Date Presented 4/19/2018
This scoping review found 22 documents on the clinical construct of gravitational insecurity, development of an assessment for this problem, and intervention techniques. Only eight peer-reviewed articles were located that addressed test development, indicating a need for more research in this area.
Primary Author and Speaker: Teresa May-Benson
Contributing Authors: Alison Teasdale
PURPOSE: Sensory modulation problems are increasingly prevalent in children; 6% of school-age children and 80% of children with autism demonstrate sensory processing problems. Patterns of sensory processing dysfunction are well documented clinically and increasingly supported by empirical research. Although discussed in nearly every text or discussion of sensory modulation dysfunction, empirical literature on one pattern of movement sensitivity, gravitational insecurity (GI), is surprisingly sparse. The purpose of this scoping review was to examine and synthesize the existing literature on GI and identify potential gaps and future research needed to better understand the nature and etiology of and intervention for this specific sensory processing problem.
METHOD: This five-stage scoping review followed the process advocated by Arksey and O’Malley (2005). The research question was, What is the state of the literature on the occupational therapy construct of gravitational insecurity? Key words included gravitational insecurity, vestibular defensiveness, vestibular disorder, vestibular hypersensitivity, vestibular dysfunction, and vestibular rehabilitation. Inclusion criteria were studies, articles, and gray literature published between 1972 and 2016 in English that specifically addressed GI in some way, not just mentioned it as one type of modulation or sensory processing problem. Five databases (MEDLINE, CINAHL, PsycINFO, Proquest, and Google Scholar) were searched. Reference lists of retrieved articles were hand searched by research assistants. Searches returned a total of 4,472 documents; 1,355 duplicates were removed, leaving a total of 3,117 documents. Titles were examined and 1,977 articles were removed as obviously irrelevant; abstracts of the 1,140 remaining articles were reviewed. Sixteen articles meeting inclusion criteria were identified, and an additional eight documents were located via hand searching. All documents were abstracted for relevant data by occupational therapy students, and the principal investigator confirmed inclusion and analyzed the documents for themes.
RESULTS: Of the 24 documents retrieved, 4 were secondary publications of other documents (e.g., newsletter article about a dissertation, scientific poster for a published poster abstract), 9 were peer-reviewed journal articles, 5 were book chapters, 4 were theses or dissertations, and 2 were peer-reviewed poster abstracts. All publications except 1 (which looked at adults) examined children aged 3–13 yr. All publications were from the United States except seven articles from India. Two clusters of study dates emerged, 1972–1989 and 2002–2016, with three authors accounting for the majority of publications. Three themes emerged regarding GI: theoretical construct, assessment measure development, and intervention strategies. All book chapters and 1 article described clinical characteristics of GI and hypothesized underlying sensory and neurological deficits, which were examined in 2 theses and 2 posters. One thesis and 8 articles examined development of the Gravitational Insecurity Assessment. All book chapters described intervention techniques.
CONCLUSION: Research on GI is sparse and largely focused on development of a standardized performance assessment and identification of GI using this tool. Gray literature (e.g., book chapters, theses, posters) described clinical characteristics of GI and intervention techniques that have become standard practice in sensory integration–based occupational therapy; however, there is currently little peer-reviewed research to support this construct or related intervention. No intervention studies specifically examined intervention for gravitational insecurity. This scoping review informs occupational therapy practice of the need to conduct more research on the underlying neurological basis and construct of GI, which can then inform intervention practices and future efficacy studies of GI interventions.
References
Arksey, H., & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8, 19–32. https://doi.org/10.1080/1364557032000119616
Ayres, A. J., & Robbins, J. (2005). Sensory integration and the child: Understanding hidden sensory challenges. Los Angeles: Western Psychological Services.
May-Benson, T. A., & Koomar, J. A. (2007). Identifying gravitational insecurity in children: A pilot study. American Journal of Occupational Therapy, 61, 142–147. https://doi.org/10.5014/ajot.61.2.142
Potegal, M. (2015). Is gravitational insecurity a unicorn? Physical Medicine and Rehabilitation International, 2(10), 1071.
