Publications

2014
Kalia A, Hopkins R, Jin D, Yazzolino L, Verma S, Merabet L, Phillips F, Sinha P. Perception of tactile graphics: embossings versus cutouts. Multisens Res. 2014;27 (2) :111-25.Abstract
Graphical information, such as illustrations, graphs, and diagrams, are an essential complement to text for conveying knowledge about the world. Although graphics can be communicated well via the visual modality, conveying this information via touch has proven to be challenging. The lack of easily comprehensible tactile graphics poses a problem for the blind. In this paper, we advance a hypothesis for the limited effectiveness of tactile graphics. The hypothesis contends that conventional graphics that rely upon embossings on two-dimensional surfaces do not allow the deployment of tactile exploratory procedures that are crucial for assessing global shape. Besides potentially accounting for some of the shortcomings of current approaches, this hypothesis also serves a prescriptive purpose by suggesting a different strategy for conveying graphical information via touch, one based on cutouts. We describe experiments demonstrating the greater effectiveness of this approach for conveying shape and identity information. These results hold the potential for creating more comprehensible tactile drawings for the visually impaired while also providing insights into shape estimation processes in the tactile modality.
Sánchez J, de Borba Campos M, Espinoza M, Merabet LB. Audio Haptic Videogaming for Developing Wayfinding Skills in Learners Who are Blind. IUI. 2014;2014 :199-208.Abstract
Interactive digital technologies are currently being developed as a novel tool for education and skill development. Audiopolis is an audio and haptic based videogame designed for developing orientation and mobility (O&M) skills in people who are blind. We have evaluated the cognitive impact of videogame play on O&M skills by assessing performance on a series of behavioral tasks carried out in both indoor and outdoor virtual spaces. Our results demonstrate that the use of Audiopolis had a positive impact on the development and use of O&M skills in school-aged learners who are blind. The impact of audio and haptic information on learning is also discussed.
Marques LM, Lapenta OM, Merabet LB, Bolognini N, Boggio PS. Tuning and disrupting the brain-modulating the McGurk illusion with electrical stimulation. Front Hum Neurosci. 2014;8 :533.Abstract
In the so-called McGurk illusion, when the synchronized presentation of the visual stimulus /ga/ is paired with the auditory stimulus /ba/, people in general hear it as /da/. Multisensory integration processing underlying this illusion seems to occur within the Superior Temporal Sulcus (STS). Herein, we present evidence demonstrating that bilateral cathodal transcranial direct current stimulation (tDCS) of this area can decrease the McGurk illusion-type responses. Additionally, we show that the manipulation of this audio-visual integrated output occurs irrespective of the number of eye-fixations on the mouth of the speaker. Bilateral anodal tDCS of the Parietal Cortex also modulates the illusion, but in the opposite manner, inducing more illusion-type responses. This is the first demonstration of using non-invasive brain stimulation to modulate multisensory speech perception in an illusory context (i.e., both increasing and decreasing illusion-type responses to a verbal audio-visual integration task). These findings provide clear evidence that both the superior temporal and parietal areas contribute to multisensory integration processing related to speech perception. Specifically, STS seems fundamental for the temporal synchronization and integration of auditory and visual inputs. For its part, posterior parietal cortex (PPC) may adjust the arrival of incoming audio and visual information to STS thereby enhancing their interaction in this latter area.
Deer TR, Mekhail N, Petersen E, Krames E, Staats P, Pope J, Saweris Y, Lad SP, Diwan S, Falowski S, et al. The appropriate use of neurostimulation: stimulation of the intracranial and extracranial space and head for chronic pain. Neuromodulation. 2014;17 (6) :551-70.Abstract
INTRODUCTION: The International Neuromodulation Society (INS) has identified a need for evaluation and analysis of the practice of neurostimulation of the brain and extracranial nerves of the head to treat chronic pain. METHODS: The INS board of directors chose an expert panel, the Neuromodulation Appropriateness Consensus Committee (NACC), to evaluate the peer-reviewed literature, current research, and clinical experience and to give guidance for the appropriate use of these methods. The literature searches involved key word searches in PubMed, EMBASE, and Google Scholar dated 1970-2013, which were graded and evaluated by the authors. RESULTS: The NACC found that evidence supports extracranial stimulation for facial pain, migraine, and scalp pain but is limited for intracranial neuromodulation. High cervical spinal cord stimulation is an evolving option for facial pain. Intracranial neurostimulation may be an excellent option to treat diseases of the nervous system, such as tremor and Parkinson's disease, and in the future, potentially Alzheimer's disease and traumatic brain injury, but current use of intracranial stimulation for pain should be seen as investigational. CONCLUSIONS: The NACC concludes that extracranial nerve stimulation should be considered in the algorithmic treatment of migraine and other disorders of the head. We should strive to perfect targets outside the cranium when treating pain, if at all possible.
Bauer CM, Heidary G, Koo B-B, Killiany RJ, Bex P, Merabet LB. Abnormal white matter tractography of visual pathways detected by high-angular-resolution diffusion imaging (HARDI) corresponds to visual dysfunction in cortical/cerebral visual impairment. J AAPOS. 2014;18 (4) :398-401.Abstract
Cortical (cerebral) visual impairment (CVI) is characterized by visual dysfunction associated with damage to the optic radiations and/or visual cortex. Typically it results from pre- or perinatal hypoxic damage to postchiasmal visual structures and pathways. The neuroanatomical basis of this condition remains poorly understood, particularly with regard to how the resulting maldevelopment of visual processing pathways relates to observations in the clinical setting. We report our investigation of 2 young adults diagnosed with CVI and visual dysfunction characterized by difficulties related to visually guided attention and visuospatial processing. Using high-angular-resolution diffusion imaging (HARDI), we characterized and compared their individual white matter projections of the extrageniculo-striate visual system with a normal-sighted control. Compared to a sighted control, both CVI cases revealed a striking reduction in association fibers, including the inferior frontal-occipital fasciculus as well as superior and inferior longitudinal fasciculi. This reduction in fibers associated with the major pathways implicated in visual processing may provide a neuroanatomical basis for the visual dysfunctions observed in these patients.
Connell N, Merabet LB. Uncovering the connectivity of the brain in relation to novel vision rehabilitation strategies. Neurology. 2014;83 (6) :484-5.
Lega C, Cattaneo Z, Merabet LB, Vecchi T, Cucchi S. The effect of musical expertise on the representation of space. Front Hum Neurosci. 2014;8 :250.Abstract
Consistent evidence suggests that pitch height may be represented in a spatial format, having both a vertical and a horizontal representation. The spatial representation of pitch height results into response compatibility effects for which high pitch tones are preferentially associated to up-right responses, and low pitch tones are preferentially associated to down-left responses (i.e., the Spatial-Musical Association of Response Codes (SMARC) effect), with the strength of these associations depending on individuals' musical skills. In this study we investigated whether listening to tones of different pitch affects the representation of external space, as assessed in a visual and haptic line bisection paradigm, in musicians and non musicians. Low and high pitch tones affected the bisection performance in musicians differently, both when pitch was relevant and irrelevant for the task, and in both the visual and the haptic modality. No effect of pitch height was observed on the bisection performance of non musicians. Moreover, our data also show that musicians present a (supramodal) rightward bisection bias in both the visual and the haptic modality, extending previous findings limited to the visual modality, and consistent with the idea that intense practice with musical notation and bimanual instrument training affects hemispheric lateralization.
Connors EC, Chrastil ER, Sánchez J, Merabet LB. Virtual environments for the transfer of navigation skills in the blind: a comparison of directed instruction vs. video game based learning approaches. Front Hum Neurosci. 2014;8 :223.Abstract
For profoundly blind individuals, navigating in an unfamiliar building can represent a significant challenge. We investigated the use of an audio-based, virtual environment called Audio-based Environment Simulator (AbES) that can be explored for the purposes of learning the layout of an unfamiliar, complex indoor environment. Furthermore, we compared two modes of interaction with AbES. In one group, blind participants implicitly learned the layout of a target environment while playing an exploratory, goal-directed video game. By comparison, a second group was explicitly taught the same layout following a standard route and instructions provided by a sighted facilitator. As a control, a third group interacted with AbES while playing an exploratory, goal-directed video game however, the explored environment did not correspond to the target layout. Following interaction with AbES, a series of route navigation tasks were carried out in the virtual and physical building represented in the training environment to assess the transfer of acquired spatial information. We found that participants from both modes of interaction were able to transfer the spatial knowledge gained as indexed by their successful route navigation performance. This transfer was not apparent in the control participants. Most notably, the game-based learning strategy was also associated with enhanced performance when participants were required to find alternate routes and short cuts within the target building suggesting that a ludic-based training approach may provide for a more flexible mental representation of the environment. Furthermore, outcome comparisons between early and late blind individuals suggested that greater prior visual experience did not have a significant effect on overall navigation performance following training. Finally, performance did not appear to be associated with other factors of interest such as age, gender, and verbal memory recall. We conclude that the highly interactive and immersive exploration of the virtual environment greatly engages a blind user to develop skills akin to positive near transfer of learning. Learning through a game play strategy appears to confer certain behavioral advantages with respect to how spatial information is acquired and ultimately manipulated for navigation.
Cattaneo Z, Lega C, Gardelli C, Merabet LB, Cela-Conde CJ, Nadal M. The role of prefrontal and parietal cortices in esthetic appreciation of representational and abstract art: a TMS study. Neuroimage. 2014;99 :443-50.Abstract
To explain the biological foundations of art appreciation is to explain one of our species' distinctive traits. Previous neuroimaging and electrophysiological studies have pointed to the prefrontal and the parietal cortex as two critical regions mediating esthetic appreciation of visual art. In this study, we applied transcranial magnetic stimulation (TMS) over the left prefrontal cortex and the right posterior parietal cortex while participants were evaluating whether they liked, and by how much, a particular painting. By depolarizing cell membranes in the targeted regions, TMS transiently interferes with the activity of specific cortical areas, which allows clarifying their role in a given task. Our results show that both regions play a fundamental role in mediating esthetic appreciation. Critically though, the effects of TMS varied depending on the type of art considered (i.e. representational vs. abstract) and on participants' a-priori inclination toward one or the other.
Sánchez J, de Campos MB, Espinoza M, Merabet LB. Audio haptic videogaming for developing wayfinding skills in learners who are blind. IUI. 2014 :199-208. Publisher's VersionAbstract

Interactive digital technologies are currently being developed as a novel tool for education and skill development. Audiopolis is an audio and haptic based videogame designed for developing orientation and mobility (O&M) skills in people who are blind. We have evaluated the cognitive impact of videogame play on O&M skills by assessing performance on a series of behavioral tasks carried out in both indoor and outdoor virtual spaces. Our results demonstrate that the use of Audiopolis had a positive impact on the development and use of O&M skills in school-aged learners who are blind. The impact of audio and haptic information on learning is also discussed.

Connors EC, Chrastil ER, Jaime Sanchez, Merabet LB. Virtual Environments for the Transfer of Navigation Skills in the Blind: A Comparison of Directed Instruction Versus Video Game Based Learning Approaches. Frontiers in Human Neuroscience. 2014;8. Publisher's VersionAbstract
For profoundly blind individuals, navigating in an unfamiliar building can represent a significant challenge. We investigated the use of an audio-based, virtual environment called Audio-based Environment Simulator (AbES) that can be explored for the purposes of learning the layout of an unfamiliar, complex indoor environment. Furthermore, we compared two modes of interaction with AbES. In one group, blind participants implicitly learned the layout of a target environment while playing an exploratory, goal-directed video game. By comparison, a second group was explicitly taught the same layout following a standard route and instructions provided by a sighted facilitator. As a control, a third group interacted with AbES while playing an exploratory, goal-directed video game however, the explored environment did not correspond to the target layout. Following interaction with AbES, a series of route navigation tasks were carried out in the virtual and physical building represented in the training environment to assess the transfer of acquired spatial information. We found that participants from both modes of interaction were able to transfer the spatial knowledge gained as indexed by their successful route navigation performance. This transfer was not apparent in the control participants. Most notably, the game-based learning strategy was also associated with enhanced performance when participants were required to find alternate routes and short cuts within the target building suggesting that a ludic-based training approach may provide for a more flexible mental representation of the environment. Furthermore, outcome comparisons between early and late blind individuals suggested that greater prior visual experience did not have a significant effect on overall navigation performance following training. Finally, performance did not appear to be associated with other factors of interest such as age, gender, and verbal memory recall. We conclude that the highly interactive
Connors E, Chrastil E, Sanchez J, Merabet LB. Action Video Game Play and Transfer of Navigation and Spatial Cognition Skills in Adolescents who are Blind. Frontiers in Human Neuroscience. 2014;8. Publisher's VersionAbstract
For individuals who are blind, navigating independently in an unfamiliar environment represents a considerable challenge. Inspired from recent developments in accessible technology and the rising popularity of video games, we have developed a novel approach to train navigation and spatial cognition skills in adolescents who are blind. Audio-based Environment Simulator (AbES) is a software application that allows for the virtual exploration of an existing building set in an action video game metaphor. We investigated the ability and efficacy of adolescents with early onset blindness to acquire spatial information gained from the exploration of a virtual indoor environment using this ludic approach to learning. Following game play, participants were then assessed on their ability to transfer and mentally manipulate acquired spatial information in a set of navigation tasks carried out in the real environment represented in the game. The transfer of navigation skill performance was markedly high suggesting that interacting with AbES leads to the generation of an accurate spatial mental representation. Furthermore, there was a positive correlation between success in game play and navigation task performance. The role of virtual environments and gaming in the development of mental spatial representations is also discussed. We conclude that this novel software and learning by a gaming approach can facilitate the transfer of spatial knowledge and can be used by individuals who are blind for the purposes of navigation in real-world environments.
Cattaneo Z, Renzi C, Bona S, Merabet LB, Carbon C-C, Vecchi T. Hemispheric asymmetry in discriminating faces differing for featural or configural (second-order relations) aspects. Psychon Bull Rev. 2014;21 (2) :363-9.Abstract
The human capacity to discriminate among different faces relies on distinct parallel subprocesses, based either on the analysis of configural aspects or on the sequential analysis of the single elements of a face. A particular type of configural processing consists of considering whether two faces differ in terms of internal spacing among their features, referred to as second-order relations processing. Findings from electrophysiological, neuroimaging, and lesion studies suggest that, overall, configural processes rely more on the right hemisphere, whereas analysis of single features would involve more the left. However, results are not always consistent, and behavioral evidence for a right-hemisphere specialization in second-order relations processing is lacking. Here, we used divided visual field presentation to investigate the possible different contributions of the two hemispheres to face discrimination based on relational versus featural processing. Our data indicate a right-hemispheric specialization in relational processing of upright (but not inverted) faces. Furthermore, we provide evidence regarding the involvement of both the right and left hemispheres in the processing of faces differing for inner features, suggesting that both analytical and configural modes of processing are at play.
Halko MA, Connors EC, Sánchez J, Merabet LB. Real world navigation independence in the early blind correlates with differential brain activity associated with virtual navigation. Hum Brain Mapp. 2014;35 (6) :2768-78.Abstract
Navigating is a complex cognitive task that places high demands on spatial abilities, particularly in the absence of sight. Significant advances have been made in identifying the neural correlates associated with various aspects of this skill; however, how the brain is able to navigate in the absence of visual experience remains poorly understood. Furthermore, how neural network activity relates to the wide variability in navigational independence and skill in the blind population is also unknown. Using functional magnetic resonance imaging, we investigated the neural correlates of audio-based navigation within a large scale, indoor virtual environment in early profoundly blind participants with differing levels of spatial navigation independence (assessed by the Santa Barbara Sense of Direction scale). Performing path integration tasks in the virtual environment was associated with activation within areas of a core network implicated in navigation. Furthermore, we found a positive relationship between Santa Barbara Sense of Direction scores and activation within right temporal parietal junction during the planning and execution phases of the task. These findings suggest that differential navigational ability in the blind may be related to the utilization of different brain network structures. Further characterization of the factors that influence network activity may have important implications regarding how this skill is taught in the blind community.
2013
Sánchez J, Espinoza M, de Borba Campos M, Merabet LB. Enhancing Orientation and Mobility Skills in Learners who are Blind through Video gaming. Creat Cognit. 2013;2013 :353-356.Abstract
In this work we present the results of the cognitive impact evaluation regarding the use of Audiopolis, an audio and/or haptic-based videogame. The software has been designed, developed and evaluated for the purpose of developing orientation and mobility (O&M) skills in blind users. The videogame was evaluated through cognitive tasks performed by a sample of 12 learners. The results demonstrated that the use of Audiopolis had a positive impact on the development and use of O&M skills in school-aged blind learners.
Sánchez J, de Campos MB, Espinoza M, Merabet LB. Accessibility for people who are blind in public transportation systems. IUI. 2013 :753-756. Publisher's VersionAbstract

In order to support access for people who are blind to modes of transportation in the city, it is necessary to design technological tools that allow them to carry out activities safely, autonomously, and functionally. In this context, three mobile orientation and mobility support systems were designed for people who are blind to aid in their effective navigation using various modes of transportation in the city of Santiago, Chile. This work presents the most significant implications of the use of these systems.

Sánchez J, Espinoza M, de Campos MB, Merabet LB. Enhancing orientation and mobility skills in learners who are blind through video gaming. IUI. 2013 :353-356. Publisher's VersionAbstract

In this work we present the results of the cognitive impact evaluation regarding the use of Audiopolis, an audio and/or haptic-based videogame. The software has been designed, developed and evaluated for the purpose of developing orientation and mobility (O&M) skills in blind users. The videogame was evaluated through cognitive tasks performed by a sample of 12 learners. The results demonstrated that the use of Audiopolis had a positive impact on the development and use of O&M skills in school-aged blind learners.

Connors EC, Yazzolino LA, Sánchez J, Merabet LB. Development of an audio-based virtual gaming environment to assist with navigation skills in the blind. J Vis Exp. 2013;(73).Abstract
Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.
Peters MAK, Thompson B, Merabet LB, Wu AD, Shams L. Anodal tDCS to V1 blocks visual perceptual learning consolidation. Neuropsychologia. 2013;51 (7) :1234-9.Abstract
This study examined the effects of visual cortex transcranial direct current stimulation (tDCS) on visual processing and learning. Participants performed a contrast detection task on two consecutive days. Each session consisted of a baseline measurement followed by measurements made during active or sham stimulation. On the first day, one group received anodal stimulation to primary visual cortex (V1), while another received cathodal stimulation. Stimulation polarity was reversed for these groups on the second day. The third (control) group of subjects received sham stimulation on both days. No improvements or decrements in contrast sensitivity relative to the same-day baseline were observed during real tDCS, nor was any within-session learning trend observed. However, task performance improved significantly from Day 1 to Day 2 for the participants who received cathodal tDCS on Day 1 and for the sham group. No such improvement was found for the participants who received anodal stimulation on Day 1, indicating that anodal tDCS blocked overnight consolidation of visual learning, perhaps through engagement of inhibitory homeostatic plasticity mechanisms or alteration of the signal-to-noise ratio within stimulated cortex. These results show that applying tDCS to the visual cortex can modify consolidation of visual learning.
Cattaneo Z, Vecchi T, Monegato M, Pece A, Merabet LB, Carbon C-C. Strabismic amblyopia affects relational but not featural and Gestalt processing of faces. Vision Res. 2013;80 :19-30.Abstract
The ability to identify faces is of critical importance for normal social interactions. Previous evidence suggests that early visual deprivation may impair certain aspects of face recognition. The effects of strabismic amblyopia on face processing have not been investigated previously. In this study, a group of individuals with amblyopia were administered two tasks known to selectively measure face detection based on a Gestalt representation of a face (Mooney faces task) and featural and relational processing of faces (Jane faces task). Our data show that--when relying on their amblyopic eye only - strabismic amblyopes perform as well as normally sighted individuals in face detection and recognition on the basis of their single features. However, they are significantly impaired in discriminating among different faces on the basis of the spacing of their single features (i.e., configural processing of relational information). Our findings are the first to demonstrate that strabismic amblyopia may cause specific deficits in face recognition, and add to previous reports characterizing visual perceptual deficits associated in amblyopia as high-level and not only as low-level processing.

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