Sport As A Factor in Improving Visual Spatial Cognitive Deficits in Patients With Hearing Loss And Chronic Vestibular Deficit Part 2

The single most important nonverbal task for the assessment of visuospatial working memory (VSWM) is the Corsi block tapping task (CBTT), also known as the Corsi Span Test. It also involves spatial attention. 

Visual-spatial working memory and memory are two very important aspects of human cognitive ability. They influence each other and help us learn and live together.

Visual-spatial working memory is a cognitive ability we use to process images, graphics, and spatial layout information, which can help us remember, think, and solve problems more efficiently. For example, when reading, we need to encode visual information into a meaningful whole and then memorize it. We can use SWM (visual-spatial working memory) to help us complete this process quickly. In daily life, we need to remember the birthdays, license plate numbers, phone numbers, etc. of family members. All this information requires the help of SWM to improve our memory.

Memory is the cornerstone of human cognitive ability. Our study and life need to be completed with the help of memory. People with strong memory can better process and store information, and can more quickly and accurately recall the relevant knowledge and experience accumulated in past learning and life, thereby improving the efficiency and quality of work and life.

Therefore, visual-spatial working memory is closely related to memory, and both provide us with support for cognitive ability. We can improve memory by improving the ability of visual-spatial working memory, and vice versa. Some studies have shown that visual-spatial working memory training can improve memory. Accordingly, for those who want to improve their visual-spatial working memory ability, memory strengthening is also necessary.

In general, there is a mutually reinforcing relationship between visual-spatial working memory and memory. We can further improve these two cognitive abilities through learning and practice so that we can be more handy in learning and daily life.

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The traditional version of the Corsi apparatus consists of a set of nine identical blocks (3 × 3 × 3 cm2 ) irregularly positioned on a wooden board (23 × 28 cm2 ). The experimenter points to a series of blocks at a rate of one block per second. Subsequently, the participant is required to point to the same blocks in their order of presentation. 

The length of the block sequences (starting from 2-block sequences) increases by one item until the recall is no longer correct. The procedure ends when the number of wrong reproductions exceeds the proportion of admissible errors per length. 

A span score was calculated corresponding to the larger sequence the subject can correctly reproduce. The maximum score possible is 9. 

This test was used mainly in neurological diseases (Alzheimer's disease, autism spectrum disorder, depression, and affective disorders, Down's syndrome, e, multiple sclerosis, Parkinson's disease, schizophrenia, stroke, and cerebrovascular disease, traumatic brain injury) and it is significantly impaired in patients suffering from chronic peripheral vestibular hypofunction when compared with healthy controls [8,10]. 

It was also used in sports athletes with a history of concussion [33]. We used the digital version of Corsi's test (Corsi test) [34,35] (Figure 1). In the Corsi block-tapping task for digital tablets (Corsi), instead of cubes to be tapped on a board, the setup consists of squares that flash on a computer screen. 

Participants reproduce the sequences by tapping blocks on a (touch) screen, without substantial differences between the two versions in terms of performance. 

In addition, in the eCorsi test, the final score corresponds to the maximum number of targets reproduced correctly and therefore ranges from a minimum of 2 to a maximum of 9.

The data was confronted with the following:

• 430 subjects without vestibular deficits and hearing loss (NORM); 224 females (52.1%) and 206 M (47.9%), 300 aged 17 to 64 years (mean 31.57, SD 12.41) and 130 aged 65 years or more (mean 72.2, SD 4.79).

• 404 subjects with chronic vestibular failure (CVF group); 210 females (51.9) and 194 males (48.1%), 234 aged 17 to 64 years (mean 48.94, SD 10.44) and 170 aged 65 years or more (mean 75.08, SD 5.25).

• 34 subjects without vestibular deficits and hearing loss who practice volleyball, basketball, and football at an amateur level (SPORT group); 14 females and 31 males, with an average age of 25.44 years (SD 4.63).

• 50 professional athletes (PROF group) in basketball, volleyball, and motorsport; 15 females and 35 males, with an average age of 23.94 years (SD 3.46) without vestibular deficits and hearing loss.

• 18 females NORM who do not practice sport (NORM NS group) and 25 who often practice volleyball (NORM V group) at a professional level on par with the Italian national deaf volleyball team, without vestibular deficits and hearing loss. The average age was equivalent to the TEAM volley's group.

Statistical analysis was performed by Statistical Package for Social Science (SPSS). Groups were tested for normality. The difference between the means of normally distributed variables was calculated using Student's t-test. 

A paired sample t-test was performed to assess the differences in the same subject, while an independent sample t-test was used to compare the two groups. Differences with a p-value < 0.05 were considered statistically significant.

3. Results

A bilateral vestibular deficit was present in 66 subjects (63.5%, ENS VF group), and in 38 (36.5%, ENS noVF group) it was either absent or non-significant.

In 31.8% of subjects with vestibular deficit, vertigo was present in the medical history, and in 28.2% of subjects without a clear vestibular deficit. Therefore, all cases are to be considered in a state of good vestibular system adaptability.

Both CVF and ENS have a statistically lower score than NORM (p < 0.0001), as shown in Table 1. Previous studies showed that the score difference between subjects with unilateral and bilateral CVF is not significant (p = 0.0734) [25].

In ENS, the presence of a vestibular deficit does not significantly change the score (p = 0.6921).

ENS has a better score than CVF (p = 0.0009).

ENS NS have an equivalent score to the CVF group (p = 0.9113).

FSSI score does not differ from the NORM group (p = 0.0928).

ENS NS has a significantly lower score than NORM (t-test: p < 0.0001).

FSSI has score values equivalent to those of NORM (t-test: p < 0.0928).

In subjects over 65, the difference between ENS and NORM is lower (p = 0.0026) and is significant between the ENS itself and CVF (p = 0.0154) and between CVF and NORM (p < 0.0001).

FSSI has a significantly better score than NORM for the same age (p = 0.0130).

The comparison between the score of 34 SPORT and 34 FSSI with the same athletic skill level shows (Table 2) a non-significant difference, even if the FSSI group's age is relatively larger (p = 0.0005).

Table 2. Average values and standard deviations for Corsi's test score in NORM and FSSI with equivalent athletic skill level.

The score of both groups is lower than that of the PROF group. The comparison between SPORT and PROF, with not quite a statistically significant age difference, confirmed a statistically better performance in PROF. In the group containing the 15 athletes of the Italian national deaf volleyball team (TEAM volley group), eight had a vestibular deficit, four unilateral, and four bilateral. 

In comparison (Table 3), 18 subjects in NORM who do not practice sport (NORM NS group) and 25 who regularly practice volleyball (NORM V group) with the same gender and age showed a significantly better score (t-test: p < 0.0011) in those who practice sport rather than those who do not; the athletes of the national team have a score equivalent to the score of the athletes with normal hearing (t-test: p = 0.8857).

Table 3. Average values and standard deviations for Corsi's test score in NORM NS, NORM volley, and TEAM volley with the same age and the same athletic skill level.

In the totality of ENS and TEAM volley, there is a small but significant male advantage (Table 4). 

However, the difference is inferior to the one observed in NORM (Table 5). Comparing the TEAM volley score with the 34 FSSI with the same athletic skill level, the difference vanishes (p = 0.4641).

Table 4. Average values and standard deviation for the Corsi's test score in ENS and TEAM volley, concerning gender.

4. Discussion

The subjects suffering from chronic hearing loss and/or unilateral or bilateral vestibular deficit have shown a VSWM less efficient than that of the NORM group. 

The contemporaneous presence of these two deficits does not seem to significantly change this cognitive function. However, on average, ENS has a better score than CVF; this hints at a better adaptive strategy, likely supported by cross-model plasticity that includes the regular use of lipreading [36]. 

This characteristic occurs mainly in subjects who practice sport: their VSWM is equivalent to NORM's, or even better for subjects in the over 65 age group. The effect of physical activity is undeniable for the same athletic skill level; the performance difference concerning NORM vanishes for amateurs and professional athletes. 

Therefore, it appears to be confirmed that motor skill learning induces some differences in brain network plasticity regarding non-active peers [24,37,38]. The comparison between males and females reveals a small but significant male advantage on average, as it was often observed in VSWM tests [25,39,40] after adolescence. 

However, the difference is lower than the one found in the NORM, so the likely influence of similar adaptive strategies between the two genders in day-to-day life is confirmed. 

Indeed, the difference between genders vanishes completely if we compare the score of TEAM volley and the score of 34 FSSI at the same athletic skill level. This is most likely the effect of similar and prolonged training. 

Indeed, the sex difference in human SWM can be attributed to the complexity of the variables involved in the visuospatial domain and can be better explained by differences in spatial competencies. This could reflect the use of different strategies, rather than different competencies, in both sexes.

5. Conclusions

We have already demonstrated how vestibular rehabilitation is capable of significantly improving the spatial memory of subjects suffering from monolateral or bilateral vestibular deficit. 

The study underlines that physical activity, when practiced regularly, allows the same results to be achieved in subjects with profound hearing loss, regardless of vestibular deficit, where VSWM is lower on average than healthy peers. 

The study shows that, in both genders, physical activity improves these cognitive functions [37,41,42], promoting the same cross-modal plasticity mechanisms that support the functional adjustment in hearing loss and chronic vestibular deficit. 

Thus, it is clear that in patients with this deficit since infancy, it is suggested to support and recommend physical activity. When the patient is a newborn, we suggest stimulating the vestibular and cognitive function through daily exercises such as "hide and seek", walking, and flips from 18 months old [43,44]. 

Indeed, in this way, the newborn can develop spatial-temporal reasoning, a sense of direction, saccadic spatial exploration, and motor coordination. 

Physical activity activates different neural networks compared to sedentary life; this promotes the development of new cognitive strategies characterized by better spatial-temporal reasoning and navigation skills, which are useful in a person's social life, particularly in sports and driving [45,46].

Author Contributions: All authors contributed equally to the collection and processing of the data and critically reviewed the manuscript. All authors have read and agreed to the published version of the manuscript.

Funding: This research received no external funding.

Institutional Review Board Statement: Ethical review and approval were waived for this study since the screening tests described in the present paper were conducted as part of routinary assessments of athletes and healthy subjects by the scientific boards of Ente Nazionale Sordi (ENS) and the Federazione Sport Sordi Italia (FSSI).

Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.

Data Availability Statement: Data is available on request due to restrictions on privacy or ethics. The data presented in this study are available on request from the corresponding author. The data are not publicly available due to patients' health data.

Conflicts of Interest: The authors declare no conflict of interest.

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