Abstract
GI can impact participation in many daily tasks, including play, self-care, and social participation. Limited evidence exists to define specific interventions used in the treatment of GI, leaving therapists to rely on theory and tradition. This retrospective study reveals the most commonly used intervention techniques of therapists with advanced training in sensory integration in the treatment of GI in an attempt to define therapy interventions.
Primary Author and Speaker: Aimee Piller
Additional Authors and Speakers: Samantha Hageman
The purpose of this study was to examine and define specific interventions used in the treatment of gravitational insecurity (GI). GI is considered a pattern of sensory integrative dysfunction that is typically classified as an over responsive, vestibular reactivity issue (Mailloux et al., 2018) and impacts participation in a variety of daily tasks (Ismael et al., 2018). Research on interventions to address GI is limited, and most research focuses on clinical presentation and assessment of GI (May-Benson, 2018), even though children with GI are often difficult for therapists to understand and treat (May-Benson & Kumar, 2007). Typical treatment often utilizes graded exposure to slowly introduce changes in head position and movement to allow the child to process and integrate the information. As the child adapts to movement, the activity is graded to include higher linear and rotational accelerations, integrating the child’s vestibular system with increased stimuli (Potegal, 2015). As there is limited research on the interventions used to treat GI, this study sought to identify specific treatments used in the treatment of GI.
Researchers used a retrospective qualitative analysis using text mining to define interventions used in the treatment of GI. Participants included an analysis of charts of 100 clients ages 1-17 that had received outpatient pediatric therapy at one of three clinics located in the southwest region of the US. A narrative analysis of the initial occupational therapy evaluation was performed to determine if GI was identified within the evaluation report. A hand search for key terms such as gravitational insecurity, was used to identify a child with GI. A total of 28 of the 100 participants were identified as having symptoms consistent with GI. Of the 28, 3 were removed due to insufficient data leaving 25 total participants. Daily therapy notes of the participants were analyzed using text mining to identify the most commonly used words. A survey of occupational therapists with advanced training in SI revealed commonly used words in documentation of interventions to address GI. The words from the survey were used to run a second query on the most common words from daily notes to determine what interventions used addressed GI. Words were then placed in categories to identify types of interventions used in the treatment sessions.
Results of the study indicated four intervention strategies including vestibular, positions, tactile, and proprioceptive. Further analysis revealed twelve different types of vestibular input used in the treatment of GI. Examples of interventions included the use of specific equipment such as rocker board or therapy ball. Eight swings were identified in the notes. Changes in body position were also identified as a theme in the interventions that included changes in head positions, rotation, feet off the ground, etc. Deep pressure tactile and proprioceptive input were also common interventions mentioned in the notes.
The study concluded that four main intervention types emerged in therapist documentation in the treatment of GI including vestibular, body position changes, deep pressure tactile, and proprioceptive. This is the first study that examines the specific interventions used in the treatment of GI and provides a foundation to further define interventions and study them for effectiveness.
Ismael, N., Lawson, L. M., & Hartwell, J. (2018). Relationship between sensory processing and participation in daily occupations for children with autism spectrum disorder: A systematic review of studies that used Dunn’s sensory processing framework. American Journal of Occupational Therapy, 72, 7203205030. https://doi.org/10.5014/ajot.2018.024075
Mailloux, Z., Parham, L. D., Roley, S. S., Ruzzano, L., & Schaaf, R. C. (2018). Introduction to the Evaluation in Ayres SensoryIntegration® (EASI). American Journal of Occupational Therapy, 72, 7201195030. https://doi.org/10.5014/ajot.2018.028241
May-Benson, T. (2018). State of Understanding of Gravitational Insecurity: A Scoping Review. American Journal of Occupational Therapy, 72(4_Supplement_1):7211500011p1. doi: 10.5014/ajot.2018.72S1-PO2004.
Potegal, M. (2015). Is gravitational insecurity a unicorn? Physical Medicine and Rehabilitation International, 2(10), 1071.