Auditory and proprioceptive spatial impairments in blind children and adults

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.

Auditory localization: a comprehensive practical review

Auditory localization is a fundamental ability that allows to perceive the spatial location of a sound source in the environment. The present work aims to provide a comprehensive overview of the mechanisms and acoustic cues used by the human perceptual system to achieve such accurate auditory localization. Acoustic cues are derived from the physical properties of sound waves, and many factors allow and influence auditory localization abilities. This review presents the monaural and binaural perceptual mechanisms involved in auditory localization in the three dimensions. Besides the main mechanisms of Interaural Time Difference, Interaural Level Difference and Head Related Transfer Function, secondary important elements such as reverberation and motion, are also analyzed. For each mechanism, the perceptual limits of localization abilities are presented. A section is specifically devoted to reference systems in space, and to the pointing methods used in experimental research. Finally, some cases of misperception and auditory illusion are described. More than a simple description of the perceptual mechanisms underlying localization, this paper is intended to provide also practical information available for experiments and work in the auditory field.

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).

Blindness influences emotional authenticity perception in voices: Behavioral and ERP evidence

The ability to distinguish spontaneous from volitional emotional expressions is an important social skill. How do blind individuals perceive emotional authenticity? Unlike sighted individuals, they cannot rely on facial and body language cues, relying instead on vocal cues alone. Here, we combined behavioral and ERP measures to investigate authenticity perception in laughter and crying in individuals with early- or late-blindness onset. Early-blind, late-blind, and sighted control participants (n = 17 per group, N = 51) completed authenticity and emotion discrimination tasks while EEG data were recorded. The stimuli consisted of laughs and cries that were either spontaneous or volitional. The ERP analysis focused on the N1, P2, and late positive potential (LPP). Behaviorally, early-blind participants showed intact authenticity perception, but late-blind participants performed worse than controls. There were no group differences in the emotion discrimination task. In brain responses, all groups were sensitive to laughter authenticity at the P2 stage, and to crying authenticity at the early LPP stage. Nevertheless, only early-blind participants were sensitive to crying authenticity at the N1 and middle LPP stages, and to laughter authenticity at the early LPP stage. Furthermore, early-blind and sighted participants were more sensitive than late-blind ones to crying authenticity at the P2 and late LPP stages. Altogether, these findings suggest that early blindness relates to facilitated brain processing of authenticity in voices, both at early sensory and late cognitive-evaluative stages. Late-onset blindness, in contrast, relates to decreased sensitivity to authenticity at behavioral and brain levels.

Blindness affects the developmental trajectory of the sleeping brain

Sleep plays a crucial role in brain development, sensory information processing, and consolidation. Sleep spindles are markers of these mechanisms as they mirror the activity of the thalamocortical circuits. Spindles can be subdivided into two groups, slow (10-13 Hz) and fast (13-16 Hz), which are each associated with different functions. Specifically, fast spindles oscillate in the high-sigma band and are associated with sensorimotor processing, which is affected by visual deprivation. However, how blindness influences spindle development has not yet been investigated. We recorded nap video-EEG of 50 blind/severely visually impaired (BSI) and 64 sighted children aged 5 months to 6 years old. We considered aspects of both macro- and micro-structural spindles. The BSI children lacked the evolution of developmental spindles within the central area. Specifically, young BSI children presented low central high-sigma and high-beta (25-30 Hz) event-related spectral perturbation and showed no signs of maturational decrease. High-sigma and high-beta activity in the BSI group correlated with clinical indices predicting perceptual and motor disorders. Our findings suggest that fast spindles are pivotal biomarkers for identifying an early developmental deviation in BSI children. These findings are critical for initial therapeutic intervention.

Movement-related tactile gating in blindness

When we perform an action, self-elicited movement induces suppression of somatosensory information to the cortex, requiring a correct motor-sensory and inter-sensory (i.e. cutaneous senses, kinesthesia, and proprioception) integration processes to be successful. However, recent works show that blindness might impact some of these elements. The current study investigates the effect of movement on tactile perception and the role of vision in this process. We measured the velocity discrimination threshold in 18 sighted and 18 blind individuals by having them perceive a sequence of two movements and discriminate the faster one in passive and active touch conditions. Participants' Just Noticeable Difference (JND) was measured to quantify their precision. Results showed a generally worse performance during the active touch condition compared to the passive. In particular, this difference was significant in the blind group, regardless of the blindness duration, but not in the sighted one. These findings suggest that the absence of visual calibration impacts motor-sensory and inter-sensory integration required during movement, diminishing the reliability of tactile signals in blind individuals. Our work spotlights the need for intervention in this population and should be considered in the sensory substitution/reinforcement device design.

Does visual experience influence arm proprioception and its lateralization? Evidence from passive matching performance in congenitally-blind and sighted adults

In humans, body segments' position and movement can be estimated from multiple senses such as vision and proprioception. It has been suggested that vision and proprioception can influence each other and that upper-limb proprioception is asymmetrical, with proprioception of the non-dominant arm being more accurate and/or precise than proprioception of the dominant arm. However, the mechanisms underlying the lateralization of proprioceptive perception are not yet understood. Here we tested the hypothesis that early visual experience influences the lateralization of arm proprioceptive perception by comparing 8 congenitally-blind and 8 matched, sighted right-handed adults. Their proprioceptive perception was assessed at the elbow and wrist joints of both arms using an ipsilateral passive matching task. Results support and extend the view that proprioceptive precision is better at the non-dominant arm for blindfolded sighted individuals. While this finding was rather systematic across sighted individuals, proprioceptive precision of congenitally-blind individuals was not lateralized as systematically, suggesting that lack of visual experience during ontogenesis influences the lateralization of arm proprioception.

Vision-related tasks in children with visual impairment: a multi-method study

Objective

Functional Vision (FV) is vital for the successful growth of children with visual impairment. However, tasks related to measuring FV have not been thoroughly studied for this population. To address this gap, this study seeks to establish a comprehensive set of vision-related tasks that consider both the difficulty levels of activities and the ages of children with visual impairment.

Methods

This study utilized a sequential multi-method design, including a scoping review, a qualitative content analysis, and a focus group. Firstly, a scoping review was conducted to identify vision-related tasks based on the literature. Then, to contextualize the vision-related tasks, a qualitative content analysis was carried out. Subsequently, a focus group was conducted to categorize the identified tasks based on their difficulty levels and the children's level of dependency. We utilized the directed content analysis method to analyze the data, using the occupational domain of the Occupational Therapy Practice Framework 4th edition (OTPF-4) as the primary framework.

Results

During the review phase, which included 22 studies, and the interview phase, which involved 16 participants, a total of 95 and 85 vision-related tasks were identified, respectively. These tasks were then categorized into 17 activities and five occupations, which included activities of daily living (ADL), instrumental activities of daily living (IADL), education, play, and participation in social activities. Among these occupations, ADL was the easiest, while participation in social activities was the most challenging. Finally, the tasks were arranged based on their difficulty level for children with visual impairment.

Conclusion

A comprehensive list of vision-related tasks has been developed based on the difficulty level of the tasks and the degree of dependency of children with visual impairment. This list can be used to develop standardized instruments for assessing FV in children with visual impairment.

A novel multisensory device for the assessment and rehabilitation of perceptual and attentional competencies

The present study aims to assess a novel technological device suitable for investigating perceptual and attentional competencies in people with or without sensory impairment. The TechPAD is a cabled system including embedded sensors and actuators to enable visual, auditory, and tactile interactions and a capacitive surface receiving inputs from the user. The system is conceived to create multisensory environments, using multiple units controlled separately and simultaneously. We assessed the device by adapting a spatial attention task comparing performances in different cognitive load conditions (high or low) and stimulation (unimodal, bimodal, or trimodal). 28 sighted adults were asked to monitor both the central and peripheral parts of the device and to tap a target stimulus (either visual, auditory, haptic, or multimodal) as fast as they could. Our results suggest that this new device can provide congruent and incongruent multimodal stimuli and quantitatively measure parameters such as reaction time and accuracy, allowing to investigate perceptual mechanisms in multisensory environments.Clinical Relevance-The TechPad is a reliable tool for the assessment of spatial attention during interactive tasks. its application in clinical trials will pave the way to its role in multisensory rehabilitation.

Cognitive map formation in the blind is enhanced by three-dimensional tactile information

For blind individuals, tactile maps are useful tools to form cognitive maps through touch. However, they still experience challenges in cognitive map formation and independent navigation. Three-dimensional (3D) tactile information is thus increasingly being considered to convey enriched spatial information, but it remains unclear if it can facilitate cognitive map formation compared to traditional two-dimensional (2D) tactile information. Consequently, the present study investigated the impact of the type of sensory input (tactile 2D vs. tactile 3D vs. a visual control condition) on cognitive map formation. To do so, early blind (EB, n = 13), late blind (LB, n = 12), and sighted control (SC, n = 14) participants were tasked to learn the layouts of mazes produced with different sensory information (tactile 2D vs. tactile 3D vs. visual control) and to infer routes from memory. Results show that EB manifested stronger cognitive map formation with 3D mazes, LB performed equally well with 2D and 3D tactile mazes, and SC manifested equivalent cognitive map formation with visual and 3D tactile mazes but were negatively impacted by 2D tactile mazes. 3D tactile maps therefore have the potential to improve spatial learning for EB and newly blind individuals through a reduction of cognitive overload. Installation of 3D tactile maps in public spaces should be considered to promote universal accessibility and reduce blind individuals' wayfinding deficits related to the inaccessibility of spatial information through non-visual means.

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

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

Monaural auditory spatial abilities in early blind individuals

Early blind individuals can localize single sound sources better than sighted participants, even under monaural conditions. Yet, in binaural listening, they struggle with understanding the distances between three different sounds. The latter ability has never been tested under monaural conditions. We investigated the performance of eight early blind and eight blindfolded healthy individuals in monaural and binaural listening during two audio-spatial tasks. In the localization task, a single sound was played in front of participants who needed to localize it properly. In the auditory bisection task, three consecutive sounds were played from different spatial positions, and participants reported which sound the second one was closer to. Only early blind individuals improved their performance in the monaural bisection, while no statistical difference was present for the localization task. We concluded that early blind individuals show superior ability in using spectral cues under monaural conditions.

Methods for measuring egocentric distance perception in visual modality

Egocentric distance perception has been widely concerned by researchers in the field of spatial perception due to its significance in daily life. The frame of perception involves the perceived distance from an observer to an object. Over the years, researchers have been searching for an optimal way to measure the perceived distance and their contribution constitutes a critical aspect of the field. This paper summarizes the methodological findings and divides the measurement methods for egocentric distance perception into three categories according to the behavior types. The first is Perceptional Method, including successive equal-appearing intervals of distance judgment measurement, verbal report, and perceptual distance matching task. The second is Directed Action Method, including blind walking, blind-walking gesturing, blindfolded throwing, and blind rope pulling. The last one is Indirect Action Method, including triangulation-by-pointing and triangulation-by-walking. In the meantime, we summarize each method's procedure, core logic, scope of application, advantages, and disadvantages. In the end, we discuss the future concerns of egocentric distance perception.

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.

Neural substrates of spatial processing and navigation in blindness: An activation likelihood estimation meta-analysis

Even though vision is considered the best suited sensory modality to acquire spatial information, blind individuals can form spatial representations to navigate and orient themselves efficiently in space. Consequently, many studies support the amodality hypothesis of spatial representations since sensory modalities other than vision contribute to the formation of spatial representations, independently of visual experience and imagery. However, given the high variability in abilities and deficits observed in blind populations, a clear consensus about the neural representations of space has yet to be established. To this end, we performed a meta-analysis of the literature on the neural correlates of spatial processing and navigation via sensory modalities other than vision, like touch and audition, in individuals with early and late onset blindness. An activation likelihood estimation (ALE) analysis of the neuroimaging literature revealed that early blind individuals and sighted controls activate the same neural networks in the processing of non-visual spatial information and navigation, including the posterior parietal cortex, frontal eye fields, insula, and the hippocampal complex. Furthermore, blind individuals also recruit primary and associative occipital areas involved in visuo-spatial processing via cross-modal plasticity mechanisms. The scarcity of studies involving late blind individuals did not allow us to establish a clear consensus about the neural substrates of spatial representations in this specific population. In conclusion, the results of our analysis on neuroimaging studies involving early blind individuals support the amodality hypothesis of spatial representations.

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.

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.

Viewing Strategies in Children With Visual Impairment and Children With Normal Vision: A Systematic Scoping Review

Viewing strategies are strategies used to support visual information processing. These strategies may differ between children with cerebral visual impairment (CVI), children with ocular visual impairment, and children with normal vision since visual impairment might have an impact on viewing behavior. In current visual rehabilitation practice a variety of strategies is used without consideration of the differences in etiology of the visual impairment or in the spontaneous viewing strategies used. This systematic scoping review focuses on viewing strategies used during near school-based tasks like reading and on possible interventions aimed at viewing strategies. The goal is threefold: (1) creating a clear concept of viewing strategies, (2) mapping differences in viewing strategies between children with ocular visual impairment, children with CVI and children with normal vision, and (3) identifying interventions that can improve visual processing by targeting viewing strategies. Four databases were used to conduct the literature search: PubMed, Embase, PsycINFO and Cochrane. Seven hundred and ninety-nine articles were screened by two independent reviewers using PRISMA reporting guidelines of which 30 were included for qualitative analysis. Only five studies explicitly mentioned strategies used during visual processing, namely gaze strategies, reading strategies and search strategies. We define a viewing strategy as a conscious and systematic way of viewing during task performance. The results of this review are integrated with different attention network systems, which provide direction on how to design future interventions targeting the use of viewing strategies to improve different aspects of visual processing.

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.

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

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.

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

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

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.

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.

Spatial Competence and Brain Plasticity in Congenital Blindness via Sensory Substitution Devices

In congenital blindness (CB), tactile, and auditory information can be reinterpreted by the brain to compensate for visual information through mechanisms of brain plasticity triggered by training. Visual deprivation does not cause a cognitive spatial deficit since blind people are able to acquire spatial knowledge about the environment. However, this spatial competence takes longer to achieve but is eventually reached through training-induced plasticity. Congenitally blind individuals can further improve their spatial skills with the extensive use of sensory substitution devices (SSDs), either visual-to-tactile or visual-to-auditory. Using a combination of functional and anatomical neuroimaging techniques, our recent work has demonstrated the impact of spatial training with both visual to tactile and visual to auditory SSDs on brain plasticity, cortical processing, and the achievement of certain forms of spatial competence. The comparison of performances between CB and sighted people using several different sensory substitution devices in perceptual and sensory-motor tasks uncovered the striking ability of the brain to rewire itself during perceptual learning and to interpret novel sensory information even during adulthood. We discuss here the implications of these findings for helping blind people in navigation tasks and to increase their accessibility to both real and virtual environments.

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.

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.

How Much Spatial Information Is Lost in the Sensory Substitution Process? Comparing Visual, Tactile, and Auditory Approaches

Sensory substitution devices (SSDs) can convey visuospatial information through spatialised auditory or tactile stimulation using wearable technology. However, the level of information loss associated with this transformation is unknown. In this study, novice users discriminated the location of two objects at 1.2 m using devices that transformed a 16 × 8-depth map into spatially distributed patterns of light, sound, or touch on the abdomen. Results showed that through active sensing, participants could discriminate the vertical position of objects to a visual angle of 1°, 14°, and 21°, and their distance to 2 cm, 8 cm, and 29 cm using these visual, auditory, and haptic SSDs, respectively. Visual SSDs significantly outperformed auditory and tactile SSDs on vertical localisation, whereas for depth perception, all devices significantly differed from one another (visual > auditory > haptic). Our findings highlight the high level of acuity possible for SSDs even with low spatial resolutions (e.g., 16 × 8) and quantify the level of information loss attributable to this transformation for the SSD user. Finally, we discuss ways of closing this “modality gap” found in SSDs and conclude that this process is best benchmarked against performance with SSDs that return to their primary modality (e.g., visuospatial into visual).

The Role of Visual Experience in Auditory Space Perception around the Legs

It is widely accepted that vision plays a key role in the development of spatial skills of the other senses. Recent works have shown that blindness is often associated with auditory spatial deficits. The majority of previous studies have focused on understanding the representation of the upper frontal body space where vision and actions have a central role in mapping the space, however less research has investigated the back space and the space around the legs. Here we investigate space perception around the legs and the role of previous visual experience, by studying sighted and blind participants in an audio localization task (front-back discrimination). Participants judged if a sound was delivered in their frontal or back space. The results showed that blindfolded sighted participants were more accurate than blind participants in the frontal space. However, both groups were similarly accurate when auditory information was delivered in the back space. Blind individuals performed the task with similar accuracy for sounds delivered in the frontal and back space, while sighted people performed better in the frontal space. These results suggest that visual experience influences auditory spatial representations around the legs. Moreover, these results suggest that hearing and vision play different roles in different spaces.

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.

Audio motor training improves mobility and spatial cognition in visually impaired children

Since it has been demonstrated that spatial cognition can be affected in visually impaired children, training strategies that exploit the plasticity of the human brain should be early adopted. Here we developed and tested a new training protocol based on the reinforcement of audio-motor associations and thus supporting spatial development in visually impaired children. The study involved forty-four visually impaired children aged 6–17 years old assigned to an experimental (ABBI training) or a control (classical training) rehabilitation conditions. The experimental training group followed an intensive but entertaining rehabilitation for twelve weeks during which they performed ad-hoc developed audio-spatial exercises with the Audio Bracelet for Blind Interaction (ABBI). A battery of spatial tests administered before and after the training indicated that children significantly improved in almost all the spatial aspects considered, while the control group didn’t show any improvement. These results confirm that perceptual development in the case of blindness can be enhanced with naturally associated auditory feedbacks to body movements. Therefore the early introduction of a tailored audio-motor training could potentially prevent spatial developmental delays 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.

Soft robot perception using embedded soft sensors and recurrent neural networks

Recent work has begun to explore the design of biologically inspired soft robots composed of soft, stretchable materials for applications including the handling of delicate materials and safe interaction with humans. However, the solid-state sensors traditionally used in robotics are unable to capture the high-dimensional deformations of soft systems. Embedded soft resistive sensors have the potential to address this challenge. However, both the soft sensors—and the encasing dynamical system—often exhibit nonlinear time-variant behavior, which makes them difficult to model. In addition, the problems of sensor design, placement, and fabrication require a great deal of human input and previous knowledge. Drawing inspiration from the human perceptive system, we created a synthetic analog. Our synthetic system builds models using a redundant and unstructured sensor topology embedded in a soft actuator, a vision-based motion capture system for ground truth, and a general machine learning approach. This allows us to model an unknown soft actuated system. We demonstrate that the proposed approach is able to model the kinematics of a soft continuum actuator in real time while being robust to sensor nonlinearities and drift. In addition, we show how the same system can estimate the applied forces while interacting with external objects. The role of action in perception is also presented. This approach enables the development of force and deformation models for soft robotic systems, which can be useful for a variety of applications, including human-robot interaction, soft orthotics, and wearable robotics.

Impact of years of blindness on neural circuits underlying auditory spatial representation

Early visual deprivation impacts negatively on spatial bisection abilities. Recently, an early (50-90 ms) ERP response, selective for sound position in space, has been observed in the visual cortex of sighted individuals during the spatial but not the temporal bisection task. Here, we clarify the role of vision on spatial bisection abilities and neural correlates by studying late blind individuals. Results highlight that a shorter period of blindness is linked to a stronger contralateral activation in the visual cortex and a better performance during the spatial bisection task. Contrarily, not lateralized visual activation and lower performance are observed in individuals with a longer period of blindness. To conclude, the amount of time spent without vision may gradually impact on neural circuits underlying the construction of spatial representations in late blind participants. These findings suggest a key relationship between visual deprivation and auditory spatial abilities in humans.

Audio Feedback Associated With Body Movement Enhances Audio and Somatosensory Spatial Representation

In the last years, the positive impact of sensorimotor rehabilitation training on spatial abilities has been taken into account, e.g., providing evidence that combined multimodal compared to unimodal feedback improves responsiveness to spatial stimuli. To date, it still remains unclear to which extent spatial learning is influenced by training conditions. Here we investigated the effects of active and passive audio-motor training on spatial perception in the auditory and proprioceptive domains on 36 healthy young adults. First, to investigate the role of voluntary movements on spatial perception, we compared the effects of active vs. passive multimodal training on auditory and proprioceptive spatial localization. Second, to investigate the effectiveness of unimodal training conditions on spatial perception, we compared the impact of only proprioceptive or only auditory sensory feedback on spatial localization. Finally, to understand whether the positive effects of multimodal and unimodal trainings generalize to the untrained part, both dominant and non-dominant arms were tested. Results indicate that passive multimodal training (guided movement) is more beneficial than active multimodal training (active exploration) and only in passive condition the improvement is generalized also on the untrained hand. Moreover, we found that combined audio-motor training provides the strongest benefit because it significantly affects both auditory and somatosensory localization, while the effect of a single feedback modality is limited to a single domain, indicating a cross-modal influence of the two domains. Therefore, the use of multimodal feedback is more efficient in improving spatial perception. These results indicate that combined sensorimotor signals are effective in recalibrating auditory and proprioceptive spatial perception and that the beneficial effect is mainly due to the combination of auditory and proprioceptive spatial cues.

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 Motor Training at the Foot Level Improves Space Representation

Spatial representation is developed thanks to the integration of visual signals with the other senses. It has been shown that the lack of vision compromises the development of some spatial representations. In this study we tested the effect of a new rehabilitation device called ABBI (Audio Bracelet for Blind Interaction) to improve space representation. ABBI produces an audio feedback linked to body movement. Previous studies from our group showed that this device improves the spatial representation of space in early blind adults around the upper part of the body. Here we evaluate whether the audio motor feedback produced by ABBI can also improve audio spatial representation of sighted individuals in the space around the legs. Forty five blindfolded sighted subjects participated in the study, subdivided into three experimental groups. An audio space localization (front-back discrimination) task was performed twice by all groups of subjects before and after different kind of training conditions. A group (experimental) performed an audio-motor training with the ABBI device placed on their foot. Another group (control) performed a free motor activity without audio feedback associated with body movement. The other group (control) passively listened to the ABBI sound moved at foot level by the experimenter without producing any body movement. Results showed that only the experimental group, which performed the training with the audio-motor feedback, showed an improvement in accuracy for sound discrimination. No improvement was observed for the two control groups. These findings suggest that the audio-motor training with ABBI improves audio space perception also in the space around the legs in sighted individuals. This result provides important inputs for the rehabilitation of the space representations in the lower part of the body.

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.

Spatial localization of sound elicits early responses from occipital visual cortex in humans

Much evidence points to an interaction between vision and audition at early cortical sites. However, the functional role of these interactions is not yet understood. Here we show an early response of the occipital cortex to sound that it is strongly linked to the spatial localization task performed by the observer. The early occipital response to a sound, usually absent, increased by more than 10-fold when presented during a space localization task, but not during a time localization task. The response amplification was not only specific to the task, but surprisingly also to the position of the stimulus in the two hemifields. We suggest that early occipital processing of sound is linked to the construction of an audio spatial map that may utilize the visual map of the occipital cortex.