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Identifying Gravitational Insecurity in Children: A Pilot Study

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Reluctance to lie supine. Introduction. Dislike of everyday activities such as ... Supine on ball active. Tilt board ... 89% GI. 94% TD. Results. Phase 4 : ... – PowerPoint PPT presentation

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Title: Identifying Gravitational Insecurity in Children: A Pilot Study


1
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.

2
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.

3
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

4
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

5
Introduction
  • Dislike of everyday activities such as
  • Walking over bumpy ground
  • Climbing stairs
  • Stepping over objects
  • Leaning over backward
  • Climbing
  • Riding in cars

6
Introduction
  • Interfere with childrens participation
  • in daily life occupations
  • Roughhouse play
  • Play ground exploration
  • Sport engagement
  • Successful navigation of the out-of-doors on
    foot, bicycles or skates

7
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

8
Introduction
  • Shaffer (1979)
  • the emotional response experienced when ones
    ability to naturally maintain balance against
    gravity is disrupted

9
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

10
Introduction
  • Postural insecurity
  • extreme caution experienced as a result of
    decreased postural ability when completing
    physical challenges involving postural strength
    and stabilitylack fear response associated with
    gravitational insecurity

11
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

12
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

13
Introduction
  • Lavinson (1989) found that nearly all adults with
    anxiety disoder exhibited vestibulocerebellar
    dyfunctiona 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

14
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

15
Gravitational Insecurity
  • Operationally defined as
  • 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

16
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

17
Results
Phase I the operational definition may be
identified clinically by observing responses to
activities that challenge childrens 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)

18
Results
19
Results
20
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
21
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
lt TD , Mean TD 132.6, sd 1.33 Mean GI
123.9, sd 5.87 F(1,34) 38.035, p lt.001
22
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
23
Results
Phase 4 developmental trends
24
Discussion
  • is a reliable and accurate means of identifying
    children with GI
  • small sample sizesare 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.

25
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.

26
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

27
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
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