The role of the retino-colliculo-extrastriate pathway in visual awareness and visual field recovery

Patients with visual field defects resulting from post-chiasmatic lesions experience loss of visual function in up to one half of their visual field, with consequent impairments in their daily life activities. Therefore, effective strategies for compensating for the visual field loss are of great clinical relevance. After lesions to the primary visual pathway -which conveys visual information from the retina to the lateral geniculate nucleus, the optic radiations and, then, to the striate cortex-an alternative visual pathway, which projects from the superior colliculus to the extrastriate cortex, is usually spared in patients with visual field defects. In the present review, evidence for spared functioning of this alternative pathway in patients with visual field defects will be presented, both in terms of residual visual abilities, without awareness, for stimuli presented in the blind field, and the ability to integrate unseen visual signals presented in the blind field with concurrent auditory stimuli. Crucially, this review will discuss how the spared retino-colliculo-extrastriate pathway might be a useful tool for compensating for the loss of visual perception. Accordingly, evidence for the compensatory effects of systematic multisensory audio-visual stimulation in patients with visual field defects will be reviewed.

Compensatory Recovery after Multisensory Stimulation in Hemianopic Patients: Behavioral and Neurophysiological Components

Lateralized post-chiasmatic lesions of the primary visual pathway result in loss of visual perception in the field retinotopically corresponding to the damaged cortical area. However, patients with visual field defects have shown enhanced detection and localization of multisensory audio-visual pairs presented in the blind field. This preserved multisensory integrative ability (i.e., crossmodal blindsight) seems to be subserved by the spared retino-colliculo-dorsal pathway. According to this view, audio-visual integrative mechanisms could be used to increase the functionality of the spared circuit and, as a consequence, might represent an important tool for the rehabilitation of visual field defects. The present study tested this hypothesis, investigating whether exposure to systematic multisensory audio-visual stimulation could induce long-lasting improvements in the visual performance of patients with visual field defects. A group of 10 patients with chronic visual field defects were exposed to audio-visual training for 4 h daily, over a period of 2 weeks. Behavioral, oculomotor and electroencephalography (EEG) measures were recorded during several visual tasks before and after audio-visual training. After audio-visual training, improvements in visual search abilities, visual detection, self-perceived disability in daily life activities and oculomotor parameters were found, suggesting the implementation of more effective visual exploration strategies. At the electrophysiological level, after training, patients showed a significant reduction of the P3 amplitude in response to stimuli presented in the intact field, reflecting a reduction in attentional resources allocated to the intact field, which might co-occur with a shift of spatial attention towards the blind field. More interestingly, both the behavioral improvements and the electrophysiological changes observed after training were found to be stable at a follow-up session (on average, 8 months after training), suggesting long-term effects of multisensory audio-visual training. These long-lasting effects seem to be subserved by the activation of the spared retino-colliculo-dorsal pathway, which promotes orienting responses towards the blind field, able to both compensate for the visual field loss and concurrently attenuate visual attention towards the intact field. These results add to previous findings the knowledge that audio-visual multisensory stimulation promote long-term plastic changes in hemianopics, resulting in stable and long-lasting ameliorations in behavioral and electrophysiological measures.

Audio‐visual multisensory training enhances visual processing of motion stimuli in healthy participants: an electrophysiological study

Evidence from electrophysiological and imaging studies suggests that audio‐visual (AV) stimuli presented in spatial coincidence enhance activity in the subcortical colliculo‐dorsal extrastriate pathway. To test whether repetitive AV stimulation might specifically activate this neural circuit underlying multisensory integrative processes, electroencephalographic data were recorded before and after 2 h of AV training, during the execution of two lateralized visual tasks: a motion discrimination task, relying on activity in the colliculo‐dorsal MT pathway, and an orientation discrimination task, relying on activity in the striate and early ventral extrastriate cortices. During training, participants were asked to detect and perform a saccade towards AV stimuli that were disproportionally allocated to one hemifield (the trained hemifield). Half of the participants underwent a training in which AV stimuli were presented in spatial coincidence, while the remaining half underwent a training in which AV stimuli were presented in spatial disparity (32°). Participants who received AV training with stimuli in spatial coincidence had a post‐training enhancement of the anterior N1 component in the motion discrimination task, but only in response to stimuli presented in the trained hemifield. However, no effect was found in the orientation discrimination task. In contrast, participants who received AV training with stimuli in spatial disparity showed no effects on either task. The observed N1 enhancement might reflect enhanced discrimination for motion stimuli, probably due to increased activity in the colliculo‐dorsal MT pathway induced by multisensory training.