The clinical effectiveness of Eye-Search therapy for patients with hemianopia, neglect or hemianopia and neglect.

We investigated the clinical effectiveness of Eye-Search, a web-based therapy app designed to improve visual search times, in a large group of patients with either hemianopia, neglect or both hemianopia and neglect. A prospective, interventional cohort design was used. For the main, impairment-based outcome measure (average visual search time), the within-subject control was affected vs. unaffected side. Four hundred and twenty-six participants who fitted the inclusion criteria completed all 4 time points (1200 therapy trials). We found a significant three-way interaction between therapy, side and group. Eye-Search therapy improved search times to the affected visual field of patients with either hemianopia alone or neglect and hemianopia, but not those with neglect alone. Effect sizes were moderate to large and consistent with previous studies. We found a similar significant interaction between therapy and group for the patient-reported outcome measure "finding things" that most closely matched the impairment-based outcome (visual search). Eye-Search therapy improves both impairment-based and patient-reported outcome measures related to visual search in patients with hemianopia alone or hemianopia and neglect.

Plasticity of human auditory-evoked fields induced by shock conditioning and contingency reversal.

We used magnetoencephalography (MEG) to assess plasticity of human auditory cortex induced by classical conditioning and contingency reversal. Participants listened to random sequences of high or low tones. A first baseline phase presented these without further associations. In phase 2, one of the frequencies (CS(+)) was paired with shock on half its occurrences, whereas the other frequency (CS(-)) was not. In phase 3, the contingency assigning CS(+) and CS(-) was reversed. Conditioned pupil dilation was observed in phase 2 but extinguished in phase 3. MEG revealed that, during phase-2 initial conditioning, the P1m, N1m, and P2m auditory components, measured from sensors over auditory temporal cortex, came to distinguish between CS(+) and CS(-). After contingency reversal in phase 3, the later P2m component rapidly reversed its selectivity (unlike the pupil response) but the earlier P1m did not, whereas N1m showed some new learning but not reversal. These results confirm plasticity of human auditory responses due to classical conditioning, but go further in revealing distinct constraints on different levels of the auditory hierarchy. The later P2m component can reverse affiliation immediately in accord with an updated expectancy after contingency reversal, whereas the earlier auditory components cannot. These findings indicate distinct cognitive and emotional influences on auditory processing.