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 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

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 one’s 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 stability…lack 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 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

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 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

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 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)

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 < TD , Mean TD = 132.6, sd =1.33 Mean GI = 123.9, sd =5.87 F(1,34) = 38.035, p <.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 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.

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