Results: the main areas which were modified based on participatory feedback were the variety of immersive scenarios to cover a range of ages and interests, the number of levels of complexity to ensure small improvements were measured, the feedback and reward schemes to ensure positive reinforcement, and specific provision for participants with balance issues, who had difficulties when using head-mounted displays. The effectiveness of the finalised BEARS suite will be evaluated in a large-scale clinical trial. We have added in additional login options for other members of the family and based on patient feedback we have improved the accompanying reward schemes. Conclusions: Through participatory design we have developed a training package (BEARS) for young people with bilateral cochlear implants. The training games are appropriate for use by the study population and ultimately should lead to patients taking control of their own management and reducing the reliance upon outpatient-based rehabilitation programmes. Virtual reality training provides a more relevant and engaging approach to rehabilitation for young people.

The overall aim of my research is to understand how the organisation of the synapse, with particular reference to the postsynaptic proteome (PSP) of excitatory synapses in the brain, informs the fundamental mechanisms of learning, memory and behaviour and how these mechanisms go awry in neurological dysfunction. The PSP indeed bears a remarkable burden of disease, with components being disrupted in disorders (synaptopathies) including schizophrenia, depression, autism and intellectual disability. Our work has been fundamental in revealing and then characterising the unprecedented complexity (>1000 highly conserved proteins) of the PSP in terms of the subsynaptic architecture of postsynaptic proteins such as PSD95 and how these proteins assemble into complexes and supercomplexes in different neurons and regions of the brain. Characterising the PSPs in multiple species, including human and mouse, has revealed differences in key sets of functionally important proteins, correlates with brain imaging and connectome data, and a differential distribution of disease-relevant proteins and pathways. Such studies have also provided important insight into synapse evolution, establishing that vertebrate behavioural complexity is a product of the evolutionary expansion in synapse proteomes that occurred ~500 million years ago. My lab has identified many mutations causing cognitive impairments in mice before they were found to cause human disorders. Our proteomic studies revealed that >130 brain diseases are caused by mutations affecting postsynaptic proteins. We uncovered mechanisms that explain the polygenic basis and age of onset of schizophrenia, with postsynaptic proteins, including PSD95 supercomplexes, carrying much of the polygenic burden. We discovered the “Genetic Lifespan Calendar”, a genomic programme controlling when genes are regulated. We showed that this could explain how schizophrenia susceptibility genes are timed to exert their effects in young adults. The Genes to Cognition programme is the largest genetic study so far undertaken into the synaptic molecular mechanisms underlying behaviour and physiology. We made important conceptual advances that inform how the repertoire of both innate and learned behaviours is built from unique combinations of postsynaptic proteins that either amplify or attenuate the behavioural response. This constitutes a key advance in understanding how the brain decodes information inherent in patterns of nerve impulses, and provides insight into why the PSP has evolved to be so complex, and consequently why the phenotypes of synaptopathies are so diverse. Our most recent work has opened a new phase, and scale, in understanding synapses with the first synaptome maps of the brain. We have developed next-generation methods (SYNMAP) that enable single-synapse resolution molecular mapping across the whole mouse brain and extensive regions of the human brain, revealing the molecular and morphological features of a billion synapses. This has already uncovered unprecedented spatiotemporal synapse diversity organised into an architecture that correlates with the structural and functional connectomes, and shown how mutations that cause cognitive disorders reorganise these synaptome maps; for example, by detecting vulnerable synapse subtypes and synapse loss in Alzheimer’s disease. This innovative synaptome mapping technology has huge potential to help characterise how the brain changes during normal development, including in specific cell types, and with degeneration, facilitating novel pathways to diagnosis and therapy.

Neural responses are variable: even under identical experimental conditions, single neuron and population responses typically differ from trial to trial and across time. Recent work has demonstrated that this variability has predictable structure, can be modulated by sensory input and behaviour, and bears critical signatures of the underlying network dynamics and computations. However, current methods for characterising neural variability are primarily geared towards sensory coding in the laboratory: they require trials with repeatable experimental stimuli and behavioural covariates. In addition, they make strong assumptions about the parametric form of variability, rely on assumption-free but data-inefficient histogram-based approaches, or are altogether ill-suited for capturing variability modulation by covariates. Here we present a universal probabilistic spike count model that eliminates these shortcomings. Our method uses scalable Bayesian machine learning techniques to model arbitrary spike count distributions (SCDs) with flexible dependence on observed as well as latent covariates. Without requiring repeatable trials, it can flexibly capture covariate-dependent joint SCDs, and provide interpretable latent causes underlying the statistical dependencies between neurons. We apply the model to recordings from a canonical non-sensory neural population: head direction cells in the mouse. We find that variability in these cells defies a simple parametric relationship with mean spike count as assumed in standard models, its modulation by external covariates can be comparably strong to that of the mean firing rate, and slow low-dimensional latent factors explain away neural correlations. Our approach paves the way to understanding the mechanisms and computations underlying neural variability under naturalistic conditions, beyond the realm of sensory coding with repeatable stimuli.

The evolution of speech is considered to be one of the hardest problems in science. Studies of the communicative abilities of our closest living relatives, the nonhuman primates, aim to contribute to a better understanding of the emergence of this uniquely human capability. Following a brief introduction over the key building blocks that make up the human speech faculty, I will focus on the question of meaning in nonhuman primate vocalizations. While nonhuman primate calls may be highly context specific, thus giving rise to the notion of ‘referentiality’, comparisons across closely related species suggest that this specificity is evolved rather than learned. Yet, as in humans, the structure of calls varies with arousal and affective state, and there is some evidence for effects of sensory-motor integration in vocal production. Thus, the vocal production of nonhuman primates bears little resemblance to the symbolic and combinatorial features of human speech, while basic production mechanisms are shared. Listeners, in contrast, are able learning the meaning of new sounds. A recent study using artificial predator shows that this learning may be extremely rapid. Furthermore, listeners are able to integrate information from multiple sources to make adaptive decisions, which renders the vocal communication system as a whole relatively flexible and powerful. In conclusion, constraints at the side of vocal production, including limits in social cognition and motivation to share experiences, rather than constraints at the side of the recipient explain the differences in communicative abilities between humans and other animals.