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A Functional Neuroimaging Study of Sound
Localization: Visual Cortex Activity Predicts
Performance in Early-Blind Individuals
Fre
´de
´ric Gougoux
1
, Robert J. Zatorre
2
, Maryse Lassonde
1
, Patrice Voss
1
, Franco Lepore
1,3
*
1Centre de Recherche en Neuropsychologie et Cognition, De
´partement de Psychologie, Universite
´de Montre
´al, Montre
´al, Que
´bec, Canada, 2Neuropsychology/Cognitive
Neuroscience Unit, Montreal Neurological Institute, McGill University, Montreal, Que
´bec, Canada, 3Institut Universitaire de Ge
´riatrie de Montre
´al, Montre
´al, Que
´bec, Canada
Blind individuals often demonstrate enhanced nonvisual perceptual abilities. However, the neural substrate that
underlies this improved performance remains to be fully understood. An earlier behavioral study demonstrated that
some early-blind people localize sounds more accurately than sighted controls using monaural cues. In order to
investigate the neural basis of these behavioral differences in humans, we carried out functional imaging studies using
positron emission tomography and a speaker array that permitted pseudo-free-field presentations within the scanner.
During binaural sound localization, a sighted control group showed decreased cerebral blood flow in the occipital lobe,
which was not seen in early-blind individuals. During monaural sound localization (one ear plugged), the subgroup of
early-blind subjects who were behaviorally superior at sound localization displayed two activation foci in the occipital
cortex. This effect was not seen in blind persons who did not have superior monaural sound localization abilities, nor in
sighted individuals. The degree of activation of one of these foci was strongly correlated with sound localization
accuracy across the entire group of blind subjects. The results show that those blind persons who perform better than
sighted persons recruit occipital areas to carry out auditory localization under monaural conditions. We therefore
conclude that computations carried out in the occipital cortex specifically underlie the enhanced capacity to use
monaural cues. Our findings shed light not only on intermodal compensatory mechanisms, but also on individual
differences in these mechanisms and on inhibitory patterns that differ between sighted individuals and those deprived
of vision early in life.
Citation: Gougoux F, Zatorre RJ, Lassonde M, Voss P, Lepore F (2005) A functional neuroimaging study of sound localization: Visual cortex activity predicts performance in
early-blind individuals. PLoS Biol 3(2): e27.
Introduction
Animals and humans deprived of vision have been shown
to have enhanced nonvisual perceptual abilities. Indeed,
many blind individuals are extremely efficient in tactile
processing, including Braille reading; the talent manifested
by some well-known blind musicians, singers, and even piano
tuners is often in part attributed to the fact that they were
blind since their youth. One may conclude that blind persons
should be better in nonvisual tasks since they compensate for
their lack of vision by focusing on their remaining modalities.
Many studies have in fact shown that some early-blind human
subjects outperform sighted persons in nonvisual tasks, such
as speech perception [1,2,3], unfamiliar voice recognition [4],
verbal memory [5,6,7], and musical abilities [8,9,10]. Of
particular relevance to the present study are data suggesting
that some blind individuals show better auditory spatial
discrimination [11] or localization of sound sources than
sighted subjects [2,12,13]; however, other studies have failed
to show this advantage [14,15], raising the question of what
may underlie individual differences. In general, the nature of
any behavioral enhancement, its extent, and its neural bases
are still matters of considerable debate.
Animal studies provide some insight as to the neural
substrates underlying such enhanced capacities (reviewed in
[16]). For instance, in cats that had been visually deprived for
several years by eyelid suture shortly after birth, the auditory
cortical representation expanded into visual areas [17], and
auditory spatial tuning was sharpened in the auditory cortex
[18]. Similarly, in neonatally enucleated rats, electrophysio-
logical recordings showed somatosensory responses in the
visual cortex [19], and the somatosensory cortex showed an
enlargement of receptive fields of the cells in some barrels
together with an increase of angular sensitivity for deflection
in another barrel [20]. Thus, those experiments indicate a
recruitment of the visual cortex for nonvisual tasks, but do
not conclusively prove that the enhanced perceptions of the
blind rely on the visual cortex.
Several studies using neuroimaging techniques have also
established that posterior visual areas in blind individuals
may be active during the performance of nonvisual tasks such
as Braille reading [21,22], memory retrieval [7], and auditory
Received June 6, 2004; Accepted November 16, 2004; Published January 25,
2005
DOI: 10.1371/journal.pbio.0030027
Copyright: Ó2005 Gougoux et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original work is properly cited.
Abbreviations: BA, Brodmann area; BSL, binaural sound localization; CBF, cerebral
blood flow; EBNP, early blind with normal performance; EBSP, early blind with
superior performance; MSL, monaural sound localization; PET, positron emission
tomography; SIG, sighted control group; SPL, sound pressure level
Academic Editor: Marcus Raichle, Washington University in St. Louis, United States
of America
*To whom correspondence should be addressed. E-mail: franco.lepore@umontreal.ca
PLoS Biology | www.plosbiology.org February 2005 | Volume 3 | Issue 2 | e270324
Open access, freely available online
P
L
o
S
BIOLOGY
localization [23,24] as well as other auditory functions
[25,26,27,28,29]. It remains to be established whether recruit-
ment of visual cortices necessarily reflects functional reor-
ganization, or whether it indicates a nonspecific or even
pathological response. Indeed, despite numerous studies
showing activation in visual areas during nonvisual tasks,
the functional significance of this phenomenon has been
questioned by some investigators who suggest that the
occipital cortex might be nonspecifically coactivated [30]. If
the visual cortex participates in nonvisual functions in the
blind, then its activity level should be related to individual
differences in behavior, and in effect predict behavioral
outcome.
Localization of sound, a very important function for the
blind, is one domain in which it is particularly useful to study
the cross-modal interactions that may occur following visual
deprivation. This task entails integration of binaural and
monaural cues to derive spatial information. In accordance
with the idea that nonvisual processing can be enhanced in
the blind, a prior study demonstrated that a subset of early-
blind subjects was more accurate than sighted controls (SIG)
at localizing sound sources, specifically when using monaural
cues [12]. These findings provide a clear opportunity to study
the nature of visual cortical recruitment, and the extent to
which it relates to behavioral improvements.
Thus, in the present study, subjects were first studied in an
anechoic chamber using binaural and monaural sound
localization tasks. Depending on their performance at the
monaural task, they were divided into three groups: (i) early-
blind participants who could localize the sounds more
accurately than control subjects (early blind with superior
performance [EBSP]); (ii) early-blind participants who were
unable to localize the sounds any more accurately than
controls (early blind with normal performance [EBNP]); and
(iii) SIG. The same localization task was next adapted so that
it could be carried out within the positron emission
tomography (PET) apparatus, using a speaker array which
permitted pseudo-free-field presentations [31]. Two control
conditions, for monaural sound localization (MSL) and
binaural sound localization (BSL), were used to control for
the auditory input and motor responses.
The hypothesis tested was that blind persons showing
supranormal performance do so because they recruit visual
cortical areas to carry out the task. We therefore predicted
that they would show activation in visual areas specifically
during the MSL task, and not during the binaural or control
tasks. The other blind group, which does not have enhanced
MSL ability, should not show this activation pattern. We
further hypothesized that the degree of visual cortical activity
would be predictive of individual differences in the behav-
ioral performance of the monaural task.
Results
Anechoic Chamber Experiments
In the anechoic chamber experiments, only five of the 12
early-blind subjects could accurately localize the sounds
monaurally, whereas most of the sighted subjects could not
(Figure 1). In order to differentiate two groups of early-blind
participants on the basis of their performance at this
monaural task, we computed their mean absolute error score
and set the cut-off at a score of 458(see Materials and
Methods). Individuals with scores below this value formed the
EBSP group, while those above it constituted the EBNP
group. The results of the former group are illustrated on the
right side of Figure 1B. As can be seen, in these subjects the
regression line was very close to the dashed line representing
ideal performance. By contrast, the other subgroup of early
blind subjects, EBNP, and the SIG could not localize the
sounds correctly, and the regression line is quite distant from
that representing ideal performance. To confirm this local-
ization performance, the mean absolute error score was
compared for the three groups; a group X position
interaction was observed (F
30, 225
=6.299,p,0.01),
localization being more accurate in the EBSP group,
especially on the side of the obstructed ear. The performance
of the EBNP did not differ from that of the SIG. These
findings confirm the previous study of Lessard et al. [12] with
a different group of early-blind participants.
In contrast, all 19 subjects tested, whether sighted or early
blind, could correctly localize sounds binaurally (Figure 2).
Despite an overall good performance, as measured by the
absolute error score, the EBNP group was somewhat less
efficient than the other two groups, especially for more
lateral positions (group X position: F
30,225
= 4.058, p,0.01;
see Figure 2C). The latter finding is reminiscent of the
undershooting performance also found in visually deprived
cats [32].
PET Scanner Experiments
Binaural sound localization. During binaural localization of
the sound, when compared to the control task (Figure 2A and
Table 1), cerebral blood flow (CBF) decreased in the
extrastriate and striate cortex of SIG, suggesting inhibition
between visual and auditory areas. However, neither group of
early-blind subjects showed this deactivation. A further
confirmation of these results was obtained by carrying out a
direct intergroup comparison of the activation of each of the
blind groups to that of the sighted one. These differences are
presented in Figure 3. The two blind groups show what
appears to be an increase in CBF relative to the SIG,
confirming that the CBF response of these groups differ in
this region. However, given the deactivation observed within
this region in the SIG in the first analysis, as opposed to the
lack of CBF difference in the blind, the more likely
interpretation is that this effect reflects a decrease in CBF
in the sighted.
Another finding from the binaural versus control task
contrast was a small region of activation in the visual cortex
(ventral extrastriate) of the EBSP group, but not in the other
two groups (Figure 2B and Table 1). Finally, all three groups
also showed activation in several other cortical regions (see
Table S1 for further details); among the most relevant of
these is a focus in right inferior parietal cortex (Figure S1).
Monaural sound localization. Of greatest relevance to our
hypotheses, during monaural stimulation (one ear plugged),
as compared to control task, right-hemisphere striate and
ventral extrastriate areas showed increased CBF only in the
EBSP subset of blind subjects (Figure 1A and Table 1). For the
EBNP subset, occipital activation was not significant, as was
also the case with the SIG. Once again, direct intergroup
contrasts confirmed the differences in activation in occipital
areas during MSL between the EBSP group and the two other
groups (Figure 4).
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Sound Localization in Early-Blind Persons
While parietal and frontal activations were also seen in the
three groups, temporal activations were not found for
monaural stimulation, the EBNP group showing even some
deactivation in temporal areas. The EBSP group also showed
some activation in the right cerebellum (see Table S1 for
further details). Significant differences between groups were
not observed in temporal and parietal cortices, however.
Correlation analysis. In order to assess whether occipital
activations have a functional role in auditory localization,
independent voxel-wise covariation analyses were carried
out across the entire group of blind individuals. Irrespective
of the group to which they had been assigned, the individual
absolute error score was entered as a regressor in the
analysis examining covariation with CBF change between
overall accuracy at the localization tasks and activation
across the entire brain volume, following the procedure
outlined by Paus et al. [33]. For MSL, a negative and
significant correlation was observed between the absolute
error score and CBF in some areas of the visual cortex
(especially extrastriate but also striate [Figure 5 and Table
1]). It follows from these results that the degree of activation
(percent CBF change) predicted behavioral performance in
MSL. The highest correlation observed was in the right
ventral extrastriate cortex (lingual gyrus; Brodmann area
[BA]18, r= –0.81, p,0.01) but two other significant foci
were found in right dorsal extrastriate cortex (superior
occipital gyrus; BA19, r= –0.77, p,0.01), and striate cortex
(BA17, r= –0.68, p,0.05). Two of these foci are close to the
ones identified in the analyses presented for MSL. These
findings support the hypothesis that the visual cortex is
directly involved in localizing a sound stimulus in the
monaural condition.
Discussion
The imaging results of this study support our hypothesis
that blind persons recruit occipital areas in the context of
auditory localization and, more importantly, the correlation
observed with MSL performance strongly suggests that
individual differences in reorganization of the occipital
cortex have behavioral consequences. Hence, this relation-
ship does not support the possibility that the recruitment is a
nonspecific coactivation or a pathological response. Instead,
these results suggest that visual cortex is specifically recruited
to process subtle monaural cues more effectively.
Functional activation of the visual cortex by nonvisual
stimulation in the blind has already been shown in several
previous studies. Activation of primary and secondary visual
areas was observed during Braille reading and other tactile
discrimination tasks in early-blind persons [21]. This tactile-
induced activation in the occipital cortex was also confirmed
by a series of subsequent studies [7,22,34]. The hypothesis
proposing a functional role for this activation in the visual
cortex was supported by the study of Cohen et al. [35] who
showed, using transcranial magnetic stimulation, that this
occipital area is required for Braille reading in blind subjects.
This phenomenon was further illustrated in the case of a
proficient Braille reader, blind since birth, who became
unable to read Braille, despite normal somatosensory
perception, after bilateral occipital damage resulting from
an ischemic stroke [36]. Moreover, in a speech processing
study in the blind, it was shown that occipital activity (striate
and extrastriate) varied as a function of semantic or syntactic
content [29]. Activation of area V1 has also been found to
correlate with performance in memory tasks [7].
Figure 1. Monaural Sound Localization in PET Experiments Performed in the Three Groups of Subjects
(A) CBF increases. Activations of the right striate and extrastriate cortices are observed in EBSP but not in the two other groups for the contrast
of MSL minus its control task. Upper image series, sagittal slices; lower image series, coronal slices. X and Y coordinates refer to standardized
stereotaxic space.
(B) Behavioral data. Behavioral results in MSL task (with SE bars). The dashed lines represent the ideal performance, whereas the solid lines
indicate the best linear fit to the observed localization performance. Negative angles on the abscissa correspond to the obstructed ear, while
positive angles correspond to the unobstructed ear. Note the better performance of the EBSP group compared to the EBNP and SIG.
DOI: 10.1371/journal.pbio.0030027.g001
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Sound Localization in Early-Blind Persons
Of greatest relevance for the present findings are the
results of Weeks et al. [24] in which CBF was measured
during BSL in blind and sighted individuals, and reported
activation in posterior parietal areas and also in association
areas in the right occipital cortex only in the blind. In
addition, interregional covariations observed between the
right parietal and occipital (ventral, dorsal, and parieto-
occipital) cortices were interpreted as reflecting parts of a
functional network for auditory localization [24]. These data
and the present findings converge on the conclusion that
the visual cortex is recruited during auditory localization in
the blind. However, whereas the study of Weeks et al. [24]
reports extensive recruitment of visual areas during
binaural processing, we observed only a small area of
activation in the ventral visual area in the binaural
condition. Instead, our data point to the importance of
visual regions in successful localization under monaural
conditions, which we interpret as reflecting a recruitment of
these areas for processing of spectral cues. One possible
interpretation of the discrepancy is that the BSL task of
Weeks et al. [24] may have involved spectral cues, provided
by the head-related transfer functions used in that study to
simulate extrapersonal space.
Functional Significance of the Recruitment of Visual Areas
in the Blind: Better Use of Spectral Cues?
It is interesting to consider the function of the right
occipital areas, which seem to be important for MSL.
Monaural cues (spectral cues and head shadow effect) are
involved in the localization of sounds when one ear is
obstructed, or in unilaterally deaf subjects [37]. However,
spectral cues also contribute to BSL, particularly for vertical
and front-back discrimination [38], but also for azimuth
localization [39,40]. Moreover, some authors suggest that
spectral cues based on head-related transfer function
templates are sensitive to experience [41,42]. In this vein,
Doucet and coworkers [43] showed that the supranormal
performance of early-blind persons in MSL was decreased by
occlusion of the pinna or by high-pass and low-pass filtering
of the stimuli, again suggesting that use of spectral cues is
Figure 2. Binaural Sound Localization in PET Experiments Performed in the Three Groups of Subjects
(A) CBF decreases. In the sagittal (upper image series) and coronal (lower image series) slices, a decreased CBF is observed in the visual cortex of
SIG (striate and extrastriate cortices), for the contrast of BSL minus its control task. X and Y coordinates refer to standardized stereotaxic space.
(B) CBF increases. In the sagittal (upper image series) and coronal (lower image series) images, a CBF activation peak is seen in the right ventral
extrastriate cortex for the EBSP group, but not for the other two groups, for the contrast of BSL minus its control task.
(C) Behavioral data. Behavioral results in the BSL task are presented (with SE bars). The dashed lines represent the ideal performance, and the
solid lines indicate the best linear fit to the observed localization performance. All three groups were able to localize sounds accurately.
DOI: 10.1371/journal.pbio.0030027.g002
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Sound Localization in Early-Blind Persons
important for this task. However, because performance was
not completely abolished, head shadowing cues [37] might
also have operated. Similarly, the study by Ro
¨der and
collaborators [13] suggests that blind persons might be more
sensitive to spectral cues, since their blind participants were
better at localizing at lateral positions. Finally, a recent study
showed superior binaural spatial discrimination performance
in both early- and late-blind subjects compared to sighted
subjects, when the stimuli were presented in peripheral field
[44]
Combination of Intramodal and Cross-Modal Plasticity?
Cross-modal plasticity may not necessarily be the only
mechanism to explain the present results. Some studies have
also shown intramodal plasticity in auditory cortex of the
blind. For example, the tonotopic region of area A1 in blind
persons seems to be enlarged compared to that of sighted
subjects [45], presumably reflecting greater use of auditory
cues by the blind. Enhanced recruitment and sharpening of
spatial tuning of auditory cortical neurons has also been
found in binocularly deprived cats [17,18]. Thus, a combina-
tion of intramodal plasticity in auditory cortex and cross-
Table 1. Stereotaxic Coordinates and tValues of Activation and Deactivation Foci in Occipital Areas
Task Groups Areas x y z t Value
BSL minus control task
SIG R Cuneus 7 88 29 4.88
L Cuneus (V1) 13 99 3 4.36
R Lingual gyrus 3 78 2 4.06
L Lingual gyrus 21 78 93.95
EBNP
EBSP R Lingual gyrus 16 83 14 3.88
MSL minus control task
SIG
EBNP
EBSP R Cuneus (V1) 13 81 15 4.14
R Lingual gyrus 15 73 6 3.39
Covariation with behavioral
measure (absolute error), early
blind only: BSL minus control task
L Cuneus (V1) 13 79 9 3.35
Covariation with behavioral
measure (absolute error), early
blind only: MSL minus control task
R Lingual gyrus 12 67 65.13
R Sup occipital gyrus 46 64 17 4.01
R Cuneus (V1) 3 83 12 3.12
R Cuneus (V1) 17 93 2 3.09
R Mid occipital gyrus 42 76 32 3.01
Empty cells indicate that there is no activation abo ve the threshold for this group. Coordinates x, y, and zrefer to standardized stere otaxic space [75]. See Table S1 for complete list of foci.
DOI: 10.1371/journal.pbio.0030027.t001
Figure 3. Intergroup Contrasts in Binaural Sound Localization Minus
Control Task
Sagittal (top) and coronal (bottom) images showing the contrasts
between EBNP (left) compared to SIG, and EBSP (right) compared to
SIG. These contrasts confirmed the differences in occipital areas
between the SIG and the two other groups, which are likely
attributable to a decrease in CBF activity in the sighted relative to
the control task (see Figure 2). X and Y coordinates refer to
standardized stereotaxic space.
DOI: 10.1371/journal.pbio.0030027.g003
Figure 4. Intergroup Contrasts in Monaural Sound Localization Minus
Control Task
Sagittal (top) and coronal (bottom) images showing contrasts between
the EBSP and EBNP (left), and between the EBSP and SIG (right).
These contrasts confirmed the differences in occipital areas between
the EBSP group and the two other groups. X and Y coordinates refer
to standardized stereotaxic space.
DOI: 10.1371/journal.pbio.0030027.g004
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Sound Localization in Early-Blind Persons
modal plasticity involving visual cortex may have contributed
to the superior performance seen in our early-blind subjects.
In the present study, a significant difference in activation in
auditory cortical areas was not observed among the three
groups. However, we cannot exclude the possibility of
plasticity at this level, as CBF responses might not be sensitive
to effects such as better spatial tuning properties of auditory
neurons.
Experience-driven improvements in auditory localization
can occur without necessarily invoking cross-modal recruit-
ment. Indeed, some studies have shown that in MSL tasks,
practice may lead to increased performance in the case of
unilaterally deaf patients [46] or even normal subjects [47].
Excellent performance in MSL was also observed in juvenile
ferrets when they were raised with one ear plugged. Even in
adult ferrets, changes were seen in the performance during
MSL after regular practice [48]. Moreover, adult humans seem
to be able to calibrate auditory cues after their pinnae were
modified with moulds, showing good performance with their
‘‘new ears’’ after a few weeks [49]. These results would favor
the hypothesis that, instead of becoming supranormal in their
remaining senses, blind persons may use them more
efficiently within normal limits [50]. Nonetheless, our data
suggest that this efficiency gain in the blind is achieved at
least in part via recruitment of visual cortical areas.
Why do some blind persons and not others acquire
superior monaural sound localization skills? It may be that
these changes are entirely experience-driven. That is, some
blind persons may have had more practice navigating or
using auditory cues to explore their environments. On the
other hand, the individual differences we observed in the
degree of cross-modal plasticity could reflect innate factors
that remain to be identified. An additional explanation may
be that the blind persons who are not better than normal at
sound localization may be superior in other nonvisual tasks,
such as Braille reading or other somatosensory discrimina-
tion, because the visual cortex was preferentially recruited to
carry out these tasks instead of auditory ones. If this is the
case, it is possible that cross-modal plasticity is limited to a
certain extent, such that recruitment of these areas by one
modality inhibits recruitment by another. These speculations
will have to be explored systematically in future studies.
How Does the Visual Cortex of the Blind Process Auditory
Information?
What is the nature of the mechanism implied in the
processing of auditory stimuli by visual cortical areas? The
specific areas of visual cortex recruited may provide a clue.
The analyses yielded one peak in the right V1 area. V1 has
already been shown to be activated in other studies
examining Braille reading [21,22,34], verbal memory [7], verb
generation [7,28], and speech processing [29]. These findings
therefore suggest that V1 may play a very general role in a
variety of nonvisual tasks in the blind. However, a right
lingual gyrus peak was the main focus revealed by the analyses
in the present study. This cortical region is known to form
part of the ventral visual pathway, which is important for
identifying visual objects [51]. If this region is important for
the processing of visual object features, such as contour or
texture [52,53], we may speculate that the same area is
possibly used in the blind to process analogous features for
Figure 5. Correlational Analysis for Monaural Sound Localization in Blind Persons
These data show the correlational analysis between performance (mean absolute error) in pointing task to monaurally presented sounds and
CBF in a group of blind subjects. The two columns of brain images (left image series, sagittal sections; right image series, coronal sections)
illustrate the statistical parametric map of the correlation, which is maximal in the ventral extrastriate cortex (A) but also significant in dorsal
extrastriate (B) and striate (C) cortices. The red arrows in the coronal slices indicate the focus selected for the respective sagittal slices. The
scattergram shows the individual values extracted from each of these regions; closed circles indicate blind subjects; open circles indicate SIG.
The dotted vertical line represents the cutoff in performance for the a priori classification of blind subjects into those with low error rates
(EBSP) and those who do not show the enhancement (EBNP). X and Y coordinates refer to standardized stereotaxic space.
DOI: 10.1371/journal.pbio.0030027.g005
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Sound Localization in Early-Blind Persons
auditory stimuli such as spectral contour. These cues to
auditory object identity, which are normally processed in
anteroventral regions of the auditory cortex [54], might be
processed in the occipital ventral stream in the blind when
they are relevant for spatial position.
Contribution of Parietal Cortex to Binaural Sound
Localization
The parietal activation observed in all groups during BSL
suggests that these areas are important when carrying out the
task used in the present experiment (see Figure S1). This
finding agrees with a previous study, which reported a right-
sided inferior parietal activation that positively correlated
with absolute error score in normal sighted subjects with the
same procedure as in our study [31]. Parietal activation of
both hemispheres, or a right hemisphere advantage, has been
shown in several other neuroimaging studies of auditory
localization and spatial discrimination experiments with
sighted subjects [24,55,56,57,58,59,60]. In the study of Weeks
et al. [24], a strong right-hemisphere recruitment of parietal
and occipital regions was shown for blind subjects. Our
findings therefore agree with these studies and with the well-
known right-hemisphere advantage for spatial processing.
However, we did not observe preferential activation in this
parietal region in the blind as compared to the sighted, nor
did CBF correlate with behavioral performance in this region.
Based on those findings, we conclude that parietal area
activation is related to the sensory-motor integration and
spatial coordinate transformation required by the pointing
task [31,61] at some stage after sensory processing has
occurred. Thus, we propose that in those blind subjects who
have specifically learned to use monaural cues, parietal
regions receive additional input from the ventral visual
cortex, but that no reorganization within the parietal cortex
itself has occurred.
Different Inhibitory Patterns for the Visual Cortex in Blind
and Sighted Persons
During BSL, the sighted control group (SIG) showed a
deactivation in both extrastriate and striate areas of the
occipital lobe, a phenomenon that was not observed in either
subset of early-blind individuals. Many previous studies with
sighted subjects have shown that following stimulation in one
modality, cross-modal inhibition occurs in the unattended
modalities [62,63,64,65,66] or even in some areas within the
same modality [66,67]. Interestingly, an imaging study with
sighted subjects carried out by Zatorre and coworkers [57]
reported a visual deactivation in tasks of pitch and location
discrimination. Because deactivation is not seen in all studies,
the phenomenon may be related to the nature of the task
[64,65,68].
Deactivation of primary visual areas has also been seen in
sighted subjects during a tactile discrimination task, whereas
in blind subjects activation was shown in the same area [21].
Within the context of auditory localization, Weeks and
coworkers [24] also reported some occipital deactivation in
sighted subjects, while the blind showed activation in the
same area. All these results suggest that cross-modal
inhibitory processes could be different in blind and sighted
subjects, at least under some experimental conditions. Blind
subjects might not have to inhibit the normally competing
visual cortex when they perform some of the same nonvisual
tasks as sighted people do. By contrast, the specific recruit-
ment of the same cortex in order to complete a difficult task
might permit them to compensate for their handicap.
Conclusion
The present study establishes for the first time in certain
early-blind persons a clear relationship between monaural
sound localization performance and increased CBF in
occipital areas. Indeed, some of the blind persons showed
occipital activation that appeared to be functional, since this
phenomenon was correlated with a supranormal perform-
ance in MSL. This finding suggests that visual deprivation
from an early age could lead to important cross-modal
plasticity and give blind persons an advantage in using
spectral cues to carry out a crucial everyday task, sound
localization. Moreover, we report that inhibitory patterns
differ between early-blind and sighted individuals. Under
binaural conditions, the SIG seemed to inhibit part of the
occipital areas when localizing sounds, but this was not the
case for either group of blind persons. This differential
pattern may provide clues as to how different parts of the
brain normally interact during unimodal stimulation, and
further suggests that these interactions may be modified in
the absence of a sensory modality.
It may also be important in future studies to investigate
whether blind persons can recruit visual areas in other
auditory tasks, for example in a task in which spectral and
level cues are relevant but in a nonspatial context. Along the
same lines, a spatial discrimination task not requiring the
explicit localization of the sounds may also be of interest.
One can thus verify that this special competence of some
blind persons can be generalized in different auditory
contexts other than MSL. Indeed, it would be interesting to
know whether this ability is related to more complex tasks
such as navigation, obstacle detection, or analysis of sound
flow, for example when the subject moves or objects move
around the subject. Similarly, it may be pertinent to
investigate whether special training or substitution devices,
frequently described in the literature, not only improve the
relevant behavior but also facilitate cross-modal plasticity.
Materials and Methods
Subjects. The participants were seven healthy sighted volunteers
and 12 early-blind subjects who had lost their vision before puberty,
most of them in the first few years of life (see Table 2). In each case,
the visual deficit was of peripheral origin and led to total blindness
except for some light perception in a few subjects (categories 4 and 5,
according to the World Health Organization classification [69]). All
participants underwent audiometric testing to ensure good hearing,
equal in both ears. They gave their written informed consent in
accordance with guidelines approved by the Ethics and Research
Committees of the Montreal Neurological Institute and the Nazareth
and Louis Braille Institute for the Blind.
Anechoic chamber experiments. Subjects were asked to localize
sounds binaurally or monaurally while they were seated in the
anechoic room. The acoustic apparatus used to test sound local-
ization, previously described in detail [70], consisted of 16 loud-
speakers mounted on a graduated semicircular perimeter with a
radius of 50 cm (positions: 658,6168,6268,6378,6478,6588,6688,
and 6788). The subject was seated in the center of the perimeter, the
head placed on a headrest attached to the chair with the speakers
positioned at ear level.
The stimuli were broadband noise bursts that lasted 30 ms (10-ms
rise and fall times, and a 10-ms plateau). The sound pressure level
(SPL) was maintained at 40 dB. A stimulus was delivered through a
randomly selected loudspeaker and repeated five times for each
position. A buzzer warned the subjects that a sound was about to be
PLoS Biology | www.plosbiology.org February 2005 | Volume 3 | Issue 2 | e270330
Sound Localization in Early-Blind Persons
presented and that they should maintain a stable head position and
fixate straight ahead. Compliance with all instructions was ascer-
tained by an experimenter remaining in the chamber behind the
subject. The response consisted of pointing with the dominant hand
toward the apparent source of stimulation. Lines graduated in 18
steps were drawn on the perimeter, and the response of the subject
was recorded by the experimenter.
For monaural testing, one ear was plugged with a combination of
an ear plug (mean attenuation = 37.5 dB SPL) and a hearing
protection muff (mean attenuation = 29 dB SPL). In order to
compare the overall accuracy in localization between the subjects, the
absolute error score was utilized in both the anechoic chamber and
scanner experiments. This value is the average of the difference (in
absolute value) between the correct position and the response for
each trial. To allow combining of data from subjects with left or right
ear plugged, the behavioral results were transformed such that the
left side was arbitrarily assigned to correspond to the obstructed ear.
Thus, in the behavioral data presented, negative angles on the
abscissa correspond to the obstructed side, while positive angles
correspond to the unobstructed side.
Scanner experiments. In this part of the experiment, subjects were
asked to localize sounds binaurally or monaurally while they were
lying within the scanner. Monaural testing was carried out using the
same ear attenuation procedure as used in the anechoic chamber. All
conditions, localization tasks, and their specific control task, were
part of a larger study. These conditions were counterbalanced across
subjects for the order of scan conditions. Approximately half of the
subjects within each group received the ear plug in the left and the
other half in the right ear during the monaural part of the scanning
session. Auditory stimuli were presented using a circular array of
nine speakers, positioned 158apart from 6608, and having a radius of
24 cm [31]. The array was placed inside the PET scanner such that the
head was in the center of the array, with speakers positioned on the
horizontal plane relative to the subject’s head, at the level of the ears.
In order to ensure stable head position, the head was maintained by a
Velcro band, and its position was checked frequently by means of
three laser pointers included in the scanner. Background noise in the
scanner room was 56 dB SPL.
The stimuli were two broadband noise bursts that lasted 30 ms and
were separated by a 0.5-s intrapair interval while the intertrial interval
was 2.5 s. Each pair of stimuli was presented from a single speaker at 60
dB SPL, as measured at the center of the array. Each of the nine
speakers was utilized 12 times in random order for a total of 108 trials
for each condition. The behavioral tasks were started around 15 s
before the beginning of data acquisition with the scanner. The
response consisted of pointing with a joystick, placed at the subject’s
side, to the apparent source of stimulation. It was ascertained before
the experiments that all subjects were familiar with the use of the
joystick and with the task requirements. In a series of preliminary
experiments, it was verified that subjects (n= 6) wearing binaural
earplugs and ear muffs could not localize any of the stimuli from the
speakers. The control task consisted of pointing in alternation to the
left and right (908,þ908,908, and so on), after hearing a stimulus pair
presented always in the frontal (08) position. Two control tasks were
tested, one binaural and one monaural; in the monaural case the same
ear was plugged as was used for the localization task for that
individual. Thus, four conditions were tested in all subjects:BSL,
binaural control task, MSL, and monaural control task.
PET scans were obtained with a Siemens Exact HRþtomograph
(Forchheim, Germany) operating in three-dimensional acquisition
mode. The distribution of CBF was measured during each 60-s scan
using the H
2
O
15
water bolus method [71]. MRI scans (160 1-mm slices)
were also obtained for each subject with a 1.5T Philips ACS system
(Andover, Massachusetts, United States) to provide anatomical detail.
CBF images were reconstructed using a 14-mm Hanning filter,
normalized for differences in global CBF, and co-registered with the
individual MRI data [72]. Each matched MRI/PET dataset was then
linearly resampled into a standardized stereotaxic coordinate system
based on the MNI305 target (a sample of 305 normal subjects) via an
automated feature-matching algorithm [73], resulting in a normalized
brain space similar to the Talairach and Tournoux atlas (for
additional information, see: http://www.mrc-cbu.cam.ac.uk/Imaging/).
Statistical analysis was performed applying the method described by
Worsley et al. [74]; covariation analysis followed the procedure
outlined by Paus et al. [33]. A tvalue of 3.5 was used for significant
changes in CBF during exploratory searches. However, a tvalue of 3.0
was used for a priori regions of interest, such as occipital areas.
Supporting Information
Figure S1. Parietal Activation Foci in Binaural Sound Localization
Task
Sagittal and coronal images contrasting BSL to the control task. All
three groups showed increased CBF in the right inferior parietal lobe
(as shown by the red arrows), consistent with other neuroimaging
studies of auditory localization. X and Y coordinates refer to
standardized stereotaxic space.
Found at DOI: 10.1371/journal.pbio.0030027.sg001 (2.2 MB TIF).
Table 2. Characteristics of Blind and Sighted Subjects
Subject Gender Age (Years) Onset of Blindness Etiology Residual Light Perception Braille Reading (Mean Hours/Day)
EBNP (n= 7; mean age 32 y)
1 F 36 0 Bilateral retinal dysplasia Y 6
2 M 39 0 Retinopathy of prematurity N ,1
3 F 23 0 Retinopathy of prematurity N 4
4 F 21 0 Retinal detachment N 2
5 M 40 0 Congenital N 3
6 F 41 5 Retinoblastoma Y ,1
7 F 24 8 Retinal detachment N 2
EBSP (n= 5; mean age 30.2 y)
1 F 25 1 Retinoblastoma N 6
2 M 32 0 Leber’s disease Y 3
3 M 37 1 Cataract, glaucoma N 2
4 M 23 2 Retinoblastoma N 1
5 M 34 14 Leber’s disease N ,1
SIG (n= 7; mean age 27.9 y)
1M25 – – – –
2F22 – – – –
3M22 – – – –
4M27 – – – –
5F48 – – – –
6M26 – – – –
7F25 – – – –
DOI: 10.1371/journal.pbio.0030027.t002
PLoS Biology | www.plosbiology.org February 2005 | Volume 3 | Issue 2 | e270331
Sound Localization in Early-Blind Persons
Table S1. Stereotaxic Coordinates and tValues of Activation and
Deactivation Foci
Found at DOI: 10.1371/journal.pbio.0030027.st001 (35 KB DOC).
Acknowledgments
FG was supported by a postgraduate fellowship from the Natural
Sciences and Engineering Research Council of Canada and the Fonds
de la Recherche en Sante´ du Que´bec. The work was supported by
grants from the Canadian Institutes of Health Research to ML, RZ,
and FL and the Canada Research Chairs programs to ML and FL. We
thank Kate Hanratty, Pierre Ahad, Marc Bouffard, Francine Giroux,
Sylvain Milot, Robert Lisbonna, Gary Sauchuck, Rick Fukasawa, Alan
Evans, Bruce Pike, the McConnell Brain Imaging Center, the Nazareth
and Louis Braille Institute (Pierre Rondeau), the Montreal Associa-
tion for the Blind (Patricia Ferrarezi, Maria Moschopoulos), the
Regroupement pour les Aveugles et Amblyopes de Montre´al (Serge
Poulin), Charles Leclerc, Marie-Eve Doucet, Nadia Lessard, and all the
participants.
Competing interests. The authors have declared that no competing
interests exist.
Author contributions. FG, RZ, ML, and FL conceived and designed
the experiments. FG, RZ, ML, PV, and FL performed the experiments.
FG, RZ, ML, PV, and FL analyzed the data. FG, RZ, ML, and FL
contributed reagents/materials/analysis tools. FG, RZ, ML, and FL
wrote the paper. &
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