We have previously shown that some visual motion areas can be specifically recruited by auditory motion processing in blindfolded sighted subjects [Poirier, C., Collignon, O., De Volder, A.G., Renier, L., Vanlierde, A., Tranduy, D., Scheiber, C., 2005. Specific activation of V5 brain area by auditory motion processing: an fMRI study. Brain Res. Cogn. Brain Res. 25, 650–658]. The present fMRI study investigated whether auditory motion processing may recruit the same brain areas in early blind subjects. The task consisted of simultaneously determining both the nature of a sound stimulus (pure tone or complex sound) and the presence or absence of its movement. When a movement was present, blind subjects had to identify its direction. Auditory motion processing, as compared to static sound processing, activated the brain network of auditory and visual motion processing classically observed in sighted subjects. Accordingly, brain areas previously considered as specific to visual motion processing could be specifically recruited in blind people by motion stimuli presented through the auditory modality. This indicates that the occipital cortex of blind people could be organized in a modular way, as in sighted people. The similarity of these results with those we previously observed in sighted subjects suggests that occipital recruitment in blind people could be mediated by the same anatomical connections as in sighted subjects.

Previous neuroimaging studies devoted to auditory motion processing have shown the involvement of a cerebral network encompassing the temporoparietal and premotor areas. Most of these studies were based on a comparison between moving stimuli and static stimuli placed at a single location. However, moving stimuli vary in spatial location, and therefore motion detection can include both spatial localisation and motion processing. In this study, we used fMRI to compare neural processing of moving sounds and static sounds in various spatial locations in blindfolded sighted subjects. The task consisted of simultaneously determining both the nature of a sound stimulus (pure tone or complex sound) and the presence or absence of its movement. When movement was present, subjects had to identify its direction. This comparison of how moving and static stimuli are processed showed the involvement of the parietal lobules, the dorsal and ventral premotor cortex and the planum temporale during auditory motion processing. It also showed the specific recruitment of V5, the visual motion area. These results suggest that the previously proposed network of auditory motion processing is distinct from the network of auditory localisation. In addition, they suggest that the occipital cortex can process non-visual stimuli and that V5 is not restricted to visual processing.

Previous neuroimaging studies identified multimodal brain areas in the visual cortex that are specialized for processing specific information, such as visual-haptic object recognition. Here, we test whether visual brain areas are involved in depth perception when auditory substitution of vision is used. Nine sighted volunteers were trained blindfolded to use a prosthesis substituting vision with audition both to recognize two-dimensional figures and to estimate distance of an object in a real three-dimensional environment. Using positron emission tomography, regional cerebral blood flow was assessed while the prosthesis was used to explore virtual 3D images; subjects focused either on 2D features (target search) or on depth (target distance comparison). Activation foci were found in visual association areas during both the target search task, which recruited the occipito-parietal cortex, and the depth perception task, which recruited occipito-parietal and occipito-temporal areas. This indicates that some brain areas of the visual cortex are relatively multimodal and may be recruited for depth processing via a sense other than vision.

The mental imagery of participants who became blind early in life (EB participants), participants who became blind later in life (LB participants), and sighted participants was compared in two experiments. In the first experiment, the participants were asked to image common objects and to estimate how far away these objects appeared in their image. In the second experiment, the participants were asked to point to the left and right sides of three objects, imaged at three increasing distances. The LB participants’ performance of the tasks in both experiments was similar to that of the sighted participants, whereas the performance of the EB participants differed. The results reflect the close relationship between the development of visual perception and the properties of images.

We tested the effects of using a prosthesis for substitution of vision with audition (PSVA) on sensitivity to the Ponzo illusion. The effects of visual experience on the susceptibility to this illusion were also assessed. In one experiment, both early-blind and blindfolded sighted volunteers used the PSVA to explore several variants of the Ponzo illusion as well as control stimuli. No effects of the illusion were observed. The results indicate that subjects focused their attention on the two central horizontal bars of the stimuli, without processing the contextual cues that convey perspective in the Ponzo figure. In a second experiment, we required subjects to use the PSVA to consider the two converging oblique lines of the stimuli before comparing the length of the two horizontal bars. Here we were able to observe susceptibility to the Ponzo illusion in the sighted group, but to a lesser extent than in a sighted non-PSVA control group. No clear effect of the ilusion was obtained in early-blind subjects. These results suggest that, at least in sighted subjects, perception obtained with the PSVA shares perceptual processes with vision. Visual experience appears mandatory for a Ponzo illusion to occur with the PSVA.

An active visuo-spatial memory task was used in order to determine the characteristics of mental imagery in subjects with and without visual experience. Subjects were instructed to generate a mental representation of verbally presented 2D patterns that were placed in a grid and to indicate how many pattern elements were in corresponding positions in the two halves of the grid according to a specific grid axis (vertical or horizontal). Unexpectedly, results showed a similar performance in early blind, late blind and sighted subjects. However, subjects' debriefing showed that the three groups used different strategies. The sighted and the late blind subjects took advantage of a visuo-spatial strategy. They generated a mental image of the matrix and they simplified this image to maintain only the relevant information in memory. In contrast, the early blind subjects encoded each pattern element by its location in a (X,Y) coordinate system without visual representation. This indicates that both early and late blind subjects are able to perform an active visuo-spatial imagery task as well as sighted subjects although they use different strategies.

Using positron emission tomography, regional cerebral blood flow was studied in five early blind and five control volunteers during visuo-spatial imagery. Subjects were instructed to generate a mental representation of verbally provided bidimensional patterns that were placed in a grid and to assess pattern symmetry in relation to a grid axis. This condition was contrasted with a verbal memory task. Cerebral activation in both groups was similar during the visuo-spatial imagery task. It involved the precuneus (BA 7), superior parietal lobule (BA 7), and occipital gyrus (BA 19). These results are in accordance with previous studies conducted in sighted subjects that indicated that the same occipito-parietal areas are involved in visual perception as well as in mental imagery dealing with spatial components. The dorsal pathway seems to be involved in visuo-spatial imagery in early blind subjects, indicating that this pathway undergoes development in the absence of vision.

A volunteer with retinitis pigmentosa and no residual vision was chronically implanted with an optic nerve electrode connected to an implanted neurostimulator and antenna. An external controller with telemetry was used for electrical activation of the nerve which resulted in phosphene perception. Open-loop stimulation allowed the collection of phosphene attributes and the ability to elicit perception of simple geometrical patterns. Low perception thresholds allowed for large current intensity range within safety limits. In a closed-loop paradigm, the volunteer was using a head-worn video camera to explore a projection screen. The volunteer underwent performance evaluation during the course of a training program with 45 simple patterns. After learning, the volunteer reached a recognition score of 63% with a processing time of 60 s. Mean performance in orientation discrimination reached 100% with a processing time of 8s.

This study takes part in the analysis of phosphene perception thresholds as obtained by electrical stimulation through a spiral cuff electrode previously implanted around the right optic nerve of a blind retinitis pigmentosa patient. The enhanced efficiency of higher frequency or multiple pulse stimulation trains indicate temporal integration. Similarly, spatial summation takes place with increasing intensity. Considering a uniform population of typical axons, a rough model of phosphene perception thresholds can be constructed. Therefore, the strength-duration equation is combined with an S shaped axon recruitment curve. A simplified EPSP integrating synaptic mechanism takes temporal and spatial summation into account. Despite the crude approximations, a stable and well fitting model is identified, providing expected values against which all experimental values can be compared, showing obvious fluctuations. The observed changes demonstrate a rather negligible long term drop in the average threshold. The implanted cuff electrode thus appears stable in this human application.

Previous neuroimaging studies identified a large network of cortical areas involved in visual imagery in the human brain, which includes occipitotemporal and visual associative areas. Here we test whether the same processes can be elicited by tactile and auditory experiences in subjects who became blind early in life. Using positron emission tomography, regional cerebral blood flow was assessed in six right-handed early blind and six age-matched control volunteers during three conditions: resting state, passive listening to noise sounds, and mental imagery task (imagery of object shape) triggered by the sound of familiar objects. Activation foci were found in occipitotemporal and visual association areas, particularly in the left fusiform gyrus (Brodmann areas 19-37), during mental imagery of shape by both groups. Since shape imagery by early blind subjects does involve similar visual structures as controls at an adult age, it indicates their developmental crossmodal reorganization to allow perceptual representation in the absence of vision.

Pattern recognition in a computer environment was investigated in 6 early blind and 6 blindfolded sighted subjects using auditory substitution of vision. Subjects had to scan visual patterns displayed on a PC screen by moving the pen of a graphics tablet, which lead to corresponding displacements of the cursor on the screen. A small screen area centered on the pointer was then translated into sounds according to a visual-auditory transcription code. Subjects were trained to learn this code during 12 one-hour sessions. Performance of both groups significantly increased with practice. This indicates that mental representations Of Visual patterns can be acquired through the auditory channel, even in the absence of visual experience. Moreover, blind subjects performed significantly better than sighted subjects did. This could be interpreted as a result of partial compensation for their loss of vision. Pattern recognition in a computer environment is thus possible using a fairly natural vision-to-audition coding scheme. Copyright (C) 2001 John Wiley & Sons, Ltd.

Gloria Kirby-Green, Ph.D., CRC, COMS, assistant professor, Rehabilitation Counseling Program, South Carolina State University, 300 College Street, NE, Orangeburg, SC 29117; E-mail: .J. Elton Moore, Ed.D., CRC, professor and director, Rehabilitation Research and Training Center on Blindness and Low Vision, Mississippi State University, P.O. Box 6189, Mississippi State, MS 39762; E-mail: .

This PET study aimed at investigating the neural structures involved in pattern recognition in early blind subjects using sensory substitution equipment (SSE). Six early blind and six blindfolded sighted subjects were studied during three auditory processing tasks: a detection task with noise stimuli, a detection task with familiar sounds, and a pattern recognition task using the SSE. The results showed a differential activation pattern with the SSE as a function of the visual experience: in addition to the regions involved in the recognition process in sighted control subjects, occipital areas of early blind subjects were also activated. The occipital activation was more important when the early blind subjects used SSE than during the other auditory tasks. These results suggest that activity of the extrastriate visual cortex of early blind subjects can be modulated and bring additional evidence that early visual deprivation leads to cross-modal cerebral reorganization.

A blind volunteer affected with retinitis pigmentosa was intracranially implanted with a selfsizing cuff electrode around her right optic nerve. The nerve cuff electrode included 4 monopolar contacts. Its leads were brought through the skin where they ended in an external connector12. After recovery from surgery, electrical activation of the implanted optic nerve was undertaken. A specially dedicated Computer Based Stimulator was used. Stimulation consisted in charge balanced biphasic rectangular pulses. The stimulation resulted consistently and exclusively in visual sensations. The thresholds have remained stable for 14 months, so far. Phosphenes were broadly distributed throughout the visual field. They were either solid surface, or organized in rows, arrays, or clusters of dots. A topological organization was observed between phosphene location and the stimulating contact. Increasing the stimulation frequency decreased the current threshold for perception. The results of this experiment are consistent with the hypothesis that a visual prosthesis, based on electrical stimulation of the optic nerve, can be developed for human subjects with retinitis pigmentosa.

A blind volunteer with retinitis pigmentosa was chronically implanted with a self-sizing spiral cuff electrode around an optic nerve. Electrical stimuli applied to the nerve produced localized visual sensations that were broadly distributed throughout the visual field and could be varied by changing the stimulating conditions. These results demonstrate the potential for constructing a visual prosthesis, based on electrical stimulation of the optic nerve, for blind subjects who have intact retinal ganglion cells.