Early visual deprivation severely compromises the auditory sense of space in congenitally blind children

Perceiving depth beyond sight: Evaluating intrinsic and learned cues via a proof of concept sensory substitution method in the visually impaired and sighted

This study explores spatial perception of depth by employing a novel proof of concept sensory substitution algorithm. The algorithm taps into existing cognitive scaffolds such as language and cross modal correspondences by naming objects in the scene while representing their elevation and depth by manipulation of the auditory properties for each axis. While the representation of verticality utilized a previously tested correspondence with pitch, the representation of depth employed an ecologically inspired manipulation, based on the loss of gain and filtration of higher frequency sounds over distance. The study, involving 40 participants, seven of which were blind (5) or visually impaired (2), investigates the intrinsicness of an ecologically inspired mapping of auditory cues for depth by comparing it to an interchanged condition where the mappings of the two axes are swapped. All participants successfully learned to use the algorithm following a very brief period of training, with the blind and visually impaired participants showing similar levels of success for learning to use the algorithm as did their sighted counterparts. A significant difference was found at baseline between the two conditions, indicating the intuitiveness of the original ecologically inspired mapping. Despite this, participants were able to achieve similar success rates following the training in both conditions. The findings indicate that both intrinsic and learned cues come into play with respect to depth perception. Moreover, they suggest that by employing perceptual learning, novel sensory mappings can be trained in adulthood. Regarding the blind and visually impaired, the results also support the convergence view, which claims that with training, their spatial abilities can converge with those of the sighted. Finally, we discuss how the algorithm can open new avenues for accessibility technologies, virtual reality, and other practical applications.

The Impact of Spectral and Temporal Degradation on Vocoded Speech Recognition in Early-Blind Individuals

This study compared the impact of spectral and temporal degradation on vocoded speech recognition between early-blind and sighted subjects. The participants included 25 early-blind subjects (30.32 ± 4.88 years; male:female, 14:11) and 25 age- and sex-matched sighted subjects. Tests included monosyllable recognition in noise at various signal-to-noise ratios (-18 to -4 dB), matrix sentence-in-noise recognition, and vocoded speech recognition with different numbers of channels (4, 8, 16, and 32) and temporal envelope cutoff frequencies (50 vs 500 Hz). Cortical-evoked potentials (N2 and P3b) were measured in response to spectrally and temporally degraded stimuli. The early-blind subjects displayed superior monosyllable and sentence recognition than sighted subjects (all p < 0.01). In the vocoded speech recognition test, a three-way repeated-measure analysis of variance (two groups × four channels × two cutoff frequencies) revealed significant main effects of group, channel, and cutoff frequency (all p < 0.001). Early-blind subjects showed increased sensitivity to spectral degradation for speech recognition, evident in the significant interaction between group and channel (p = 0.007). N2 responses in early-blind subjects exhibited shorter latency and greater amplitude in the 8-channel (p = 0.022 and 0.034, respectively) and shorter latency in the 16-channel (p = 0.049) compared with sighted subjects. In conclusion, early-blind subjects demonstrated speech recognition advantages over sighted subjects, even in the presence of spectral and temporal degradation. Spectral degradation had a greater impact on speech recognition in early-blind subjects, while the effect of temporal degradation was similar in both groups.

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).

Auditory Spatial Bisection of Blind and Normally Sighted Individuals in Free Field and Virtual Acoustics

Sound localization is an important ability in everyday life. This study investigates the influence of vision and presentation mode on auditory spatial bisection performance. Subjects were asked to identify the smaller perceived distance between three consecutive stimuli that were either presented via loudspeakers (free field) or via headphones after convolution with generic head-related impulse responses (binaural reproduction). Thirteen azimuthal sound incidence angles on a circular arc segment of ±24° at a radius of 3 m were included in three regions of space (front, rear, and laterally left). Twenty normally sighted (measured both sighted and blindfolded) and eight blind persons participated. Results showed no significant differences with respect to visual condition, but strong effects of sound direction and presentation mode. Psychometric functions were steepest in frontal space and indicated median spatial bisection thresholds of 11°-14°. Thresholds increased significantly in rear (11°-17°) and laterally left (20°-28°) space in free field. Individual pinna and torso cues, as available only in free field presentation, improved the performance of all participants compared to binaural reproduction. Especially in rear space, auditory spatial bisection thresholds were three to four times higher (i.e., poorer) using binaural reproduction than in free field. The results underline the importance of individual auditory spatial cues for spatial bisection, irrespective of access to vision, which indicates that vision may not be strictly necessary to calibrate allocentric spatial hearing.

Do blind people hear better?

For centuries, anecdotal evidence such as the perfect pitch of the blind piano tuner or blind musician has supported the notion that individuals who have lost their sight early in life have superior hearing abilities compared with sighted people. Recently, auditory psychophysical and functional imaging studies have identified that specific auditory enhancements in the early blind can be linked to activation in extrastriate visual cortex, suggesting crossmodal plasticity. Furthermore, the nature of the sensory reorganization in occipital cortex supports the concept of a task-based functional cartography for the cerebral cortex rather than a sensory-based organization. In total, studies of early-blind individuals provide valuable insights into mechanisms of cortical plasticity and principles of cerebral organization.

The power of vision: calibration of auditory space after sight restoration from congenital cataracts

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.

Multisensory representations of space and time in sensory cortices

Clear evidence demonstrated a supramodal organization of sensory cortices with multisensory processing occurring even at early stages of information encoding. Within this context, early recruitment of sensory areas is necessary for the development of fine domain-specific (i.e., spatial or temporal) skills regardless of the sensory modality involved, with auditory areas playing a crucial role in temporal processing and visual areas in spatial processing. Given the domain-specificity and the multisensory nature of sensory areas, in this study, we hypothesized that preferential domains of representation (i.e., space and time) of visual and auditory cortices are also evident in the early processing of multisensory information. Thus, we measured the event-related potential (ERP) responses of 16 participants while performing multisensory spatial and temporal bisection tasks. Audiovisual stimuli occurred at three different spatial positions and time lags and participants had to evaluate whether the second stimulus was spatially (spatial bisection task) or temporally (temporal bisection task) farther from the first or third audiovisual stimulus. As predicted, the second audiovisual stimulus of both spatial and temporal bisection tasks elicited an early ERP response (time window 50-90 ms) in visual and auditory regions. However, this early ERP component was more substantial in the occipital areas during the spatial bisection task, and in the temporal regions during the temporal bisection task. Overall, these results confirmed the domain specificity of visual and auditory cortices and revealed that this aspect selectively modulates also the cortical activity in response to multisensory stimuli.

Motor Influence in Developing Auditory Spatial Cognition in Hemiplegic Children with and without Visual Field Disorder

Spatial representation is a crucial skill for everyday interaction with the environment. Different factors seem to influence spatial perception, such as body movements and vision. However, it is still unknown if motor impairment affects the building of simple spatial perception. To investigate this point, we tested hemiplegic children with (HV) and without visual field (H) disorders in an auditory and visual-spatial localization and pitch discrimination task. Fifteen hemiplegic children (nine H and six HV) and twenty with typical development took part in the experiment. The tasks consisted in listening to a sound coming from a series of speakers positioned at the front or back of the subject. In one condition, subjects were asked to discriminate the pitch, while in the other, subjects had to localize the position of the sound. We also replicated the spatial task in a visual modality. Both groups of hemiplegic children performed worse in the auditory spatial localization task compared with the control, while no difference was found in the pitch discrimination task. For the visual-spatial localization task, only HV children differed from the two other groups. These results suggest that movement is important for the development of auditory spatial representation.

Enhanced Dichotic Listening and Temporal Sequencing Ability in Early-Blind Individuals

Several studies have reported the better auditory performance of early-blind subjects over sighted subjects. However, few studies have compared the auditory functions of both hemispheres or evaluated interhemispheric transfer and binaural integration in blind individuals. Therefore, we evaluated whether there are differences in dichotic listening, auditory temporal sequencing ability, or speech perception in noise (all of which have been used to diagnose central auditory processing disorder) between early-blind subjects and sighted subjects. The study included 23 early-blind subjects and 22 age-matched sighted subjects. In the dichotic listening test (three-digit pair), the early-blind subjects achieved higher scores than the sighted subjects in the left ear (p = 0.003, Bonferroni’s corrected α = 0.05/6 = 0.008), but not in the right ear, indicating a right ear advantage in sighted subjects (p < 0.001) but not in early-blind subjects. In the frequency patterning test (five tones), the early-blind subjects performed better (both ears in the humming response, but the left ear only in the labeling response) than the sighted subjects (p < 0.008, Bonferroni’s corrected α = 0.05/6 = 0.008). Monosyllable perception in noise tended to be better in early-blind subjects than in sighted subjects at a signal-to-noise ratio of –8 (p = 0.054), the results at signal-to-noise ratios of –4, 0, +4, and +8 did not differ. Acoustic change complex responses to/ba/in babble noise, recorded with electroencephalography, showed a greater N1 peak amplitude at only FC5 electrode under a signal-to-noise ratio of –8 and –4 dB in the early-blind subjects than in the sighted subjects (p = 0.004 and p = 0.003, respectively, Bonferroni’s corrected α = 0.05/5 = 0.01). The results of this study revealed early-blind subjects exhibited some advantages in dichotic listening, and temporal sequencing ability compared to those shown in sighted subjects. These advantages may be attributable to the enhanced activity of the central auditory nervous system, especially the right hemisphere function, and the transfer of auditory information between the two hemispheres.

Spatial Memory and Blindness: The Role of Visual Loss on the Exploration and Memorization of Spatialized Sounds

Spatial memory relies on encoding, storing, and retrieval of knowledge about objects’ positions in their surrounding environment. Blind people have to rely on sensory modalities other than vision to memorize items that are spatially displaced, however, to date, very little is known about the influence of early visual deprivation on a person’s ability to remember and process sound locations. To fill this gap, we tested sighted and congenitally blind adults and adolescents in an audio-spatial memory task inspired by the classical card game “Memory.” In this research, subjects (blind, n = 12; sighted, n = 12) had to find pairs among sounds (i.e., animal calls) displaced on an audio-tactile device composed of loudspeakers covered by tactile sensors. To accomplish this task, participants had to remember the spatialized sounds’ position and develop a proper mental spatial representation of their locations. The test was divided into two experimental conditions of increasing difficulty dependent on the number of sounds to be remembered (8 vs. 24). Results showed that sighted participants outperformed blind participants in both conditions. Findings were discussed considering the crucial role of visual experience in properly manipulating auditory spatial representations, particularly in relation to the ability to explore complex acoustic configurations.

Delayed Auditory Brainstem Responses (ABR) in children after sight-recovery

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.

Multisensory spatial perception in visually impaired infants

Congenitally blind infants are not only deprived of visual input but also of visual influences on the intact senses. The important role that vision plays in the early development of multisensory spatial perception1, 2, 3, 4, 5, 6, 7 (e.g., in crossmodal calibration8, 9, 10 and in the formation of multisensory spatial representations of the body and the world^1,2) raises the possibility that impairments in spatial perception are at the heart of the wide range of difficulties that visually impaired infants show across spatial,8, 9, 10, 11, 12 motor,13, 14, 15, 16, 17 and social domains.^8,18,19 But investigations of early development are needed to clarify how visually impaired infants’ spatial hearing and touch support their emerging ability to make sense of their body and the outside world. We compared sighted (S) and severely visually impaired (SVI) infants’ responses to auditory and tactile stimuli presented on their hands. No statistically reliable differences in the direction or latency of responses to auditory stimuli emerged, but significant group differences emerged in responses to tactile and audiotactile stimuli. The visually impaired infants showed attenuated audiotactile spatial integration and interference, weighted more tactile than auditory cues when the two were presented in conflict, and showed a more limited influence of representations of the external layout of the body on tactile spatial perception.²⁰ These findings uncover a distinct phenotype of multisensory spatial perception in early postnatal visual deprivation. Importantly, evidence of audiotactile spatial integration in visually impaired infants, albeit to a lesser degree than in sighted infants, signals the potential of multisensory rehabilitation methods in early development.

Video abstract

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Visually impaired infants have a distinct phenotype of audiotactile perception

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Infants with severe visual impairment (SVI) place more weight on tactile locations

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SVI infants show attenuated audiotactile spatial integration and interference

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SVI infants do not show an influence of body representations on tactile space

Interactions between auditory statistics processing and visual experience emerge only in late development

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.

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Computational and deprivation models can be combined to assess sensory plasticity

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Basic auditory computations develop independently from early visual input

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Late-onset sight loss can hamper the efficiency of local auditory processing

Colorophone 2.0: A Wearable Color Sonification Device Generating Live Stereo-Soundscapes-Design, Implementation, and Usability Audit

The successful development of a system realizing color sonification would enable auditory representation of the visual environment. The primary beneficiary of such a system would be people that cannot directly access visual information—the visually impaired community. Despite the plethora of sensory substitution devices, developing systems that provide intuitive color sonification remains a challenge. This paper presents design considerations, development, and the usability audit of a sensory substitution device that converts spatial color information into soundscapes. The implemented wearable system uses a dedicated color space and continuously generates natural, spatialized sounds based on the information acquired from a camera. We developed two head-mounted prototype devices and two graphical user interface (GUI) versions. The first GUI is dedicated to researchers, and the second has been designed to be easily accessible for visually impaired persons. Finally, we ran fundamental usability tests to evaluate the new spatial color sonification algorithm and to compare the two prototypes. Furthermore, we propose recommendations for the development of the next iteration of the system.

Auditory speed processing in sighted and blind individuals

Multisensory experience is crucial for developing a coherent perception of the world. In this context, vision and audition are essential tools to scaffold spatial and temporal representations, respectively. Since speed encompasses both space and time, investigating this dimension in blindness allows deepening the relationship between sensory modalities and the two representation domains. In the present study, we hypothesized that visual deprivation influences the use of spatial and temporal cues underlying acoustic speed perception. To this end, ten early blind and ten blindfolded sighted participants performed a speed discrimination task in which spatial, temporal, or both cues were available to infer moving sounds' velocity. The results indicated that both sighted and early blind participants preferentially relied on temporal cues to determine stimuli speed, by following an assumption that identified as faster those sounds with a shorter duration. However, in some cases, this temporal assumption produces a misperception of the stimulus speed that negatively affected participants' performance. Interestingly, early blind participants were more influenced by this misleading temporal assumption than sighted controls, resulting in a stronger impairment in the speed discrimination performance. These findings demonstrate that the absence of visual experience in early life increases the auditory system's preference for the time domain and, consequentially, affects the perception of speed through audition.

The development of allocentric spatial frame in the auditory system

The ability to encode space is a crucial aspect of interacting with the external world. Therefore, this ability appears to be fundamental for the correct development of the capacity to integrate different spatial reference frames. The spatial reference frame seems to be present in all the sensory modalities. However, it has been demonstrated that different sensory modalities follow various developmental courses. Nevertheless, to date these courses have been investigated only in people with sensory impairments, where there is a possible bias due to compensatory strategies and it is complicated to assess the exact age when these skills emerge. For these reasons, we investigated the development of the allocentric frame in the auditory domain in a group of typically developing children aged 6-10 years. To do so, we used an auditory Simon task, a paradigm that involves implicit spatial processing, and we asked children to perform the task in both the uncrossed and crossed hands postures. We demonstrated that the crossed hands posture affected the performance only in younger children (6-7 years), whereas at 10 years of age children performed as adults and were not affected by such posture. Moreover, we found that this task's performance correlated with age and developmental differences in spatial abilities. Our results support the hypothesis that auditory spatial cognition's developmental course is similar to the visual modality development as reported in the literature.

Backward spatial perception can be augmented through a novel visual-to-auditory sensory substitution algorithm

Can humans extend and augment their natural perceptions during adulthood? Here, we address this fascinating question by investigating the extent to which it is possible to successfully augment visual spatial perception to include the backward spatial field (a region where humans are naturally blind) via other sensory modalities (i.e., audition). We thus developed a sensory-substitution algorithm, the “Topo-Speech” which conveys identity of objects through language, and their exact locations via vocal-sound manipulations, namely two key features of visual spatial perception. Using two different groups of blindfolded sighted participants, we tested the efficacy of this algorithm to successfully convey location of objects in the forward or backward spatial fields following ~ 10 min of training. Results showed that blindfolded sighted adults successfully used the Topo-Speech to locate objects on a 3 × 3 grid either positioned in front of them (forward condition), or behind their back (backward condition). Crucially, performances in the two conditions were entirely comparable. This suggests that novel spatial sensory information conveyed via our existing sensory systems can be successfully encoded to extend/augment human perceptions. The implications of these results are discussed in relation to spatial perception, sensory augmentation and sensory rehabilitation.

Sensitive period for the plasticity of alpha activity in humans

Visual experience is crucial for the development of neural processing. For example, alpha activity development is a vision-dependent mechanism. Indeed, studies report no alpha activity is present in blind adults. Nevertheless, studies have not investigated the developmental trajectory of this activity in infants and children with blindness. Here, we hypothesize that the difference in neural activity of blind compared to sighted subjects is: absent at birth, progressive with age, specifically occipital and linked to a gradual motor impairment. Therefore, we consider spectral power of resting-state EEG and its association with motor impairment indices, in blind subjects and in sighted controls between 0 and 11 years of age. Blind subjects show posterior alpha activity during the first three years of life, although weaker and slower maturing compared to sighted subjects. The first great differentiation between blind and sighted subjects occurs between 3 and 6 years of age. Starting in this period, reduced alpha activity increases the probability of motor impairment in blind subjects, likely because of impaired perception/interaction. These results show that visual experience mediates the neural mechanisms generating alpha oscillations during the first years of life, suggesting that it is a sensitive period for the plasticity of this process.

Factors Affecting Auditory Estimates of Virtual Room Size: Effects of Stimulus, Level, and Reverberation

When vision is unavailable, auditory level and reverberation cues provide important spatial information regarding the environment, such as the size of a room. We investigated how room-size estimates were affected by stimulus type, level, and reverberation. In Experiment 1, 15 blindfolded participants estimated room size after performing a distance bisection task in virtual rooms that were either anechoic (with level cues only) or reverberant (with level and reverberation cues) with a relatively short reverberation time of T₆₀ = 400 milliseconds. Speech, noise, or clicks were presented at distances between 1.9 and 7.1 m. The reverberant room was judged to be significantly larger than the anechoic room (p < .05) for all stimuli. In Experiment 2, only the reverberant room was used and the overall level of all sounds was equalized, so only reverberation cues were available. Ten blindfolded participants took part. Room-size estimates were significantly larger for speech than for clicks or noise. The results show that when level and reverberation cues are present, reverberation increases judged room size. Even relatively weak reverberation cues provide room-size information, which could potentially be used by blind or visually impaired individuals encountering novel rooms.

Balance, gait, and navigation performance are related to physical exercise in blind and visually impaired children and adolescents

Self-motion perception used for locomotion and navigation requires the integration of visual, vestibular, and proprioceptive input. In the absence of vision, postural stability and locomotor tasks become more difficult. Previous research has suggested that in visually deprived children, postural stability and levels of physical activity are overall lower than in sighted controls. Here we hypothesized that visually impaired and blind children and adolescents differ from sighted controls in postural stability and gait parameters, and that physically active individuals outperform sedentary peers in postural stability and gait parameters as well as in navigation performance. Fourteen blind and visually impaired children and adolescents (8-18 years of age) and 14 matched sighted individuals took part. Assessments included postural sway, single-leg stance time, parameters of gait variability and stability, self-reported physical activity, and navigation performance. Postural sway was larger and single-leg stance time was lower in blind and visually impaired participants than in blindfolded sighted individuals. Physical activity was higher in the sighted group. No differences between the group of blind and visually impaired and blindfolded sighted participants were observed for gait parameters and navigation performance. Higher levels of physical activity were related to lower postural sway, longer single-leg stance time, higher gait stability, and superior navigation performance in blind and visually impaired participants. The present data suggest that physical activity may enhance postural stability and gait parameters, and thereby promote navigation performance in blind and visually impaired children and adolescents.

Standardized and Experimental Tools to Assess Spatial Cognition in Visually Impaired Children: A Mini-Review

The acquisition of spatial cognition is essential for both everyday functioning (e.g., navigation) and more specific goals (e.g., mathematics), therefore being able to assess and monitor spatial cognition from the first years of life would be essential to predict developmental outcomes and timely intervene whenever spatial development is compromised. Several shreds of evidence have indicated that spatial development can be compromised in the case of development with atypical sensory experience such as blindness. Despite the massive importance of spatial abilities for the development of psychomotor competencies across childhood, only a few standardized and experimental methods have been developed to assess them in visually impaired children. In this review, we will give a short overview of current formal (standardized) and informal (experimental) methods to assess spatial cognition in visually impaired children, demonstrating that very few validated tools have been proposed to date. The main contribution of this current work is to highlight the need of ad hoc studies to create and validate clinical measures to assess spatial cognition in visually impaired individuals and address potential future developments in this area of research.

Multisystemic Increment of Cortical Thickness in Congenital Blind Children

It has been shown that the total or partial lack of visual experience is associated with a plastic reorganization at the brain level, more prominent in congenital blind. Cortical thickness (CT) studies, to date involving only adult subjects, showed that only congenital blind have a thicker cortex than age-matched sighted population while late blind do not. This was explained as a deviation from the physiological mechanism of initial neural growth followed by a pruning mechanism that, in congenital blind children, might be reduced by their visual deprivation, thus determining a thicker cortex. Since those studies involved only adults, it is unknown when these changes may appear and whether they are related to impairment degree. To address this question, we compared the CT among 28 children, from 2 to 12 years, with congenital visual impairments of different degree and an age-matched sighted population. Vertex-wise analysis showed that blind children, but not low vision one, had a thicker cortical surface in few clusters located in occipital, superior parietal, anterior-cingular, orbito-frontal, and mesial precentral regions. Our data suggest that the effect of visual impairment on determining thicker cortex is an early phenomenon, is multisystemic, and occurs only when blindness is almost complete.

Non-spatial skills differ in the front and rear peri-personal space

In measuring behavioural and pupillary responses to auditory oddball stimuli delivered in the front and rear peri-personal space, we find that pupils dilate in response to rare stimuli, both target and distracters. Dilation in response to targets is stronger than the response to distracters, implying a task relevance effect on pupil responses. Crucially, pupil dilation in response to targets is also selectively modulated by the location of sound sources: stronger in the front than in the rear peri-personal space, in spite of matching behavioural performance. This supports the concept that even non-spatial skills, such as the ability to alert in response to behaviourally relevant events, are differentially engaged across subregions of the peri-personal space.

General Enhancement of Spatial Hearing in Congenitally Blind People

Vision is thought to support the development of spatial abilities in the other senses. If this is true, how does spatial hearing develop in people lacking visual experience? We comprehensively addressed this question by investigating auditory-localization abilities in 17 congenitally blind and 17 sighted individuals using a psychophysical minimum-audible-angle task that lacked sensorimotor confounds. Participants were asked to compare the relative position of two sound sources located in central and peripheral, horizontal and vertical, or frontal and rear spaces. We observed unequivocal enhancement of spatial-hearing abilities in congenitally blind people, irrespective of the field of space that was assessed. Our results conclusively demonstrate that visual experience is not a prerequisite for developing optimal spatial-hearing abilities and that, in striking contrast, the lack of vision leads to a general enhancement of auditory-spatial skills.

A Multidimensional, Multisensory and Comprehensive Rehabilitation Intervention to Improve Spatial Functioning in the Visually Impaired Child: A Community Case Study

Congenital visual impairment may have a negative impact on spatial abilities and result in severe delays in perceptual, social, motor, and cognitive skills across life span. Despite several evidences have highlighted the need for an early introduction of re-habilitation interventions, such interventions are rarely adapted to children’s visual capabilities and very few studies have been conducted to assess their long-term efficacy. In this work, we present a case study of a visually impaired child enrolled in a newly developed re-habilitation intervention aimed at improving the overall development through the diversification of re-habilitation activities based on visual potential and developmental profile, with a focus on spatial functioning. We argue that intervention for visually impaired children should be (a) adapted to their visual capabilities, in order to increase re-habilitation outcomes, (b) multi-interdisciplinary and multidimensional, to improve adaptive abilities across development, (c) multisensory, to promote the integration of different perceptual information coming from the environment.

The role of spatial selective attention in the processing of affective prosodies in congenitally blind adults: An ERP study

The question whether spatial selective attention is necessary in order to process vocal affective prosody has been controversially discussed in sighted individuals: whereas some studies argue that attention is required in order to process emotions, other studies conclude that vocal prosody can be processed even outside the focus of spatial selective attention. Here, we asked whether spatial selective attention is necessary for the processing of affective prosodies after visual deprivation from birth. For this purpose, pseudowords spoken in happy, neutral, fearful or threatening prosodies were presented at the left or right loudspeaker. Congenitally blind individuals (N = 8) and sighted controls (N = 13) had to attend to one of the loudspeakers and detect rare pseudowords presented at the attended loudspeaker during EEG recording. Emotional prosody of the syllables was task-irrelevant. Blind individuals outperformed sighted controls by being more efficient in detecting deviant syllables at the attended loudspeaker. A higher auditory N1 amplitude was observed in blind individuals compared to sighted controls. Additionally, sighted controls showed enhanced attention-related ERP amplitudes in response to fearful and threatening voices during the time range of the N1. By contrast, blind individuals revealed enhanced ERP amplitudes in attended relative to unattended locations irrespective of the affective valence in all time windows (110-350 ms). These effects were mainly observed at posterior electrodes. The results provide evidence for "emotion-general" auditory spatial selective attention effects in congenitally blind individuals and suggest a potential reorganization of the voice processing brain system following visual deprivation from birth.

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.

Temporal cues trick the visual and auditory cortices mimicking spatial cues in blind individuals

In the absence of vision, spatial representation may be altered. When asked to compare the relative distances between three sounds (i.e., auditory spatial bisection task), blind individuals demonstrate significant deficits and do not show an event-related potential response mimicking the visual C1 reported in sighted people. However, we have recently demonstrated that the spatial deficit disappears if coherent time and space cues are presented to blind people, suggesting that they may use time information to infer spatial maps. In this study, we examined whether the modification of temporal cues during space evaluation altered the recruitment of the visual and auditory cortices in blind individuals. We demonstrated that the early (50-90 ms) occipital response, mimicking the visual C1, is not elicited by the physical position of the sound, but by its virtual position suggested by its temporal delay. Even more impressively, in the same time window, the auditory cortex also showed this pattern and responded to temporal instead of spatial coordinates.

Temporal representation impairment in developmental dyslexia for unisensory and multisensory stimuli

Dyslexia has been associated with a problem in visual-audio integration mechanisms. Here, we investigate for the first time the contribution of unisensory cues on multisensory audio and visual integration in 32 dyslexic children by modelling results using the Bayesian approach. Non-linguistic stimuli were used. Children performed a temporal task: they had to report whether the middle of three stimuli was closer in time to the first one or to the last one presented. Children with dyslexia, compared with typical children, exhibited poorer unimodal thresholds, requiring greater temporal distance between items for correct judgements, while multisensory thresholds were well predicted by the Bayesian model. This result suggests that the multisensory deficit in dyslexia is due to impaired audio and visual inputs rather than impaired multisensory processing per se. We also observed that poorer temporal skills correlated with lower reading skills in dyslexic children, suggesting that this temporal capability can be linked to reading abilities.

Comparison of auditory spatial bisection and minimum audible angle in front, lateral, and back space

Although vision is important for calibrating auditory spatial perception, it only provides information about frontal sound sources. Previous studies of blind and sighted people support the idea that azimuthal spatial bisection in frontal space requires visual calibration, while detection of a change in azimuth (minimum audible angle, MAA) does not. The influence of vision on the ability to map frontal, lateral and back space has not been investigated. Performance in spatial bisection and MAA tasks was assessed for normally sighted blindfolded subjects using bursts of white noise presented frontally, laterally, or from the back relative to the subjects. Thresholds for both tasks were similar in frontal space, lower for the MAA task than for the bisection task in back space, and higher for the MAA task in lateral space. Two interpretations of the results are discussed, one in terms of visual calibration and the use of internal representations of source location and the other based on comparison of the magnitude or direction of change of the available binaural cues. That bisection thresholds were increased in back space relative to front space, where visual calibration information is unavailable, suggests that an internal representation of source location was used for the bisection task.

Time attracts auditory space representation during development

Vision is the most accurate sense for spatial representation, whereas audition is for temporal representation. However, how different sensory modalities shape the development of spatial and temporal representations is still unclear. Here, 45 children aged 11-13 years were tested to investigate the abilities to evaluate spatial features of auditory stimuli during bisection tasks, while conflicting or non-conflicting spatial and temporal information was delivered. Since audition is fundamental for temporal representation, the hypothesis was that temporal information could influence auditory spatial representation development. Results show a strong interaction between the temporal and the spatial domain. Younger children are not able to build complex spatial representations when the temporal domain is uninformative about space. However, when the spatial information is coherent with the temporal information children of all age are able to decode complex spatial relationships. When spatial and temporal cues are conflicting, younger children are strongly attracted by the temporal instead of spatial information, while older participants result unaffected by the cross-domain conflict. These findings suggest that during development temporal representation of events is used to infer spatial coordinates of the environment, offering important opportunities for new teaching and rehabilitation strategies.

Audio-Motor Training Enhances Auditory and Proprioceptive Functions in the Blind Adult

Several reports indicate that spatial perception in blind individuals can be impaired as the lack of visual experience severely affects the development of multisensory spatial correspondences. Despite the growing interest in the development of technological devices to support blind people in their daily lives, very few studies have assessed the benefit of interventions that help to refine sensorimotor perception. In the present study, we directly investigated the impact of a short audio-motor training on auditory and proprioceptive spatial perception in blind individuals. Our findings indicate that auditory and proprioceptive spatial capabilities can be enhanced through interventions designed to foster sensorimotor perception in the form of audio-motor correspondences, demonstrating the importance of the early introduction of sensorimotor training in therapeutic intervention for blind individuals.

The Cross-Modal Effects of Sensory Deprivation on Spatial and Temporal Processes in Vision and Audition: A Systematic Review on Behavioral and Neuroimaging Research since 2000

One of the most significant effects of neural plasticity manifests in the case of sensory deprivation when cortical areas that were originally specialized for the functions of the deprived sense take over the processing of another modality. Vision and audition represent two important senses needed to navigate through space and time. Therefore, the current systematic review discusses the cross-modal behavioral and neural consequences of deafness and blindness by focusing on spatial and temporal processing abilities, respectively. In addition, movement processing is evaluated as compiling both spatial and temporal information. We examine whether the sense that is not primarily affected changes in its own properties or in the properties of the deprived modality (i.e., temporal processing as the main specialization of audition and spatial processing as the main specialization of vision). References to the metamodal organization, supramodal functioning, and the revised neural recycling theory are made to address global brain organization and plasticity principles. Generally, according to the reviewed studies, behavioral performance is enhanced in those aspects for which both the deprived and the overtaking senses provide adequate processing resources. Furthermore, the behavioral enhancements observed in the overtaking sense (i.e., vision in the case of deafness and audition in the case of blindness) are clearly limited by the processing resources of the overtaking modality. Thus, the brain regions that were previously recruited during the behavioral performance of the deprived sense now support a similar behavioral performance for the overtaking sense. This finding suggests a more input-unspecific and processing principle-based organization of the brain. Finally, we highlight the importance of controlling for and stating factors that might impact neural plasticity and the need for further research into visual temporal processing in deaf subjects.

Comparison of temporal judgments in sighted and visually impaired children

AIM

We studied visually impaired and blind children to investigate the effects of visual damage on time perception.

METHODS

Sixty-three children (11 blind, 16 visually impaired, 20 sighted and 16 sighted but blindfolded) performed a temporal bisection task, which consisted of judging different temporal intervals presented in the auditory modality.

RESULTS

The visually impaired children showed lower constant error than sighted children but higher variability (Weber ratio). The blindfolded children had a temporal estimation comparable to the clinical groups and time sensitivity comparable to the controls.

CONCLUSION

These findings are interpreted in the light of inter-modality interference, assuming that the coexistence of both sensory modalities, present only in controls, leads to a trade-off between the two senses with an indirect contribution of sight, which does not happen either in the clinical groups or in the blindfolded children, despite the single sensory task.

Influence of Visual Deprivation on Auditory Spectral Resolution, Temporal Resolution, and Speech Perception

We evaluated whether blind subjects have advantages in auditory spectral resolution, temporal resolution, and speech perception in noise compared with sighted subjects. We also compared psychoacoustic performance between early blind (EB) subjects and late blind (LB) subjects. Nineteen EB subjects, 16 LB subjects, and 20 sighted individuals were enrolled. All subjects were right-handed with normal and symmetric hearing thresholds and without cognitive impairments. Three psychoacoustic measurements of the subjects’ right ears were performed via an inserted earphone to determine spectral-ripple discrimination (SRD), temporal modulation detection (TMD), and speech recognition threshold (SRT) in noisy conditions. Acoustic change complex (ACC) responses were recorded during passive listening to standard ripple-inverted ripple stimuli. EB subjects exhibited better SRD than did LB (p = 0.020) and sighted (p = 0.003) subjects. TMD was better in EB (p < 0.001) and LB (p = 0.007) subjects compared with sighted subjects. SRD was positively correlated with the duration of blindness (r = 0.386, p = 0.024). Acoustic change complex data for ripple noise change at the Cz and Fz electrodes showed trends toward significant correlations with the behavioral results. In conclusion, compared with sighted subjects, EB subjects showed advantages in terms of auditory spectral and temporal resolution, while LB subjects showed an advantage in temporal resolution exclusively. These findings suggest that it might take longer for auditory spectral resolution to functionally enhance following visual deprivation compared to temporal resolution. Alternatively, a critical period of very young age may be required for auditory spectral resolution to improve following visual deprivation.

Exploring the lived experience of acquiring life skills with congenital total blindness: An interpretative phenomenological analysis

This phenomenological study explored how individual young adults understood their lived experience of acquiring life skills with congenital total blindness (CTB). Four young adults with CTB, and five parents of the young adults, participated in the study. In depth, semi-structured interviews were used to gather information from the research participants. The interviews were analysed using interpretative phenomenological analysis (IPA). Five superordinate themes emerged from the IPA: (1) life skills acquisition as ‘a means to an end’, (2) appraising life skills acquisition, (3) acquiring disability-specific skills, (4) reaching adulthood with life skill gaps, and (5) making sense of independence. The findings revealed that the young adults had reached adulthood with significant gaps in their acquisition of basic life skills. This indicates that more needs to be done, to improve the efficacy and meaning of life skill acquisition programmes provided in childhood and adolescence, to young people living with CTB.

Test-retest reliability of BSP, a battery of tests for assessing spatial cognition in visually impaired children

Blind individuals are particularly dependent on their hearing for defining space. It has been found that both children and adults with visual impairments can struggle with complex spatial tasks that require a metric representation of space. Nonetheless the variability of methods employed to assess spatial abilities in absence of vision is wide, especially in the case of visually impaired children. For this reason, it would be necessary to define a battery of tests that appropriately assess different aspects of spatial perception and to investigate its reliability in order to provide a standard assessment of spatial abilities not only in experimental but also in clinical settings. The aim of this study is to determine the test–retest reliability of a battery of six spatial tasks (BSP, Blind Spatial Perception) and provide the first gold standard for assessing spatial cognition deficits in visually impaired children. Thirty visually impaired children aged 6–17 participated in two identical sessions, at a distance of 10 weeks, in which they performed six spatial tasks: auditory bisection, auditory localization, auditory distance discrimination, auditory reaching, proprioceptive reaching, and general mobility. Test–retest reliability was assessed using the test-retest scatter plots, intra-class correlation coefficient (ICC), and coefficient of variation (CV). The results showed good-to-excellent reliability for all six tests, with average ICC values ranging from 0.77 to 0.89 and average CV values ranging from 3.44% to 15.27%. In conclusion, the newly proposed battery (BSP) results as a reliable tool to identify spatial impairments in visually impaired children.

Stronger responses in the visual cortex of sighted compared to blind individuals during auditory space representation

It has been previously shown that the interaction between vision and audition involves early sensory cortices. However, the functional role of these interactions and their modulation due to sensory impairment is not yet understood. To shed light on the impact of vision on auditory spatial processing, we recorded ERPs and collected psychophysical responses during space and time bisection tasks in sighted and blind participants. They listened to three consecutive sounds and judged whether the second sound was either spatially or temporally further from the first or the third sound. We demonstrate that spatial metric representation of sounds elicits an early response of the visual cortex (P70) which is different between sighted and visually deprived individuals. Indeed, only in sighted and not in blind people P70 is strongly selective for the spatial position of sounds, mimicking many aspects of the visual-evoked C1. These results suggest that early auditory processing associated with the construction of spatial maps is mediated by visual experience. The lack of vision might impair the projection of multi-sensory maps on the retinotopic maps used by the visual cortex.

Temporal Cues Influence Space Estimations in Visually Impaired Individuals

Many works have highlighted enhanced auditory processing in blind individuals, suggesting that they compensate for lack of vision with greater sensitivity of the other senses. Few years ago, we demonstrated severely impaired auditory precision in congenitally blind individuals performing an auditory spatial metric task: their thresholds for bisecting three consecutive spatially distributed sounds were seriously compromised, ranging from three times typical thresholds to total randomness. Here, we show that the deficit disappears if blind individuals are presented with coherent temporal and spatial cues. More interestingly, when the audio information is presented in conflict for space and time, sighted individuals are unaffected by the perturbation, whereas blind individuals are strongly attracted by the temporal cue. These results highlight that temporal cues influence space estimations in blind participants, suggesting for the first time that blind individuals use temporal information to infer spatial environmental coordinates.

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Blind individuals are not able to perform auditory spatial metric tasks

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Their deficit disappears when coherent temporal and spatial cues are presented

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In some cases, blind people use temporal cues to infer spatial coordinates

Visual loss alters multisensory face maps in humans

Topographically organised responses to visual and tactile stimulation are aligned in the ventral intraparietal cortex. The critical biological importance of this region, which is thought to mediate visually guided defensive movements of the head and upper body, suggests that these maps might be hardwired from birth. Here, we investigated whether visual experience is necessary for the creation and positioning of these maps by assessing the representation of tactile stimulation in congenitally and totally blind participants, who had no visual experience, and late and totally blind participants. We used a single-subject approach to the analysis to focus on the potential individual differences in the functional neuroanatomy that might arise from different causes, durations and sensory experiences of visual impairment among participants. The overall results did not show any significant difference between congenitally and late blind participants; however, single-subject trends suggested that visual experience is not necessary to develop topographically organised maps in the intraparietal cortex, whilst losing vision disrupted topographic maps' integrity and organisation. These results discussed in terms of brain plasticity and sensitive periods.

Different audio spatial metric representation around the body

Vision seems to have a pivotal role in developing spatial cognition. A recent approach, based on sensory calibration, has highlighted the role of vision in calibrating hearing in spatial tasks. It was shown that blind individuals have specific impairments during audio spatial bisection tasks. Vision is available only in the frontal space, leading to a "natural" blindness in the back. If vision is important for audio space calibration, then the auditory frontal space should be better represented than the back auditory space. In this study, we investigated this point by comparing frontal and back audio spatial metric representations. We measured precision in the spatial bisection task, for which vision seems to be fundamental to calibrate audition, in twenty-three sighted subjects. Two control tasks, a minimum audible angle and a temporal bisection were employed in order to evaluate auditory precision in the different regions considered. While no differences were observed between frontal and back space in the minimum audible angle (MAA) and temporal bisection task, a significant difference was found in the spatial bisection task, where subjects performed better in the frontal space. Our results are in agreement with the idea that vision is important in developing auditory spatial metric representation in sighted individuals.

Audio Spatial Representation Around the Body

Studies have found that portions of space around our body are differently coded by our brain. Numerous works have investigated visual and auditory spatial representation, focusing mostly on the spatial representation of stimuli presented at head level, especially in the frontal space. Only few studies have investigated spatial representation around the entire body and its relationship with motor activity. Moreover, it is still not clear whether the space surrounding us is represented as a unitary dimension or whether it is split up into different portions, differently shaped by our senses and motor activity. To clarify these points, we investigated audio localization of dynamic and static sounds at different body levels. In order to understand the role of a motor action in auditory space representation, we asked subjects to localize sounds by pointing with the hand or the foot, or by giving a verbal answer. We found that the audio sound localization was different depending on the body part considered. Moreover, a different pattern of response was observed when subjects were asked to make actions with respect to the verbal responses. These results suggest that the audio space around our body is split in various spatial portions, which are perceived differently: front, back, around chest, and around foot, suggesting that these four areas could be differently modulated by our senses and our actions.

Multisensory Rehabilitation Training Improves Spatial Perception in Totally but Not Partially Visually Deprived Children

Since it has been shown that spatial development can be delayed in blind children, focused sensorimotor trainings that associate auditory and motor information might be used to prevent the risk of spatial-related developmental delays or impairments from an early age. With this aim, we proposed a new technological device based on the implicit link between action and perception: ABBI (Audio Bracelet for Blind Interaction) is an audio bracelet that produces a sound when a movement occurs by allowing the substitution of the visuo-motor association with a new audio-motor association. In this study, we assessed the effects of an extensive but entertaining sensorimotor training with ABBI on the development of spatial hearing in a group of seven 3–5 years old children with congenital blindness (n = 2; light perception or no perception of light) or low vision (n = 5; visual acuity range 1.1–1.7 LogMAR). The training required the participants to play several spatial games individually and/or together with the psychomotor therapist 1 h per week for 3 months: the spatial games consisted of exercises meant to train their ability to associate visual and motor-related signals from their body, in order to foster the development of multisensory processes. We measured spatial performance by asking participants to indicate the position of one single fixed (static condition) or moving (dynamic condition) sound source on a vertical sensorized surface. We found that spatial performance of congenitally blind but not low vision children is improved after the training, indicating that early interventions with the use of science-driven devices based on multisensory capabilities can provide consistent advancements in therapeutic interventions, improving the quality of life of children with visual disability.

Neurophysiological evidence for enhanced tactile acuity in early blindness in some but not all haptic tasks

Previous research assessing the presence of enhanced tactile skills in early-blind (EB) population obtained conflicting results. Most of the studies relied on behavioral measures with which different mechanisms leading to the same outcome go unnoticed. Moreover, the scarce electrophysiological research that has been conducted focused exclusively on the processing of microgeometric properties. To clarify the extent of superior tactile abilities in EBs using high-density multichannel electrophysiological recordings, the present study compared the electrophysiological correlates of EBs and sighted controls (CON) in two tactile discrimination tasks that targeted microgeometric (texture) and macrogeometric (shape) properties. After a restricted exploration (haptic glance), participants judged whether a touched stimulus corresponded to an expected stimulus whose name had been previously presented aurally. In the texture discrimination task, differences between groups emerged at ∼75 ms (early perceptual processing stages) whereas we found no between-group differences during shape discrimination. Furthermore, for the first time, we were able to determine the latency at which EBs started to discriminate micro- (EB: 170 ms; CON: 230 ms) and macrogeometric (EB: 250 ms; CON: 270 ms) properties. Altogether, the results suggest different electrophysiological signatures during texture (but not shape) discrimination in EBs, possibly due to cortical reorganization in occipital areas and their increased connectivity with S1.

Intercepting a sound without vision

Visual information is extremely important to generate internal spatial representations. In the auditory modality, the absence of visual cues during early infancy does not preclude the development of some spatial strategies. However, specific spatial abilities might result impaired. In the current study, we investigated the effect of early visual deprivation on the ability to localize static and moving auditory stimuli by comparing sighted and early blind individuals' performance in different spatial tasks. We also examined perceptual stability in the two groups of participants by matching localization accuracy in a static and a dynamic head condition that involved rotational head movements. Sighted participants accurately localized static and moving sounds. Their localization ability remained unchanged after rotational movements of the head. Conversely, blind participants showed a leftward bias during the localization of static sounds and a little bias for moving sounds. Moreover, head movements induced a significant bias in the direction of head motion during the localization of moving sounds. These results suggest that internal spatial representations might be body-centered in blind individuals and that in sighted people the availability of visual cues during early infancy may affect sensory-motor interactions.

The Impact of Early Visual Deprivation on Spatial Hearing: A Comparison between Totally and Partially Visually Deprived Children

The specific role of early visual deprivation on spatial hearing is still unclear, mainly due to the difficulty of comparing similar spatial skills at different ages and to the difficulty in recruiting young blind children from birth. In this study, the effects of early visual deprivation on the development of auditory spatial localization have been assessed in a group of seven 3–5 years old children with congenital blindness (n = 2; light perception or no perception of light) or low vision (n = 5; visual acuity range 1.1–1.7 LogMAR), with the main aim to understand if visual experience is fundamental to the development of specific spatial skills. Our study led to three main findings: firstly, totally blind children performed overall more poorly compared sighted and low vision children in all the spatial tasks performed; secondly, low vision children performed equally or better than sighted children in the same auditory spatial tasks; thirdly, higher residual levels of visual acuity are positively correlated with better spatial performance in the dynamic condition of the auditory localization task indicating that the more residual vision the better spatial performance. These results suggest that early visual experience has an important role in the development of spatial cognition, even when the visual input during the critical period of visual calibration is partially degraded like in the case of low vision children. Overall these results shed light on the importance of early assessment of spatial impairments in visually impaired children and early intervention to prevent the risk of isolation and social exclusion.