Revealing the relationships between perceptual representations in the brain and mechanisms of adult perceptual learning is of great importance, potentially leading to significantly improved training techniques both for improving skills in the general population and for ameliorating deficits in special populations. In this review, we summarize the essentials of reverse hierarchy theory for perceptual learning in the visual and auditory modalities and describe the theory's implications for designing improved training procedures, for a variety of goals and populations.

Previous studies have employed different experimental approaches to enhance visual function in adults with amblyopia including perceptual learning, videogame play, and dichoptic training. Here, we evaluated the efficacy of a novel dichoptic action videogame combining all three approaches. This experimental intervention was compared to a conventional, yet unstudied method of supervised occlusion while watching movies. Adults with unilateral amblyopia were assigned to either playing the dichoptic action game (n = 23; ‘game’ group), or to watching movies monocularly while the fellow eye was patched (n = 15; ‘movies’ group) for a total of 40 h. Following training, visual acuity (VA) improved on average by ≈0.14 logMAR (≈27%) in the game group, with improvements noted in both anisometropic and strabismic patients. This improvement is similar to that described after perceptual learning, video game play or dichoptic training. Surprisingly, patients with anisometropic amblyopia in the movies group showed similar improvement, revealing a greater impact of supervised occlusion in adults than typically thought. Stereoacuity, reading speed, and contrast sensitivity improved more for game group participants compared with movies group participants. Most improvements were largely retained following a 2-month no-contact period. This novel video game, which combines action gaming, perceptual learning and dichoptic presentation, results in VA improvements equivalent to those previously documented with each of these techniques alone. Interestingly, however, our game intervention led to greater improvement than control training in a variety of visual functions, thus suggesting that this approach has promise for the treatment of adult amblyopia.

The primary objective of this review article is to summarize how the neuroscience of brain plasticity, exploiting new findings in fundamental, integrative and cognitive neuroscience, is changing the therapeutic landscape for professional communities addressing brain-based disorders and disease. After considering the neurological bases of training-driven neuroplasticity, we shall describe how this neuroscience-guided perspective distinguishes this new approach from (a) the more-behavioral, traditional clinical strategies of professional therapy practitioners, and (b) an even more widely applied pharmaceutical treatment model for neurological and psychiatric treatment domains. With that background, we shall argue that neuroplasticity-based treatments will be an important part of future best-treatment practices in neurological and psychiatric medicine.

Auditory information is processed in a fine-to-crude hierarchical scheme, from low-level acoustic information to high-level abstract representations, such as phonological labels. We now ask whether fine acoustic information, which is not retained at high levels, can still be used to extract speech from noise. Previous theories suggested either full availability of low-level information or availability that is limited by task difficulty. We propose a third alternative, based on the Reverse Hierarchy Theory (RHT), originally derived to describe the relations between the processing hierarchy and visual perception. RHT asserts that only the higher levels of the hierarchy are immediately available for perception. Direct access to low-level information requires specific conditions, and can be achieved only at the cost of concurrent comprehension. We tested the predictions of these three views in a series of experiments in which we measured the benefits from utilizing low-level binaural information for speech perception, and compared it to that predicted from a model of the early auditory system. Only auditory RHT could account for the full pattern of the results, suggesting that similar defaults and tradeoffs underlie the relations between hierarchical processing and perception in the visual and auditory modalities.