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Sensory Restoration and Substitution

One way of coping with blindness and deafness has been some form of sensory substitution—allowing one or more remaining senses to take over for the nonfunctioning sense. Because the senses of vision, hearing, and touch all convey information about the physical and social environments, they can substitute for each other to varying extents. However, because unaided sensory substitution is only partially effective, humans have long improvised with artifices to facilitate sensory substitution (e.g., Braille and the long white cane for blindness, sign language for deafness, and the Tadoma method of speech reception used by deaf and blind people, in which the listener places the hand over the mouth and jaw of the speaker in order to sense articulatory speech information). In recent decades, the advent of electronics and computers has resulted in assistive technology that greatly enhances sensory substitution and, in some cases, allows for the restoration of a nonfunctioning sensory apparatus. This entry discusses the correction and restoration of the senses, as well as sensory substitutions by use of abstract meaning, amodal spatial representations, synesthesia, rote learning, and brain plasticity.

Sensory Correction and Restoration

Sensory correction is a way to ameliorate sensory loss prior to transduction, the stage at which light or sound is converted into neural activity. Optical correction, such as eyeglasses and contact lenses, and surgical correction have been employed over the years to correct for refractive errors in the optical media prior to the retina. For more serious deformations of the optical media, surgery has been used to provide a clear optical path. Likewise, hearing aids and surgery on the tiny bones of the middle ear have long been used to compensate for hearing losses short of profound deafness.

When blindness or deafness results from sensorineural loss in the retina or inner ear or from lesions in the central nervous system, the only recourse for people wishing replacement of the missing visual or auditory function is some form of sensory substitution or sensory restoration. As an example of the latter, one of the great success stories in modern times is the cochlear implant, a device that electrically stimulates auditory nerve fibers in place of transduction by the hair cells. Many people who were profoundly deaf are now able to understand ordinary speech, hear environmental sounds, and even enjoy music as the result of receiving cochlear implants. With blindness, sight restoration remains in the research stage because of enormous technical challenges. There are two primary approaches to remedying blindness: retinal and cortical prostheses. A retinal prosthesis involves electrically stimulating retinal neurons beyond the receptor layer with signals from a video camera. A cortical prosthesis involves direct stimulation of the visual cortex with input driven by a video camera.

Sensory Substitution

Sensory substitution offers several advantages over sensory replacement. First, sensory substitution is suitable even for patients suffering sensory loss because of lesions in the primary projection areas of the cortex. Second, because the interface with the substituting modality involves normal sensory stimulation, problems associated with implanting electrodes (such as infection) are avoided.

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