that was easy um so you've today we're um just going to talk a little bit about some of the work that we've done over the past dare I say it I don't know 20 years or something um on multisensory processing and um so I I got involved in multisensory processing when I started working with John as a student even though as you can tell he's he's not older than me um and uh he got me really excited about it and um kind of started off my career in this area so um we're going to tell you about a little bit of that work so what is multisensory processing and usot I'm sure have a lot of thoughts about it um and when uh we started thinking about multi-sensory integration in a clinical context we realize that there are very different ways of thinking about multisensory processing and integration and that different groups use different languages so we'll tell you a little bit about how we think about it and approach it in our field so um obviously our sensory and perceptual systems although they're highly specialized interact extensively and this has h huge implications for how we experience the world um and uh so here you can just see some examples of you know and and let's focus in on the balance example because I think that's you know a very uh relevant to OT um and so now it's really remarkable what's been discovered about multisensory processing in the brain um and this is a slide from the work of Stein and Meredith who I think we kind of think of as the grandfathers of multisensory integration um and they did recordings in the in a brain region of the cat um called The Superior calculus and found that there were neurons in there that responded to different types of stimuli so somata sensory auditory visual um but then they also showed that these neurons got there were some of them that really really responded when you presented two of these together so that this is an example um all the way to the left of the slide in you can see a visual stimulus comes on and in the middle panel um that that's the neuron responding so just see that's it spiking over time um and you see the same thing on the bottom and then in the and then next is an auditory stimulus okay that neuron responds to the auditory stimulus but just a little bit kind of similar to how it responded to the visual but when you present these two stimula together that particular neuron goes Gang Busters and um gets really excited and it increases its response over a thousandfold so um this is this what we call Super additive multisensory integration and that's just to illustrate that you know there are neurons in the brain that actually respond in a nonlinear fashion as they're getting multisensory inputs um and uh so I think one of the really important things to think about is that and and to be aware of is that multisensory integration as we measure it has a really protract Ed developmental trajectory um meaning if you compare it to the development of the visual system or the auditory system those um systems are near near developed um much ear fully developed much earlier than multisensor integration and we'll tell you a little bit about that um and and the other thing to be aware of and and so I'm going to show you some data that show this but another thing to be aware of is is that postnatal experiences and we know this from the animal research literature hugely influence how the brain learns to integrate information from the different senses so this protracted developmental trajectory really represents an interaction of the organism with the environment getting exposure to the different multisensory inputs and we think of it as you really have to learn how to put them together in order to optimally put them together and that's been shown in animal studies where you can do dep you can do all sorts of manipulations to um make it so that one type of information doesn't get in or the animals deprived of a type of information and see how that influences development um so so the first study I'm going to tell you about and I'm just going to you know go through this quickly is um using one of the main tools that both John and I use and um so it's which is electrophysiology um and I'll show you I'll tell you a little bit more about it but um and so here what we did was we um presented can you see my cursor I no can you see it here yes okay yes you can all right good so sorry I I thought you were seeing it before um so so in this we present auditory stimula visual stimula either alone or together and um the so this is just kind of a sequence of the stimula coming along here's an audio visual stimulus visual stimulus auditory Etc and how do we measure this um to to assay is the brain how's the brain integrating this information we measure brain activ um and then we compare the brain activity when the stimula come together compared to when they come alone and if we see that the brain responds differently when these inputs come together versus the sum of when they come alone we know that that information's being integrated in the brain that's that's how we demonstrate it um and I won't go more into the details of why that is um so and here's how we do it so here's um a kid in an EEG cap it's kind of like a swim cap and these are just little sensors on the scalp um that pick up electrical activity the electrical activity is really small because there's a SC skull and scalp in between but we can actually record what the brain's doing in this way um this is your EEG that we record uh while we present those stim and what we do is we Mark the record when a given stimulus comes and then we look at the brain response to that type of stimulus by averaging many trials and we can see how the brain responds to a certain type of stimulus and um so here's what it looks like so here here you have just imagine that um swim caps on the head again and these are all the little electrodes and then we can just take data from one of those electrodes and show you what the electrical activity of the brain looks like there um this is time on the xaxis and this is the size of the signal and microvolts on the Y AIS and um this is what we call an event related potential so what we're looking at is the brain's response to the multisensory stimulus in Black that's the black trace and the sum of the unisensory stimulate that's the red trace and what I want to point out here so so these squiggles I think you know if you haven't looked at them for 10 years of your life they're kind of like what's the big deal that's a squiggle but that that's actually representing electrical activity in the brain and how it responds when a stimulus is being processed by the brain um and so you can imagine that the brain response to an input is very big and so when we see a little modulation like this it's actually quite meaningful because that's how the brain is treating these inputs differently when they come together versus when they come alone and so this is what we call multisense evidence for multisense integration and this is in adults so um if we go and look at Children Here 7 to9 years old this is the same electrode and this is the brain response to the same stimuli and maybe just focus in on this one channel um to simplify things and what you can see is that there's no difference to speak of between the multisensory response and the um sum of the unisensory responses so from from this we conclude that um there's a long developmental trajectory to how the brain integrates these inputs and um then if here we're just showing if we can look at different age groups so 7 to 9 years of age 10 to 12 13 to 16 and adults and you can see how this response emerges over development so so it's really quite remarkable how this happens and and just to um let you know the these are what we call scalp topographies so it's showing the distribution of the signal across the scalp because we record not just from one channel but from many channels and from this we can make in educated um inferences about the underlying uh neural cortical generators of the signal that we're looking at um and and now I'm going to sh in the next slide I'm going to show you just highlighting data from a sample of younger and older children with autism compared to age matched groups um just focusing in on this response here and so here's younger the response in the younger children and you can see it looks very similar between the healthy control group and the autism group TD stands for typically developing ASD for autism spectrum disorder whereas um for the older group then you're you see that uh differential response coming in there's multisensory ation but for that same age group of children when they have autism you don't see that coming in at all um so that that's quite surprising and shows that there's a developmental what we think is a developmental delay um in these kids so that brings us to the question and actually you know something that's motivated a lot of our research is um do children with autism are they failing to bind this information and is that contributing to the autism experience and maybe some of the um atypical responses to the sensory environment so um I think probably most of you know the how we Define autism but the defining characteristics are deficits in social interaction and communication and stereo yped behaviors and restricted interests those are like the two necessary criteria you have to meet but also I don't know maybe five 10 years ago they um another Criterium was kind of highlighted which is this atypical responses to sensory stimula um and you can think of that as being under reactive or overreactive now in ter terms of autism and sensory processing as as I just mentioned children with autism tend to have sensory processing difficulties or differences um being over sensitive to sound fixating on visual objects having adverse responses to some types of touch and 70 to 90% of parents report sensory issues in their child that has autism and furthermore there are some interest in anecdotal reports from um usually or always adults with autism um who have written some books about their experience and so for example Temple grandon says she thinks in pictures um and then Toto M said I could not see you and at the same time hear you the result was a knowledge of a fragmented World perceived through isolated sense organs so this is part of what motivated us to go from just trying to understand how multisensory integration works in the healthy brain to trying to understand what's what might be happening that disrupts this process how is it disrupted in this clinical group and how might that contribute to some of the clinical phenotype that we see um so I showed you very briefly a a waveform showing that multisensory integration is impaired in autism so we took we were interested in understanding how do these atypical brain responses relate to the clinical phenotype um so for that we did a regression analysis uh where we took measures of basic auditory and visual processing and multisensory integration and um we look to see how well could those predict things like autis symptom severity or Visual and auditory sensitivities and um what we found actually is that 44% of the variance in autistic symptom severity was accounted for by these Erp measures um which was quite remarkable um but maybe not surprising because you know the brain activity um map is highly related to behavior and experience um and then if we just focused in on the multisensory response MSI for multisensory integration we found that uh that accounted for a substantial part of of the um autism severity and uh so here we we separated our autism group into those with more severe symptoms um a calibrated severity score for those of you who are familiar with it of between 8 and 10 or more moderate symptoms so a calibrated severity score 5 to7 and here you can see the brain responses that they're pretty similar between those two groups but what you can notice is how different they are from the um typ AG matched typically developing group um and then so I want to go on to show you a little bit of Behavioral data I I actually think I might skip well I I'll go through it quickly so um the the Paradigm that I was showing you the electrophysiology the brain data from um participants had to press every time a stimulus came and so we got Reaction Time behavior and um so here we here's an example of reaction times to the visual stimulus and you can see there's a range of reaction times from very fast at 110 milliseconds to slower at 510 um if you look at the auditory responses there they are so these the unisensory responses reaction times are really mapping on each other and what's remarkable is that we get this big speeding of response to the multisensory stimuli so the auditory and visual stimuli when they come together and and you can see that that speeding is really evident at the faster reaction times um and so we looked at this just to also look at how these brain processes are impacting behavior and uh I'm just going to jump into this very busy slide uh that this this is mcross Dr mcross Who Um did did all the work that led to these data that I'm showing you um but just focus on this bottom panel here E and F and um these are individual data points and we're looking at age and multisensory gain and the blue dots are healthy control group neurotypical group and the red dots are the autism group and you can see how uh multisensory gain gets bigger over development um but that there's and and there's a lot of variance but if we then look at it um kind of do a smoothing function what you can see is that multisensory effects on Behavior are developing over childhood in in your um typically developing group that's the blue Trace here so we're going out that's 20 years of age um and they're also developing in the children with autism but they're kind of delayed and then by about 22 years of age they catch up so that's a key point that multisensory integration seems to be delayed in autism it's not that it never develops um and and here's another Paradigm and this this is work uh that was begun by Dr Lis Ross when he was a PhD student no a PhD student with John um and and event you know we we looked in healthy adults and then eventually translated this work to try and understand um multisensory processing in autism so this is now with instead of like boring old flashes and beeps that you know we as scientists we try and simplify everything as much as possible now now we got to slightly more complex maybe more interesting stimuli these are speech stimulate um they're monosyllabic words that are and where you have the video of somebody saying the word and you have the audio of the word and the audio AO is presented in different levels of noise so just imagine the radio when it's not well tuned you've got that fuzzy noise in the background that's layering on as somebody's talking to you and you're going what what and uh but you're really looking at their face and and it turns out that being able to see somebody articulate a word even when it's presented in noise really helps you to hear what's being said um and so so here are the data these are from adults so this is just like doing the basic work understanding multisensory integration in speech and healthy adults um and let me just unpack this chart for you here so on this axis you have uh basically this is when there's more noise the most noise down at this end and this is when there's no noise added to the words and participants are identif they're to identify the word that they hear um and this is percent correct okay when you have a lot of noise really high poor signal to noise ratio people cannot identify those words as you have less and less noise this is just the auditory alone response you can see that um word detection percent correct is getting up to 85% what what happens here is when they hear that word but they also see the video and you can see that performance increases hugely um so here you're going from 0o to 20% words correct that you can actually now hear because you can see the person articulating that word that's multisensory integration and by the way they can't identify those words when they just see the talk or speaking but they don't hear anything so you really need the audio signal and the visual signal to get this gain um the way we quantify that is we subtract the auditory from the audio visual and we can see how much gain do you get in this multisensory condition um and so this is what we call a gain curve and you can see that um at different signal to noise ratio you you get different amounts of gain but the the main point is that you're you're getting gain you get the most gain at a certain um noisiness level and of course when there's no noise you get no gain because you don't need that visual input to help you hear uh but then we more even more interestingly we looked at how does this develop over childhood and so here I'm just showing you data from um three age groups just to break it down simply 5 to 7 year olds 10 to 12 year olds and adults and if you just look at um okay here's your uh how noisy it is so minus 18 is very noisy NN is no noise um and then you have the accuracy of word identification for the three groups and the main point here is that you get a little bit of um improved performance as people get older um especially as you go from 5 to 7 to 10 to 12 just in auditory word identification um but where you really see Improvement is when you add the video so let's just jump right to the Audi visual gain curves and um so here you can can see the influence of development the 5 to seven year-olds are not able to use that visual information to improve their per speech perception as much as the 10 to 12 year olds and the 10 to 12 year olds are not able to use it as much as the adults so we see these huge changes over the course of development in the ability to use these multisensory cues um I I kind of wish we could have questions because it's hard to know if um if these things are being explained well enough for you but um you know hold hold your questions at the end and we can clarify things as needed yeah I think um Marco do you want to just let Sophie know if there's a lot of questions coming in sure yeah so far we don't have any questions but I already told our audience that if they have questions they can use the Q&A option option and we'll navigate and there there have actually there was a question in the Q&A but I've been sort of answering as we go oh okay perfect oh and yeah by the way I have a lot of questions too so interesting I'm fine with your interrupting at any point because and you're you're really clear I think what you're presenting is really clear and people are getting it so thank you I'll let you just go ahead and continue okay yeah just maybe just to for folks to go ahead and put the the questions in the Q&A section rather than the chat it's easier to follow them there and answer them for you yeah okay so so now I'm next going to present you some developmental data but now comparing children with autism their performance with um children without autism and focusing on that so here we're just looking at development um healthy development of these processes uh now here we we're looking at a age group of 7 to 9 years of age um and you can see that their performance on the auditory alone condition does not differ between the groups so kids with autism are performing just as well as the kids without autism kind of interesting because there are a bunch of studies that say kids with autism don't deal with noise as well as other people but in this context they they did deal just fine with it um but if you've gotten used to if interpreting these data we'll just jump to the gain curves you can see that the children with autism have much less gain let's just go to that Peak Point than do the um children without autism and so they're just not benefiting from these um multisensory inputs and and getting that benefit to actually hear what's being said to the same extent that kids without autism are and here this is just kind of summarizing that effect for you um now looking at 10 to 12 year olds we see much the same thing for auditory process for identification of words when they're just in the auditory modality um and then if we look at the gain curves again you can see that there's a clear difference between the groups and how much they're able to gain once that video of the person articulating the word is also present and by the way it's it's key for you to know children with autism um are known for avoiding eye contacts but um here we controlled for that and we measured it and that does not account for the differences here um so at least during the experiment they were looking at the stimuli and they were looking at them in the same way that the um control group kids were looking at it and now 13 to 14 year olds same thing ah but now when you get to uh what happens when you add the video you can see that there's not any difference between the um T the control group and the a St group if if anything the kids here the teens with autism seem to be improving more but when we kind of look at our measures that that doesn't come out significantly so um the the remarkable finding here is that in this cross-sectional study we have evidence that it seems like over the course of development children with autism are acquiring this information but maybe just the ability to integrate but maybe just at a slower rate than are the typically developing children could either be at a slower rate or you know something kicks in that makes a difference um it's it's hard to know and um most I'm sure the vast majority of you know what a cross-sectional versus longitudinal study is but that just means in our different age groups we had different children it's uh much easier to do a cross-sectional design than a um longitudinal design where you have to track kids and get measures from the same children over many years although John is doing that pretty phenomenally in another project right now um and and I'm not going to get into this now but these data I'm just going to say that we've found the same thing for continuous speech so so um you know we were talking about words and word recognition but we can also present continuous speech to people and in a multisensory context where they can see the person articulating the speech and um we find that in adulthood there do not seem to be any major differences between individuals with autism and without whereas um in children there is and um th this is just a schematic here um of what might be going on you know some some thoughts and and this is just a really like simplest simple or basic way to think about it obviously it's an incredibly complex process that we're talking about here um and and in fact in our we were chatting before the webinar started and um kind of remarking on the fact that so much of the brain is involved in multisensory integration so here I'm going to present a really simplified view um so here you have somebody talking and you have the the sound that your participant hears and the articulations that they see and that information is coming to visual cortex that's you know in the back of the brain here over occipital regions and to auditory cor cortex and the temporal lobe and somehow that information has to be synchronized right the visual articulations and the speech that's going on so that's a huge task for the brain how is this information brought together and you can imagine that if somehow the um communication between these different regions was somehow disrupted even ever so slightly that could lead to difficulty in um your ability to integrate this information and um the the reason we were thinking we came up with this schematic here is um to consider that you know the the fact that multisensory integration seems to be typical looking by adulthood and even the late teens and autism is great but we believe that having this process not work so well early in development during critical periods of development can have negative consequences that you can never go back and fix that so you know how can we you know that's why it's so important for people like you um to think about are are there ways to to help the child to kind of facilitate this process and move it earlier so that it's present at developmentally appropriate stages um so last slide kind of so so this is just basically what we've talked about today there's extremely protracted development of multisensory processing in healthy children this is a normal process um there's delayed development of multisensory processing in autism even for what what we call you know higher functioning individuals um and that these basic multisensory integration deficits have significant and possibly compounded consequences for higher or order socially relevant speech processes um however by adulthood multisensory processing as indexed by behavioral measures appears to normalize and and a brain measures we should add in there appears to normalize for many tasks and um Etc so training on multisensory integration tasks and increased exposure to multisensory events might accelerate improvements that naturally occur in um just you know some some of the people a small set of people that have um helped myself and John do some of this work I'm I'm not going to say their names because you just but but they're all wonderful people and then of course we've gotten um support from both foundations and from from uh Federal granting agencies that we're very grateful for okay so I think I will stop sharing now yeah thank you Sophie um just before we open up for questions uh John did you have any comments that you wanted to make to add to what Sophie had to say or any of the clarifications no I know I think Sophie covered it I I've been trying to answer the questions in the Q&A as we go so looking forward any questions but yeah I think so did thank you I have one question that I want to ask I have several but I'm going to focus on this one you know most of the work that you have done is on Visual and auditory system I know you've done some with tactile and what do you think what are your thoughts about whether these same phenomenon are happening in other sensory systems like tacl vestibular the old factory Etc U John you go for it if it's all you Sophie sorry um okay so yes yeah I I'm I think without a doubt that that this is not unique to Auditorium visual stimuli but it's uh represents a more General phenomenon across the sensory modalities and just how it and and there are studies that uh show impaired well that that show this amazing developmental trajectory for different sensory modalities um and a couple studies that show impaired multisensory integration for different sensory Pairs and you know it it would be nice to be able to do these studies across many different sensory modalities Auditorium visual happen to be really easy to control experimentally and so so I'm afraid that's part of the the truth is that's part of the reason that at least in my case you know so so much the work is in that area we you know I think tacti CA of sensory processing tactile processing you know all these areas are so important um and and the Technologies are improving for um presenting tactile stimula or even Al Factory stimuli to make it a little more easy to do these kind of studies yeah thank you and one of the things that I love that you said many but one of the things was when you talked about um how our uh experiences with the sensory environment the uni or the multi- sensory environment really shape and impact how the brain integrates information from the senses early on and that this may have a cascading effect all throughout the lifespan and you know in fact more more uh well more research is being done in that but there's now a um it's called the sensory first hypothesis of autism you might be familiar with it which is that very idea that the Miss or the differences in the way we perceive and process and integrate sens ation even in utero uh for the autistic brain um May set a course for an atypical neurodevelopmental trajectory because which we call autism because the um the early processing and I would argue too integration of sensation is different or a skew and then just sets up the way the brain eventually unfolds and develops and so again to all the participants that are clinicians it it underscores um the importance of uh intervention and especially early intervention you know if we can provide and help these kids have uh functional experiences I'll just say with sensation it may be helping them um down the line as well with their ability to function and just kind of riffing on on that it's it's not something I've thought about too extensively but you know that that approach is taken for communication and social engagement it's like provide it the the typical environment isn't quite doing the trick we need to exaggerate it or really you know have that be the mode where you have the parents and caregivers doing super engagement and and not getting put off if the child's not reciprocating and so likewise maybe with multisensory experiences it's like the the typical ex environment's not enough you know there's something different in the brain and but maybe by exaggerating it enhancing it actually impact and accelerate the processes the development of this processes yeah good thoughts uh thank you yeah I just add to you know this goes to it's quite similar to some of the questions that have been in the in the chat or in the Q&A um you know if you take the uh example of multisensory speech integration you know and we find we find this sort of uh recovery function quite early in the in the sort of teenage years and you know we Sophie and I and and you as well rosan we've talked about this like what what drives this and it's it's a real it's a real puzzle two I see two possible answers one is that there's a Frank difference in brain development so you can imagine a scenario whereby you know white matter tracks let's just I'll just pick something are not developing as quickly in autism but they catch up later and so the actual neural architecture is not there for multisensory speech integration and when it catches up the kids they're often smart they they learn just like like any kid uh I think that's actually relatively unlikely we I think we'd have found that in the Imaging studies over the years there may be subtle differences along those lines I think much more likely is that this is a social issue that you're a child with autism who's eight and you're spinning the wheel on the truck and you're not engaging which appears so you're not doing what the average kid does which is engaging with other people speaking all the time and looking at them and so you're really not engaging with the stimulus set you hit puberty you finally realize you know you're smart kid you finally realize that you're kind of you know you're having a hard time socializing and you get motivated to socialize and you start engaging with other kids and other people and you and because you're smart you learn just like everybody else did but you catch up at 14 years of age but it's kind of an infernal cycle because without that multisensory speech integration your interaction your abilities to interact in crowds and in noisy environments are lower through all those childhood years so it's kind of self-feeding Prof prophecy and by the time you figure out how to do it you're 14 years of age and a lot of your ability to learn how to socially interact with other kids has passed you by and know we learned that stuff when we're five and we're six and we're seven and we're at school and you know you you step out of line and the kids put you back in your place and those sort of things and so so so then you spend the a long life trying to figure out stuff that you should have figured out when you're seven or eight so I've just made that all up but that's that is a much more likely explanation in my view than some fundamental structural delay and and what I I think about that though is then that's really hopeful if there's a fundamental structural delay there's not much we can do as interventionists you got to wait for the you can't train somebody to do something with a brain area that doesn't exist yet right that's that would be the thought so but if it's a social explanation and again I think that's much more likely then then we know that the architecture is there to do this we know it can be learned at five six and seven years of age and that gives us an opportunity to get in there and and try to bring it on maybe we can't bring it on to normal levels in those early kids but we can certainly you know have a shot at it and so I I think it's a really hopeful message that's that's great one just um qualifier um most of your studies are with high functioning autistic individuals right so we don't know if this catchup occurs in those that are more severely involved and in fact I might hypothesis that it it may not I think you're almost certainly correct about that that's absolutely right so now with the provider that what we call high functioning means you know an IQ above is it 70 Sophie or 75 so so there are quite a lot of kids here who would be of moderate function at best you know they they some of these kids do have pretty pretty serious autism but some of them are some of them are super smart as well you know yeah okay Marco I'm GNA turn it over to you we've had a lot of activity coming in now so I'm going to give you the task of maybe like picking the most salient um points that uh we can ask uh doctors mohol and fox to clarify or respond to um there's this interesting question wondering um about research on neuro feedback and whether it can be applied to improving or ring this process of multisensor integration children with ASD would you like to take on that sure I think John might be answering something in the text so I'll I'll give it a go so neuro feedback I I guess you would have to have a very clear Target for for that to be effective and we don't yet know what that Target might be so you know some studies suggest that there are certain frequency bands that are more important for let's say multisensory integration so you could maybe do some neuro feedback around that to try and enhance I'm just throwing this out beta band activity it wouldn't be my first choice it seems like a unlikely that you know the this activity in some frequency band is going to have these affect this complex system in the way that we hope it would but you know it's not my field so off of that oh go ahead go ahead Marco oh no I was just kind of changing the room of the the question so if you want to add something yeah let me just say that um you know what we do when we're using occupational therapy with air sensory integration is we are providing the environment and the options for the child to engage in activities that are interesting and meaningful for them so you know it's not too far-fetched to think that we're we're following the child's lead maybe we're hitting these areas like Sophie said earlier it has it maybe it has to be more intense which is what we do you know but the whole idea and the whole active ingredients of air sensory integration sort of Target that so that we are hopefully and we I think we have some data to show that we do you know help the children improve their ability to interact world and by proy process and integrate sensation and my comment was along those lines because John was talking about motivation right and when when it seems like it plays a big role on what to do I tune in what do I attend and and I wonder when we think about multisensory integration training or or treatment and and it's often so clear in our heads that as occupational therapist that meaningful participation in in you know occupations and and play and significant activities play such a big role in how you process this sensation and how you make sense out of it and I wonder if that I mean it kind of makes me think how how important we are as occupational therapists using air sensor integration in this process yeah well yes I agree well I I think that's a nice cue to kind of mention that you know this project that we had which was we were testing we we were implementing sensory integration therapy um versus ABA and um one of our outcome measures was multisensory integration as we measure it you know as as I just showed you because thinking that these what's done in sensory integration therapy is kind of a whole body experience that really does is likely to kind of help the individual integrate information better yeah this is so cool can we can we extend this just it would be so nice we're just getting to this one hour mark and we have others things to announce so Suzanne can can we move on and take it from here yeah we can but like you Marco I'm I'm just kind of wanting to listen more and more and learn more and more from you thank you so much for presenting I'm I'm really serious about that um I find this really fascinating and and you know I was also thinking about this concept of motivation that if if the multisensory stimuli or not enhancing whatever they're perceiving then the motivation may be less to do both looking and listening simultaneously in those early years and I thought oh and you know if we can get them moving and get that vestibular system going sometimes we see that the looking coming in and then suddenly there's there's a little more awareness but we need more research so thank you for all of the work that you're doing um thank you Rosanne for for stewarding that discussion I'm going to share my screen again and all right and just to remember that you know we have our six module courses in more than 30 countries and um so look on the website and you can find the certificate program there um we will have uh two more webinars coming up in October and November and we'll be announcing those soon so put those on your calendars the same time um we're really looking uh forward to hearing more from our guest presenters and here's the finale turning it back over to to Marco thank you okay so time to announce our winners and this time the easy starit winner is Carrie teag congratulations ter Carrie and we congratulations moving to the southp equipment winner susette Mirabal so thank you so much for attending to stay till the end and congratulations and thank you all right all for being here today with us yeah thanks again sop pleasure yeah great to see you both great to see thank you that wasie such a great presentation thank you yeah and good luck with all the your future research as well thank you let's let's get tactile in there absolutely work on it yeah we'll help you oh good thank you we'll talk nobody nobody can Corral people and get participants like Zoe So if it's gonna happen all right we have published some audio tactile data so we do we have done some of it yes oh interesting for another day anything with the vestibular system um a little bit right because one of the things we we do is what we call mobile brain body Imaging um so so's actually done a bunch of this work where where we actually get people up and walking with the with the high density EG on and we we monitor them with 3D camera system so we have the kinematics and soop's looked at sort of visual vestibular stuff using motion fields and snow feels to try sort of play with the optic responses and we have some nice data there actually we're working on writing those up right now so oh that's exciting more to come yeah we we're trying it all we're trying it all yeah well thank you for your work it's really exciting yeah I know it's late there so