impairment (CVI) has become the leading cause of children's visual impairment in developed countries. Since CVI may negatively affect neuropsychomotor development, an early diagnosis and characterization become fundamental to define effective habilitation approaches. To date, there is a lack of standardized diagnostic methods to assess CVI in children, and the role of visual functions in children's neuropsychological profiles has been poorly investigated. In the present paper, we aim to describe the clinical and neuropsychological profiles and to investigate the possible effects of visual functions on neuropsychological performance of a cohort of children diagnosed with CVI. Fifty-one children with CVI were included in our retrospective analysis (inclusion criteria: verbal IQ > 70 in Wechsler scales; absence of significant ocular involvement). For each participant, we collected data on neuropsychological assessment (i.e., cognitive, cognitive visual, and learning abilities), basic visual functions (e.g., Best Corrected Visual Acuity­BCVA, contrast sensitivity, and ocular motor abilities) and global development features (e.g., neurological signs and motor development delay) based on standardized tests, according to patients' ages. The results showed that oculomotor dysfunction involving saccades and smooth pursuit may be a core symptom of CVI and might have a significant impact on cognitive visual and other neuropsychological abilities. Furthermore, visual acuity and contrast sensitivity may influence cognitive, cognitive visual, and academic performances. Our findings suggest the importance of a comprehensive assessment of both visual and neuropsychological functions in children when CVI is suspected, which is needed to provide a more comprehensive functional profile and define the best habilitation strategy to sustain functional vision.

Allocentric spatial perception through vision and touch in sighted and blind children.

Vision and touch play a critical role in spatial development, facilitating the acquisition of allocentric and egocentric frames of reference, respectively. Previous works have shown that children's ability to adopt an allocentric frame of reference might be impaired by the absence of visual experience during growth. In the current work, we investigated whether visual deprivation also impairs the ability to shift from egocentric to allocentric frames of reference in a switching-perspective task performed in the visual and haptic domains. Children with and without visual impairments from 6 to 13 years of age were asked to visually (only sighted children) or haptically (blindfolded sighted children and blind children) explore and reproduce a spatial configuration of coins by assuming either an egocentric perspective or an allocentric perspective. Results indicated that temporary visual deprivation impaired the ability of blindfolded sighted children to switch from egocentric to allocentric perspective more in the haptic domain than in the visual domain. Moreover, results on visually impaired children indicated that blindness did not impair allocentric spatial coding in the haptic domain but rather affected the ability to rely on haptic egocentric cues in the switching-perspective task. Finally, our findings suggested that the total absence of vision might impair the development of an egocentric perspective in case of body midline-crossing targets.

Effects of Increasing Stimulated Area in Spatiotemporally Congruent Unisensory and Multisensory Conditions.

Research has shown that the ability to integrate complementary sensory inputs into a unique and coherent percept based on spatiotemporal coincidence can improve perceptual precision, namely multisensory integration. Despite the extensive research on multisensory integration, very little is known about the principal mechanisms responsible for the spatial interaction of multiple sensory stimuli. Furthermore, it is not clear whether the size of spatialized stimulation can affect unisensory and multisensory perception. The present study aims to unravel whether the stimulated area's increase has a detrimental or beneficial effect on sensory threshold. Sixteen typical adults were asked to discriminate unimodal (visual, auditory, tactile), bimodal (audio-visual, audio-tactile, visuo-tactile) and trimodal (audio-visual-tactile) stimulation produced by one, two, three or four devices positioned on the forearm. Results related to unisensory conditions indicate that the increase of the stimulated area has a detrimental effect on auditory and tactile accuracy and visual reaction times, suggesting that the size of stimulated areas affects these perceptual stimulations. Concerning multisensory stimulation, our findings indicate that integrating auditory and tactile information improves sensory precision only when the stimulation area is augmented to four devices, suggesting that multisensory interaction is occurring for expanded spatial areas.

Audio-Visual Thumble (AVT): A low-vision rehabilitation device using multisensory feedbacks.

Since the 70s sensory substitution devices have been used for blind individuals to compensate for the lack of vision and enable them to perceive environment through intact sensory modalities. In this study, we present a rehabilitation device called Audio Visual Thumble (AVT), which is a small ring-like device with LED and buzzer, that can be worn on pharynx. We focus on a unique group of low-vision individuals with a black spot or scotoma in their visual field due to a disease called Macular Degeneration. The visual localization abilities of these individuals are highly impaired due to developing scotoma. We recently showed that also their audio localization skills are impaired [9]. Rehabilitation techniques developed so far for Macular Degeneration focus on visual modality only. Since audition can also be used to improve their spatial skills, we developed the AVT device. It permits to associate the multisensory information (audio and visual feedbacks) coming from the device with the own movement (proprioceptive feedback). We propose that the AVT has the potential to help people with visual dysfunctions to improve in the identification of audio and visual targets outside or at the edge of the residual visual field. AVT could be used for a wide range of applications combined with classical rehabilitation techniques in Macular Degeneration patients.Clinical relevance- This device can be an effective addition for low-vision rehabilitation experts and can be used combined with classical rehabilitation methods.

The Impact of Vision Loss on Allocentric Spatial Coding.

Several works have demonstrated that visual experience plays a critical role in the development of allocentric spatial coding. Indeed, while children with a typical development start to code space by relying on allocentric landmarks from the first year of life, blind children remain anchored to an egocentric perspective until late adolescence. Nonetheless, little is known about when and how visually impaired children acquire the ability to switch from an egocentric to an allocentric frame of reference across childhood. This work aims to investigate whether visual experience is necessary to shift from bodily to external frames of reference. Children with visual impairment and normally sighted controls between 4 and 9 years of age were asked to solve a visual switching-perspective task requiring them to assume an egocentric or an allocentric perspective depending on the task condition. We hypothesize that, if visual experience is necessary for allocentric spatial coding, then visually impaired children would have been impaired to switch from egocentric to allocentric perspectives. Results support this hypothesis, confirming a developmental delay in the ability to update spatial coordinates in visually impaired children. It suggests a pivotal role of vision in shaping allocentric spatial coding across development.

Shape Recognition With Sounds: Improvement in Sighted Individuals After Audio-Motor Training.

Recent studies have demonstrated that audition used to complement or substitute visual feedback is effective in conveying spatial information, e.g., sighted individuals can understand the curvature of a shape when solely auditory input is provided. Recently we also demonstrated that, in the absence of vision, auditory feedback of body movements can enhance spatial perception in visually impaired adults and children. In the present study, we assessed whether sighted adults can also improve their spatial abilities related to shape recognition with an audio-motor training based on the idea that the coupling of auditory and motor information can further refine the representation of space when vision is missing. Auditory shape recognition was assessed in 22 blindfolded sighted adults with an auditory task requiring participants to identify four shapes by means of the sound conveyed through a set of consecutive loudspeakers embedded on a fixed two-dimensional vertical array. We divided participants into two groups of 11 adults each, performing a training session in two different modalities: active audio-motor training (experimental group) and passive auditory training (control group). The audio-motor training consisted in the reproduction of specific movements with the arm by relying on the sound produced by an auditory source positioned on the wrist of participants. Results showed that sighted individuals improved the recognition of auditory shapes only after active training, suggesting that audio-motor feedback can be an effective tool to enhance spatial representation when visual information is lacking.