Possible blindsight in infants lacking one cerebral hemisphere

Coregistration of EEG and eye-tracking in infants and developing populations

Infants cannot be instructed where to look; therefore, infant researchers rely on observation of their participant's gaze to make inferences about their cognitive processes. They therefore started studying infant attention in the real world from early on. Developmental researchers were early adopters of methods combining observations of gaze and behaviour with electroencephalography (EEG) to study attention and other cognitive functions. However, the direct combination of eye-tracking methods and EEG to test infants is still rare, as it includes specific challenges. The current article reviews the development of co-registration research in infancy. It points out specific challenges of co-registration in infant research and suggests ways to overcome them. It ends with recommendations for implementing the co-registration of EEG and eye-tracking in infant research to maximise the benefits of the two measures and their combination and to orient on Open Science principles while doing so. In summary, this work shows that the co-registration of EEG and eye-tracking in infant research can be beneficial to studying natural and real-world behaviour despite its challenges.

Developmental changes in visual-cognitive and attentional functions in infancy

BACKGROUND

Identifying developmental changes in visual-cognitive and attentional functions during infancy may lead to early diagnosis of neurodevelopmental disorders such as ASD and ADHD.

AIMS

To clarify the developmental changes in visual-cognitive and attentional functions during infancy (3-36 months of age).

STUDY DESIGN

Cross-sectional study.

SUBJECTS

We included 23, 24, 31, and 26 participants aged 3, 9, 18, and 36 months, respectively (full-term births). Fifteen children who cried intensely or whose data could not be accurately recorded were excluded.

OUTCOME MEASURES

Three activities were given to each child while they were seated in front of a gaze-tracking device to evaluate re-gaze, motion transparency, and color-motion integration. We analyzed whether the child's attention shifted to the new stimulus in their peripheral vision in the re-gaze task. In the motion transparency and color-motion integration tasks, two images were presented simultaneously on the screen. In the motion transparency task, participants preferred random dots moving in opposite directions; in the color-motion task, they preferred subjective contours from apparent motion stimuli consisting of random red and green dots with different luminance.

RESULTS

In the re-gaze task, fewer 3-month-olds gazed at the new target than other age groups participants. All ages showed preference for target stimuli in the motion transparency task, but 3-month-olds showed significantly lower preference in the color-motion integration task.

CONCLUSION

These tasks may be useful for measuring visual-cognitive and attentional functions in infants.

Normal Retinotopy in Primary Visual Cortex in a Congenital Complete Unilateral Lesion of Lateral Geniculate Nucleus in Human: A Case Study

Impairment of the geniculostriate pathway results in scotomas in the corresponding part of the visual field. Here, we present a case of patient IB with left eye microphthalmia and with lesions in most of the left geniculostriate pathway, including the Lateral Geniculate Nucleus (LGN). Despite the severe lesions, the patient has a very narrow scotoma in the peripheral part of the lower-right-hemifield only (beyond 15° of eccentricity) and complete visual field representation in the primary visual cortex. Population receptive field mapping (pRF) of the patient’s visual field reveals orderly eccentricity maps together with contralateral activation in both hemispheres. With diffusion tractography, we revealed connections between superior colliculus (SC) and cortical structures in the hemisphere affected by the lesions, which could mediate the retinotopic reorganization at the cortical level. Our results indicate an astonishing case for the flexibility of the developing retinotopic maps where the contralateral thalamus receives fibers from both the nasal and temporal retinae.

Emotional content influences eye-movements under natural but not under instructed conditions

ABSTRACTIn everyday life, people can freely decide if and where they would like to move their attention and gaze, often influenced by physical and emotional salience of stimuli. However, many laboratory paradigms explicitly instruct participants when and how to move their eyes, leading to unnatural instructed eye-movements. The current preregistered study compared eye-movements to peripherally appearing faces with happy, angry and neutral expressions under natural and instructed conditions. Participants reliably moved their eyes towards peripheral faces, even when they were not instructed to do so; however, eye-movements were significantly slower under natural than under instructed conditions. Competing central stimuli decelerated eye-movements independently of instructions. Unexpectedly, the emotional salience only affected eye-movements under natural conditions, with faster saccades towards emotional than towards neutral faces. No effects of emotional expression occurred when participants were instructed to move their eyes. The study shows that natural eye-movements significantly differ from instructed eye-movements and emotion-driven attention effects are reduced when participants are artificially instructed to move their eyes, suggesting that research should investigate eye-movements under natural conditions.

Visual Neuropsychology in Development: Anatomo-Functional Brain Mechanisms of Action/Perception Binding in Health and Disease

Vision is the main entrance for environmental input to the human brain. Even if vision is our most used sensory modality, its importance is not limited to environmental exploration. Rather it has strong links to motor competences, further extending to cognitive and social aspects of human life. These multifaceted relationships are particularly important in developmental age and become dramatically evident in presence of complex deficits originating from visual aberrancies. The present review summarizes the available neuropsychological evidence on the development of visual competences, with a particular focus on the associated visuo-motor integration skills in health and disease. With the aim of supporting future research and interventional settings, the goal of the present review is to constitute a solid base to help the translation of neuropsychological hypotheses into straightforward empirical investigations and rehabilitation/training protocols. This approach will further increase the impact, ameliorate the acceptance, and ease the use and implementation of lab-derived intervention protocols in real-life situations.

Visual development

The developing visual brain is an integrated system, linking analysis of the visual input to visuomotor control, visual cognition, and attention. Major points in human visual development are the presence of rudimentary pathways present at birth which can control fixation behavior, with subsequent development of specific functions. These functions include the emergence of cortical selectivity; the integration of local signals to provide global representations of motion, shape, and space; the development of visuomotor modules for eye movements, manual reaching, and locomotion; and the development of distinct attentional systems. Measures of these processes in infancy and early childhood can provide indicators of broader brain development in the at-risk child. A key system in development is the dorsal cortical stream. Measures of global motion processing, visuomotor actions, and attention suggest that this system is particularly vulnerable in children with a wide range of neurodevelopmental disorders. Early disorders of the eye (strabismus, cataract) reveal the level of plasticity in the developing visual system and the ways in which early experience can affect the course of functional development.

The Effect of Stimulus Size and Eccentricity on Attention Shift Latencies

The ability to shift attention between relevant stimuli is crucial in everyday life and allows us to focus on relevant events. It develops during early childhood and is often impaired in clinical populations, as can be investigated in the fixation shift paradigm and the gap-overlap paradigm. Different tests use stimuli of different sizes presented at different eccentricities, making it difficult to compare them. This study systematically investigates the effect of eccentricity and target size on refixation latencies towards target stimuli. Eccentricity and target size affected attention shift latencies with greatest latencies to big targets that were presented at a small eccentricity. Slowed responses to large parafoveal targets are in line with the idea that specific areas in the superior colliculus can lead to inhibition of eye movements. Findings suggest that the two different paradigms are generally comparable, as long as the target is scaled in proportion to the eccentricity.

Disentangling the mechanisms underlying infant fixation durations in scene perception: A computational account

The goal of this article is to investigate the unexplored mechanisms underlying the development of saccadic control in infancy by determining the generalizability and potential limitations of extending the CRISP theoretical framework and computational model of fixation durations (FDs) in adult scene-viewing to infants. The CRISP model was used to investigate the underlying mechanisms modulating FDs in 6-month-olds by applying the model to empirical eye-movement data gathered from groups of infants and adults during free-viewing of naturalistic and semi-naturalistic videos. Participants also performed a gap-overlap task to measure their disengagement abilities. Results confirmed the CRISP model's applicability to infant data. Specifically, model simulations support the view that infant saccade programming is completed in two stages: an initial labile stage, followed by a non-labile stage. Moreover, results from the empirical data and simulation studies highlighted the influence of the material viewed on the FD distributions in infants and adults, as well as the impact that the developmental state of the oculomotor system can have on saccade programming and execution at 6months. The present work suggests that infant FDs reflect on-line perceptual and cognitive activity in a similar way to adults, but that the individual developmental state of the oculomotor system affects this relationship at 6months. Furthermore, computational modeling filled the gaps of psychophysical studies and allowed the effects of these two factors on FDs to be simulated in infant data providing greater insights into the development of oculomotor and attentional control than can be gained from behavioral results alone.

The Davida Teller Award Lecture, 2016: Visual Brain Development: A review of "Dorsal Stream Vulnerability"-motion, mathematics, amblyopia, actions, and attention

Research in the Visual Development Unit on "dorsal stream vulnerability' (DSV) arose from research in two somewhat different areas. In the first, using cortical milestones for local and global processing from our neurobiological model, we identified cerebral visual impairment in infants in the first year of life. In the second, using photo/videorefraction in population refractive screening programs, we showed that infant spectacle wear could reduce the incidence of strabismus and amblyopia, but many preschool children, who had been significantly hyperopic earlier, showed visuo-motor and attentional deficits. This led us to compare developing dorsal and ventral streams, using sensitivity to global motion and form as signatures, finding deficits in motion sensitivity relative to form in children with Williams syndrome, or perinatal brain injury in hemiplegia or preterm birth. Later research showed that this "DSV" was common across many disorders, both genetic and acquired, from autism to amblyopia. Here, we extend DSV to be a cluster of problems, common to many disorders, including poor motion sensitivity, visuo-motor spatial integration for planning actions, attention, and number skills. In current research, we find that individual differences in motion coherence sensitivity in typically developing children are correlated with MRI measures of area variations in parietal lobe, fractional anisotropy (from TBSS) of the superior longitudinal fasciculus, and performance on tasks of mathematics and visuo-motor integration. These findings suggest that individual differences in motion sensitivity reflect decision making and attentional control rather than integration in MT/V5 or V3A. Its neural underpinnings may be related to Duncan's "multiple-demand" (MD) system.

Plasticity of Visual Pathways and Function in the Developing Brain: Is the Pulvinar a Crucial Player?

The pulvinar is the largest of the thalamic nuclei in the primates, including humans. In the primates, two of the three major subdivisions, the lateral and inferior pulvinar, are heavily interconnected with a significant proportion of the visual association cortex. However, while we now have a better understanding of the bidirectional connectivity of these pulvinar subdivisions, its functions remain somewhat of an enigma. Over the past few years, researchers have started to tackle this problem by addressing it from the angle of development and visual cortical lesions. In this review, we will draw together literature from the realms of studies in nonhuman primates and humans that have informed much of the current understanding. This literature has been responsible for changing many long-held opinions on the development of the visual cortex and how the pulvinar interacts dynamically with cortices during early life to ensure rapid development and functional capacity Furthermore, there is evidence to suggest involvement of the pulvinar following lesions of the primary visual cortex (V1) and geniculostriate pathway in early life which have far better functional outcomes than identical lesions obtained in adulthood. Shedding new light on the pulvinar and its role following lesions of the visual brain has implications for our understanding of visual brain disorders and the potential for recovery.

Egocentric Action in Early Infancy: Spatial Frames of Reference for Saccades

The extent to which infants combine visual (i e, retinal position) and nonvisual (eye or head position) spatial information in planning saccades relates to the issue of what spatial frame or frames of reference influence early visually guided action We explored this question by testing infants from 4 to 6 months of age on the double-step saccade paradigm, which has shown that adults combine visual and eye position information into an egocentric (head- or trunk-centered) representation of saccade target locations In contrast, our results imply that infants depend on a simple retinocentric representation at age 4 months, but by 6 months use egocentric representations more often to control saccade planning Shifts in the representation of visual space for this simple sensorimotor behavior may index maturation in cortical circuitry devoted to visual spatial processing in general

Automatic Detection of Attention Shifts in Infancy: Eye Tracking in the Fixation Shift Paradigm

This study measured changes in switches of attention between 1 and 9 months of age in 67 typically developing infants. Remote eye-tracking (Tobii X120) was used to measure saccadic latencies, related to switches of fixation, as a measure of shifts of attention, from a central stimulus to a peripheral visual target, measured in the Fixation Shift Paradigm. Fixation shifts occur later if the central fixation stimulus stays visible when the peripheral target appears (competition condition), than if the central stimulus disappears as the peripheral target appears (non-competition condition). This difference decreases with age. Our results show significantly faster disengagement in infants over 4 months than in the younger group, and provide more precise measures of fixation shifts, than behavioural observation with the same paradigm. Reduced saccadic latencies in the course of a test session indicate a novel learning effect. The Fixation Shift Paradigm combined with remote eye-tracking measures showed improved temporal and spatial accuracy compared to direct observation by a trained observer, and allowed an increased number of trials in a short testing time. This makes it an infant-friendly non-invasive procedure, involving minimal observational training, suitable for use in future studies of clinical populations to detect early attentional abnormalities in the first few months of life.

BOLD Response Selective to Flow-Motion in Very Young Infants

In adults, motion perception is mediated by an extensive network of occipital, parietal, temporal, and insular cortical areas. Little is known about the neural substrate of visual motion in infants, although behavioural studies suggest that motion perception is rudimentary at birth and matures steadily over the first few years. Here, by measuring Blood Oxygenated Level Dependent (BOLD) responses to flow versus random-motion stimuli, we demonstrate that the major cortical areas serving motion processing in adults are operative by 7 wk of age. Resting-state correlations demonstrate adult-like functional connectivity between the motion-selective associative areas, but not between primary cortex and temporo-occipital and posterior-insular cortices. Taken together, the results suggest that the development of motion perception may be limited by slow maturation of the subcortical input and of the cortico-cortical connections. In addition they support the existence of independent input to primary (V1) and temporo-occipital (V5/MT+) cortices very early in life.

Although 7-wk-old infants do not perceive motion with fine sensitivity, this study shows that their brains have a well-established network of associative cortical areas selective to visual flow-motion.

While it is known that the visual brain is immature at birth, there is little firm information about the developmental timeline of the visual system in humans. Despite this, it is commonly assumed that the cortex matures slowly, with primary visual areas developing first, followed by higher associative regions. Here we use fMRI in very young infants to show that this isn’t the case. Adults are highly sensitive to moving objects, and to the spurious flow projected on their retinas while they move in the environment. Flow perception is mediated by an extensive network of areas involving primary and associative visual areas, but also vestibular associative cortices that mediate the perception of body motion (vection). Our data demonstrate that this complex network of higher associative areas is established and well developed by 7 wk of age, including the vestibular associative cortex. Interestingly, the maturation of the primary visual cortex lags behind the higher associative cortex; this suggests the existence of independent cortical inputs to the primary and the associative cortex at this stage of development, explaining why infants do not yet perceive motion with the same sensitivity as adults.

Functional plasticity in childhood brain disorders: when, what, how, and whom to assess

At every point in the lifespan, the brain balances malleable processes representing neural plasticity that promote change with homeostatic processes that promote stability. Whether a child develops typically or with brain injury, his or her neural and behavioral outcome is constructed through transactions between plastic and homeostatic processes and the environment. In clinical research with children in whom the developing brain has been malformed or injured, behavioral outcomes provide an index of the result of plasticity, homeostasis, and environmental transactions. When should we assess outcome in relation to age at brain insult, time since brain insult, and age of the child at testing? What should we measure? Functions involving reacting to the past and predicting the future, as well as social-affective skills, are important. How should we assess outcome? Information from performance variability, direct measures and informants, overt and covert measures, and laboratory and ecological measures should be considered. In whom are we assessing outcome? Assessment should be cognizant of individual differences in gene, socio-economic status (SES), parenting, nutrition, and interpersonal supports, which are moderators that interact with other factors influencing functional outcome.

Individual Differences in Infant Oculomotor Behavior During the Viewing of Complex Naturalistic Scenes

Little research hitherto has examined how individual differences in attention, as assessed using standard experimental paradigms, relate to individual differences in how attention is spontaneously allocated in more naturalistic contexts. Here, we analyzed the time intervals between refoveating eye movements (fixation durations) while typically developing 11-month-old infants viewed a 90-min battery ranging from complex dynamic to noncomplex static materials. The same infants also completed experimental assessments of cognitive control, psychomotor reaction times (RT), processing speed (indexed via peak look during habituation), and arousal (indexed via tonic pupil size). High test-retest reliability was found for fixation duration, across testing sessions and across types of viewing material. Increased cognitive control and increased arousal were associated with reduced variability in fixation duration. For fixations to dynamic stimuli, in which a large proportion of saccades may be exogenously cued, we found that psychomotor RT measures were most predictive of mean fixation duration; for fixations to static stimuli, in contrast, in which there is less exogenous attentional capture, we found that psychomotor RT did not predict performance, but that measures of cognitive control and arousal did. The implications of these findings for understanding the development of attentional control in naturalistic settings are discussed.

Are patients with Parkinson's disease blind to blindsight?

In Parkinson's disease, visual dysfunction is prominent. Visual hallucinations can be a major hallmark of late stage disease, but numerous visual deficits also occur in early stage Parkinson's disease. Specific retinopathy, deficits in the primary visual pathway and the secondary ventral and dorsal pathways, as well as dysfunction of the attention pathways have all been posited as causes of hallucinations in Parkinson's disease. We present data from patients with Parkinson's disease that contrast with a known neuro-ophthalmological syndrome, termed 'blindsight'. In this syndrome, there is an absence of conscious object identification, but preserved 'guess' of the location of a stimulus, preserved reflexive saccades and motion perception and preserved autonomical and expressive reactions to negative emotional facial expressions. We propose that patients with Parkinson's disease have the converse of blindsight, being 'blind to blindsight'. As such they preserve conscious vision, but show erroneous 'guess' localization of visual stimuli, poor saccades and motion perception, and poor emotional face perception with blunted autonomic reaction. Although a large data set on these deficits in Parkinson's disease has been accumulated, consolidation into one specific syndrome has not been proposed. Focusing on neuropathological and physiological data from two phylogenetically old and subconscious pathways, the retino-colliculo-thalamo-amygdala and the retino-geniculo-extrastriate pathways, we propose that aberrant function of these systems, including pathologically inhibited superior colliculus activity, deficient corollary discharges to the frontal eye fields, dysfunctional pulvinar, claustrum and amygdaloid subnuclei of the amygdala, the latter progressively burdened with Lewy bodies, underlie this syndrome. These network impairments are further corroborated by the concept of the 'silent amygdala'. Functionally being 'blind to blindsight' may facilitate the highly distinctive 'presence' or 'passage' hallucinations of Parkinson's disease and can help to explain handicaps in driving capacities and dysfunctional 'theory of mind'. We propose this synthesis to prompt refined neuropathological and neuroimaging studies on the pivotal nuclei in these pathways in order to better understand the networks underpinning this newly conceptualized syndrome in Parkinson's disease.

Inferences about infants’ visual brain mechanisms

We discuss hypotheses that link the measurements we can make with infants to inferences about their developing neural mechanisms. First, we examine evidence from the sensitivity to visual stimulus properties seen in infants’ responses, using both electrophysiological measures (transient and steady-state recordings of visual evoked potentials/visual event-related potentials) and behavioral measures and compare this with the sensitivity of brain processes, known from data on mammalian neurophysiology and human neuroimaging. The evidence for multiple behavioral systems with different patterns of visual sensitivity is discussed. Second, we consider the analogies which can be made between infants’ behavior and that of adults with identified brain damage, and extend these links to hypothesize about the brain basis of visual deficits in infants and children with developmental disorders. Last, we consider how these lines of data might allow us to form “inverse linking hypotheses” about infants’ visual experience.

White matter microstructure and atypical visual orienting in 7-month-olds at risk for autism

OBJECTIVE The authors sought to determine whether specific patterns of oculomotor functioning and visual orienting characterize 7-month-old infants who later meet criteria for an autism spectrum disorder (ASD) and to identify the neural correlates of these behaviors. METHOD Data were collected from 97 infants, of whom 16 were high-familial-risk infants later classified as having an ASD, 40 were high-familial-risk infants who did not later meet ASD criteria (high-risk negative), and 41 were low-risk infants. All infants underwent an eye-tracking task at a mean age of 7 months and a clinical assessment at a mean age of 25 months. Diffusion-weighted imaging data were acquired for 84 of the infants at 7 months. Primary outcome measures included average saccadic reaction time in a visually guided saccade procedure and radial diffusivity (an index of white matter organization) in fiber tracts that included corticospinal pathways and the splenium and genu of the corpus callosum. RESULTS Visual orienting latencies were longer in 7-month-old infants who expressed ASD symptoms at 25 months compared with both high-risk negative infants and low-risk infants. Visual orienting latencies were uniquely associated with the microstructural organization of the splenium of the corpus callosum in low-risk infants, but this association was not apparent in infants later classified as having an ASD. CONCLUSIONS Flexibly and efficiently orienting to salient information in the environment is critical for subsequent cognitive and social-cognitive development. Atypical visual orienting may represent an early prodromal feature of an ASD, and abnormal functional specialization of posterior cortical circuits directly informs a novel model of ASD pathogenesis.

Visual search and line bisection in hemianopia: computational modelling of cortical compensatory mechanisms and comparison with hemineglect

Hemianopia patients have lost vision from the contralateral hemifield, but make behavioural adjustments to compensate for this field loss. As a result, their visual performance and behaviour contrast with those of hemineglect patients who fail to attend to objects contralateral to their lesion. These conditions differ in their ocular fixations and perceptual judgments. During visual search, hemianopic patients make more fixations in contralesional space while hemineglect patients make fewer. During line bisection, hemianopic patients fixate the contralesional line segment more and make a small contralesional bisection error, while hemineglect patients make few contralesional fixations and a larger ipsilesional bisection error. Hence, there is an attentional failure for contralesional space in hemineglect but a compensatory adaptation to attend more to the blind side in hemianopia. A challenge for models of visual attentional processes is to show how compensation is achieved in hemianopia, and why such processes are hindered or inaccessible in hemineglect. We used a neurophysiology-derived computational model to examine possible cortical compensatory processes in simulated hemianopia from a V1 lesion and compared results with those obtained with the same processes under conditions of simulated hemineglect from a parietal lesion. A spatial compensatory bias to increase attention contralesionally replicated hemianopic scanning patterns during visual search but not during line bisection. To reproduce the latter required a second process, an extrastriate lateral connectivity facilitating form completion into the blind field: this allowed accurate placement of fixations on contralesional stimuli and reproduced fixation patterns and the contralesional bisection error of hemianopia. Neither of these two cortical compensatory processes was effective in ameliorating the ipsilesional bias in the hemineglect model. Our results replicate normal and pathological patterns of visual scanning, line bisection, and differences between hemianopia and hemineglect, and may explain why compensatory processes that counter the effects of hemianopia are ineffective in hemineglect.

Visual attention in the first years: typical development and developmental disorders

The development of attention is critical for the young child's competence in dealing with the demands of everyday life. Here we review evidence from infants and preschool children regarding the development of three neural subsystems of attention: selective attention, sustained attention, and attentional (executive) control. These systems overlap with dorsal cortical visual streams and their disorders are related to the general hypothesis of 'dorsal stream vulnerability'. Infants' ability to control spatial selective attention can be measured using the 'Fixation Shift' task. From around 4 months of age, infants start to show cortical control in disengaging to switch between competing targets. Fixation shifts have proved to be an effective early indicator of attentional disorders associated with perinatal brain damage. Executive function emerges slowly, starting around 1 year of age. The new Early Childhood Attention Battery has identified the three attention subsystems as distinct before 5 years of age in typical development and allows assessment of individual attention profiles across these subsystems. The Early Childhood Attention Battery is now being used to identify specific profiles associated with developmental syndromes such as Williams, Down, and fragile X. These new methods offer the possibility of very early identification of attention disorders, raising the challenge of effective remediation and treatment at an early age.

The effect of distractors on saccades and adaptation of saccades in strabismus

This paper reports two experiments to determine the contribution of the suppressing eye to the generation of saccadic eye movements in constant strabismus. Eye movements were recorded using a Skalar infra-red recorder. Experiment 1 tested six participants with constant strabismus, pathological suppression and no clinically demonstrable binocular single vision (BSV). We explored the effect of visual distractors presented monocularly (to either the fixing eye or the strabismic eye) and binocularly, on saccade latency and accuracy. Saccade latency significantly increased when distractors were presented to the strabismic eye compared to the no distractor condition. In all participants the effect on latency, with distractors presented to the strabismic eye, was maximum when distractors were presented towards the location of the anatomical fovea. Saccade accuracy was reduced with ipsilateral distractors to the target when presented binocularly or monocularly to the fixing eye but not affected by distractors presented to the strabismic eye. Experiment 2 investigated fast disconjugate saccade adaptations in six participants with constant strabismus, pathological suppression and no clinically demonstrable BSV and for comparison 8 with normal bifoveal BSV. Saccade disconjugacy was induced using an electronic feedback system in which the calibrated eye movement position signal could be scaled by a factor (the feedback gain) to move the target visible to one eye during binocular viewing. In all BSV participants and 3 of 6 participants with constant strabismus, saccadic adaptation occurred rapidly such that under conditions of visual feedback saccades became increasingly disconjugate. These disconjugacies persisted when normal viewing conditions were restored. The presence of an adaptive mechanism to adjust the binocular co-ordination of saccades in the presence of constant strabismus with suppression and no clinically demonstrable BSV has been demonstrated. Mechanisms that might explain such results are discussed.

Assessment of cortical visual impairment in infants with periventricular leukomalacia: a pilot event-related FMRI study

Objective

We wanted to investigate the usefulness of event-related (ER) functional MRI (fMRI) for the assessment of cortical visual impairment in infants with periventricular leukomalacia (PVL).

Materials and Methods

FMRI data were collected from 24 infants who suffered from PVL and from 12 age-matched normal controls. Slow ER fMRI was performed using a 3.0T MR scanner while visual stimuli were being presented. Data analysis was performed using Statistical Parametric Mapping software (SPM2), the SPM toolbox MarsBar was used to analyze the region of interest data, and the time to peak (TTP) of hemodynamic response functions (HRFs) was estimated for the surviving voxels. The number of activated voxels and the TTP values of HRFs were compared. Pearson correlation analysis was performed to compare visual impairment evaluated by using Teller Acuity Cards (TAC) with the number of activated voxels in the occipital lobes in all patients.

Results

In all 12 control infants, the blood oxygenation level-dependent (BOLD) signal was negative and the maximum response was located in the anterior and superior part of the calcarine fissure, and this might correspond to the anterior region of the primary visual cortex (PVC). In contrast, for the 24 cases of PVL, there were no activated pixels in the PVC in four subjects, small and weak activations in six subjects, deviated activations in seven subjects and both small and deviated activations in three subjects. The number of active voxels in the occipital lobe was significantly correlated with the TAC-evaluated visual impairment (p < 0.001). The mean TTP of the HRFs was significantly delayed in the cases of PVL as compared with that of the normal controls.

Conclusion

Determining the characteristics of both the BOLD response and the ER fMRI activation may play an important role in the cortical visual assessment of infants with PVL.

Greater Sparing of Visual Search Abilities in Children After Congenital Rather Than Acquired Focal Brain Damage

Background. Visual search refers to the capacity of an individual to find a target among simultaneously presented distracters and is based on visual abilities such as a fast visual processing and an accurate control of ballistic eye movements (saccades) that guide the fovea to the target location. Objective. In adults, visual field defects caused by brain damage are often associated with visual search disorders; in children, little is known about the effects of early brain lesions on visual search abilities. Methods. To test the presence of visual search defects and to investigate the role of cortical plasticity after early brain lesions, 29 children with congenital or acquired cerebral lesions, with and without visual field defects, underwent a visual search test battery. Results. The children with acquired lesions and visual field defects had longer reaction times (RTs) in the contralesional visual field compared with the ipsilesional, whereas those with congenital lesions and visual field defects did not have differences in RTs between the contralateral and ipsilateral visual fields and had a visual search pattern similar to children without a visual field defect. Conclusions. These findings support the hypothesis of more effective mechanisms of functional compensation and reorganization of the visual system in children with very early brain lesions, as opposed to those with later damage.

Development of human visual function

By 1985 newly devised behavioral and electrophysiological techniques had been used to track development of infants' acuity, contrast sensitivity and binocularity, and for clinical evaluation of developing visual function. This review focus on advances in the development and assessment of infant vision in the following 25 years. Infants' visual cortical function has been studied through selectivity for orientation, directional motion and binocular disparity, and the control of subcortical oculomotor mechanisms in fixation shifts and optokinetic nystagmus, leading to a model of increasing cortical dominance over subcortical pathways. Neonatal face processing remains a challenge for this model. Recent research has focused on development of integrative processing (hyperacuity, texture segmentation, and sensitivity to global form and motion coherence) in extra-striate visual areas, including signatures of dorsal and ventral stream processing. Asynchronies in development of these two streams may be related to their differential vulnerability in both acquired and genetic disorders. New methods and approaches to clinical disorders are reviewed, in particular the increasing focus on paediatric neurology as well as ophthalmology. Visual measures in early infancy in high-risk children are allowing measures not only of existing deficits in infancy but prediction of later visual and cognitive outcome. Work with early cataract and later recovery from blinding disorders has thrown new light on the plasticity of the visual system and its limitations. The review concludes with a forward look to future opportunities provided by studies of development post infancy, new imaging and eye tracking methods, and sampling infants' visual ecology.

From genes to brain development to phenotypic behavior: "dorsal-stream vulnerability" in relation to spatial cognition, attention, and planning of actions in Williams syndrome (WS) and other developmental disorders

Visual information is believed to be processed through two distinct, yet interacting cortical streams. The ventral stream performs the computations needed for recognition of objects and faces ("what" and "who"?) and the dorsal stream the computations for registering spatial relationships and for controlling visually guided actions ("where" and "how"?). We initially proposed a model of spatial deficits in Williams syndrome (WS) in which visual abilities subserved by the ventral stream, such as face recognition, are relatively well developed (although not necessarily in exactly the same way as in typical development), whereas dorsal-stream functions, such as visuospatial actions, are markedly impaired. Since these initial findings in WS, deficits of motion coherence sensitivity, a dorsal-stream function has been found in other genetic disorders such as Fragile X and autism, and as a consequence of perinatal events (in hemiplegia, perinatal brain anomalies following very premature birth), leading to the proposal of a general "dorsal-stream vulnerability" in many different conditions of abnormal human development. In addition, dorsal-stream systems provide information used in tasks of visuospatial memory and locomotor planning, and these systems are closely coupled to networks for attentional control. We and several other research groups have previously shown deficits of frontal and parietal lobe function in WS individuals for specific attention tasks [e.g., Atkinson, J., Braddick, O., Anker, S., Curran, W., & Andrew, R. (2003). Neurobiological models of visuospatial cognition in children with Williams Syndrome: Measures of dorsal-stream and frontal function. Developmental Neuropsychology, 23(1/2), 141-174.]. We have used the Test of Everyday Attention for Children (TEA-Ch) which aims to attempt to separate components of attention with distinct brain networks (selective attention, sustained attention, and attention control-executive function) testing a group of older children with WS, but this test battery is too demanding for many children and adults with WS. Consequently, we have devised a new set of tests of attention, the Early Childhood Attention Battery (ECAB). This uses similar principles to the TEA-Ch, but adapted for mental ages younger than 6 years. The ECAB shows a distinctive attention profile for WS individuals relative to their overall cognitive development, with relative strength in tasks of sustained attention and poorer performance on tasks of selective attention and executive control. These profiles, and the characteristic developmental courses, also show differences between children with Down's syndrome and WS. This chapter briefly reviews new research findings on WS in these areas, relating the development of brain systems in WS to evidence from neuroimaging in typically developing infants, children born very preterm, and normal adults. The hypothesis of "dorsal-stream(s) vulnerability" which will be discussed includes a number of interlinked brain networks, subserving not only global visual processing and formulation of visuomotor actions but interlinked networks of attention.

Social and attention factors during infancy and the later emergence of autism characteristics

Characteristic features of autism include atypical social perception and social-communication skills, and atypical visual attention, alongside rigid and repetitive thinking and behavior. Debate has focused on whether the later emergence of atypical social skills is a consequence of attention problems early in life, or, conversely, whether early social deficits have knock-on consequences for the later development of attention skills. We investigated this question based on evidence from infants at familial risk for a later diagnosis of autism by virtue of being younger siblings of children with a diagnosis. Around 9months, at-risk siblings differed as a group from controls, both in measures of social perception and inhibitory control. We present preliminary data from an ongoing longitudinal research program, suggesting clear associations between some of these infant measures and autism-related characteristics at 3years. We discuss the findings in terms of the emergent nature of autism as a result of complex developmental interactions among brain networks.

Plasticity of the visual system after early brain damage

The aim of this review is to discuss the existing evidence supporting different processes of visual brain plasticity after early damage, as opposed to damage that occurs during adulthood. There is initial evidence that some of the neuroplastic mechanisms adopted by the brain after early damage to the visual system are unavailable at a later stage. These are, for example, the ability to differentiate functional tissue within a larger dysplastic cortex during its formation, or to develop new thalamo-cortical connections able to bypass the lesion and reach their cortical destination in the occipital cortex. The young brain also uses the same mechanisms available at later stages of development but in a more efficient way. For example, in people with visual field defects of central origin, the anatomical expansion of the extrastriatal visual network is greater after an early lesion than after a later one, which results in more efficient mechanisms of visual exploration of the blind field. A similar mechanism is likely to support some of the differences found in people with blindsight, the phenomenon of unconscious visual perception in the blind field. In particular, compared with people with late lesions, those with early brain damage appear to have stronger subjective awareness of stimuli hitting the blind visual field, reported as a conscious feeling that something is present in the visual field. Expanding our knowledge of these mechanisms could help the development of early therapeutic interventions aimed at supporting and enhancing visual reorganization at a time of greatest potential brain plasticity.

Cortical visual function in preterm infants in the first year

OBJECTIVE

To assess visual function in low-risk preterm infants at 3, 5, and 12 months corrected age to determine whether the maturation of visual function in the first year is similar to that reported in term-born infants.

STUDY DESIGN

Seventy-five low-risk infants (25.0-30.9 weeks gestation) underwent ophthalmological examinations and a battery of tests (fix and follow, visual fields, acuity, attention at distance, and fixation shift) designed to assess various aspects of visual function at 3, 5, and 12 months corrected age.

RESULTS

The results were comparable with normative data from term-born infants in all tests but fixation shift, suggesting that maturation of most aspects of visual function is not significantly affected by preterm birth. In contrast, >25% of preterm infants failed the fixation shift test at 3 months, with a higher percentage of failing at 5 and 12 months.

CONCLUSIONS

There is a specific profile of early visual behavior in low-risk preterm infants, with a high percentage of infants failing a test that specifically assesses visual attention and provides a measure of cortical processing.

Functional MRI of postnatal visual development in normal rat superior colliculi

This study employed blood oxygenation level-dependent functional MRI (BOLD-fMRI) to evaluate the visual responses in the superior colliculus of the developing rat brain from the time of eyelid opening to adulthood. Upon flash illumination to the contralateral eye, the regional BOLD response underwent a systematic increase in amplitude with age especially after the third postnatal week. However, no significant difference in BOLD signal increase was found between postnatal days 14 and 21. Our results constitute the first fMRI report in demonstrating the critical period of visual functions in the rat brain during maturation. This can be potentially useful in establishing the links between changes in relation to visual sensory development.

Functional MRI of postnatal visual development in normal and hypoxic-ischemic-injured superior colliculi

The superior colliculus (SC) is a laminated subcortical structure in the mammalian midbrain, whose superficial layers receive visual information from the retina and the visual cortex. To date, its functional organization and development in the visual system remain largely unknown. This study employed blood oxygenation level-dependent (BOLD) functional MRI to evaluate the visual responses of the SC in normally developing and severe neonatal hypoxic-ischemic (HI)-injured rat brains from the time of eyelid opening to adulthood. MRI was performed to the normal animals (n=7) at postnatal days (P) 14, 21, 28 and 60. In the HI-injured group (n=7), the ipsilesional primary and secondary visual cortices were completely damaged after unilateral ligation of the left common carotid artery at P7 followed by hypoxia for 2 h, and MRI was performed at P60. Upon unilateral flash illumination, the normal contralateral SC underwent a systematic increase in BOLD signal amplitude with age especially after the third postnatal week. However, no significant difference in BOLD signal increase was found between P14 and P21. These findings implied the presence of neurovascular coupling at the time of eyelid opening, and the progressive development of hemodynamic regulation in the subcortical visual system. In the HI-injured group at P60, the BOLD signal increases in both SC remained at the same level as the normal group at P28 though they were significantly lower than the normal group at P60. These observations suggested the residual visual functions on both sides of the subcortical brain, despite the damages to the entire ipsilesional visual cortex. The results of this study constitute important evidence on the progressive maturation of visual functions and hemodynamic responses in the normal subcortical brain, and its functional plasticity upon neonatal HI injury.

Visual functions without the occipital lobe or after cerebral hemispherectomy in infancy

This paper investigates whether and to what extent vision with awareness is still possible in the whole visual field after loss of the occipital lobe of one or both cerebral hemispheres or after hemispherectomy in childhood. The visual functions of four children who suffered from unilateral or bilateral loss of the occipital lobe or who had been hemispherectomized were examined. The results show that even after unilateral loss of the striate and prestriate cortex the extent of the visual field may still be in the normal range. The residual visual functions may be mediated by intact extrastriate areas such as V5 and LO of the damaged cerebral hemisphere. It is also shown that even after complete hemispherectomy in early life the visual field may have a normal extent and that conscious visual perception in the whole visual field may be preserved. In hemispherectomized children, the remaining cerebral hemisphere or neural structures in the midbrain, including the superior colliculi and the praetectum, may be able to mediate these visual functions.

The early development of visual attention and its implications for social and cognitive development

Looking behavior plays a crucial role in the daily life of an infant and forms the basis for cognitive and social development. The infant's visual attentional systems undergo rapid development during the first few months of life. During the last decennia, the study of visual attentional development in infants has received increasing interest. Several reliable measures to investigate the early development of attentional processes have been developed, and currently a number of new methods are giving fresh impetus to the field. Research on overt and covert as well as exogenously and endogenously controlled attention shifts is presented. The development of gaze shifts to peripheral targets, covert attention, and visual scanning behavior is treated. Whereas most attentional mechanisms in very young infants are thought to be mediated mainly by subcortical structures, cortical mechanisms become increasingly more functional throughout the first months. Different accounts of the neurophysiological underpinnings of attentional processes and their developmental changes are discussed. Finally, a number of studies investigating the implications of attentional development for early cognitive and social development are presented.

Restitution of visual functions in cerebrally blind children

In adult patients who suffer from a visual field defect due to cerebral lesions, visual functions can be restored by systematic visual field training. Such visual field training is not feasible in young, brain-damaged children, who are unable to cooperate like adults. We have already shown earlier [Werth, R., and Moehrenschlager, M. (1999). The development of visual functions in cerebrally blind children during a systematic visual field training. Restorative Neurology and Neuroscience, 15, 229-241.] that systematic visual field training, which requires no ability to understand instructions or to cooperate, is successful in brain-damaged children and may lead to complete recovery of the visual field within 3 months. The present study provides more behavioral evidence and a control of intraocular light scatter. In addition to the earlier study, the luminance difference thresholds in the recovered visual field were compared with those of a normal control group. Seventeen children aged 1-4 years who had been blind for more than 1 year after perinatal asphyxia and two children suffering from homonymous hemianopia due to asphyxic-ischemic lesions participated in systematic visual field training. The functional visual field was assessed with a specially designed arc perimeter. Visual functions developed within a training period of 3 months in 11 children who received visual field training, whereas there was no recovery in the control group (N=37). The findings support the assumption that systematic visual field training facilitates the development of vision in cerebrally blind children. In two children who recovered from blindness, it was shown in functional magnetic resonance imaging (fMRI) that brain tissue in the area of the visual cortex contralateral to the blind visual hemifield was activated by light. In two children suffering from asphyxic-ischemic lesions who did not recover only brain tissue in the area of the visual cortex contralateral to the good visual hemifield could be activated by light. These results support the assumption that activity in spared tissue of the striate and extrastriate visual cortex are a necessary condition for recovery of the visual field in children suffering from cerebral blindness.

Visual recovery after perinatal stroke evidenced by functional and diffusion MRI: case report

BACKGROUND

After perinatal brain injury, clinico-anatomic correlations of functional deficits and brain plasticity remain difficult to evaluate clinically in the young infant. Thus, new non-invasive methods capable of early functional diagnosis are needed in young infants.

CASE PRESENTATION

The visual system recovery in an infant with perinatal stroke is assessed by combining diffusion tensor imaging (DTI) and event-related functional MRI (ER-fMRI). All experiments were done at 1.5T. A first DTI experiment was performed at 12 months of age. At 20 months of age, a second DTI experiment was performed and combined with an ER-fMRI experiment with visual stimuli (2 Hz visual flash). At 20 months of age, ER-fMRI showed significant negative activation in the visual cortex of the injured left hemisphere that was not previously observed in the same infant. DTI maps suggest recovery of the optic radiation in the vicinity of the lesion. Optic radiations in the injured hemisphere are more prominent in DTI at 20 months of age than in DTI at 12 months of age.

CONCLUSION

Our data indicate that functional cortical recovery is supported by structural modifications that concern major pathways of the visual system. These neuroimaging findings might contribute to elaborate a pertinent strategy in terms of diagnosis and rehabilitation.

The 30th Sir Frederick Bartlett lecture. Fact, artefact, and myth about blindsight

Blindsight is the ability, still controversial if a vote is taken, of subjects with clinically blind field defects to detect, localize, and discriminate visual stimuli of which the subjects say they are completely unaware--the original definition--or of which they might be aware but not in the sense of experiencing a visual percept. These two conditions are known as blindsight Types I and II. This Bartlett lecture narrates the discovery of blindsight and its mounting opposition, and it evaluates the continuing and often perplexing debate about its standing as a visual cognitive phenomenon.

Combination of event-related fMRI and diffusion tensor imaging in an infant with perinatal stroke

Focal ischemic brain injury, or stroke, is an important cause of later handicap in children. Early assessment of structure-function relationships after such injury will provide insight into clinico-anatomic correlation and potentially guide early intervention strategies. We used combined functional MRI (fMRI) with diffusion tensor imaging (DTI) in a 3-month-old infant to explore the structure-function relationship after unilateral perinatal stroke that involved the visual pathways. With visual stimuli, fMRI showed a negative BOLD activation in the visual cortex of the intact right hemisphere, principally in the anterior part, and no activation in the injured hemisphere. The functional activation in the intact hemisphere correlated clearly with the fiber tract of the optic radiation visualized with DTI. DTI confirmed the absence of the optic radiation in the damaged left hemisphere. In addition, event-related fMRI (ER-fMRI) experiments were performed to define the characteristics of the BOLD response. The shape is that of an inverted gamma function (similar to a negative mirror image of the known positive adult BOLD response). The maximum decrease was reached at 5-7 s with signal changes of -1.7 +/- 0.4%.Thus, this report describes for the first time the combined use of DTI and event-related fMRI in an infant and provides insight into the localization of the fMRI visual response in the young infant and the characteristics of the BOLD response.

Normal and anomalous development of visual motion processing: motion coherence and 'dorsal-stream vulnerability'

Directional motion processing is a pervasive and functionally important feature of the visual system. Behavioural and VEP studies indicate that it appears as a cortical function after about 7 weeks of age, with global processing, motion based segmentation, and the use of motion in complex perceptual tasks emerging shortly afterwards. A distinct, subcortical motion system controls optokinetic nystagmus (OKN) from birth, showing characteristic monocular asymmetries which disappear as binocular cortical function takes over in normal development. Asymmetries in cortical responses are linked to this interaction in a way that is not yet fully understood. Beyond infancy, a range of developmental disorders show a deficit of global motion compared to global form processing which we argue reflects a general 'dorsal-stream vulnerability'.

Neonatal cerebral infarction and visual function at school age

OBJECTIVE

To assess various aspects of visual function at school age in children with neonatal cerebral infarction.

PATIENTS AND METHODS

Sixteen children born at term, who had cerebral infarction of perinatal onset on neonatal magnetic resonance imaging (MRI) were assessed using a battery of visual tests. This included measures of crowding acuity (Cambridge Crowding Cards), stereopsis (TNO test), and visual fields. The results of the visual assessment were compared with the type and the extent of the lesion observed on neonatal MRI.

RESULTS

Only six of the 16 children (28%) had some abnormalities of visual function on these tests. Visual abnormalities were more common in children with more extensive lesions involving the main branch of the middle cerebral artery and were less often associated with lesions in the territory of one of the cortical branches of the middle cerebral artery. The presence of visual abnormalities was not always associated with the involvement of optic radiations or occipital primary visual cortex. Abnormal visual fields were only found in children who also developed hemiplegia.

CONCLUSIONS

Abnormality of visual function is not common in children who had neonatal infarction and, when present, tends to be associated with hemiplegia and more extensive lesions.

Speech and non-speech processing in hemispherectomised children: an event-related potential study

Although hemispherectomy is now used as a radical treatment for intractable seizures in a number of centres, there have been limited electrophysiological studies investigating post-procedure auditory-speech processing and recovery or reorganisation. We therefore recorded auditory event-related potentials (ERPs) evoked by pure tones and syllables employing a 51-channel electrode array concentrated over the functional hemisphere in 17 patients (nine males, mean age 14.2 years) who had undergone hemispherectomy for intractable seizures; eight of the patients had congenital brain damage and nine had sustained their initial insult at an age of 1 year or older. For comparison, recordings were made from 10 controls (five males, mean age 13.5 years). Responses from patients consisted of five small amplitude components restricted to the functional hemisphere whose scalp polarity was opposite to the ERPs observed in control subjects. The topography of the auditory ERPs in the patients was localised to the centro-temporal regions of the functional hemisphere in comparison to the midline distribution observed in control subjects. As in the control subjects, the latencies of the components evoked by tones were shorter than those evoked by syllables in both left and right hemispherectomised children. In addition, further analysis of the N1 and P2 component revealed increased syllable latencies in left hemispherectomised children only. The results of this study suggest that the left hemisphere alone may be more efficient at processing both pure tones and syllables compared to the right or both together.