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Identifying Gravitational Insecurity in Children: A Pilot Study. Source: May-Benson, T.A. & Koomar, J. A.(2007). Identifying gravitational insecurity in children: A pilot study. American Journal of Occupational Therapy 61, 142-147. Introduction.

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identifying gravitational insecurity in children a pilot study

Identifying Gravitational Insecurity in Children: A Pilot Study

Source:

May-Benson, T.A. & Koomar, J. A.(2007). Identifying gravitational insecurity in children: A pilot study. American Journal of Occupational Therapy 61, 142-147.

introduction
Introduction
  • A sensory integration frame of reference is used to identify and provide intervention to children who are overresponsive to sensory experiences
  • However, those children who display excessive reaction to movement experiences are especially challenging for therapist to understand and treat.
introduction3
Introduction

“gravitational insecurity”

  • Ayres (1979)
  • a unique subgroup of children with sensory integration dysfunction
  • who exhibit excessive emotional reactions in response to changes in movement or head position
introduction4
Introduction

gravitational insecurity symptoms

  • Fear of falling
  • Fear of inverted head positions
  • Inability to jump or have the feet leave the ground
  • Inability to perform a somersault
  • Reluctance to lie supine
introduction5
Introduction

Dislike of everyday activities such as

  • Walking over bumpy ground
  • Climbing stairs
  • Stepping over objects
  • Leaning over backward
  • Climbing
  • Riding in cars
introduction6
Introduction

Interfere with children’s participation

in daily life occupations

  • Roughhouse play
  • Play ground exploration
  • Sport engagement
  • Successful navigation of the out-of-doors on foot, bicycles or skates
introduction7
Introduction

Ayres stated that

“ a primal threat to the pull of gravity”

“fear, anxiety, and distress whenever a child is in a position to which he is not accustomed…”

“…his fear is not rational; it comes from deep inside his brain where words and rewards have no effect”

introduction8
Introduction
  • Shaffer (1979)
  • “the emotional response experienced when one’s ability to naturally maintain balance against gravity is disrupted”
introduction9
Introduction

Ayres differentiated gravitational insecurity from intolerance to movement and postural insecurity

Intolerance to movement

great discomfort after nonthreatening stimulation of the semi-circular canals of the inner ear, usually accompanied by nausea, vertigo, or headache

introduction10
Introduction

Postural insecurity

extreme caution experienced as a result of decreased postural ability when completing physical challenges involving postural strength and stability…lack fear response associated with gravitational insecurity

introduction11
Introduction

gravitational insecurity is conceptualized as

  • A subtype of sensory integration dysfunction
  • Characterized by decreased vestibulocerebellar functioning and possibly decreased vestibular-occular integration

High arousal and irrational limbic system

Fear responses to sudden or disorienting movement experiences

introduction12
Introduction
  • A number of researchers have supported the relationship of vestibulocerebellar dysfunction to increased arousal state, anxiety, and fear responses
  • Koomar (1995) found a strong relationship between anxiety and gravitational insecurity in a group of teens with dyspraxia
introduction13
Introduction
  • Lavinson (1989) found that nearly all adults with anxiety disoder exhibited vestibulocerebellar dyfunction…a major contributing factor to fear responses

Fear of heights, elevators, crowds, amusement park rides, escalators, and plans- that are commonly found in persons with GI

purpose
Purpose
  • was to develop an assessment to identify children with gravitational insecurity
    • to examine preliminary reliability and validity for the GI assessment
    • to examine developmental age trends
gravitational insecurity
Gravitational Insecurity

Operationally definedas

an abnormal, excessive display of emotion characterized by fear or anxiety when engaged in an activity involving (a) a change in head position; (b) movement onto a raised or unstable surface; (c) movement through space; or (d) disorienting, or lack of visual stimuli

method
Method

The study was divided into 4 phases.

  • Initial Planning and construct specification
  • Test construction and pretesting
  • Pilot testing for discrimative ability
  • Preliminary validation of developmental trends
results
Results

Phase I: the operational definition may be identified clinically by observing responses to activities that challenge children’s vestibular system

Phase II: Preliminary test activities, item format& scoring criteria were developed …resulting in 15 tasks (table1)

…3 categories of behavior response to be rated for each task (table 2)

results20
Results

Phase II: Interrater by Interclass correlation coefficient

.79 for total score

.91 for postural subscore

.71 for emotion

.23 for avoidance

.49 - .97 for items

results21
Results

Phase III: Discriminative ability of the GI Assessment

2 groups of children, ages 5-10 year old

GI, n= 18

TD, n= 18

One-way Analysies of Variance

Total score

GI < TD ,

Mean TD = 132.6, sd =1.33

Mean GI = 123.9, sd =5.87

F(1,34) = 38.035, p <.001

results22
Results

Phase III: Discriminant analysis of total score

83% GI

100% TD

were correctly classified.

Stepwise discriminant analysis

4 items

Backward roll

Jump off chair- eye closed

Supine on ball – active

Tilt board … 89% GI

94% TD

results23
Results

Phase 4 : developmental trends

discussion
Discussion
  • is a reliable and accurate means of identifying children with GI
  • small sample sizes…are a limitation.
  • further studies are needed
    • to refine this tool and
    • to establish the reliability and validity of the revised version before it may be routinely used.
discussion25
Discussion
  • The strength… is the ability to discriminate between groups
    • even when the participants have a minimal degree of GI…
    • this sensitivity may allow the tool to be used for test-retest purposes.
  • Collaboration with professions
    • may facilitate development of the most effective assessments and interventions for GI.
discussion26
Discussion
  • Content of the 9 significant tasks validated the 3 different movement components of the operational def. of GI
  • Tasks that assessed responses to direct visual stimuli were not found to contribute strongly to the total score, other sig. tasks did incorporate visual components; therefore, visual perception should not be excluded from the construct
discussion27
Discussion
  • Examination of the GI Assessment and measures of anxiety, other emotional indicators, physiological responses and involvement in daily occupations
    • would help identify the relationship of GI to emotional difficulties, arousal state, chronic stress, and occupational performance