>> AS YOU HEARD I'M SHERRY WIGS, I'M PROGRAM DIRECTOR AT THE NATIONAL EYE INSTITUTE. AND ONE OF MY PROGRAMS IS LOW VISION AND BLINDNESS REHABILITATION. DR. MERBETH'S WORK, I KNOW HIM BECAUSE HE'S A GRANTEE IN THE PROGRAM BUT A SHEENING EXAMPLE OF THE KIND OF WORK THAT THAT PROGRAM SUPPORTS. IF YOU WILL INDULGE ME, I ASK YOU TO CLOSE YOUR EYES. IT'S NOT MEDITATION. PROMISE YOU'LL KEEP THEM CLOSED FOR A BIT. NOW, THIS IS A VERY SIMPLISTIC STIMULUS OF WHAT IT'S LIKE TO BE BLIND. YOU HAVE NO VISUAL INPUT COMING IN. BUT IF I WERE TO TELL YOU TO IMAGINE THAT NOW YOU CAN HEAR OVER THE LOUD SPEAKER, THE FIRE ALARM GOING OFF, AND IT SAYS TO LOCATE THE NEAREST EXIT AND VACATE THE BUILDING, I GUARANTY NONE OF YOU WILL HONOR THAT PROMISE. I ASKED YOU TO MAKE. YOU'RE GOING TO OPEN YOUR EYES, AND YOU ARE OWE I GOING TO USE YOUR VISUAL SYSTEM TO FIND THAT DOOR AND GET OUT OF HERE. THAT'S PERFECTLY NATURAL BECAUSE WE'RE VISUAL CREATOR CREATURENS. WHAT IF YOUERN BORN BLIND OR WHAT IF YOU WERE ONE OF THE PEOPLE WHO STARTS TO LOSE YOUR VISION? YOU ACTUALLY HAVE TO ADAPT TO NO LONGER BEING A PERSON WHO JUST AUTOMATICALLY RELIES ON YOUR VISUAL SYSTEM. YOU HAVE TO ADAPT AND LEARN TO NAVIGATE IN THE WORLD IN A VERY DIFFERENT WAY. SO DR. MERABET IS AN OP TOMTRIST, INTEREST IN NEURO PLASTICITY ASSOCIATED WITH THIS ADAPTATION, EITHER TO USING YOUR VISION OR BEING VISUALLY IMPAIRED OR BLIND. AND HIS TITLE TELLS YOU A LOT ABOUT THE WAY HE BLENDS ALL OF THESE DIFFERENT AREAS IN AN OVERARCHING GOAL OF USING THIS INFORMATION TO UNDERSTAND REHABILITATION TECHNIQUES THAT WORK WELL TO INFORM THEM, AND TO DEVELOP NEW PLATFORMS THAT CAN HELP PEOPLE WITH VISUAL IMPAIRMENT. ABOUT THE WORLD. PRETTY MUCH THE SAME WAY YOU AND I DO. SO TO GIVE YOU A BIC OF BACKGROUND, DR. MERABET HOLDS A BACHELOR OF SCIENCE IN BIOLOGY FROM THE UNIVERSITY OF OTTAWA. A Ph.D. IN NEUROSCIENCE FROM THE UNIVERSITY OF MONTREAL. WE'RE VERY FORTUNATE -- THEN HE OBTAINED HIS DOCTORATE IN OPTOMETRY AT THE NEW ENGLAND COLLEGE OF OPTOMETRY IN BOSTON. WE'RE VERY HAPPY HE DECIDED TO GO SOUTH OF THE BORDER AND JOIN US HERE IN THE UNITED STATES. HE ALSO HOLDS MASTERS DEGREES IN CLINICAL INVESTIGATION FROM HARVARD MEDICAL SCHOOL AND MIT HEALTH SCIENCES TECHNOLOGY PROGRAM. AND MPH FROM HARVARD. TO STUDY PUBLIC HEALTH. HE'S ALSO COMPETED TWO POSTDOCTORAL FELLOWSHIPS IN NEURO IMAGING AND NON INVASIVE BRAIN STIMULATION. YOU GET A SENSE HE HAS A VERY, VERY BROAD EXPERTISE IN THE BASIC SCIENCES BUT ALSO THE CLINICAL SCIENCES. THAT'S WHAT HE BRINGS TOGETHER TO REALLY GET AT WHAT REHABILITATION IS ABOUT AND HOW REHABILITATION CAN HELP PEOPLE WITH VISUAL IMPAIRMENTS. HE'S CURRENTLY THE DIRECTOR OF THE LABORATORY FOR VISUAL NEURO PLASTICITY AT THE MASSACHUSETTS EYE AND EAR INIF I REMEMBERRY, AS WELL AS THE FACULTY MEMBER IN THE DEPARTMENT OF OPTHALMOLOGY IN HARVARD MIDDLE SCHOOL. IT'S MY GREAT PLEASURE TO INTRODUCE DOCTOR MERABET. >> I WANT TO THANK YOU FOR THAT WARM WELCOME. IT'S WONDERFUL TO BE HERE ON CAMPUS HERE AT THE NIH AND ALSO COLLEAGUES FROM THE NATIONAL EYE INSTITUTE. THIS IS A TREMENDOUS HONOR, I HAVE TO TELL YOU. BECAUSE I -- AS I WAS SAYING TO MY COLLEAGUES EARLIER, I REALLY FEEL THAT I OWE MY CAREER TO THE NATIONAL EYE INSTITUTE, NIH IN GENERAL. EVERYTHING FROM LOAN ROW PAYMENT PROGRAMS TO EARLY CAREER DEVELOPMENT AWARDS TO PARENT GRANTS AND FUNDING PROGRAMS. IT'S REALLY, REALLY INSTRUMENTAL IN DEVELOPING ME CAREER. YOU CAN ALSO IMAGINE THIS IS INTIMIDATING FOR ME. I HAVE AN HOUR TO CONVINCE ALL THAT FUNDING WAS FOR A GOOD PURPOSE. SO YOU HAVE TO BARE WITH ME. HOPEFULLY I CAN GET IT ALL ENIN AN HOUR. I THANK YOU FOR THIS INVITATION, I CONSIDER THIS A TREMENDOUS HONOR. MY INTEREST IS UNDERSTANDING THE BRAIN, PARTICULARLY IN THE CONTEXT OF BLINDNESS AND VISUAL IMPAIRMENT. I THOUGHT I'D START OFF WITH THAT CONCEPT AND EXPLAIN THAT MORE TO YOU. WHAT I CALL -- WHAT'S CALLED NEURO PLASTICITY. IT COMES FROM THE GREEK WORK THAT MEANS TO MOLD OR CONFORM. LIKE PLASTIC CAN BE CHANGED INTO A DIFFERENT SHAPE AND FUNCTION, SO, TOO, CAN THE BRAIN UNDER THE RIGHT CONDITIONS. SO I LIKE THIS DEFINITION. IT SAYS THE ABILITY OF THE BRAIN OR INDIANAPOLIS PLASTICITY, TO CHANGE THE BRAIN AND CHANGE ITS ITS -- OALL OF US LIKE TO EXCHANGE STORIES ABOUT BRAIN DEVELOPMENT. I'LL SHARE ONE WITH YOU THAT I LIKE. THIS WAS A GENTLEMAN, A STORY REPORTED IN THE UK PRESS A FEW YEARS AGO. TINY BREAKING NEWS IS NO OBSTACLE FOR FRENCH CIVIL SERVANTS. THIS IS A STANDARD NEURO MRI SCAN. THIS IS THEIR EYE, THEIR BRAIN. WHITE MATTER ON TOP, THIS IS THE FLUID FILLED AREA. THAT'S WHAT A NORMAL MRI LOOKS LIKE. THIS GENTLEMAN WENT TO SEE HIS DOCTOR. SAID I HAVE THESE HEAD ACADEMICS. FEELS STRANGE. I DON'T KNOW WHAT'S GOING ON. AND IF YOU LIVE IN FRANCE, I'M SURE THE DOCTOR SENT HEM HOME. YOU'LL BE PHONE, HAVE SOME -- HOME. HAVE SOME WINE. HE CAME BACK, HE SAID MY HEAD ACADEMICS ARE BAD. -- HEADACHES ARE BAD. THIS IS WHAT HIS BRAIN LOOKS LIKE. WHAT YOU SEE IN BLACK IS WATER. THAT'S SPINAL FLUID. HIS BRAIN IS THIS 4, 5-CENTIMETER LIP GOING AROUND LIKE THIS. THIS GUY HAD NO IDEA, THIS WAS WHAT HIS BRAIN WAS LIB. HE GREW UP, GOT A JOB, MARRIED WITH KIDS. AND HAD NO SENSE AT ALL THAT THERE WAS KNEEING -- ANYTHING STRANGE. WHEN IT COMES TO NEURO PLASTICITY, THINGS HAPPEN VERY EARLY AND SLOWLY, THE BRAIN IS VERY, VERY GOOD AND ADAPTING AND CHANGING. LESS SO IF IT HAPPENS WHEN YOU'RE AN ADULT AND ALSO QUICKLY. THINK OF TRAUMIC BRAIN INJURY. SO GIVE YOU A SENSE ENSOME CASES NEURO PLASTTITIONTY IS BE EXTREME, REMARKABLE SITUATION. IT'S IMPORTANT TO THINK BOUTS IT'S NOT ALWAYS POSITIVE. WE HAVE AN IDEA THAT IT'S ALWAYS THIS POSITIVE THING THAT GETS YOU OUT OF A TOUGH SITUATION. I THINK THAT'S OVER- SIMPLIFICATION. IT CAN BE MALADAPTIVE. PHANTOM LIMB PAIN IS A GOOD EXAMPLE. THEY HAVE AN AMPUBLISHERTATION AND THEY COMPLAIN ABOUT CHRONIC PAIN IN THAT LYMPH, EVEN THOUGH THE LIMB IS NOT THERE. THE REASON HAS THIS MALDEVELOPMENTAL PLASTICITY IN TERMS OF HOW IT REORGANIZES AND TRANSLATES INTO THIS MASSIVE ACUTE PAIN. SO THE POINT IS THIS IS NOT A GUARANTIED FIX. IT'S THE CONSEQUENCE HOW THE BRAIN WORKS THROUGHOUT A LIFETIME AND OUR GOAL FOR THOSE IN THIS FIELD IS TO UNDERSTAND THOSE CONSTRAINTS. TO UNDERSTAND HOW THE BRAIN DEVELOPS. NOW TO LEVERAGE THAT IN A POSITIVE WAY. AND HOW TO USE THAT IN A WAY THAT ULTIMATELY TRANSLATES FOR THINGS LIKE REHABILITATION AND EDUCATION AFTER BRAIN INJURY. I WANT TO SHARE WITH YOU WHAT I THINK IS REALLY A CLASSIC EXAMPLE OF INDIVIDUALS WHO UNDERSTOOD THIS AT A VERY, VERY EARLY -- EARLY LEVEL IN TERMS OF VISION SCIENCES AND NEUROSCIENCE. THAT IS THE CONCEPT OF THE CRITICAL PERIOD. THE 2 PEOPLE I'M TALKING ABOUT, THEY SHARED THE NOBLE PRIZE FOR MEDICINE IN THE 80s FOR ESSENTIALLY CHARACTERIZEING AND DISCOVERING ALL THE PHYSIOLOGICAL PROPERTIES OF WHAT WE KNOW AS THE OX ISN'TTLE VISUAL CORTEX. THEY WERE SUTURE ONE EYE OF A KITTEN, OPEN IT AGAIN AND LOOK AT TIMING. THEY REALIZED THE DEVELOPMENT OF THE VISUAL CORTEX IN TERMS OF ANATOMY WAS TIED TO THE VISUAL EXPERIENCE THAT THE KITTENS WENT THROUGH. TODAY, HOW WE TREAT VARIOUS CONDITIONS IS A DIRECT RESULT OF THAT SCIENCE THAT WAS DONE IN NEUROSCIENCE. SO IT'S AN EXCELLENT EXAMPLE HOW NEURO SCIENCE AT A BASIC LEVEL TRANSLATES INTO WHAT HAPPENS AT THE CLINICAL LEVEL. THAT'S VERY MUCH THE SAME GOAL WE TRIED TO USE IN OUR RESEARCH. I HOPE TO CONVINCE YOU WITH THE EXAMPLES THAT I'M GOING TO SHARE WITH YOU TODAY. LET'S GO RIGHT AWAY TO THE SITUATION OF PROFOUND BLINDNESS THAT DR. WIGS MENTIONED. AN EXAMPLE, SOMEONE LIKE STEVIE WONDER, A VERY TALENTED MUSICIAN. YOU HAVE TO ASK, IF HE WASN'T BLIND, WOULD HE BE THE INDIVIDUAL THAT HE IS TODAY? WOULD HE HAVE THE SAME SORT OF TALENT, WOULD HE HAVE BEEN AS SUCCESSFUL. OR JUST A GENERIC MUSICIAN? DID BLINDNESS CONFER AN ADVANTAGE? I THINK THAT'S AN INTERESTING PHILOSOPHICAL QUESTION. EVEN MORE INTERESTING NEUROSCIENCE QUESTION. THERE ARE MANY EXAMPLES LIKE THIS. PLENTY OF CELEBRITIES THAT LOST THEIR SIGHT AT SOME POINT IN THEIR LIVES AND THEY WENT ON AND HAD VERY, VERY PRODUCTIVE LIVES IN TERMS OF MUSIC AND ARTS, ATHLETICS, SO ON. YOU HAVE TO ASK HOW IS THIS POSSIBLE? THERE IS THIS IDEA THAT BRIND PEOPLE COMPENSATE FOR THEIR LACK OF SIGHT THROUGH OTHER SENSES. THEY HEAR BERT, HAVE A KEENER SENSE OF TOURNAMENT THIS IS QUITE A BIT OF BEHAVIORAL EVIDENCE THAT THIS IS TRUE. I'M GIVING YOU SOME EXAMPLES HERE. PEOPLE HAVE DEMONSTRATED THAT BLIND PEOPLE HAVE A KEENER SENSE OF TOUCH, FOR EXAMPLE. A KEENER SENSE OF BEING ABLE TO IDENTIFY OR LOCALIZE SOUNDS AND SPACE. ALSO ABLE TO IDENTIFY SMELLS, AGAIN, COMPARED TO SIGHTED PEOPLE. FAMILY, VERBAL MEMORY RECALL. IF YOU ASK A BLIND PERSON TO MEMORIZE 30 WORDS AND ASKED THEM TO RECALL THE WORDS, THEY'LL DO BETTER THAN A SIGHTED PERSON. SO THIS IS INTERESTING BEHAVIORAL EVIDENCE THERE IS A COMPENSATORY NON VISUAL BEHAVIORS THAT SEEM TO TAKE OVER. THERE ARE CAVEATS IMPORTANT TO THINK ABOUT. I'LL SHARE A COUPLE. THIS IS NOT UNIVERSAL. THIS IS NOT ACROSS THE BOARD. NOT INDIVIDUAL BLIND SHOWS THESE ADVANTAGES. SECONDLY, UPDATE VERY CONTROLLED ATYPICAL OR ANATURAL, IF YOU WILL, EXPERIMENTAL CONDITIONS. AN INDIVIDUAL IS ABLE TO LOCALIZE SOUNDS. YOU PUT THEM IN THE REAL WORLD. IT DOESN'T SHOW ADVANTAGE. THAT TRANSFERENCE ISN'T ALWAYS OBVIOUS. SENSORY THRESHOLDS VERSES ATTENTION. NOT A QUESTION THAT THESE INDIVIDUALS HAVE A KEEPER SENSE OF SMELL BUT THEY CAN ATTEND MORE DIRECTLY TO IT. THEY HAVE MORE ATTENTIONAL RESOURCES AVAILABLE TO ATTEND TO THOSE SENSES. AND THIRD HERE, COMPARISON TO SIGHTED CONTROLS. WHEN WE SAY BLIND PEOPLE ARE BETTER IT'S COMPARED TO THEIR SIGHTED CONTRAPARTS. THE OTHER WAY, ARE BLIND PEOPLE BETTER OR SIGHTED PEOPLE WORSE WHEN YOU ASK THEM TO DO THE SAME THING WITH A BLINDFOLD ON? THERE IS TWO WAYS TO LOOK AT THE DATA. THE LAST THING KNOWN, THIS IDEA OF CONTRIBUTING FACTORS. WHAT DRIVES THESE CHANGES THAT WE SEE? DOES IT MATTER IF YOU'RE BORN BLIND VERSES LOSING SIGHT LATER IN LIFE. MATTER IF YOU'RE A PROFICIENT BRAIL LEADER? THESE ARE FACTORS NOT KNOWN BUT NEED TO BE UNDERSTOOD AS WE TRANSLATE THIS KNOWLEDGE. SO LET ME JUMP DIRECTLY TO THE NEURO PLASTICITY QUESTION TO CIRCLE BACK TO THE IDEA I WAS TRYING TO GET AT. TO REMIND YOU, THE BRAIN IS A VERY SPECIALIZED ORGAN. DIFFERENT PARTS DO DIFFERENT THINGS. IN TERMS OF FIVE SENSES, THERE IS A PART OF THE BRAIN RESPONSIBLE FOR SMELL, TOUCH, TASTE T VISUAL PARTED IS CALLED THE OX ISN'TTLE CORTEX. THAT TRANSLATES TO 30-40% OF THE SURFACE. WHAT DOES ALL TO DO IF YOU WERE BLIND? DOES IT SAY SILENT? DO SOMETHING ELSE? DOES IT MATTER IF YOU WERE BORN BLIND VERSES SOMEONE WHO LOST THEIR SIGHT LATER IN LIFE. WHAT IS THE FATE? AND THE WAY THIS WAS ANSWERED WITH YOU USING TECHNOLOGY FUNCTIONAL NEURO IMAGING. IT'S A WAY TO SEE THE HUMAN BRAIN IN ACTION. YOU ASK AN INDIVIDUAL TO LIE IN A SCANNER, PERFORM A TASK AND CAUSE OF CHANGES IN BLOOD FLOW IN THE BRAIN WE CAN ASSOCIATE PARTICULAR PARTS OF THE BRAIN THAT WORK HARDER THAN OTHERWISE A PARTICULAR TASK. IN THIS IMAGE THAT I'M SHOWING YOU HERE, YOU SEE THIS REALLY NICE AREA OF ACTIVATION, THIS HOT SPOT IN THE BACK OF THIS PERSON'S BRAIN. BUT THIS PERSON IS CONGENTALE BLIND. WHY WOULD THIS BE ACTIVE IF THEY'RE BLIND. THEY'RE READING BRAIL. THIS IS ONE OF THE FIRST EXAMPLES OF THE VISUAL BRAIN TAKING ON A NON VISUAL FUNCTION. THIS HAS BEEN REPLICATED MANY TIMES BY MANY GROUPS. IT'S BEEN SHOWN IN OTHER MODALITIES AS WELL. SMELL, LOCALIZING SOUND, VERBAL MEMORY, LANG, ALL THESE NON VISUAL TASKS RECRUIT THE VISUAL CORTEX. TO CARRY THEM OUT. AND THE THOUGHT NOW IS THAT THE VISUAL CORTEX IS THE SEAT OF COMPETENCE COMPENSATORY BLINDNESS. THE WAY THEY CAN COMPENSATE FOR LACK OF SIGHT IS TIED TO WHAT HAPPENS IN THE VISUAL BRAIN OR THE OCCIPITALE CORTEX. THIS BEGS A LOT OF QUESTIONS. IF YOU'RE BORN BLIND HOW DOES THAT PLAY OUT IN TERMS OF THIS RECRUITMENT? HE DID A STUDY AND FOUND IN BOTH CASES THE VISUAL CORTEX WAS ACTIVE. YOU'RE EARLY BLIND OR BORN BLIND THIS WAS GREATER RECRUITMENT OF THE OCCIPITALE CORTEX. SO GOING BACK TO MY EARLIER EXAMPLES WHEN THINGS HAPPEN VERY, VERY EARLY THERE IS A GREATER OPPORTUNITY FOR THESE NEURO PLASTIC CHANGES TO OCCUR. DOESN'T MEAN THEY'RE IMPOSSIBLE. JUST MEANS THAT THAT WINDOW OF OPPORTUNITY IS LARGEER. THIS WAS A STUDY I WAS INVOLVED WITH, SOMETHING CALLED THE BLINDFOLD EXPERIMENT. WE TOOK NORMAL SIGHTED ADULTS WHO CAME AND LIVED AT THE HOSPITAL FOR FIVE DAYS. AND THEY WERE BLINDFOLDED THROUGHOUT THAT PERIOD. THEY WERE INTENSIVELY TAUGHT BRAIL FOR 4-6 HOURS A AT THAT. AND WE SCANNED THEM TO SEE WHAT HAPPENED TO THEIR VISUAL BRAINS. WHAT YOU SEE HERE ON DAY ONE IS IN RESPONSE TO TACTILE STIMULATION, THERE IS REALLY NO STIMULATION, NO ACTIVATION. AS THE WEEK PROGRESSES, AS THEY GET BETTER AT BRAIL READING NOTICE HOW THE VISUAL BRAIN IS NOW RESPONDING MORE AND MORE TO TACTILE STIMULATION. SO FIVE DAYS IS ENOUGH TO INDUCE THESE NEURO PLASTIC CHANGES IN AN ADULT BRAIN WITH DEVELOPED VISUAL SYSTEM. 6th DAY, WE GIVE THEM 24 HOURS, WE PUT THEM BACK INTO THE SCANNER. THE ACTIVITY IS ALMOST GONE. THESE CHANGES ARE VERY, VERY RAPID. SO THIS BRINGS ME TO THE SECOND POINT. EARLIER, I SAID THESE CHANGES ARE DRAMATIC WHEN IT HAPPENS EARLY IN LIFE. THIS POINT HERE TELLS YOU CHANGES CAN BE VERY DRAMATIC WHEN INTERVENTION IS VERY, VERY INTENSE AND PROFOUND. SO ANOTHER, I THINK, IMPORTANT TAKE HOME MESSAGE FROM THIS REHABILITATION STANDPOINT. TO SHOW YOU IT'S NOT JUST ONE SUBJECT. THERE IS A LARGE SCALE STUDY. I'M SHOWING YOU WHAT'S CALLED A 2 WAY COMPARISON. WE TAKE ALL THE INDIVIDUALS BLINDFOLDED VERSES ALL THE CONTROL SUBJECTS THAT WERE SIGHTED, WENT THROUGH THE BRAIL READING OR INSTRUCTION FOR THE FIVE DAYS. WE SUBTRACT ACT VACCINE ON DAY 5 VERSES DAY 1. WOE SEE THIS HOT SPOT OF ACTIVATION IN THE VISUAL CORTEX. NOT JUST IN ONE SUBJECT. EVEN WHEN YOU CONTROL FOR EXPOSURE OF LIGHT, CONTROL THE TIMING YOU SEE THIS ACTIVATION IN THESE AREAS, WITH THESE CHANGES HAPPENING VERY QUICKLY. IT'S A QUESTION OF TIMING AND INTENSITY. NOW, THE NEXT PIECE YOU'RE SAYING WELL, THIS IS PROBABLY SOME FANCY THING WITH PHOTO SHOP. THESE BRAIN PICTURES. I DON'T KNOW WHAT'S GOING ON HERE. CAN YOU GIVE ME SOMETHING MORE CONCLUSIVE TO DEMONSTRATE THIS VISUAL CORE TEXT IS IMPORTANT? I'M GOING TO GIVE YOU A CLINICAL EXAMPLE. I LOOK FOR THESE CLINICAL CORRELATES AS WELL. THIS IS A STORY I HEARD AS A FELLOW. I'LL SHARE IT WITH YOU THE SAME WAY I WAS TOLD. IT LOOKS LIKE THIS. THIS WAS A WOMAN WHO WAS 63-YEAR OLD AT THE TIME, A RIGHT-HANDED FEMALE. SHE HAD CONGENITAL BLINDNESS. RETINOPATHY. HITS NORMAL MILESTONES, READS BRAIL AT 6. HIGH LAY EFFICIENT. 120 SYMBOLS PER MINUTE IS EXTREMELY FAST. SHE WAS AN EDITOR FOR A MAGAZINE IN SPAIN. SHE WAS VERY, VERY USED TO READING BRAIL AND WRITING RAIL AND WORKING WITH BRAIL. ONE DAY SHE WAKES UP, HAS A TERRIBLE HEADACHE. NOT FEELING VERY, VERY WELL. SHE SAID I'M GOING TO WORK ANYWAY. SHE GOES THROUGH THE DAY FEELING REALLY, REALLY STRANGE. DITCHY SWALLOWS, AND FALLS INTO A COMA. LOSES CONSCIOUSNESS. THEY RUSH HER TO THE HOSPITAL. SHE'S IN A COMA FOR 24 HOURS. COMES THROUGH AFTER 24 HOURS. AND THE DOCTORS SAY YOU'RE FINE. YOU HAD A STROKE. EVERYTHING IS OKAY. YOU'RE IN THE HOSPITAL NOW. AND SHE SAYS I NEED MY PHONE BOOK WHICH IS WRITTEN IN BRAIL. SHE TAKES THE PHONE BOOK. STARTS TO READ THE PHONE BOOK. SAYS THIS IS STRANGE. I FEEL THE DOTS BUT I HAVE NO IDEA WHAT'S WRITTEN HERE. I KNOW THIS IS BRAIL. BUT I HAVE NO SENSE OF WHAT THE LANGUAGE IS. SO AS YOU MIGHT HAVE GUESSED, SHE HAD A STROKE. THE QUESTION IS WHERE. AND IT WAS IN HER VISUAL CORTEX. WHAT YOU'RE LOOKING AT HERE, TWO WEIGHTED SCAN LOOKING THROUGH. WHAT YOU SEE IN WHITE IS INFARCTED TISSUE. WHAT HAPPENED, AN. BOW LIMP THAT BLEW OUT BOTH BANKS. AND TO THIS DAY SHE IS ALEXIC, THE ACQUIRED INABILITY TO READ BRAIL FROM DAMAGE TO HER VISUAL CORTEX. NOT THE PART OF THE BRAIN RESPONSIBLE FOR TOUCH OR LANGUAGE. BUT THE PART THAT SHE DOESN'T NEED GIVEN SHE WAS BORN BLIND. PERVASIVE TRAGIC EVIDENCE THAT WHAT IS HAPPENING IN THE CORTEX IS INTIMATELY RELATED FOR THE ABILITY OF BLIND PERSON TO COMPENSATE FOR LACK OF SITE. MOVING FROM THAT I'LL TALK TO A STUDY THAT WAS FUNDED BY THE NEI WOE JUST COMPLETED. DR. WIG'S MENTIONED, I'M VERY INTERESTED IN TRANSLATING THIS KNOWLEDGE INTO ROW BILLITATIVE SKILLS AND DEVELOPING ASSISTIVE TECHNOLOGY. I BECAME TECHNICALLY INTERESTED HOW CHILDREN COULD FIND THEIR WAY OUT OF A ROOM. AND I CAME ACROSS THE WORK OF THIS COMPUTER SCIENTIST, FROM THE UNIVERSITY OF CHILE. HE DEVELOPED VIDEO GAMES FOR BLIND CHILDREN. YOU MAY REMEMBER THIS IN THE 80s CALLED DOOM. IT WAS A POPULAR GAME, CALLED THE FIRST PERSON SHOOTER GAME. I'LL SHOW YOU A VIDEO. THE IDEA, YOU HAVE TO WALK AROUND THIS WITH A GUN AND KILL THE WAD GUYS, FIND YOUR WAY THROUGH. AND TO SUCCEED IN THE GAME YOU HAVE TO BUILD A MENTAL MAP OF THE LAYOUT IN YOUR MIND. SO YOU KNOW THAT THIS IS AN EXIT. THIS IS A CORRIDOR. THIS IS A ROOM YOU HAVE BEEN IN, SO ONLY. AS THE GAME PROGRESSES, YOU'RE BUILDING THE SPATIAL MAP IN YOUR MIND OF HOW TO EXIT. VERY POPULAR AND ADDICTIVE. IT TURNS OUT THE PROFESSOR AND HIS GROUP DEVELOPED AUDIO DOOM FOR BLIND CHILDREN. WHICH WORKS EXACTLY THE SAME WAY EXCEPT BASED ON AUDITORY CUES. IF YOU HEAR A KNOCKING SOUND, THAT SIGNALS THE PRESENCE OF A DOOR. IF YOU HEAR IT IN YOUR LEFT EAR, THE DOOR IS ON THE LEFT SIDE. IF I WALK PAST THE DOOR AND WALK BACK, NOW I SHOULD HEAR THE KNOCKING SOUND IN MY RIGHT EAR. SO WHAT THE SOFTWARE IS DOING IS KEEPING TRACK OF YOUR HEADING AND PRESENTING SOUNDS IN A WAY THAT IS SPATIALLY AND TEMPORAL IN REGISTER TO THE WORLD AROUND YOU. THE KIDS PLAY THE GAMES FOR HOURS AND HOURS. THEY LOVE PLAYING THIS GAME. WHAT'S INTERESTING, IF I GIVE THEM A LEVEL TO NAVIGATE THROUGH. THE KIDS WILL PLAY. IF YOU GIVE THEM LEGO PIECES THEY CAN BUILD A PERFECT ONE TO ONE REPRESENTATION OF THE WORLD THEY WALK THROUGH, EVEN THOUGH THEY'VE NEVER SEEN THE WORLD. THEY'VE NEAR SEEN THE SCREEN BECAUSE THEY'RE BLIND. SO THEY CAN BUILD A PERFECT SPATIAL MAP IN THEIR MIND OF THEIR SURROUNDINGS BASED ON NON VISUAL CUES. SO IF THIS IS TRUE THE QUESTION I WAS INTERESTED IN, WHY NOT TAKE THE SAME STRATEGY AND USE THIS IN REAL WORLD SETTINGS? WHAT WE DID, WE TOOK THE SAME APPROACH. AND WE MAPPED OUT A BUILDING THAT EXISTS ON A CAMPUS OF THE SCHOOL FOR THE BLIND OR CENTER FOR THE BLIND, ARROW CENTER FOR THE BLIND. WE ASKED THE KIDS TO PLAY THE GAME. THIS IS HOW YOU PLAY. YOU HAVE TO FIND THESE JEWELS HIDDEN THROUGHOUT THE BUILDING. ONCE THEY PLAYED WE TOOK THEM TO THE ACTUAL BUILD HAG THIS WAS MAPPED OUT ON TO SEE WHETHER OR NOT THEY COULD FIND THEIR WAY. I'LL SHOW YOU THE DATA WE COMPLETED IN THIS STUDY. SO DO SHOW YOU, ONE PARTICULAR INDIVIDUAL BEFORE I SHOW YOU THE GROUP DATA, WHAT YOU SEE HERE IS TWO SORT OF STRATEGIES TO LEARN. ONE IS THE GAMING APPROACH THAT I MENTIONED WHERE I SAID YOU HAVE TO EXPLORE THIS, FIND THE JEWELS HIDDEN. MONSTERS THAT WILL CHASE YOU, IF THEY CATCH YOU, THEY HIDE THE JEWEL SOMEWHERE ELSE. WE BUILT IN AIRSTREAM TO FORCE THEM TO KEEP EXPLORING. THE SECOND WAY TO LEARN, THE CONTROL GROUP, CALLED DIRECTED NAVIGATORS. THESE WERE MATCHED WITH A RESEARCH ASSISTANCE WHO SHOWED THEM A STEP BY STEP LAYOUT OF WHAT THE BUILDING WAS LIKE. IF I HAD AN ORIENTATION INSTRUCTOR WHO TAUGHT ME THE LAYOUT OF THE BUILDING. SO THERE WERE 2 WAYS AND WE COMPARED THEIR PERFORMANCE. ONCE WE TAKE THEM TO THE BUILDING -- THIS PARTICULAR CASE WE ASKED THE PERSON TO WALK THROUGH THE LOBE HE A THROUGH THE STALE WELL TO THIS BEDROOM, A LONG PATH. WE FOUND WHETHER YOU LEARNED THROUGH GAMING, IMPLIES THELY OR THROUGH DIRECTED NAVIGATION, YOU WERE ABLE TO TRANSFER THIS INTO A REAL WORLD SETTING. THE INTERESTING THING AFTER THAT, WHAT WE WOULD DO -- NOW, BASED WHERE YOU'RE STANDING, CAN YOU FIND THE QUICKEST WAY OUT OF THE BUILDING? WE FOUND THAT THOSE THAT LEARN BY GAMING ALWAYS KNEE WHERE ALL THE EXITS WERE. THOSE THAT LEARNED BY DIRECTED NAVIGATION RETRACED THEIR PATHS, THROUGH LEARNING. SO BASED WHERE YOU ARE IN THE BUILDING IF YOU FIND THE FACE WAY OUT, WE GIVE YOU 3 POINTS. SECOND, 2 POINTS, ANYWAY OUT IS 1. IF YOU GET LOST IN THE AMOUNT OF TIME WE GIVE YOU, 0. AND OUR THEORY WAS OR HYPOTHESIS WAS THAT IF YOU WERE A GAMER YOU HAD A MUCH MORE ROBUST SPATIAL REPRESENTATION IN YOUR MIND. YOU KNEW HOW THE LAYOUT OF THE BUILDING WAS. YOU COULD FIND SHORT CUTS. IF YOU DID IT BY DIRECTED NAVIGATION, YOU WERE MORE CONSTRAINED TO HOW YOU WERE TAUGHT. WHICH AGAIN I THINK TRANSLATES IN THE CLASS ROME, HOW WE'RE TAUGHT. BEING A PROBLEM SOLVER VERSES MEMIZATION AND ROTE LEARNING. TO SHOW YOU AGAIN OVER 30 PARTICIPANTS IN THIS STUDY, THIS IS THE GROUP DATA. THIS NAVIGATION OF GOING FROM POINT A TO B OR C TO D, THEY DID VERY, VERY WELL, ALMOST THE -- 90% CORRECT. WHETHER YOU WERE EARLY OR LATED BLIND, A GAMER OR NAVIGATOR. THE OVERALL TRANSFERRINS WAS VERY, VERY HIGH. THIS DROP OFF EXPERIMENT, WE PUT THEM IN DIFFERENT AREAS, ASKED THEM TO FIND THE SHORTEST WAY OUT, THAT'S WHERE WE SAW THE ADVANTAGE. THEY WERE MORE LIKELY TO FIND THE SHORTCUTS THAN THE INDIVIDUALS WHO LEARNED BY ROTE MEMIZATION. THAT'S VERY, VERY, IMPORTANT. IF YOU THINK OF AIZATION WHERE YOU HAVE TO FIND A WAY OUT OF A BUILDING DIFFERENT THAN THE ONE YOU CAME IN. THESE ALLOW YOU TO INTERACT WITH THE INFORMATION IN A MORE CREATIVE WAY TO CREATE REPRESENTATION IN YOUR MIND THAT YOU CAN USE FOR OTHER TASKS. THAT WAS THE GOAL OF THE STUDY AND TO SHOW YOU FROM fMRI STANDPOINT, WE PUT OUR BEST GAMERS INTO THE SCANNER. HERE IS A SIGHTED INDIVIDUAL SHOWING YOU A NETWORK OF AREAS INVOLVED WITH THIS VIRTUAL NAVIGATION, FRONTAL, MOTOR TACTILE, MOVING THE KEYS, AUDITORY CORTEX. VISUAL CORTEX. AND ALSO PARAHIPPOCAMPUS, RESPONSIBLE FOR MEMORY AND SPATIAL PROCESSING. WHEN WOE ASKED THE BLIND INDIVIDUALS TO DO THE SAME THING, NOW HOW SIMILAR THE NETWORK LOOKS LIKE, INCLUDING VISUAL CORTEX. THEY ARE USING THE EXACT SAME NETWORKS, THE SAME FUNCTIONALITY BUT IN A DIFFERENT CIRCUMSTANCE. THIS IS THE TAME HOME MESSAGE. ALL FOR THE TAKING. IT TAKES THE RIGHT TASK, RIGHT INTERVENTION TO USE ALL THE MACHINERY AT ITS DISPOSEAL. SO JUST TO SUMMARIZE THE FIRST PART OF MY LECTURE ABOUT -- IN TERMS OF OCCULAR BLINDNESS. COMPENSATORY SKILLS AND BEHAVIORS ARE LINKED TO NEURO PLASTIC CHANGES TIN BRAIN. IN PARTICULAR THE DEVELOPMENT FATE OF THE OCCIPITAL CORTEX. THAT'S WHAT WE'VE LEARNED STUDYING, THIS THE COMPENSATORY BEHAVIORS IS RELATED TO WHAT HAPPENS IN THE VISUAL CORTEX. TO PUT THAT VISUALLY TO YOU. IF YOU'RE BLIND, THE FATE OF THE CORTEX IS SUCH THAT IT'S RECRUITED FOR NON VISUAL TASKS, LIKE TOUCH, HEARING, SMELL AND MEMORY. I NOW WANT TO BEG THIS QUESTION TO YOU. WHAT WOULD HAPPEN IF YOUR EYES WERE FINE BUT YOU WERE BORN WITH BRAIN DAMAGE TO YOUR VISUAL CORTEX. >> I THINK THAT'S A LOGICAL QUESTION TO ASK. HOW DOES THIS COMPENSATION HAPPEN? IF YOUR VISUAL IMPAIRMENT OR BLINDNESS ISN'T BECAUSE OF YOUR EYES, BUT BECAUSE YOU WERE BORN WITH DAMAGE TO YOUR VISUAL CORTEX. THAT POPULATION ACTUALLY EXISTS, WHICH IS HOW I WANT TO SHIFT SECOND -- THE SECOND PHASE OF MY TALK AND TALK ABOUT THESE INDIVIDUALS. THE CASE IS CALLED CORTICAL OR CEREBRAL VISUAL IMPAIRMENT. I WANT TO SHARE WITH YOU, I THINK THIS IS SOMETHING THAT REALLY ISN'T TRIVIAL. I HOPE TO CONVINCE YOU WITH DATA. CDI EFFECTS 2 OUT OF EVERY 1,000 LIVE BIRTHS. COUNTS FOR 20-25 VISUALLY IMPAIRED CHILDREN IN DEVELOPED COUNTRIES. DEVELOPED COUNTRIES. HOW DOES THAT TRANSLATE? HERE WAS A STUDY FROM THE UNITED STATES WHERE THEY LOOKED AT CAUSES OF VISION LOSS IN THE UNITED STATES, SCHOOLS FOR THE BLIND, OVER 3,000 KIDS. AND NUMBER ONE WAS CVI. THIS IS NOT TYPICALLY WHAT YOU EXPECT. LET'S LOOK AT THE CAUSES. THINK ABOUT THIS. RETINOPATHY OF PROCEED MATURITY. OVER TIMES THOSE NUMBERS WILL DECREASE. THINGS LIKE DISEASES, INEFFICIENCY CAUSES, WE'LL GET A BETTER HANDLE WITH PUBLIC HEALTH INTERVENTIONS, YOU HAVE TO BE OPTIMISTIC FOR OTHER THINGS, GENE THERAPY GETS MORE ADVANCED WE CAN HELP THESE INDIVIDUALS. SO MY THOUGHT IS THAT THE TIME, OVER TIME WHAT VISUAL IMPAIRMENT WILL LOOK LIKE, IT WILL CHANGE TREMENDOUSLY OVER THE NEXT 40, 50 YEARS. WHAT IT MEANS TO BE VISUALLY IMPAIRED IS GOING TO LOOK VERY, VERY DIFFERENT THAN HOW IT DID 50 YEARS AGO. I KNOW THIS IS WORKING WITH MY COLLEAGUE AT THE PERKINS SCHOOL FOR THE BLIND IN BOSTON, THE CLASSIC CHILD PRESENTED WITH RETINOPATHY PREMATURITY, THEY'RE NOW PRESENTING WITH COGNITIVE ISSUES BECAUSE OF THE CEREBRAL PIECE. HOW WE TEACH AND REHABILITATE THESE KIDS USING STRATEGIES USED FOR A COMPLETELY DIFFERENT GROUP MAYBE ARE NOT EFFECTIVE, AND MAYBE DON'T APPLY SO WE HAVE TO KIND OF RETHINK THIS PROBLEM COMPLETELY. SO THE QUESTION IS, WHY IS THIS SO HIGH. >> WHERE DID THIS COME FROM? WHEN I WAS GOING THROUGH SCHOOL, I DIDN'T HEAR ANYTHING ABOUT THIS. THE REASON IS THIS. THESE KIDS ARE BORN PREMATURE. WE'RE GETTING REALLY GOOD AT TAKING CARE OF THESE KIDS. THEY'RE SURVIVALING WITH COMPLICATIONS. THAT'S WHERE THIS IS COMING FROM AND WHY THIS SEEMS SURPRISEING. NUMBER ONE CAUSE IN DEVELOPED COUNTRIES, NOT DEVELOPING COUNTRIES. IT'S INTIMATELY TIED WITH OUR ABILITY TO TAKE CARE OF PREMATURE BABIES. THE MARM CAUSES -- THE NUMBER ONE AND MOST COMMON, IS A HYPOXIC OR ISCHEMIC VOLUNTEER. THE BABY HAS A STROKE ENUTERO. WHAT HAPPENS, THE BABY -- I APOLOGIZE FOR THE QUALITY FIGURE HERE. WHAT YOU SEE IN THE VENTRICLES, THERE IS A BLOOD INTO THE VENTRICLES THAT BLEED TAKES ALL THE SPACE AND OVER TIME, AS THE BLOOD IS RESO MUCHED THE VENTRICLES ENLARGE. I'LL SHOW YOU MORE PICTURES IN A SEND. SO THIS LARGE VENTRICULAR SIZE AND THE PROBLEM IS, AROUND THE VENTRICLES, YOU HAVE FOCAL NECROSIS OF WHAT THE MATTER TRACKS, THOSE TRACKS ARE THE COMMUNICATION PATHWAY FOR THE VISUAL SYSTEM, MOTOR SYSTEM AND SO ON. WHEN THEY KNOCK OUT MOTOR -- VERY OFTEN THE TWO COME TOGETHER. SO JUST A COUPLE MORE DETAILS ABOUT CDI. SUSPECTED BY, QUOTE, A NORMAL EYE EXAM WHICH IS NOT ENTIRELY TRUE. BUT THE POINT IS THAT THEIR OCCULAR FINDINGS DON'T CORRESPOND TO THEVERSIAL IMPAIRMENT THAT YOU SEE. THE VISUAL CUTTY [TECHNICAL DIFFICULTIES] IT'S NOT AS OBVIOUS AS YOU THINK, WHICH IS WHY WE'RE TRYING TO DO THIS RESEARCH. I'LL GIVE YOU MORE DETAILS IN A SECOND. THEY MAY ALSO HAVE VISUAL DEFICITS. THEY HAVE CHARACTERISTIC NEURO FINDINGS, LIKE ENLARGED VENTRICLES THAT I MENTIONED. PERIVENTRIQUAL, SURROUNDING THE TRENRYICALS. WHITE AND SOFT. LOOKS FLURRY. IF YOU LOOK AT IT ON AN MRI. THEY TYPICALLY HAVE A MEDICAL HISTORY THAT HAS AN ASSOCIATED NEUROLOGIC DEFICIT LIKE CEREBRAL PALSY OR A MOTOR ISSUE. THE PRESENCE OF REALLY COMPLEX SPECIAL SPATIAL PROBLEMS LOOK LIKE MOTION PERCEPTION, LIKE NOT BOEING ABLE TO UNDERSTAND A CROWD. NOT BEING ABLE TO SPOT THEIR PARENTS IN A BUSY ROME, FOR EXAMPLE. THEY DON'T LIKE WATCHING TV WHERE THERE IS A LOT OF ACTION, THEY CAN'T FOLLOW IT. YOU MIGHT IMAGINE, THIS HAS TREMENDOUS REPERCUSSIONS IN THE CLASSROOM. AND WHEN THEY GO AND SEE THEIR EYE DOCTOR, HE SAYS WELL, HERE ARE YOUR EYES, YOU'RE FINE. AND THE REASON IS BECAUSE IT'S NOT AT THE LEVEL OF THE EYES. SO WE HAVE TO RETHINK THIS WHOLE PROBLEM. HERE ARE JUST SOME EXAMPLES OF WHAT A STANDARD MRI WOULD LOOK LIKE. A, I'M SHOWING YOU NORMALLY SIGHTED CONTROL. B, THIS IS OCCULAR BLIND, THEY LOOK AWFULLY SIMILAR. I WOULD CHALLENGE YOU TO TELL ME WHICH WAS BLIND. HERE IS AN EXAMPLE OF CONTROLS. THERE IS THAT CLASSIC PRESENTATION OF THIS ENLARGED VENTRICLES THAT YOU SEE EXTENDING BACK INTO THE VISUAL CORTEX. THE PROBLEM IS, THAT STANDARD IMAGING ONLY CONFIRMS THAT THE VENTRICLES ARE LARGER. IT DOESN'T SAYING ANYTHING ABOUT THE TYPE OF PROBLEMS THAT THESE KIDS ARE PROBLEMS. I'LL DEMONSTRATE THAT FOR YOU. WE'RE GOING TO PLAY. REMEMBER -- ONE OF THESE BRAINS WITH NOT LIKE THE OTHER. I HAVE FOUR BRAINS HERE. WHO DO YOU THINK HAS THE NORMAL VISUAL ACUITY, AND WHO HAS THE WORST VISUAL ACOULD YOU TELLTY, BY LOOKING AT THIS? YOUR LOGIC SOUNDS SOMETHING LIKE THIS. NO. '4, THOSE LOOK LIKE NORMAL. I QUESTIONS THAT'S THE BEST. NO. 2, IN BETWEEN. 3 AND 1 KIND OF A TOSSUP. I MIGHT GIVE IT TO NUMBER ONE, EXTENDS FURTHER BACK. 1 AND 3 ARE THE WORST, RIGHT? HERE ARE THE RESULTS. TURNS OUT NO. 3 HAS 2020 VISION. NO. 2 HAS 20/80. NO. 4 IS IN A COMBINGA. THAT SHOWS YOU THAT BASIC OR STANDARD STRUCTURAL IMAGING DOESN'T TELL YOU ANYTHING ABOUT OVERALL FUNCTION AND THAT'S THE PROBLEM. THAT'S WHY I THINK WE HAVEN'T BEEN ABLE TO MAKE HEAD WAY INTO THIS PARTICULAR CONDITION. WE NEED A BETTER WAY TO UNDERSTAND HOW THE BRAIN IS WIRED AND HOW THAT STRUCTURE AND FUNCTION RELATES TO THOSE CLINICAL DEFICITS THAT WE'RE SEEING IN THE HOSPITAL SETTING IN THE CLINICAL SETTING. THIS RELATES TO NEURO RADIOLOGY PARADOX. LESION LOAD, THE EXTENT OF A LOAD DOESN'T ALWAYS CORRELATE WITH SYMPTOMS. MY OWN CLINICAL PRACTICE I SEE THIS ALL THE TIME. I LOOK AT STANDARD MR.Is, I SEE MASSIVE BRAIN DAMAGE AND THE PATIENT IS TALKING TO ME. OTHER PATIENTS, THEY'RE IN A COMA BUT THEIR BREAKING NEWSES LOOK NORMAL. SO WHAT IS HAPPENING FUNCTIONALLY, VERY OFTEN THERE IS A GAP. AND WE HAVE TO TRY TO FIND OTHER WAY TO CHARACTERIZE THIS. SO TBI IS NOT SO MUCH A DISORDER OF STRUCTURE. IT'S A DISORDER OF CONDUCTIVITY. IT HAS TO DO WITH HOW THE BRAIN IS WIRED. THIS UNDERLYING CONDUCTIVITY IS ASSOCIATED WITH A VISUAL DYSFUNCTION. I'LL TRY TO GIVE YOU SOME EXAMPLES. OUR GOAL IS REALLY THIS TWO OR THREE PRONGED APPROACH. WE LOOK AT CLINICAL MANIFESTATIONS, SIGNS OF VISUAL DYSFUNCTION. THE STRUCTURE OF THE BRAIN. I'LL GIVE YOU DETAILS OF HOW WE DO THAT, WITH THE FUNCTION OF THE BRAIN. WE GO BACK TO fMRI. S THAT THESE THREE PIECES SHOULD BE INTERRELATED. I'LL GIVE YOU AN EXAMPLE OF HOW WE DID THAT. HOW OUR BRAINS WIRED, HOW CAN WE FIGURE THIS OUT BEYOND STRUCTURAL IMAGING? WE USE A TECHNIQUE, DIFFUSION BASED IMAGING. I LIKE TO SHOW YOU THIS VIDEO. IF YOU WERE TO TRACK MOVEMENT OF WATER AT ANY GIVEN TIME, THAT MOVEMENT WOULD BE COMPLETELY RANDOM. AND IF YOU PUT SOME MATH TO THIS WE CALL THIS ISOTROPIC DIFFUSION. ANY GIVEN TIME THAT WATER MOLECULE CAN MOVE ANYWHERE IN 3 DIMENSIONAL SPACE. IF, HOWEVER, THE MOVEMENT OF THAT WATER MOLECULE WAS CONSTRAINED, MOVING ONE DIRECTION MORE THAN ANOTHER, WE CALL THIS ANTI-TROPIC DIFFUSION. THE MORE CONSTRAINED IT IS, THE MORE LIKELY IT WILL GO DOWN A PARTICULAR PATH. IN THE BRAIN, WHAT WOULD CONSTRAIN THAT MOVEMENT? AN AXON. SO WHAT WE DO, WE MATHEMATICALLY FIGURE OUT WHAT, ARE THE DIFFUSION PROPERTIES OF WATER INTO THE BRAIN. WE FIGURE OUT HOW THE BRAIN IS WIRED THROUGH THE MOTION OF WATER MOLECULES. I'LL GIVE YOU AN EXAMPLE. THIS IS A NORM DEVELOPED INDIVIDUAL. AND I'LL PUT IT IN 3 DIMENSIONS, THIS IS THE WHITE MATTER TRACKS, THIS IS THE CONNECTIONS, THE INFORMATION SUPER HIGHWAY OF THIS INDIVIDUAL. # TELL US ALL THE CONNECTIONS OF THE VISUAL CORTEX TO THE BRAIN. SO NOT ONLY CAN WOE FIGURE OUT ALL THE -- WE CAN LOOK AT THE SPECIFIC TRACKS OF INTEREST DEPENDING ON WHAT WE'RE INTERESTED IN STUDYING. JUST SOME NOTES, OBVIOUSLY THE BRAIN IS NOT COLOR CODED. GREEN REPRESENTS PATHWAYS THAT RUNNING FROM THE BACK TO FRONT OF THE BRAIN. BLUE, UP AND DOWN, RED, RUNNING FROM SIDE TO SIDE. ALLOWS YOU TO GET A SENSE OF THE ORTATION. SECONDLY, IT DOESN'T LOOK LIKE SPAGHETTI. IT'S THE RESOLUTION OF THE SOFTWARE, TRYING TO COLLAPSE OVER THOUSANDS OF ABCENS, PUTTING THEM INTO AN EXPRESSION, BECAUSE AN OXEN LOOKS THIN, DOESN'T MEAN THERE IS NO BRAIN CELLS THERE. MATHEMATICALLY, THAT'S THE GREATEST NUMBER THAT COULD BE RECONSTRUCTED USING THIS ALGORITHM. LET'S LOOK AT THE PATHWAY WAYS WE CAN IDENTIFY USING THIS TECHNIQUE. WE HAVE NORMAL SIGHTED CONTROL, SOFTWARE TO IDENTIFY THE PATHWAY S ARE THE VISUAL BRAIN TO THE REST OF THE BRAIN. THERE IS 3 MAIN PATHWAYS IDENTIFIED HERE. THE NAMES ARE NOT CRUCIAL. IT'S MORE THEIR ANATOMICAL CORRELATE, WHAT THEY'RE ASSOCIATED WITH THAT'S VERY IMPORTANT. SO IT'S THE SUPERIOR LONGITUDINAL. THIS CORRESPONDS TO THE DORSAL STREAM OR THE SPATIAL PROCESSING STREAM OF THE VISUAL SYSTEM. THE ILF, THE INFERIOR. THIS RUNS FROM THE OX ACCEPT ACCEPTTLE -- THIS IS THE PART OF THE VISUAL SYSTEM RESPONSIBLE FOR IDENTIFYING WHAT TYPE OF -- WHAT THE OBJECT IS IN FRONT OF YOU. THE MIDDLE, THIS IFOF, INTERIOR, IT'S A DIRECT CONNECTION FROM THE OX ACCEPTTLE TO THE FRONTAL. THIS IS RESPONSIBILITY FOR ATTENTION AND OCULAR MOVEMENTS. WE HAVE THREE MAIN PATHWAYS. OF THE VISUAL SYSTEM. HERE IS WHAT IT LOOKS LIKE IN A CDI. A COMPLETE LACK OF THESE CONNECTIONS DIRECTLY TO THE FRONTAL, INVOLVED WITH ATTENTION. FOR THE MOST PART, THE ILF, THIS DIRECT PATHWAY SEEMS TO BE ALL RIGHT. INTERESTING THING, THIS WAS THE CLINICAL ASSESSMENT WITH THIS CHILD. BIG, BIG SPATIAL AWARENESS DEFICITS. NO OBJECT DEFICITS. THEY COULDN'T TELL YOU WHERE IT WAS. THIS CHILD, THE OR 3 MINUTES. IF YOU ASKED THEM TO LOOK AT A COMPUTER SCREEN, WITHIN A MINUTE OR TWO THEY CLOSED THEIR EYES, THEY COULDN'T DO IT T CLINICAL MANIFEST ALLEGATIONS SEEM TO FIT WITH THIS IDEA OF PARSING OUT THE PATHWAYS. WE NEED TO PUT NUMBERS TO THIS. HOW TO QUANTIFY THE INTEGRITY. TRACK NUMBER, TRACK LENGTHS, SO ON. AND CORRELATE WITH THE DEFICITS WE SEE CLINICALLY. THAT'S THE MAIN DIRECTION OF RESEARCH WE'RE IN. HOW THIS GOES BACK TO OUR ORIGINAL CONVERSATION, HERE IS A SITED CONTROL. I'M SHOWING YOU THE LEFT HEMISPHERE. YOU SEE THE EYES. THOSE ARE THE THREE PATHWAYS. DORSAL, VENTAL STREAM. HERE IT IS ISEN AN OCCULAR BLIND INDIVIDUAL. ALL THERE. COMPLETELY IN TACT. AND HERE IT IS IN CDI INDIVIDUALS. YOU CAN SIGH CLEARLY A LOT OF THESE PATHWAYS SEEM TO BE IMPAIRED, NOT AT ALL AS ANYWHERE IN TACT AS THEY ARE IN THE CASE OF A SIGHTED CONTROL. WE CAN PUT NUMBERS TO THIS. NETWORK, WE CAN QUANTIFY HOW DENSE THE CONNECTIONS ARE BETWEEN DIFFERENT PARTS OF THE BRAIN. HERE IT IS IN THE NORMALLY SIGHTED CONTROL. HERE IT IS IN THE CBI. IT IS HYPOCONNECTED. OUR THOUGHT IS, BECAUSE OF THE CASE OF OCCULAR BLINDNESS, BECAUSE ALL THE MACHINERY IS THERE, THAT INCREASED CONDUCTIVITY HAS OTHER SENSES INTERACT MORE WITH ANOTHER OTHER, WHAT SUPPORTS THESE NON VISUAL COMPENSATORY BEHAVIORS. IN CDI BECAUSE OF THE POSITIVE CONNECTIONS THAT HAPPEN OR BECAUSE OF THE DAMAGE EARLY ON IN THE BRAIN, THAT IS RELATED TO THE DEFICITS THAT WE SEE IN THESE INDIVIDUALS. EVEN THOUGH A LOT OF THESE INDIVIDUALS MAY HAVE A FUNCTIONAL VISION, 20-40, 20-60, THE BRAIN IS ACTUALLY LESS CONNECTED THAN IN THE CASE OF OCCULAR BLINDNESS. THESE ARE MATRIX ANALYSES, JUST ALLOWS YOU TO QUANTIFY, PUT NUMBERS TO THE STRENGTH OF THESE CONNECTIONS. LOTS OF RED MEANS LOTS OF STRONG CONNECTIONS. LET'S EXPENSIVE AN EXAMPLE OF FUNCTIONAL APPLICATIONS. THESE KIDS HAVE A LOT OF RITUAL DEFICITS. AND MOTION TENDS TO BE A VERY, V BIG ONE. THESE KIDS HAVE -- THEY CAN'T IDENTIFY THEIR PARENTS IN A GROUP. THEY HAVE A HARD TIME WALKING. AND IDENTIFYING TARGETS AS THEY WALK. THEY'LL WALK RIGHT PAST THE DOOR, FOR EXAMPLE. SO CLEARLY, SOMETHING IS OFF WITH THEIR MOTION PERCEPTION, GLOBAL MOTION PERCEPTION. THIS IS SOMETHING THAT IN STUDIES SINCE THE EARLY DAYS OF JJ GIBSON, THIS IDEA OF FLOW PERCEPTION, SOMETHING THAT'S VERY, VERY WELL-KNOWN IN THE PSYCHO PHYSICAL LITERATURE. WE DECIDED TO ADAPT THIS PRINCIPAL, USING TABLET BASED TESTS. AGAIN, A LOT OF THESE, VERY, VERY LOW LEVELS OF ATTENTION. THEY CAN'T SIT THROUGH A TEST FOR A HALF HOUR. WHO HAVE DEVELOPED TESTS USING TABLETS THAT ARE TOUCH BASED. THEY TELL US THE ANSWER, JUST BY TOUCHING THE SCREEN. WE USE ALGORITHMS, THE FIRST SCORE DETERMINES WHAT THE TEST LEVEL WILL BE. THIS ALLOWS US TO ACAL ARE THE THE TEST TO DO THIS IN A MUCH FASTER WAY. THIS IS THE MOTION TEST WE HAVE THESE KIDS DOING. I'M GOING TO ASK YOU TO LOOK AT THE DOC HERE. I'LL PLAY THIS VIDEO. AND I'M GOING TO ASK YOU TO FOLLOW THESE DOTS. WHEN YOU LOOK AT THE GREEN DOT. WHICH WAY ARE THEY GOING? THIS SHOULD BE EXPANDING. THAT SHOULD BE GOING AWAY, CONTRACTING. THIS SHOULD BE COMING OUT AGAIN FOR YOU. INTERESTING, IF YOU DON'T LOCK AT THE GREEN DOTS, YOU CAN STILL UNTIL WHICH WAY IT'S GOING. IF YOU'RE SITTING WAY BACK AT THE ROOM YOU CAN STILL DO IT, LIKE YOU CAN UP FRONT. IF YOUR VISUAL ACUITY IS NOT THAT GREAT, YOU CAN STILL DO THIS TASK. SO IF THEY HAVE LOW ATTENTION, CAN'T COPY FIX ALLEGATION, POOR VISUAL ACUITY, THEY CAN ALL DO THIS AND ALLOWS US TO GET A SOLID ROBUST NUMBER WOKE USES. HERE ARE EARLY RESULTS. SO TYPICALLY, WHAT'S CALLED A MOTION CLEARANCE THRESHOLD. HOW MANY DOTS HAVE TO TRAVEL -- WHAT PERCENTAGE HAVE TO BE TRAVELING IN THE SAME DIRECTION. OR TELL ME WHAT DIRECTION IT'S GOING. TYPICALLY, RANGES BETWEEN 5-25%. OUR SITED CONTROL KITS AGE MATCHED, AROUND 16. RIGHT IN THAT WINDOW WHERE THEY'RE SUPPOSED TO BE. HERE ARE THE CDI KIDS, REALLY, REALLY REDUCED. TAKES THEM 3 TIMES THE INFORMATION. TO UNDERSTAND WHICH DIRECTION THINGS ARE MOVING IN. SO IT'S NOT DIFFICULT TO UNDERSTAND WHY THESE PEOPLE HAVE SUCH A HARD TIME FOLLOWING MOTION. THEY JUST DON'T HAVE THE MACHINERY THAT ALLOWS THEM TO DO THIS. HOW DO I KNOW THAT? WE HAVE THE IMAGING COMPONENT TO THIS. WE TRY TO PROBE THIS QUESTION. SO REMINDING YOU THIS IS THE DORSAL STREAM, THE VENTRAL STREAM, DIVISION OF LABOR. THERE IS PART OF THE BRAIN -- THIS IS RESPONSIBLE FOR MOTION PERCEPTION. VERY, VERY WELL CHARACTERIZED, WELL-KNOWN. LET'S LOOK AT THAT IN OUR INDIVIDUALS. LEFT, A SIGHTED CONTROL. THIS YELLOW IS THE PROBLEMISTIC LOCATION. YELLOW THAT YOU SEE IN THERE IS AN ACTIVATION RESPONSE TO THIS MOTION TASK THAT I JUST SHOWED YOU. WE ASKED THE SAME -- WE DO THE SAME TASK IN A CHILD WITH CDI. THIS IS PAIRLY ACTIVATION THIS. SO NOT ONLY ARE THEY SHOWING DEFICITS FROM A PSYCHO PHYSICAL STANDPOINT. THEY'RE SHOWING DEFICITS FROM A CORTICO ACTIVATION STANDPOINT. THE THIRD PIECE, HOW IS THE VISUAL BRAIN WIRED. IF I ASKED THE SOFTWARE WHAT ARE THE CONNECTIONS BETWEEN THE VISUAL CORE TEXT AND AREA MT, YOU SEE THIS NICE HARBORIZATION BETWEEN THESE AREAS, IN CDI, MUCH THINNER. THE STRUCTURE, THE FUNCTION, AND THE CLINICAL MANIFEST ALLEGES ALL SEEM TO GO TOGETHER. AND THE POINT OF THE OVERALL STUDY IS TO PUT ALL THAT TOGETHER. USE DIFFERENT OUTCOMES. VERSIAL ACUITY, VISUAL FIELDS, OTHER ISSUES, LETTER ACUITY, RELATE THAT TO THEIR WIRING. USING WHITE MATTER [INDISCERNIBLE] ROLATING TO HOW THE BRAIN ACTIVATES. THE IDEA IS 3 ARE ALL INTERLOW LATED. THAT'S DEDIRECTION WE'RE HEADED IN NOW TRYING TO PIECE THESE ASPECTS TOGETHER AND HOW THEY'RE INTERCONNECTED. I'LL MAKE A COMMENT ON HOW WE WORK WITH THESE INDIVIDUALS. IT'S A CHALLENGE WORKING WITH TEENAGERS IN GENERAL AND ADOLESCENCE. THEY'RE -- WE CAN BECAUSE THEY CAN'T DO THE FUNCTIONAL TESTS SO WOE SPEND A LOT OF TIME. THIS IS, AGAIN, PUTTING MY CLINICAL HAT BACK ON, TRYING TO GET TO KNOW THESE KIDS. THIS IS A MOCK SCANNER, IT DOESN'T HAVE A REAL MAGNET. THEY SPEND THE DAY WITH US. THEY WALK AROUND, EXPLORE, THEY CAN TOUCH IT, DO WHATEVER THEY WANT. GET COMFORTABLE, CLIMB IN, LOOK AROUND. ANY DANGER, ANY SAFETY CONCERNS, THIS AREN'T ANY. WE ASK THEM TO BRING ANY STUFFED ANIMALS. THE PARENTS ARE ENGAGED, INVOLVED WITH THEM TO REASSURE THEM EVERYTHING IS ONGOING. WE SEND THEM MP3 FILES WHERE THEY PLAY THE SCANNER IN THEIR IPODS SO THEY'RE COMFORTABLE WITH THE SOUNDS. WE DO EVERYTHING TO TRY TO UNDERSTAND WHAT THESE KIDS LIKE AND DON'T LIKE. THIS PARTICULAR CHILD FOR WHATEVER REASON REALLY LIKES EGYPTOLOGY. PHARAOH AND THINGS LIKE THAT. SO WE'LL WRAP YOU UP LIKE THIS MUMMY PUT YOU IN HERE NOW. [LAUGHTER] AND SHE DIDN'T MOVE A MILLIMETER AND AGAIN, IT'S THAT UP FRONT INVESTMENT. BUILDING A REPOUR OF CONFIDENCE THAT ALLOWS US TO DO THIS STUDY. THAT'S THE IDEA. WHEN THE KIDS ARE COMFORTABLE, WHEN THEY ARE TRUSTWORTHY AND FEEL THIS IS SOMETHING POSITIVE FOR THEM, THAT'S WHAT ALLOWS YOU TO GET THE HIGH QUALITY DATA. WE SPENT A LOT OF TIME UP FRONT GETTING COMFORTABLE WITH THESE KIDS TO MAKE SURE THEY'RE WILLING TO WORK WITH US. SOME FINAL THOUGHTS AS I WRAP UP NOW. SO THE SITUATION OF OCCULAR BLINDNESS, IN THE SETTING OF TBI THERE APPEARS TO BE EXTENSIVE REORGANIZATION THROUGHOUT THE BRAIN. HOWEVER, HOW THIS REWIRING RELATES TO VISUAL DEVELOPMENT, COMPENSATORY TRAGEDIES AND RECOVERY OF FUNCTION IS LARGELY UNKNOWN. NOTICE THAT THIS IS VERY, VERY DIFFERENT THAT BE WHAT I TOLD YOU IN THE CASE OF BLINDNESS. SO CERTAINLY FROM A NEURO PHYSIOLOGICAL STANDPOINT, THINGS ARE VERY DIFFERENT. THINK ABOUT TWO INDIVIDUALS THAT TRY TO REGISTER FOUR BENEFITS, ONE IS 20/80, THE OTHER FROM CORTICAL CAUSE. THOSE ARE 2 VERY, VERY DIFFERENT INDIVIDUALS, CLEARLY NEED VERY DIFFERENT STRATEGIES. BUT AS FAR AS THE BENEFITS ENDPOINTS, THRESHOLD IS THEIR VISUAL ACUITY. I HOPE TO CONVINCE THAT ACUITY DOESN'T TELL YOU EVERYTHING. IT'S MORE WHAT'S HAPPENING AT THE LEVEL OF THE BRAIN. WHAT WORKS FOR ONE POPULATION PROBABLY DOESN'T APPLY FOR THE OTHER. I THINK THAT'S THAT RETHINKING FROM A PUBLIC HEALTH STAND OPPONENT THAT WE NEED TO UNDERSTAND THAT WILL TRANSLATE IN THE WAY WE DO RESEARCH IN THIS POPULATION AS WELL. SO AGAIN, FINAL THOUGHTS IN THIS AREA. SO YOU MIGHT REMEMBER WHEN KEVIN COSTNER MADE GOOD MOVIES. THERE WAS A LONG TIME AGO, THERE WAS A FIELD OF DREAMS, HE PLAYED A FARMER IN IOWA. HEARS VOICES IN HIS HEAD. HE SAYS IF YOU BUILD IT THEY WILL COME. AND ENDS UP MOWING DOWN HALF HIS CORN FIELD AND BUILDING A BASEBALL PARK. WHERE THESE PLAYERS COME BACK AND HIS DAD COMES AND THAT'S WHERE THE MOVIE GETS REALLY BORING. BUT ANYWAY, THE POINT I'M TRYING TO MAKE, I'M CONCERNED THAT THIS DOESN'T TURN INTO A FIELD OF DREAMS. IT'S BEEN A VERY, VERY INTERESTING SCENARIO. AS WE DO THIS PROJECT AND GET AHOLD OF THIS DATA, THEN WHAT? AND THAT'S REALLY THE BIG QUESTION WE'RE TRYING TO ASK RIGHT NOW. ULTIMATELY, HOW DOES THIS DATA TRANSLATE INTO SOMETHING THAT ACTUALLY MATTERS FOR THESE FAMILIES AND THESE INDIVIDUALS. >> TO GIVE YOU AN EXAMPLE, LET'S SAY FOR EXAMPLE, WE HAVE AN INDIVIDUAL -- I SHOW YOU THAT THEIR DORSAL VISUAL PATHWAY IS INVOLVED, RELATED TO PROCESSING DEFICITS. NOW WHAT? DOES THAT PERSON STAIR AT DOTS ALL DAY? TO BE HONEST, I DON'T HAVE THE ANSWER BUT I DO THINK THIS IS THE STARTING POINTED. I USE THE ANALOGY OF AUTISM. IT WASN'T THAT LONG AGO WE THOUGHT AUTISM WAS CAUSED BY MOTHERS THAT NEGLECTED THEIR CHILDREN. NOTHING IS FURTHER THERE THE TRUTH. IT WAS ONLY FROM -- IT CAME FROM PARENTS AND FUNDING AGENCIES, THAT CAME FROM FOCUS GROUPS, FROM FOUNDATIONS, RESEARCHERS, FROM CLINICIANS, CAME FROM EDUCATORS, THAT THEY WERE ABLE TO APPLY ENOUGH PRESSURE FROM ENOUGH DIRECTIONS. THOSE ADVANCEMENTS LED TO THE NEXT PIECE. I THINK CDI DESERVES THE SAME THING. I THINK ENOUGH PRESSURE FROM ENOUGH DIRECTION IS HOW YOU INSTITUTE CHANGE. WE HAVE A RESPONSIBILITY FROM A MEDICAL RESEARCH STANDPOINT TO DO THAT AND DO OUR PART. THAT'S WHERE I HOPE THE PROJECT WILL HEAD. I WANT TO THANK A NUMBER OF INDIVIDUALS, OBVIOUSLY, I TALKED ABOUT A LOT OF PROJECTS IN THIS HOUR. A LOT OF INDIVIDUALS WHO MAKE THIS POSSIBLE. AT THE LAB [LIST OF NAMES] WAS BLIND HERSELF, AND WORKED AT THE EYE INSTITUTE. IT WAS WONDERFUL HAVING A BLIND PERSON SHARING HER EXPERTISE ON A DAY TO DAY BASIS. [INDISCERNIBLE] [LIST OF NAMES] SCHOOL FOR THE BLIND, CAROL CENTER FOR THE BLIND. VARIOUS INSTITUTIONS, AND, OF COURSE, THE NATIONAL EYE INSTITUTE WHO HAS BEHIND US. AS WELL AS PRIVATE FOUNDATIONS AND OUR PATIENTS AND OUR FAMILIES THAT REALLY MAKE THIS POSSIBLE. I WANT TO REMIND YOU THAT IN TERMS OF THE NIH, IN TERMS OF BRAIN INITIATIVE, THIS IS A BRAIN -- UNDERSTANDING THE BRAIN AND HOW IT'S WIRED RELATES TO CONDITIONS LIKE ADHD, LIKE AUTISM, LIKE ALZHEIMER'S, SO ON. AGAIN, THE SITUATION OF BLINDERNESS AND VISUAL IMPAIRMENT. OCCULAR OR CORTICAL CAUSE, FITS IN MUCH INTO THE SAME IDEA. UNDERSTANDING HOW THE BRAIN IS WIRED CAN ULTIMATELY TRANSLATE HOW TO EDUCATE AND REHABILITATE INDIVIDUALS. AND TO CELEBRATE THIS YEAR, THE 25th ANNIVERSARY OF THE AMERICANS WITH DISABILITIES ACTED, AND INTERESTING CONVERSATION, WE'RE VERY, VERY IS FORTUNATE WE LIVE IN A COUNTRY WHERE WE PROTECT THE INDIVIDUALS WHO HAVE DISABILITIES. I THINK IT'S A VERY, VERY IMPORTANT PIECE WE CAN'T NEGLECT. I'LL END WITH A STORY, I PRIZE FOR THE QUALITY OF THIS PICTURE. THIS IS A PHOTO THAT HANGS NOT ONLY DC BUT ALSO IN MY OFFICE. CAME FROM LIFE MAGAZINE. DAVID WAS A PHOTOGRAPHER THAT WENT AROUND AFTER THE SECOND WORLD WAR, INTERESTED IN TRYING TO CAPTURE THE PLIGHT OF CHILDREN. AND THIS WAS A BLIND CHILD HE SAW IN ITALY, AND LIKE ALL BLIND CHILDREN, OR MOST IN THAT SITUATION, THEY LEARN TO READ BRAIL. UNFORTUNATELY THIS CHILD ONE DAY WENT OUT INTO THE FIELD AND PICKED UP A LANDMINE. IT EXPLODEED. DESTROYED HIS HAND, A DOUBLING AMPUTEE BY STILL READS BRAIL. NOT BECAUSE HE SEES THE DOTS, BECAUSE HE'S USING THE TIP OF HIS NORTHEAST AND LIPS TO -- NOSE AND LIPS TO READ THE DOTS. THIS IS NEURO PLASTICITY AT ITS BEST. THIS IS WHAT I HOPE TO CONVINCE YOU. THINGS ARE POSSIBLE. WE HAVE TO UNDERSTAND WHAT THE CONSTRAINTS ARE. WHAT ARE THE IDEAL INTERVENTIONS, WHAT ARE THE TIMINGS? I THINK IF WE FIGURE THAT OUT, GOOD THINGS CAN HAPPEN. SO WITH THAT, I THANK YOU VERY MUCH FOR YOUR TIME. I THINK WE HAVE TIME FOR QUESTIONS. IS THAT RIGHT? RUSSIA. [APPLAUSE] >> WE HAVE ABOUT FIVE MINUTES FOR QUESTIONS. >> THE QUESTION IS, THE KIDS THAT WE HAVE BEEN TALKING ABOUT WITH CDI, CORTICAL VISUAL IMPAIRMENT. THE ANSWER IS NO, WE'RE NOT THERE YET. I THINK THAT ULTIMATELY WE'LL GET THERE. WHEN WE STARTED THIS PROJECT THAT'S WHAT WE WERE THINKING ABOUT. USING THE INTERVENTIONS THAT WE DEVELOP, THESE VISUAL -- SORRY, TACTILE AND AUDITORY APPROACHES. THEY APPLY? WERE THEY USEFUL TO THESE PARTICULAR INDIVIDUALS. AS WE STARTED WORKING WITH THIS POPULATION AND SCHOOLS AND ORGANIZATIONS, WE FOUND THAT THERE WAS VERY, VERY LITTLE KNOWN. AND WE STARTED OKAY, FINE, LET'S START FROM THE VERY BEGINNING NOW FROM A WIRING STANDPOINT AND STRUCTURAL STANDPOINT. OUR HOPE IS THAT IN PARALLEL WE'LL START DOING THE INTERVENTIONS AT THE SAME TIME. NOT JUST IN TERMS OF GAMING BUT ALSO ACROSS STRATEGIES AS WELL. SO IF A CHILD, FOR EXAMPLE, HAS PROBLEMS LOOKING AT MOTION, BUT THEY'RE HEARING A LOOMING AUDITORY TONE COMING IN AND OUT, DOES THAT OVER TIME ULTIMATELY PROVE THEIR [INDISCERNIBLE]. SO THAT IS A MUCH BIGGER ENDER, WHERE WE'RE HEADED. I THINK WE NEED TO LAY THE GROUNDWORK FIRST TO UNDERSTAND WHAT WE'RE TALKING ABOUT AND DEALING WITH BEFORE WE INTERVENE WITH SOME OF THESE STRATEGIES. >> THE QUESTION AGAIN, I SHOWED SOME EPIDEMIOLOGY DAMAGE ABOUT DVI AND THE CASE IN THE UNITED STATES. VERY SIMILAR NUMBERS AGAIN IN OTHER DEVELOPS COUNTRIES. IT'S IMPORTANT TO REALIZE THIS IS A PAT EACH IN DEVELOPED COUNTRIES. WE BELIEVE IT'S RELATED WITH IMPROVED NEO NATAL CARE AND HIGH SURVIVAL WITH PREMATURE BABIES. IN THE PAST AND IT'S REALLY, REALLY TRAGIC. I THINK YOU'RE RIGHT, A LOT OF THIS WAS MISDIAGNOSED. EYE CARE PROVIDERS DIDN'T KNOW WHAT THIS WAS. AND THEY WERE DUMP FOUNDED. THEY LOOK AT THE EYES, THEY LOOKED FINE. YOUR KID IS FAKING IT. YOUR KID HAS A LEARNING DISABILITY. YOUR KID CLEARLY AS EMOTIONAL ISSUES. RIGHT? AND THOSE WERE, QUOTES, THE EASY ONES. WHO HAD 20/25 ACUITY. SO A LOT OF -- TRAGIC STORIES FROM PARENTS WHO JUST SIMPLY DIDN'T KNOW WHAT THIS WAS. AND THE MORE EXTREME CASES, WHERE IT'S CLEARLY THE VISUAL DEFICIT IS THERE, OFTEN ASSOCIATED WITH COGNITIVE ISSUES, THEY TEND TO BE PUT IN EERIE RINA. WE'RE STARTING TO DIVIDE THIS POPULATION UP. LARGELY BASED ON VISUAL ACUITY. I THINK WE NEED A MUCH MORE HOLISTIC APPROACH. SO YOU'RE RIGHT. A LOT OF THESE KIDS WERE MISDIAGNOSED. WE DIDN'T KNOW WHAT THIS WAS. WHEN I WAS GOING THROUGH SCHOOL, I DIDN'T HEAR OF ANYTHING LIKE THIS. AND BECAUSE OF THESE ADVANCES IT'S CHANGING THE LANDSCAPE. AND I'M THINKING IN THE FUTURE, THIS WILL ALSO START TO SEPARATE AS WELL. AS WE GET BETTER DEALING WITH OCCULAR CAUSES, WHAT WILL WE DO FOR THESE CEREBRAL CAUSES? SO IT'S AN UNFORTUNATE REALITY. WE HAD TO LEARN THE HARD WORK. I'M CONCERNED WE'RE STARTING TO MAKE THE SAME MISTAKE WITH THIS POPULATION AS WELL. >> IF YOU KNOW YOU HAVE A CHILD, IF YOU CAN SHIELD THAT CHILD FROM COMPLICATIONS, I DON'T KNOW FROM A MOLECULAR STANDPOINT WHERE THAT'S HEADING. I KNOW IN THE FIELD OF CEREBRAL PALS HE, THEY'RE LOOKING AT THINGS LIKE THIS. I CAN'T COMMENT FROM IN UTERO. SOME PEOPLE BELIEVE HIGH OXYGEN, BUT I CAN'T SPEAK FROM PERSONAL EXPERIENCE. I SEE THIS AS AN EDUCATION AND REHABILITATION ISSUE. THIS IS A REALITY, THESE KIDS WILL BE HERE AND WE HAVE TO TAKE CARE OF THEM. I THINK IT STARTS WITH UNDERSTANDING WHAT'S GOING ON. MY HOPE IS AS WE HAVE DONE WITH OTHER CONDITIONS AS WELL, AS WE HAVE A BETTER MECHANISTIC UNDERSTANDING OF WHAT'S GOING ON, THEN WE'LL COME UP WITH THESE STRATEGIES THAT YOU'RE PRESENTING. I DON'T THINK WOE HAVE THAT AT THIS STAGE. >> THE QUESTION WAS IF WE SEE THIS ENHANCED CONDUCTIVITY IN THE CASE OF OCCULAR BLINDNESS, IS THERE THE OPPORTUNITY OF BLINDFOLDING THE CHILD TO IF CREASE THE CONDUCTIVITY. FANTASTIC QUESTION. IT'S A BIG, BIG QUESTION TO TAKE ON. I'LL BACK TRACK. REMEMBER THAT EXAMPLE I SHOWEDOUT THE BLINDFOLDING. OUR ULTIMATE IDEA, WHAT WE THOUGHT WHERE THIS WAS HEADED, IF YOU HAD A CHILD THAT YOU KNEW WAS GOING TO GO BLIND, SAY RETINITIS BIG MEN TOSA, THAT CHILD LEARNED BRAIL THROUGH SITE, BLINDER FOLDING. THAT WAS AN EVEN SIMPLER QUESTION. THIS WAS A DEBATE WE HAD WITH MANY, MANY PEOPLE AT THE PERKINS SCHOOL FOR BLIND IN BOSTON. THEY SAY AT THE PERKINS SCHOOL, YOU CANNOT DENY A CHILD. USE EVERYTHING THEY HAVE AS MUCH AS POSSIBLE. I ECONTROL AS THE DEFICITS ECONTROL. AT THE CAROL CENTER, THEY BLINDFOLD YOU THE DAY YOU WALK INTO THE DOOR. AND THE SOONER YOU CAN DEAL WITH THIS, THE EMOTIONAL AND PHYSIOLOGICAL TRAUMA, IS BETTER IT IS FOR YOU. SO THEY HAVE A VERY, VERY DIFFERENT PHILOSOPHY A LOT OF THAT IS GROUNDED IN TERMS OF HOW THEY REHABILITATE AND EDUCATES THEIR INDIVIDUALS. A LOT OF THAT HAS TO DO WITH ETHICS. ADULTS VERSES CHILDREN BEING BORN BLIND, VERSES LATE BLIND. I DON'T CARE THAT ISSUE IS RESOLVED. THE ONE THING I DIDN'T SHOW WITH THAT DATA, VERY, VERY IMPORTANT, THEIR BRAIL READING SKILLS ACTUALLY IMPROVED OVER THE WEEK. RIGHT? SO THEY GOT BETTER AND BETTER. WE CAN SHOW THAT. WHAT DO YOU THINK HAPPENED WHEN WE TOOK THE BLINDFOLD OFF? THEY GOT WORSE. SO YOU LOSE THAT GAIN. SO NOW YOU HAVE A CHILD AS I SAID WHO IS BLINDFOLDED TRYING TO TAKE ADVANTAGE OF THAT, LEARNING BRAIL. IF YOU PUT SIGHT BACK INTO THE EQUATION, DO THEY HAVE [INDISCERNIBLE]. RIGHT? TAKE A STEP FURTHER TO THE QUESTION ABOUT CVI, MORE CHALLENGEING, I THINK THAT'S SOMETHING TO C THERE ARE A LOT OF ETHICAL QUESTIONS. DEMONSTRATING THE EFFICACY OF THAT INTERVENTION IS A BIG CHALLENGE. WHERE I HOPE THIS RESEARCH GOES, FROM A LONGITUDINAL STANDPOINT WHEREVER KID IN THEIR FIRST YEAR GETS A BASELINE SCAN. WE FALL FIVE, SIX YEARS, LOOK AT CONDUCTIVITY OF KIDS THAT DO WELL INVESTORS THOSE THAT DON'T. I HOPE TO CONVINCE YOU, THIS IS STILL VERY, VERY MUCH IN THE EARLY STAGES. WE HAD NO IDEA WHEN WE STARTED, WE THINK THAT WE REALLY NEED TO LAY THE GROUND WORK FIRST, CARRY A LOT OF THE INFORMATION THAT WE LEARNED FROM THE OCCULAR BLIND SITUATION AND SEE HOW RELEVANT THAT IS. ULTIMATELY THAT'S WHERE WE'RE HEADED. REALLY GOOD QUESTION. >> YEAH. YEAH. EXCELLENT QUESTION. TO REITERATE THE QUESTION FOR THOSE INDIVIDUALS LATE BLINDED -- IT'S IMPORTANT TO KNOW FROM A DEMOGRAPHIC STANDPOINT, THAT IS THE MUCH LARGER POPULATION. THE MAJORITY OF AMERICANS WHO ARE VISUALLY IMPAIRED AND BLIND ARE LATE BLIND. IN OTHER WORDS, THEY HAD VISION AND LOST THEIR SITE AS ADULTS, RIGHT? INDICATIONS LINE DIABETIC RETINOPATHY, THAT IS A MUCH DIFFERENT SITUATION. IN THE CASE OF KIDS BORN BLIND OR LOSE SIGHT EARLY ON. I'M NOT SKIRTING THE QUESTION BUT ONE POINT. THIS IS A ETHICAL COMPONENT. IN THE CASE OF CHILDREN BORN BLIND, THEY NEVER HAD SIGHT SO THEY DON'T KNOW WHAT THEY LOST. SO THEY'RE VERY, VERY DIFFERENT. WE HAVE AN EXAMPLE, AND I HAVE GOOD FRIEND, BLIND, I REMEMBER HAVING A CONVERSATION WITH HIM ABOUT RACISM. DIDN'T UNDERSTAND WHAT I WAS TALKING ABOUT. SO -- AND IT'S A REALLY INTERESTING IDEA. SO THAT KIND OF PUTS YOU ON A DEVELOPMENTAL TRAJECTORY, VERY DIFFERENT THAN AN INDIVIDUAL WHO IS SIGHTED, WENT TO COLLEGE, HAS A FAMILY, BREAD WINNER, THEN -- WITH THE BREAD WINNER OF THE FAMILY, AND ALL OF A SUDDEN LOST THAT SIGHT OR KNOWS THAT THAT VISION IS GOING TO DECREASE. AND IS NOW ABOUT TRYING TO ADJUST TO A NON VISUAL WORLD, IF YOU WILL. AND LIVING IN A WORLD THAT'S CERTAINLY BUILT FOR PEOPLE SIGHTED. THAT'S THE IMPORTANT THING TO RECOGNIZE. TO ANSWER YOUR QUESTION, I THINK THERE IS TWO COMPONENTS. THIS IS WHAT I WAS DRIVING AT. A LOT OF THE INDIVIDUALS WHO LOSE THEIR SIGHT AS ADULTS HAVE DEPRESSION, FOR EXAMPLE. THERE IS A MASSIVE PSYCHOLOGICAL LOSS COMPONENT THAT YOU DON'T SEE IN KIDS WHO ARE BORN BLIND. SO TO ANSWER THE QUESTION I THINK THAT'S ONE PIECE NEGLECTED. I THINK WE NEED TO ADDRESS. THAT PSYCHOLOGICAL PIECE. THAT, I THINK, ONCE ADDRESSED, WILL ALSO FACILITATE THE ORIENTATION, THE SKILL TRAINING, AND BRING PEOPLE UP TO SPEED IT WILY SPEAKING WL. AS WELL. SCREEN READERS. HOW TO STAY CONNECTED IN A WORLD TECHNICAL DRIVEN IF YOU'RE NOT A TECHNOLOGY PERSON TO BEGIN W SO THE PSYCHOLOGY, THE REHABILITATION, I THINK ALL HAS TO COME TOGETHER. AND THAT IS A VERY, VERY DIFFERENT SCENARIO THAN TYPICALLY THE POPULATION THAT WE WORK WITH. AND I RECOGNIZE THAT. AND I THINK THAT'S SOMETHING WE'RE NEGLECTING. I THINK WE'RE ASSUMING THAT NTLE WILL TECHNOLOGY WILL GET US OUT OF THIS. THERE IS A LOT MORE TO IT THAN JUST THAT. >> [INAUDIBLE QUESTION] >> VERY GOOD QUESTION. I DON'T KNOW THE ANSWER TO THAT OFF HAPPENED. I WOULD SUSPECT MUCH LOWER AND DIFFERENT CAUSE, TYPICALLY, IT WILL BE A DIRECT HEAD DRAMA OR INFECTION, SOMETHING ALONG THOSE LINES. THERE ARE SITUATIONS WHERE CHILDREN ARE DIAGNOSED WITH CVI, DON'T HAVE THAT MANIFESTATION. EPILEPSY OR EARLY ON SET WILL DO THE SAME SORT OF THING AS WELL. MY SUSPICION THAT LOOKING AT THE KIDS WE HAVE WORKED WITH, THE INCIDENTS IS MUCH LOWER BUT THEY EXIST AND CERTAINLY THERE AS WELL. THAT ALSO MAKES CVI A BIG, BIG CHALLENGE. IT'S NOT THAT MECHANISTIC PER SE. >> [INAUDIBLE QUESTION] >> THAT'S CORRECT. THAT'S CORRECT. MAKES THIS ALSO A CHALLENGE AS WELL. THAT'S RIGHT. >> OKAY. THANK YOU EVERYONE. THANK YOU VERY MUCH. [APPLAUSE] >> SO AS A REMINDER, THIS IS THE FIRST OF THE OBSSR, BSSR LECTURE SERIES. TO GIVE YOU A HEAD'S UP FOR WHAT'S COMING AHEAD NEXT MONTH ON FRIDAY, OCTOBER 16 IN THE SAME ROOM FROM 2-3. WE'RE GOING TO HAVE DR. JOHNSON, TALKING ABOUT THE HEALTH RETURNS TO EDUCATION POLICIES FROM PRESCHOOL TO HIGH SCHOOL AND BEYOND. WE HOPE YOU'LL JOIN US AGAIN NEXT MONTH. THANK YOU ALL FOR COMING. [APPLAUSE]