Identifying Gravitational Insecurity in Children: A Pilot Study

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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.

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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.

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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

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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

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Introduction

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

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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

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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

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Introduction

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

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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

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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

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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

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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

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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

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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

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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

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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

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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)

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Results
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Results
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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
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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
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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
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Results
Phase 4 developmental trends
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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.

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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.

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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

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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