Thanks to wide central connections the vestibular system is not merely involved in reflexes, but it is also connected to cognitive processes. A growing body of literature suggests that it has a substantial impact on cognitive function. These cognitive interactions include memory, attention, mental imagery, body awareness and social cognition. Spatial working memory (SWM) is a kind of short-term memory that allows to temporarily store and manipulate spatial information. It has a limited capacity and is quite vulnerable to interference. The single most important nonverbal task for assessment of visuo-spatial working memory (VSWM) is the Corsi block tapping task (CBTT), also known as the Corsi Span Test. We evaluated 263 patients suffering from chronic unilateral or bilateral vestibular loss (VL) by eCorsi Block-Tapping test before and after 5 days of instrumental vestibular training (IVT). The data were compared with those of 834 subjects submitted to the same test: 430 healthy people (HP) and 404 patients suffering from chronic VL but not treated by IVT. At all ages, the Corsi block test score was extremely statistically significantly higher (p < 0.0001) in HP than in both groups of VL. The score showed a statistically significant difference with age and sex in healthy subjects as younger males obtained the best results. Our study confirms the significant interference of the vestibular input on VSWM and impairment of this cognitive function in patients suffering from chronic UL or BIL. It also shows that IVT is able to improve VSWM even in cases where the deficit is greater.

Driving is not only a physical task, but is also a mental task. Visual inputs are indispensable in scanning the road, communicating with other road users and monitoring in-vehicle devices. The probability to detect an object while driving (conspicuity) is very important for assessment of driving effectiveness, and correct choice of information relevant to the safety of driving determines the efficiency of a driver. Accordingly, eye fixation and eye movements are essential for attention and choice in decision making. Saccades are the most used and effective means of maintaining a correct fixation while driving. In order to identify the features of the most predisposed subjects at high driving performances and those of the high-level sportsmen, we used a special tool called Visual Exploration Training System. We evaluated by saccade and attentional tests various groups of ordinary drivers, past professional racing drivers, professional truck drivers and professional athletes. Males have faster reaction time compared to females and the age below 30 seems to guarantee better precision of performance and accuracy in achieving all visual targets. The effect on physical activity and sports is confirmed. The performances of the Ferrari Driver Academy (FDA) selected students who were significantly better than those of a group of aspiring students and amateur racing drivers probably thanks to individual predisposition, training and so-called ‘neural efficiency’.

Hearing loss and chronic vestibular pathologies require brain adaptive mechanisms supported by a cross-modal cortical plasticity. They are often accompanied by cognitive deficits. Spatial memory is a cognitive process responsible for recording information about the spatial environment and spatial orientation. Visual-spatial working memory (VSWM) is a kind of short-term working memory that allows spatial information to be temporarily stored and manipulated. It can be conditioned by hearing loss and also well-compensated chronic vestibular deficit. Vestibular rehabilitation and hearing aid devices or training are able to improve the VSWM. We studied 119 subjects suffering from perinatal or congenital hearing loss, compared with 532 healthy subjects and 404 patients with well-compensated chronic vestibular deficit (CVF). VSWM was evaluated by the eCorsi test. The subjects suffering from chronic hearing loss and/or unilateral or bilateral vestibular deficit showed a VSWM less efficient than healthy people, but much better than those with CVF, suggesting a better multimodal adaptive strategy, probably favored by a cross-modal plasticity which also provides habitual use of lip reading. The sport activity cancels the difference with healthy subjects. It is therefore evident that patients with this type of deficit since childhood should be supported and advised on a sport activity or repeated vestibular stimulation.

Driving is not only a physical but also a mental task. Human errors such as misperception, information processing errors, and poor decision making are frequently identified as causes of accidents. Objective: to reduce numbers of saccadic movements (SM) and antisaccadic movements (ASM) while driving because they involve a problem of visual perception. During each one of them, the visual scene sweeps across the retina with high-speed motion with an inevitable blurring of the image, as the retina is sweeping the visual field. Object positions in retinal coordinates change, the entire visual image is not updated and humans become effectively blind but usually we are not aware of this blur during the eye movement. Therefore, reducing the number of SM allows greater precision in visual information and thus increases safety. Study Design: in collaboration with the Directorate of Specialties of the State Police of Italian Ministry of the Interior and the Autodrome of Modena we have submitted to saccadic training 23 policemen of Italian traffic police. We used Visual Exploration Training System (VET by SVEP^®) which consists in: personal computer, eyetracking system (120 Hz of frequency analisys) and new specific application software. Subjects were evaluated before and after 15 days of home training. Results: In the overall 23 cases the training significantly reduced the number of SM in driving simulation. Conclusions: our fast and easy-to-use method of saccadic training seems to be able to improve significantly both the function of visual exploration and the safety in driving. Abbreviations: ADI: Number of saccades not directed towards the target point or rather attention deficit index; ASMs: anti-saccadic movements; AT: attentional test: the subject had to maintain fixation on a target point that appeared randomly on the monitor in 50 different positions in 50 s even during the recurrent appearance of new distracting images; CORSI: score of eCorsi Span Test; GROUP A and GROUP B: groups of policemen; ORD: ordinary road drivers; RD: racing drivers; RT: average start time of ocular movements; ST: saccade test: the subject had to fix a target point that appeared randomly on the monitor in 31 different positions in 23 s; SM: saccadic movements; ST: saccade test; TIME: the time on the lap during real driving; TRT: target reaching time; VET: visual exploration training system; VETT 1: visual exploration test for evaluate SM and ASM; VETT 2: visual exploration test for evaluate the number of SM during simulated driving