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Amaral L, Thomas P, Amedi A, Striem-Amit E. Longitudinal stability of individual brain plasticity patterns in blindness. Proc Natl Acad Sci U S A 2024; 121:e2320251121. [PMID: 39078671 PMCID: PMC11317565 DOI: 10.1073/pnas.2320251121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/24/2024] [Indexed: 07/31/2024] Open
Abstract
The primary visual cortex (V1) in blindness is engaged in a wide spectrum of tasks and sensory modalities, including audition, touch, language, and memory. This widespread involvement raises questions regarding the constancy of its role and whether it might exhibit flexibility in its function over time, connecting to diverse network functions specific to task demands. This would suggest that reorganized V1 assumes a role like multiple-demand system regions. Alternatively, varying patterns of plasticity in blind V1 may be attributed to individual factors, with different blind individuals recruiting V1 preferentially for different functions. In support of this, we recently showed that V1 functional connectivity (FC) varies greatly across blind individuals. But do these represent stable individual patterns of plasticity, or are they driven more by instantaneous changes, like a multiple-demand system now inhabiting V1? Here, we tested whether individual FC patterns from the V1 of blind individuals are stable over time. We show that over two years, FC from the V1 is unique and highly stable in a small sample of repeatedly sampled congenitally blind individuals. Further, using multivoxel pattern analysis, we demonstrate that the unique reorganization patterns of these individuals allow decoding of participant identity. Together with recent evidence for substantial individual differences in V1 connectivity, this indicates that there may be a consistent role for V1 in blindness, which may differ for each individual. Further, it suggests that the variability in visual reorganization in blindness across individuals could be used to seek stable neuromarkers for sight rehabilitation and assistive approaches.
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Affiliation(s)
- Lénia Amaral
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC20057
| | - Peyton Thomas
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC20057
| | - Amir Amedi
- Ivcher School of Psychology, The Institute for Brain, Mind and Technology, Reichman University, Herzliya4610101, Israel
- The Ruth & Meir Rosenthal Brain Imaging Center, Reichman University, Herzliya4610101, Israel
| | - Ella Striem-Amit
- Department of Neuroscience, Georgetown University Medical Center, Washington, DC20057
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2
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Helmich I, Gemmerich R. Neuronal Control of Posture in Blind Individuals. Brain Topogr 2024:10.1007/s10548-024-01041-7. [PMID: 38491332 DOI: 10.1007/s10548-024-01041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/08/2024] [Indexed: 03/18/2024]
Abstract
The control of posture is guided by the integration of sensory information. Because blind individuals cannot apply visual information to control posture as sighted individuals do they must compensate by the remaining senses. We therefore hypothesize that blind individuals alter their brain activation in the sensorimotor cortex during postural control to compensate for balance control without vision by the increased integration of somatosensory information. Ten blind and ten sighted (matched) individuals controlled posture during conditions with (I) eyes closed / open, and (II) stable / unstable surface conditions. Postural sway was recorded by applying a pressure distribution measuring plate. Brain activation was collected by functional Near InfraRed Spectroscopy (fNIRS) above motor-sensory cortices of the right and left hemispheres. Blind individuals showed significantly increased postural sway when balancing with open eyes on an unstable surface and when compared to sighted individuals. Whereas blind individuals showed significantly increased brain activation when balancing with open eyes on stable and unstable surface conditions, sighted individuals increased their brain oxygenation only during closed eyes and unstable surface conditions. Overall conditions, blind individuals presented significantly increased brain activation in two channels of the left and right hemispheric motor-sensory cortex when compared to sighted individuals. We therefore conclude that sighted individuals increase their brain oxygenation in the sensorimotor cortex during postural control tasks that demand sensory integration processes. Blind individuals are characterized by increased brain activation overall conditions indicating additional sensory integration during postural control. Thus, the sensorimotor cortex of blind individuals adapts to control posture without vision.
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Affiliation(s)
- I Helmich
- Department of Sport Science, University of Goettingen, Goettingen, Germany.
- Department of Motor Behavior in Sports, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany.
| | - R Gemmerich
- Department of Motor Behavior in Sports, German Sport University Cologne, Am Sportpark Müngersdorf 6, 50933, Cologne, Germany
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3
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Sourav S, Kekunnaya R, Bottari D, Shareef I, Pitchaimuthu K, Röder B. Sound suppresses earliest visual cortical processing after sight recovery in congenitally blind humans. Commun Biol 2024; 7:118. [PMID: 38253781 PMCID: PMC10803735 DOI: 10.1038/s42003-023-05749-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
Neuroscientific research has consistently shown more extensive non-visual activity in the visual cortex of congenitally blind humans compared to sighted controls; a phenomenon known as crossmodal plasticity. Whether or not crossmodal activation of the visual cortex retracts if sight can be restored is still unknown. The present study, involving a rare group of sight-recovery individuals who were born pattern vision blind, employed visual event-related potentials to investigate persisting crossmodal modulation of the initial visual cortical processing stages. Here we report that the earliest, stimulus-driven retinotopic visual cortical activity (<100 ms) was suppressed in a spatially specific manner in sight-recovery individuals when concomitant sounds accompanied visual stimulation. In contrast, sounds did not modulate the earliest visual cortical response in two groups of typically sighted controls, nor in a third control group of sight-recovery individuals who had suffered a transient phase of later (rather than congenital) visual impairment. These results provide strong evidence for persisting crossmodal activity in the visual cortex after sight recovery following a period of congenital visual deprivation. Based on the time course of this modulation, we speculate on a role of exuberant crossmodal thalamic input which may arise during a sensitive phase of brain development.
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Affiliation(s)
- Suddha Sourav
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany.
| | - Ramesh Kekunnaya
- Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Davide Bottari
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany
- IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Idris Shareef
- Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Kabilan Pitchaimuthu
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany
- Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
- Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden
| | - Brigitte Röder
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany
- Jasti V Ramanamma Children's Eye Care Center, Child Sight Institute, L V Prasad Eye Institute, Hyderabad, India
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Heitmann C, Zhan M, Linke M, Hölig C, Kekunnaya R, van Hoof R, Goebel R, Röder B. Early visual experience refines the retinotopic organization within and across visual cortical regions. Curr Biol 2023; 33:4950-4959.e4. [PMID: 37918397 DOI: 10.1016/j.cub.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 09/29/2023] [Accepted: 10/06/2023] [Indexed: 11/04/2023]
Abstract
Early visual areas are retinotopically organized in human and non-human primates. Population receptive field (pRF) size increases with eccentricity and from lower- to higher-level visual areas. Furthermore, the cortical magnification factor (CMF), a measure of how much cortical space is devoted to each degree of visual angle, is typically larger for foveal as opposed to peripheral regions of the visual field. Whether this fine-scale organization within and across visual areas depends on early visual experience has yet been unknown. Here, we employed 7T functional magnetic resonance imaging pRF mapping to assess the retinotopic organization of early visual regions (i.e., V1, V2, and V3) in eight sight recovery individuals with a history of congenital blindness until a maximum of 4 years of age. Compared with sighted controls, foveal pRF sizes in these individuals were larger, and pRF sizes did not show the typical increase with eccentricity and down the visual cortical processing stream (V1-V2-V3). Cortical magnification was overall diminished and decreased less from foveal to parafoveal visual field locations. Furthermore, cortical magnification correlated with visual acuity in sight recovery individuals. The results of this study suggest that early visual experience is essential for refining a presumably innate prototypical retinotopic organization in humans within and across visual areas, which seems to be crucial for acquiring full visual capabilities.
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Affiliation(s)
- Carolin Heitmann
- Biological Psychology and Neuropsychology Lab, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany.
| | - Minye Zhan
- U992 (Cognitive neuroimaging unit), NeuroSpin, INSERM-CEA, 91191 Gif sur Yvette, France
| | - Madita Linke
- Biological Psychology and Neuropsychology Lab, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany
| | - Cordula Hölig
- Biological Psychology and Neuropsychology Lab, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany
| | - Ramesh Kekunnaya
- U992 (Cognitive neuroimaging unit), NeuroSpin, INSERM-CEA, 91191 Gif sur Yvette, France
| | - Rick van Hoof
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands; Department of Development and Research, Brain Innovation B.V., Oxfordlaan 55, 6229 EV Maastricht, the Netherlands
| | - Brigitte Röder
- Biological Psychology and Neuropsychology Lab, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 11, 20146 Hamburg, Germany; Child Sight Institute, Jasti V. Ramanamma Children's Eye Care Center, LV Prasad Eye Institute, Hyderabad, Telangana 500034, India.
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5
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Hernández-Lucena J, Alonso-Aliste F, Amián-Cordero J, Sánchez-González JM. Exploring the Effect of Preoperative Stereopsis on Visual Outcomes in Hyperopic Presbyopes Treated with PresbyOND ® Laser Blended Vision Micro-Monovision. J Clin Med 2023; 12:6399. [PMID: 37835042 PMCID: PMC10573515 DOI: 10.3390/jcm12196399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 09/28/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
We investigated the effects of Laser Blended Vision (LBV) on binocular summation and stereopsis in the treatment of presbyopia and hyperopia. Using a unidirectional, retrospective longitudinal design, data from 318 patients who underwent the Zeiss PresbyOND® LBV surgical procedure at Tecnolaser Clinic Vision Ophthalmology Center in Seville, Spain, were analyzed. The findings indicate that stereopsis quality significantly influenced short-term post-operative visual outcomes in measures like Uncorrected Distance and Near Visual Acuity (UDVA and UNVA). However, the impact of stereopsis on visual outcomes appeared to diminish over time, becoming statistically insignificant at the 12-month post-operative mark. The study suggests that while stereopsis is a crucial factor in the short term, its influence on visual outcomes tends to wane in the long-term postoperative period. Future studies are essential to elucidate the enduring clinical ramifications of these observations.
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Affiliation(s)
- Julia Hernández-Lucena
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes S/N, 41012 Seville, Spain;
- Department of Ophthalmology (Tecnolaser Clinic Vision), Refractive Surgery Center, Juan Antonio Cavestany, 41018 Seville, Spain
| | - Federico Alonso-Aliste
- Department of Ophthalmology (Tecnolaser Clinic Vision), Refractive Surgery Center, Juan Antonio Cavestany, 41018 Seville, Spain
| | - Jonatan Amián-Cordero
- Department of Ophthalmology (Tecnolaser Clinic Vision), Refractive Surgery Center, Juan Antonio Cavestany, 41018 Seville, Spain
| | - José-María Sánchez-González
- Department of Physics of Condensed Matter, Optics Area, University of Seville, Reina Mercedes S/N, 41012 Seville, Spain;
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Ossandón JP, Stange L, Gudi-Mindermann H, Rimmele JM, Sourav S, Bottari D, Kekunnaya R, Röder B. The development of oscillatory and aperiodic resting state activity is linked to a sensitive period in humans. Neuroimage 2023; 275:120171. [PMID: 37196987 DOI: 10.1016/j.neuroimage.2023.120171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 05/19/2023] Open
Abstract
Congenital blindness leads to profound changes in electroencephalographic (EEG) resting state activity. A well-known consequence of congenital blindness in humans is the reduction of alpha activity which seems to go together with increased gamma activity during rest. These results have been interpreted as indicating a higher excitatory/inhibitory (E/I) ratio in visual cortex compared to normally sighted controls. Yet it is unknown whether the spectral profile of EEG during rest would recover if sight were restored. To test this question, the present study evaluated periodic and aperiodic components of the EEG resting state power spectrum. Previous research has linked the aperiodic components, which exhibit a power-law distribution and are operationalized as a linear fit of the spectrum in log-log space, to cortical E/I ratio. Moreover, by correcting for the aperiodic components from the power spectrum, a more valid estimate of the periodic activity is possible. Here we analyzed resting state EEG activity from two studies involving (1) 27 permanently congenitally blind adults (CB) and 27 age-matched normally sighted controls (MCB); (2) 38 individuals with reversed blindness due to bilateral, dense, congenital cataracts (CC) and 77 age-matched sighted controls (MCC). Based on a data driven approach, aperiodic components of the spectra were extracted for the low frequency (Lf-Slope 1.5 to 19.5 Hz) and high frequency (Hf-Slope 20 to 45 Hz) range. The Lf-Slope of the aperiodic component was significantly steeper (more negative slope), and the Hf-Slope of the aperiodic component was significantly flatter (less negative slope) in CB and CC participants compared to the typically sighted controls. Alpha power was significantly reduced, and gamma power was higher in the CB and the CC groups. These results suggest a sensitive period for the typical development of the spectral profile during rest and thus likely an irreversible change in the E/I ratio in visual cortex due to congenital blindness. We speculate that these changes are a consequence of impaired inhibitory circuits and imbalanced feedforward and feedback processing in early visual areas of individuals with a history of congenital blindness.
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Affiliation(s)
- José P Ossandón
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany.
| | - Liesa Stange
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany
| | - Helene Gudi-Mindermann
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany; Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
| | - Johanna M Rimmele
- Department of Neuroscience, Max-Planck-Institute for Empirical Aesthetics, Frankfurt, Germany; Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Max Planck NYU Center for Language, Music, and Emotion Frankfurt am Main, Germany, New York, NY, USA
| | - Suddha Sourav
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany
| | - Davide Bottari
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany; IMT School for Advanced Studies Lucca, Italy
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Center, LV Prasad Eye Institute, Hyderabad, India
| | - Brigitte Röder
- Biological Psychology and Neuropsychology, University of Hamburg, Hamburg, Germany; Child Sight Institute, Jasti V Ramanamma Children's Eye Care Center, LV Prasad Eye Institute, Hyderabad, India
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7
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Maimon A, Netzer O, Heimler B, Amedi A. Testing geometry and 3D perception in children following vision restoring cataract-removal surgery. Front Neurosci 2023; 16:962817. [PMID: 36711132 PMCID: PMC9879291 DOI: 10.3389/fnins.2022.962817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
As neuroscience and rehabilitative techniques advance, age-old questions concerning the visual experience of those who gain sight after blindness, once thought to be philosophical alone, take center stage and become the target for scientific inquiries. In this study, we employ a battery of visual perception tasks to study the unique experience of a small group of children who have undergone vision-restoring cataract removal surgery as part of the Himalayan Cataract Project. We tested their abilities to perceive in three dimensions (3D) using a binocular rivalry task and the Brock string task, perceive visual illusions, use cross-modal mappings between touch and vision, and spatially group based on geometric cues. Some of the children in this study gained a sense of sight for the first time in their lives, having been born with bilateral congenital cataracts, while others suffered late-onset blindness in one eye alone. This study simultaneously supports yet raises further questions concerning Hubel and Wiesel's critical periods theory and provides additional insight into Molyneux's problem, the ability to correlate vision with touch quickly. We suggest that our findings present a relatively unexplored intermediate stage of 3D vision development. Importantly, we spotlight some essential geometrical perception visual abilities that strengthen the idea that spontaneous geometry intuitions arise independently from visual experience (and education), thus replicating and extending previous studies. We incorporate a new model, not previously explored, of testing children with congenital cataract removal surgeries who perform the task via vision. In contrast, previous work has explored these abilities in the congenitally blind via touch. Taken together, our findings provide insight into the development of what is commonly known as the visual system in the visually deprived and highlight the need to further empirically explore an amodal, task-based interpretation of specializations in the development and structure of the brain. Moreover, we propose a novel objective method, based on a simple binocular rivalry task and the Brock string task, for determining congenital (early) vs. late blindness where medical history and records are partial or lacking (e.g., as is often the case in cataract removal cases).
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Affiliation(s)
- Amber Maimon
- The Baruch Ivcher Institute for Brain, Cognition, and Technology, Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel,The Ruth & Meir Rosenthal Brain Imaging Center, Reichman University, Herzliya, Israel,*Correspondence: Amber Maimon,
| | - Ophir Netzer
- Gonda Brain Research Center, Bar-Ilan University, Ramat Gan, Israel
| | - Benedetta Heimler
- Center of Advanced Technologies in Rehabilitation (CATR), Sheba Medical Center, Ramat Gan, Israel
| | - Amir Amedi
- The Baruch Ivcher Institute for Brain, Cognition, and Technology, Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel,The Ruth & Meir Rosenthal Brain Imaging Center, Reichman University, Herzliya, Israel
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8
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May E, Arach P, Kishiki E, Geneau R, Maehara G, Sukhai M, Hamm LM. Learning to see after early and extended blindness: A scoping review. Front Psychol 2022; 13:954328. [PMID: 36389599 PMCID: PMC9648338 DOI: 10.3389/fpsyg.2022.954328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/26/2022] [Indexed: 10/03/2023] Open
Abstract
PURPOSE If an individual has been blind since birth due to a treatable eye condition, ocular treatment is urgent. Even a brief period of visual deprivation can alter the development of the visual system. The goal of our structured scoping review was to understand how we might better support children with delayed access to ocular treatment for blinding conditions. METHOD We searched MEDLINE, Embase and Global Health for peer-reviewed publications that described the impact of early (within the first year) and extended (lasting at least 2 years) bilateral visual deprivation. RESULTS Of 551 reports independently screened by two authors, 42 studies met our inclusion criteria. Synthesizing extracted data revealed several trends. The data suggests persistent deficits in visual acuity, contrast sensitivity, global motion, and visual-motor integration, and suspected concerns for understanding complex objects and faces. There is evidence for resilience in color perception, understanding of simple shapes, discriminating between a face and non-face, and the perception of biological motion. There is currently insufficient data about specific (re)habilitation strategies to update low vision services, but there are several insights to guide future research in this domain. CONCLUSION This summary will help guide the research and services provision to help children learn to see after early and extended blindness.
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Affiliation(s)
- Eloise May
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
| | | | | | - Robert Geneau
- Kilimanjaro Centre for Community Ophthalmology, Moshi, Tanzania
- Division of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Goro Maehara
- Department of Human Sciences, Kanagawa University, Yokohama, Japan
| | - Mahadeo Sukhai
- Accessibility, Research and International Affairs, Canadian National Institute for the Blind, Toronto, ON, Canada
- Department of Ophthalmology, Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Lisa M. Hamm
- School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand
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Senna I, Piller S, Gori M, Ernst M. The power of vision: calibration of auditory space after sight restoration from congenital cataracts. Proc Biol Sci 2022; 289:20220768. [PMID: 36196538 PMCID: PMC9532985 DOI: 10.1098/rspb.2022.0768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022] Open
Abstract
Early visual deprivation typically results in spatial impairments in other sensory modalities. It has been suggested that, since vision provides the most accurate spatial information, it is used for calibrating space in the other senses. Here we investigated whether sight restoration after prolonged early onset visual impairment can lead to the development of more accurate auditory space perception. We tested participants who were surgically treated for congenital dense bilateral cataracts several years after birth. In Experiment 1 we assessed participants' ability to understand spatial relationships among sounds, by asking them to spatially bisect three consecutive, laterally separated sounds. Participants performed better after surgery than participants tested before. However, they still performed worse than sighted controls. In Experiment 2, we demonstrated that single sound localization in the two-dimensional frontal plane improves quickly after surgery, approaching performance levels of sighted controls. Such recovery seems to be mediated by visual acuity, as participants gaining higher post-surgical visual acuity performed better in both experiments. These findings provide strong support for the hypothesis that vision calibrates auditory space perception. Importantly, this also demonstrates that this process can occur even when vision is restored after years of visual deprivation.
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Affiliation(s)
- Irene Senna
- Applied Cognitive Psychology, Faculty for Computer Science, Engineering, and Psychology, Ulm University, Ulm, Germany
| | - Sophia Piller
- Applied Cognitive Psychology, Faculty for Computer Science, Engineering, and Psychology, Ulm University, Ulm, Germany
| | - Monica Gori
- Unit for Visually Impaired People (U-VIP), Center for Human Technologies, Fondazione Istituto Italiano di Tecnologia, Genoa, Italy
| | - Marc Ernst
- Applied Cognitive Psychology, Faculty for Computer Science, Engineering, and Psychology, Ulm University, Ulm, Germany
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Guerreiro MJS, Kekunnaya R, Röder B. Top-down modulation of visual cortical processing after transient congenital blindness. Neuropsychologia 2022; 174:108338. [PMID: 35931134 DOI: 10.1016/j.neuropsychologia.2022.108338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 10/16/2022]
Abstract
Early visual experience has been shown to be critical for the development of visual and multisensory functions; however, its impact on functional brain organization remains largely unexplored. Here, we therefore investigated the effect of early visual deprivation on top-down attentional modulation of visual cortical processing within the occipito-temporal cortex. Furthermore, we explored whether early visual deprivation may affect the extent to which typically visual, motion-selective area hMT responds to moving visual stimuli. Using functional magnetic resonance imaging, we compared cortical responses in area hMT and in the fusiform face area (FFA) to moving face stimuli - which were either task relevant or task irrelevant - relative to stationary face stimuli between cataract-reversal participants and normally sighted controls. Although both groups exhibited significantly stronger visual cortical responses in area hMT to moving stimuli than during the stationary baseline, the magnitude of this effect was significantly lower in the cataract-reversal group. In contrast, both groups exhibited significantly enhanced visual cortical responses in area hMT and in the FFA when moving face stimuli were task relevant compared to when they were task irrelevant, with no significant differences between groups in the magnitude of these effects. These results indicate that top-down attentional modulation of visual cortical processing in area hMT and FFA does not depend on early visual experience. Furthermore, the present results suggest that the functional specialization of area hMT for visual motion processing may be partially disrupted by early visual deprivation.
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Affiliation(s)
- Maria J S Guerreiro
- Biological Psychology and Neuropsychology, Institute for Psychology, University of Hamburg, Von-Melle-Park 11, D-20146, Hamburg, Germany; Biological Psychology, Department of Psychology, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, 26111, Oldenburg, Germany.
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V. Ramanamma Children's Eye Care Center, Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, 500034, Telengana, India
| | - Brigitte Röder
- Biological Psychology and Neuropsychology, Institute for Psychology, University of Hamburg, Von-Melle-Park 11, D-20146, Hamburg, Germany
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11
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Rączy K, Hölig C, Guerreiro MJS, Lingareddy S, Kekunnaya R, Röder B. Typical resting state activity of the brain requires visual input during an early sensitive period. Brain Commun 2022; 4:fcac146. [PMID: 35836836 PMCID: PMC9275761 DOI: 10.1093/braincomms/fcac146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 03/02/2022] [Accepted: 06/01/2022] [Indexed: 11/17/2022] Open
Abstract
Sensory deprivation, following a total loss of one sensory modality e.g. vision, has been demonstrated to result in compensatory plasticity. It is yet not known to which extent neural changes, e.g. higher resting-state activity in visual areas (cross-modal plasticity) as a consequence of blindness, reverse, when sight is restored. Here, we used functional MRI to acquire blood oxygen level-dependent resting-state activity during an eyes open and an eyes closed state in congenital cataract-reversal individuals, developmental cataract-reversal individuals, congenitally permanently blind individuals and sighted controls. The amplitude of low frequency fluctuation of the blood oxygen level-dependent signal—a neural marker of spontaneous brain activity during rest—was analyzed. In accordance with previous reports, in normally sighted controls we observed an increase in amplitude of low-frequency fluctuation during rest with the eyes open compared with rest with eyes closed in visual association areas and in parietal cortex but a decrease in auditory and sensorimotor regions. In congenital cataract-reversal individuals, we found an increase of the amplitude of slow blood oxygen level-dependent fluctuations in visual cortex during rest with eyes open compared with rest with eyes closed too but this increase was larger in amplitude than in normally sighted controls. In contrast, congenital cataract-reversal individuals lagged a similar increase in parietal regions and did not show the typical decrease of amplitude of low-frequency fluctuation in auditory cortex. Congenitally blind individuals displayed an overall higher amplitude in slow blood oxygen level-dependent fluctuations in visual cortex compared with sighted individuals and compared with congenital cataract-reversal individuals in the eyes closed condition. Higher amplitude of low-frequency fluctuation in visual cortex of congenital cataract-reversal individuals than in normally sighted controls during eyes open might indicate an altered excitatory–inhibitory balance of visual neural circuits. By contrast, the lower parietal increase and the missing downregulation in auditory regions suggest a reduced influence of the visual system on multisensory and the other sensory systems after restoring sight in congenitally blind individuals. These results demonstrate a crucial dependence of visual and multisensory neural system functioning on visual experience during a sensitive phase in human brain development.
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Affiliation(s)
- Katarzyna Rączy
- University of Hamburg Biological Psychology and Neuropsychology, , 20146 Hamburg, Germany
| | - Cordula Hölig
- University of Hamburg Biological Psychology and Neuropsychology, , 20146 Hamburg, Germany
| | - Maria J. S. Guerreiro
- University of Hamburg Biological Psychology and Neuropsychology, , 20146 Hamburg, Germany
- Biological Psychology, Department of Psychology, Carl Von Ossietzky University of Oldenburg , 26111, Oldenburg, Germany
| | | | - Ramesh Kekunnaya
- Child Sight Institute, LV Prasad Eye Institute Jasti V Ramanamma Children's Eye Care Center, , 500034 Hyderabad, India
| | - Brigitte Röder
- University of Hamburg Biological Psychology and Neuropsychology, , 20146 Hamburg, Germany
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12
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Qu 曲晓霞 X, Ding 丁静文 J, Wang 王倩 Q, Cui 崔靖 J, Dong J, Guo 郭健 J, Li 李婷 T, Xie 解立志 L, Li 李冬梅 D, Xian 鲜军舫 J. Effect of the long-term lack of half visual inputs on the white matter microstructure in congenital monocular blindness. Brain Res 2022; 1781:147832. [DOI: 10.1016/j.brainres.2022.147832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 01/31/2023]
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13
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Delayed Auditory Brainstem Responses (ABR) in children after sight-recovery. Neuropsychologia 2021; 163:108089. [PMID: 34801518 DOI: 10.1016/j.neuropsychologia.2021.108089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 10/29/2021] [Accepted: 11/15/2021] [Indexed: 01/25/2023]
Abstract
Studies in non-human animal models have revealed that in early development, the onset of visual input gates the critical period closure of some auditory functions. The study of rare individuals whose sight was restored after a period of congenital blindness offers the rare opportunity to assess whether early visual input is a prerequisite for the full development of auditory functions in humans as well. Here, we investigated whether a few months of delayed visual onset would affect the development of Auditory Brainstem Responses (ABRs). ABRs are widely used in the clinical practice to assess both functionality and development of the subcortical auditory pathway and, provide reliable data at the individual level. We collected Auditory Brainstem Responses from two case studies, young children (both having less than 5 years of age) who experienced a transient visual deprivation since birth due to congenital bilateral dense cataracts (BC), and who acquired sight at about two months of age. As controls, we tested 41 children (sighted controls, SC) with typical development, as well as two children who were treated (at about two months of age) for congenital monocular cataracts (MC). The SC group data served to predict, at the individual level, wave latencies of each BC and MC participant. Statistics were performed both at the single subject as well as at the group levels on latencies of main ABR waves (I, III, V and SN10). Results revealed delayed response latencies for both BC children compared with the SC group starting from the wave III. Conversely, no difference emerged between MC children and the SC group. These findings suggest that in case the onset of patterned visual input is delayed, the functional development of the subcortical auditory pathway lags behind typical developmental trajectories. Ultimately results are in favor of the presence of a crossmodal sensitive period in the human subcortical auditory system.
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14
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Feng Y, Collignon O, Maurer D, Yao K, Gao X. Brief Postnatal Visual Deprivation Triggers Long-Lasting Interactive Structural and Functional Reorganization of the Human Cortex. Front Med (Lausanne) 2021; 8:752021. [PMID: 34869446 PMCID: PMC8635780 DOI: 10.3389/fmed.2021.752021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Patients treated for bilateral congenital cataracts provide a unique model to test the role of early visual input in shaping the development of the human cortex. Previous studies showed that brief early visual deprivation triggers long-lasting changes in the human visual cortex. However, it remains unknown if such changes interact with the development of other parts of the cortex. With high-resolution structural and resting-state fMRI images, we found changes in cortical thickness within, but not limited to, the visual cortex in adult patients, who experienced transient visual deprivation early in life as a result of congenital cataracts. Importantly, the covariation of cortical thickness across regions was also altered in the patients. The areas with altered cortical thickness in patients also showed differences in functional connectivity between patients and normally sighted controls. Together, the current findings suggest an impact of early visual deprivation on the interactive development of the human cortex.
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Affiliation(s)
- Yixuan Feng
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Olivier Collignon
- Institute of Research in Psychology/Institute of Neuroscience, University of Louvain, Louvain-la-Neuve, Belgium.,Centro Interdipartimentale Mente/Cervello, Università di Trento, Trento, Italy
| | - Daphne Maurer
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Ke Yao
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China.,Zhejiang Provincial Key Lab of Ophthalmology, Hangzhou, China
| | - Xiaoqing Gao
- Center for Psychological Sciences, Zhejiang University, Hangzhou, China
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15
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Berto M, Ricciardi E, Pietrini P, Bottari D. Interactions between auditory statistics processing and visual experience emerge only in late development. iScience 2021; 24:103383. [PMID: 34816108 PMCID: PMC8593607 DOI: 10.1016/j.isci.2021.103383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/18/2021] [Accepted: 10/27/2021] [Indexed: 01/10/2023] Open
Abstract
The auditory system relies on local and global representations to discriminate sounds. This study investigated whether vision influences the development and functioning of these fundamental sound computations. We employed a computational approach to control statistical properties embedded in sounds and tested samples of sighted controls (SC) and congenitally (CB) and late-onset (LB) blind individuals in two experiments. In experiment 1, performance relied on local features analysis; in experiment 2, performance benefited from computing global representations. In both experiments, SC and CB performance remarkably overlapped. Conversely, LB performed systematically worse than the other groups when relying on local features, with no alterations on global representations. Results suggest that auditory computations tested here develop independently from vision. The efficiency of local auditory processing can be hampered in case sight becomes unavailable later in life, supporting the existence of an audiovisual interplay for the processing of auditory details, which emerges only in late development. Computational and deprivation models can be combined to assess sensory plasticity Basic auditory computations develop independently from early visual input Late-onset sight loss can hamper the efficiency of local auditory processing
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Affiliation(s)
- Martina Berto
- Molecular Mind Lab, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy
| | - Emiliano Ricciardi
- Molecular Mind Lab, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy
| | - Pietro Pietrini
- Molecular Mind Lab, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy
| | - Davide Bottari
- Molecular Mind Lab, IMT School for Advanced Studies Lucca, 55100 Lucca, Italy
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16
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Ponticorvo S, Manara R, Cassandro E, Canna A, Scarpa A, Troisi D, Cassandro C, Cuoco S, Cappiello A, Pellecchia MT, Salle FD, Esposito F. Cross-modal connectivity effects in age-related hearing loss. Neurobiol Aging 2021; 111:1-13. [PMID: 34915240 DOI: 10.1016/j.neurobiolaging.2021.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 10/19/2022]
Abstract
Age-related sensorineural hearing loss (HL) leads to localized brain changes in the primary auditory cortex, long-range functional alterations, and is considered a risk factor for dementia. Nonhuman studies have repeatedly highlighted cross-modal brain plasticity in sensorial brain networks other than those primarily involved in the peripheral damage, thus in this study, the possible cortical alterations associated with HL have been analyzed using a whole-brain multimodal connectomic approach. Fifty-two HL and 30 normal hearing participants were examined in a 3T MRI study along with audiological and neurological assessments. Between-regions functional connectivity and whole-brain probabilistic tractography were calculated in a connectome-based manner and graph theory was used to obtain low-dimensional features for the analysis of brain connectivity at global and local levels. The HL condition was associated with a different functional organization of the visual subnetwork as revealed by a significant increase in global efficiency, density, and clustering coefficient. These functional effects were mirrored by similar (but more subtle) structural effects suggesting that a functional repurposing of visual cortical centers occurs to compensate for age-related loss of hearing abilities.
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Affiliation(s)
- Sara Ponticorvo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy
| | - Renzo Manara
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; Department of Neuroscience, University of Padova, Padova, Italy
| | - Ettore Cassandro
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Scuola Medica Salernitana, Salerno, Italy
| | - Antonietta Canna
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Scuola Medica Salernitana, Salerno, Italy
| | - Donato Troisi
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Scuola Medica Salernitana, Salerno, Italy
| | - Claudia Cassandro
- University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Scuola Medica Salernitana, Salerno, Italy
| | - Sofia Cuoco
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Scuola Medica Salernitana, Salerno, Italy
| | - Arianna Cappiello
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Scuola Medica Salernitana, Salerno, Italy
| | - Maria Teresa Pellecchia
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Scuola Medica Salernitana, Salerno, Italy
| | - Francesco Di Salle
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Baronissi, Italy; University Hospital "San Giovanni di Dio e Ruggi D'Aragona", Scuola Medica Salernitana, Salerno, Italy
| | - Fabrizio Esposito
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Napoli, Italy.
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17
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Bottari D, Berto M. Three factors to characterize plastic potential transitions in the visual system. Neurosci Biobehav Rev 2021; 126:444-446. [PMID: 33857578 DOI: 10.1016/j.neubiorev.2021.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
Abstract
A comprehensive understanding of brain-environment interactions is elusive even at the sensory level as neural plasticity waxes and wanes across the lifespan. Temporary and permanent visual deprivations remain pivotal approaches for studying the degree of experience-dependent plasticity of sensory functions. Natural models and experimental manipulations of visual experiences have contributed to uncovering some of the guiding principles that characterize transitions of plastic potentials in the human visual system. The existing literature regarding the neural plasticity associated with visual systems has been extensively discussed by two recent reviews articles (Röder et al., 2020; Castaldi et al., 2020) which provided an overview of different models of study and methods of investigations, gathering insights on both developing and adult brains. Here, we propose a framework of three main factors to characterize how the driving forces shaping visual circuits mutate, both quantitatively and qualitatively, between early development and adulthood.
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Affiliation(s)
- Davide Bottari
- Molecular Mind Lab, IMT School for Advanced Studies Lucca, Italy.
| | - Martina Berto
- Molecular Mind Lab, IMT School for Advanced Studies Lucca, Italy
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18
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Senna I, Cuturi LF, Gori M, Ernst MO, Cappagli G. Editorial: Spatial and Temporal Perception in Sensory Deprivation. Front Neurosci 2021; 15:671836. [PMID: 33859550 PMCID: PMC8042209 DOI: 10.3389/fnins.2021.671836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/04/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Irene Senna
- Department of Applied Cognitive Psychology, Ulm University, Ulm, Germany
| | | | - Monica Gori
- Italian Institute of Technology (IIT), Genoa, Italy
| | - Marc O Ernst
- Department of Applied Cognitive Psychology, Ulm University, Ulm, Germany
| | - Giulia Cappagli
- Italian Institute of Technology (IIT), Genoa, Italy.,Neurological Institute Foundation Casimiro Mondino (Istituto di Ricovero e Cura a Carattere Scientifico), Pavia, Italy
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19
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Pant R, Guerreiro MJS, Ley P, Bottari D, Shareef I, Kekunnaya R, Röder B. The size-weight illusion is unimpaired in individuals with a history of congenital visual deprivation. Sci Rep 2021; 11:6693. [PMID: 33758328 PMCID: PMC7988063 DOI: 10.1038/s41598-021-86227-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 03/10/2021] [Indexed: 11/29/2022] Open
Abstract
Visual deprivation in childhood can lead to lifelong impairments in multisensory processing. Here, the Size-Weight Illusion (SWI) was used to test whether visuo-haptic integration recovers after early visual deprivation. Normally sighted individuals perceive larger objects to be lighter than smaller objects of the same weight. In Experiment 1, individuals treated for dense bilateral congenital cataracts (who had no patterned visual experience at birth), individuals treated for developmental cataracts (who had patterned visual experience at birth, but were visually impaired), congenitally blind individuals and normally sighted individuals had to rate the weight of manually explored cubes that differed in size (Small, Medium, Large) across two possible weights (350 g, 700 g). In Experiment 2, individuals treated for dense bilateral congenital cataracts were compared to sighted individuals in a similar task using a string set-up, which removed haptic size cues. In both experiments, indistinguishable SWI effects were observed across all groups. These results provide evidence that early aberrant vision does not interfere with the development of the SWI, and suggest a recovery of the integration of size and weight cues provided by the visual and haptic modality.
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Affiliation(s)
- Rashi Pant
- Biological Psychology and Neuropsychology, University of Hamburg, 20146, Hamburg, Germany.
| | - Maria J S Guerreiro
- Biological Psychology and Neuropsychology, University of Hamburg, 20146, Hamburg, Germany
| | - Pia Ley
- Biological Psychology and Neuropsychology, University of Hamburg, 20146, Hamburg, Germany
| | - Davide Bottari
- Biological Psychology and Neuropsychology, University of Hamburg, 20146, Hamburg, Germany.,Molecular Mind Lab, IMT School for Advanced Studies, 55100, Lucca, Italy
| | - Idris Shareef
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Center, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Center, LV Prasad Eye Institute, Hyderabad, Telangana, 500034, India
| | - Brigitte Röder
- Biological Psychology and Neuropsychology, University of Hamburg, 20146, Hamburg, Germany
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20
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Visual experience dependent plasticity in humans. Curr Opin Neurobiol 2020; 67:155-162. [PMID: 33340877 DOI: 10.1016/j.conb.2020.11.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/12/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022]
Abstract
While sensitive periods in brain development have often been studied by investigating the recovery of visual functions after a congenital phase of visual deprivation in non-human animals, research in humans who had recovered sight after a transient phase of congenital blindness is still scarce. Here, we discuss the hypothesis put forward based on non-human primate work which states that the effects of experience increase downstream the visual processing hierarchy. Recent results from behavioral and neuroscience studies in sight recovery individuals are discussed in the context of research findings from permanently congenitally blind humans as well as from prospective studies in infants and children.
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