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Influence of Sensory Integration Procedures on Language Developlllent

(aphasia, apraxia, vestibular disorder)

A. Jean Ayres

(aphasia, apraxia, vestibular disorder) A. Jean Ayres Zoe Mailloux The relationship between lan- guage development

Zoe Mailloux

The relationship between lan- guage development and sensory integration was explored through single case experimental studies of one female and three male aphasic children ranging in age from 4 years, 0 months to 5 years, 3

months. 0 ther agencies had assessed all the children m the area of language development at least 6 months before the start of occupa-

tiona I therapy. Three

children had received either speech therapy, special education specific to aphasia, or both, before startmg occupational therapy. Additional baseline data on language expres- sion and comprehension, as well as on sensory integrative functIOn- ing, were gathered before begin- ning a year of occupationalther- apy that involved sensory integration procedures. Inspection of rate of language growth before

of the four

and after starting occupational therapy showed a consistent increase in rate of growth in lan- guage comprehensive concomi- tant with occupational therapy compared to prevzous growth rate. The two children with depressed postrotary nystagmus demon- strated notable gains on expressive language measures.

study gave rise to the hypothesis that some aspect of language devel- opment depended upon the matu- ration and processing of somato- sensory and vestibular input and the generalized capacity to make adap- tive responses. Since the initial study, interest in

n an early study (I) of the effect of

proced u res on

academic achievement among edu- cationally handicapped children, students with primary problems in the auditory-language domain made greater academic gains than did a matched control group. While there was a significant difference bet ween the groups in academic gain, in- spection of the data indicated that not all children with language' deficits were equally responsive. The

I

sensory integra tion

A. Jean Ayres, Ph.D., OTR, is Adjunct Associate Professor of Occupational Therapy, University of Southern California. She also IS in private practice.

Zoe Maillou\, M.A., OTR, IS research assistant to A. Jean Ayres, Instructor of Occupational Ther- apy, University of Southern Cali- fornia, and a staff therapist at T 01'- ranee Memorial Hospital, Torrance, California.

The American Journal of Occupational Therapy

383

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Table 1 Scores on Southern California Sensory Integration Tests. on Southern California Postrotary Nystagmus Test.
Table 1
Scores on Southern California Sensory Integration Tests. on Southern California
Postrotary Nystagmus Test. and on Clinical Observations
Case
A
B
C
D
Age: (years-months)
4-0
4-7
4-10
5-3
Sex
male
male
male
female
Hand
Preference
not established
right
right
left
Mean
of SV. FG, PS. DC
+0.4 SD
-1.5 SD
-0.9 SD
-1.7 SD
the association between the body
senses and language development
has continued. Furthermore, other
researchers have provided support
for this hypothesis. de Quiros (2),
for example, linked vestibular
hyporeflexia to language and learn-
ing disorders. Stilwell, Crowe, and
McCallum found a statistically sig-
nificant frequency of shortened-
duration postrotary nystagmus
among children with communica-
tion disorders. They proposed that
the "development of the language
center is in some way dependent on
previous, as well as ongoing, sub-
cortical sensory integration." (3, p
226) In a sample of 15 dysphasic
children, Rider (4) found a signifi-
cant number of abnormal postural
responses. Her study further sup-
ports the notion that vestibular and
somatosensory dysfunction may
underlie some language disorders,
particularly when viewed in light of
Ottenbacher's report (5) of strong
relationships between some postur-
al responses and duration of postro-
tary nystagmus, hence, and indirect
relationship between the vestibular
system and language development.
Educationally handicapped chil-
dren with evidence of vestibular
dysfunction have been shown to
respond to sensory integra tion pro-
cedures with academic gains (6). If
some children with language defi-
cits also exhibit evidence of vestibu-
lar and concomitant somatosensory
dysfunction, as the literature sug-
gests, it would seem reasonable to
expect them also to respond posi-
tively to sensory integration pro-
cedures.
Ki nesthesia
unable to test
+1.0 SD
-2.7 SD
unable
Manual Form Perception
+1.6 SD
-3.2 SD
-1.4 SD
-2.2 SD
Mean of FI, LTS
-1.1 SD
-2.0 SD
-1.3 SD
-3.0 SD
Imitation of Postures
-1.1 SD
-0.7 SD
-0.1 SD
-1.4SD
Mean of SB:O, SB:C
+1.6 SD
-20 SD
-2.5 SD
-2.8 SD
Mean of MAC-R, right
and left hands
-0.9 SD
-2.4 SD
+0.2 SD
-4.0 SD
SCPNT duration
-0.1
SD
-1.2 SD
-0.3 SD
-1.9 SD
SCPNT quality
irregular
irregular
directional
irregular
preponderance
Eye pursuits
adequate
poor
poor
poor
Equilibrium reactions
adequate
poor
poor
poor
Total body flexion
poor
adequate
poor
poor
Prone extension
good
poor
adequate
adequate
Motor sequencing
35
45
29
21
Praxis on verbal command
31
27
22
31
Space Visualization (SV), Figure-Ground (FG), Position in Space (PS). Design Copying
(DC), Finger Identification (FI), Localization of Tactile Stimuli (LTS), Standing Balance:
Eyes Open (SB:O), Standing Balance: Eyes Closed (SB:C), Motor Accuracy-Revised
(MAC-R), Postrotary Nystagmus (SCPNT), Standard Deviation (SD).
children with language disorders.
Through an in-depth study of four
young aphasic children, answers to
the following questions were
sought: Can a change in the rate of
acquisition of language compre-
hension and verbal expression be
observed when occupational ther-
apy, using sensory integration pro-
cedures, is introduced into the in-
tervention program of aphasic
children? Will the change iI} growth
rate be similar for both receptive
and expressive language? Will some
aphasic children respond better than
others to the therapy? If so, can the
parameters that differentiate the
good and poor respondents be iden-
tified? These questions were ad-
dressed by single case experimental
study of each child, focusing on the
nature of sensory integrative status
and the course of expressive and
recepti ve language developmen t
throughout a year of individual
occupational therapy, two 50-
minute sessions per week, using
sensory integration methods. The
overall objective of the study was to
generate,
rather
than
to
test,
hypotheses.
Method
Purpose of the Study
The purpose of this study was to
identify change in patterns of lan-
guage developmen t associa ted wi th
the institution of sensory integra-
tion methods of therapy among
Subjects. The three boys (cases A, B,
and C) in this study were diagnosed
at other agencies as aphasic without
other complications. The one girl
in the study (case D) was also diag-
nosed aphasic, but was considered
to be slow in development in all
other areas as well. At the start of the
study, ages ranged from 4 years 0
months for case A, to 5 years 3
months for case D. Each child's age
at the beginning of the study is
shown in Figures I through 4.
The sensory integrative charac-
teristics of these children were
defined through the administration
of the Southern California Sensory
Integration Tests (SCSIT) (7), the
Southern California Postrotary
Nystagmus Test (SCPNT) (8), clin-
ical observa tions of postural and
ocular responses, and two praxis
tests constructed by the authors for
research purposes.
One of the constructed tests was
384 June 1981) Volume 35, No.6

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designed to assess motor sequenc- ing skill. Following demonstration by the examiner, the child was
designed to assess motor sequenc- ing skill. Following demonstration by the examiner, the child was

designed to assess motor sequenc- ing skill. Following demonstration by the examiner, the child was re-

q uired to replica te 50 motor tasks of

a one-to-five sequence using either

unilateral or bilateral hand move- ments. For example, the examiner tapped a table first with the right fist, followed by the left fist, then with the palms of both hands. The child was expected to replica te the movements by using the opposite hands in a mirror image response. No verbal communication was in- volved in the actual test, but most items included auditory cues from clapping or tapping the table. The 50 items became successively more difficult. Two attempts to replicate each item were allowed. The test was discontinued after failure on each of two attempts of eight con- secutive items. Test-retest reliabil- ity based on the performance of four clients with generalized sensory in- tegrative dysfunction showed a mean total score agreement of 96 percent. In the second constructed test, verbal commands (without demon- stration) were given for assuming simple positions of the body and extremities. An example was: "Put your hand on your stomach." The test, consisting of 50 items, was dis- continued after failure on two attempts of eight consecutive items. Both constructed praxis tests were scored "2" for a correct performance on the firs t a ttem pt, "I" for a correct performance on the second attempt, and "0" for incorrect performance on both attempts. The higher the total score on each test, the more favorable the performance. There was 90 percent mean agreement on this test between scores on two dif- ferent testings of five clients with generalized sensory integrative dys- function. Performance of the four stud ycases on these constructed and

Figure 1

Scores on language comprehension tests and constructed language expression test (Case A)

5-0

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A

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34

40

OCCUPATIONAL

46

52

Tl-iERAPY

58

,

A

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C

OE

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F

EVENTS RELEVANT

i

G

TO

LANGUAGE DEVELOPMENT

H

Event Legend:

A Scored 2 years 5 months on Peabody Picture Vocabulary Test administered by another agency.

B Entered public school aphasia class, which he attended throughout study.

C Scored 2 years 11 months on Zimmerman Preschool Language Test, and 2 years

11 months on Peabody Picture Vocabulary Test administered by another agency.

D Started individual speech therapy one time per week.

E First baseline date obtained.

F Started occupational therapy.

G Discharged from speech therapy because of noncooperation.

H Resumed individual speech therapy two times a week.

processing tactile and vestibular

all other tests measuring aspects of

sensory integration is shown in input, in visual and manual form

Table I. Of the four children, case

A's somatosensory and motor devel- and coordina tion. If seen at an older

opment showed the least deviation age, he might be diagnosed as dis-

from age expectancy. Except for his

performance on the Imitation of tibular and bilateral integration Postures and Motor Accuracy tests, syndrome. Although right-handed, he scored more favorably than the his left hand time-adjusted raw score other three on the SCSIT and on the Motor Accuracy-Revised test

SCPNT. He could be considered was higher than his right hand

only mildly dyspraxic and without

score. Several months before case B

evidence of vestibular involvement. started occupational therapy, His intelligence was in the average another agency who evaluated his range. Hand dominance based on speech found many syntactical hand preferred for tool use was first errors and barely in telligible speech.

considered left. then later, right. When baseline data for this study

Both parents and two grandparents

were left-handed. Typical of good ta te, not ini tiate, speech. After about

were gathered, he could only imi-

perception, and in motor planning

playing characteristics of the ves-

verbal expressions after 9 months of therapy were two-word phrases such

as "Some more." Case A was highly and I'm a-a-a monster." He was

resistant to being tested and treated, absent 16 of the 100 scheduled

but he missed only 2 of the 109

scheduled treatments. termittent. Case B, judged well above aver- Case C differed from the others,

age in nonverbal intelligence by particularly in showing directional

another agency, showed deficits in

preponderance in postrotary nystag-

9 months of therapy, a typical sen- tence was, "You're a-a' pider woman

treatments. The absences were in-

The American Journal of OccupatIonal Therapy

385

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of OccupatIonal Therapy 385 Downloaded From: http://ajot.aota.org/ on 08/30/2015 Terms of Use: http://AOTA.org/terms
Figure 2 Scores on language comprehension tests, Carrow Elicited Language Inventory, and Weiss Articulation Test
Figure 2
Scores on language comprehension tests, Carrow Elicited Language Inventory, and
Weiss Articulation Test (Case B)
CASE
B
(AGE 4 -7)
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-12
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7
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19
25
31
37
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49
55
WEEKS
RELATIVE
TO START OF OCCUPAmNAL
THERAPY
AS
C
D
E
F
G
H
EVENTS RELEVANT TO
LANGl$>.GE DEVELOPMENT
Event Legend:
larly severe around the mouth. She
was considered left-handed by her
family, whose members were all
right-handed, but her right-hand
time-adjusted raw score on the
Motor Accuracy-Revised test was
more accurate than that of her left
hand. A typical sentence after 9
months of therapy was, "I wan don
piwow," for "I don't want a pil-
low." She was absent for 3 of the 96
treatments scheduled.
A Started 6-week summer session at private school; emphasis on speech.
Assessing Language Skill. Exam-
B Scored
2 years, 2 months on Peabody Picture Vocabulary Test
administered by
another agency.
C Began private, individual speech therapy, which continued to event H.
miners at other agencies had pre-
viously assessed the language com-
prehension of each child, using a
D Scored an average of 2 years, 8 months on Auditory Reception and Auditory
Association of Illinois Test of Psycholinguistic Abilities administered by another
agency.
variety of instruments. On referral
to occupational therapy, further
E First of four baseline data collections.
baseline data on receptive language
development were obtained by three
F Occupational therapy started.
or four administrations of the Test
G Entered public school aphasia class, which he attended throughout study.
H Individual speech therapy discontinued.
for Auditory Comprehension of
Language by Elizabeth Carrow (12).
The test requires the child to pick
mus. The mean duration of five
testings following rotation to the
righ twas 6 seconds or -I .1 standard
deviations (S.D.) below the mean
for 5-year-old children, and follow-
ing rotation to the left, it was 11.2
seconds or +0.2 S.D. Using the for-
mula of ]ongkees (9) and NOlTe (10)
for computing directional prepon-
derance in adults, case C showed 30
percent preponderance. This
amount, considered significant by
these authors, ProbCi.bly indicates a
lateralized brain problem. The
hyporeflexia was not in the direc-
tion most expected of a left-hemi-
sphere problem, but according to
Baloh and Honrubia (II), prepon-
derance may be either toward or
away from the lesion. A possible
indication of a left-hemisphere
problem might be found in com-
paring case C's performance on
Imitation of Postures test and two
constructed tests of praxis with those
of the other three children. Case C
could imitate the examiner's posi-
tions adequately but sequencing
motor acts (a function usually at-
tributed to the left cerebral hemi-
sphere) was difficult for him, and he
performed poorly in following ver-
bal commands to assume certain
positions. Inadequate modulation
of vestibular input was inferred from
his definite gravitational insecur-
ity. After about 9 months of ther-
apy, speech was still only partially
intelligible and there was much
jargon. A typical sentence was
"Mumbers I swing," meaning he
was going to swing a given number
of times. His absences from 23 of the
100 scheduled treatments were inter-
mittent.
The most neurologically impaired
of these children, case D, showed
generalized sensory integrative dys-
function, with vestibular and so-
matosensory processing defici ts,
hyperactivity, and distractibility.
Tactile defensiveness was particu-
one of three pictures in response to a
word or phrase said by the examiner.
In some instances the child's score
fell below the lowest age equivalent
norms given. In these cases the age
equivalence of the numerical score
was extrapolated. This test was also
given to each client at periodic
intervals during the year of receiv-
ing occupational therapy to assess
change in language comprehension
capacity. Frequency of testing and
age equivalents of scores obtained
on all audi tory comprehension test-
ings are shown in Figures I through
4.
Both baseline data and measure-
ment of change in expressive lan-
guage were obtained on cases Band
C with the Carrow Elicited Lan-
guage Inventory (CELl) (13). In this
test the child repeats increasingly
complex sentences spoken by the
examiner, and the number of errors
is tallied. Poorly articulated words
are considered correct as -long as
they are intelligible. If unintelligi-
386 June 1981, Volume 35, No.6

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Figure 3 Scores on lang uage comprehension tests and Carrow Elicited Language Inventory (Case C)

ble, they are scored as substitutions. In C's case, only the first ten items of the inventory were used. To assess expressive language in cases A and D, who could not respond to the CELl, the authors constructed a simple expressive language test. Each child was asked the same series of questions at each testing, such as "What do you like LO eat?" and "What color is this?" Performance scores were com pu t~d as the LOta I number of different words attempt- ed minus one-half the number of misarticulated words. Thus articu- lation as well as expressive vocabu- lary was represented in the lan- guage expressIOn scores. Of the four children, only case B was capable of taking a standard articulation test. To sample this aspect of language, he was given the Weiss Comprehensive Articulation Test (14) for establishing both the baseline and change of skill levels. Treatment. Occupational therapy focused on active participation in activities providing controlled ves- tibular and somaLOsensory input and eliciting adaptive responses. The severity of the children's im- pairment and their inability to organize behavior initially inter- fered with their participation in therapy. Case A accepted only the simplest active and passive vestibu- lar stimulation (mainly rotary) until about the 34th week, when he wil- lingly began to undertake the most elementary motor planning tasks. B's therapy focused on vestibular stimulation with lesser emphasis on motor planning. He was eager and inner directed, but not often in an organized manner. Case C accepted only the most simple ves- tibular and proprioceptive stimu- lating activities for most of the first half year of therapy. His gravita- tional insecurity dictated the nature of his therapeutic tasks, and he had

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(AGE

4 -10)

COMPREHENSION

ELICITED

LANGUAGE

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10

TO

16-

22

28

34

40

START OF OCCUPATIONAL

46

52

THERAPY

 

,

i

I

A

8

CO

E

F

EVENTS RELEVANT TO

LANGUAGE

DEVELOPMENT

Event Legend:

A Scored an average of 3 years, 2.5 months on Reynell Developmental Language Scale and Peabody Picture Vocabulary Test administered by another agency.

B First of four baseline data gathered.

C Started occupational therapy.

D Started individual speech therapy 3 hours per week.

E Entered public school aphasia class. Which he attended throughout the study. Discontinued individual speech therapy.

F Started developmental therapy 3 hours per week.

great difficulty staying with any but language development. Case B's

scores on the Weiss Articulation

for more than a few minutes. Test are also shown in Figure 2_

Of the four clients, Case D had the most trouble organizing her behavior, and therapy of necessity initially focused on helping her to engage in any purposeful task that would hold her attention for a

the most simple or passive activity

The timing of the various events and testing was counted by weeks forward and back from the week of the first session of sensory integra- tion therapy, identified in Figures 1 through 4 as week 1. To compare

moment. the four children on rate of change on receptive language from the time Results of initial testing at another agency

The following data for each of the to final testing for this study, the children are shown in Figures I respective curves were fitted and

through 4: I. language comprehen- sion age score assigned by agencies

seeing the child before referral LO Change in Language Compre- occupational therapy; 2. language henszon Growth Rate. Figures

I

comprehension age score on the through 5 show that the rate of Test for Auditory Comprehension growth in language comprehension of Language procured at both base- increased in all four cases when

line and periodic testing through- occupational therapy was started.

out the year of therapy; 3. baseline and periodic scores on an expressive language test: 4. an indication of

the timing of events significant to instruments other than the Carrow

The rate of change was remarkably similar among all for the first 22 weeks of therapy. The fact that

superimposed on a single graph (Figure 5).

The American Journal of Occupational Therapy

387

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of Occupational Therapy 387 Downloaded From: http://ajot.aota.org/ on 08/30/2015 Terms of Use: http://AOTA.org/terms
of Occupational Therapy 387 Downloaded From: http://ajot.aota.org/ on 08/30/2015 Terms of Use: http://AOTA.org/terms
Figure 4 Scores on language comprehension tests and -constructed language expression test (Case D) CASE
Figure 4
Scores on language comprehension tests and -constructed language expression test
(Case D)
CASE
0
(AGE 5-3)
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were used by the referral agencies
raises the question of comparability
between different language com-
prehension tests. As an additional
factor, the children each had recei ved
varying amounts of speech therapy
and special language instruction,
thus making it difficult to sort out
the effects of the different therapies.
Nevertheless, strong patterns
emerged that suggest a positive rela-
tionship between involvement in
occupational therapy and growth
in language development.
Case A was enrolled in a public
school aphasia class 35 weeks before
starting occupational therapy. Dur-
ing that time he gained an esti-
mated 5 months in language com-
prehension. His scores then showed
IO
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16
22
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34
40
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52
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RELATIVE
TO
START OF OCCUPATIONAL
THERAPY
ABC
DE
F
G
H
EVENTS
RELEVANT
TO LANGUAGE
DEVELOPMENT
Event Legend:
A Started individual speech and language therapy three times a week.
B Scored 3 years. 11 months on Peabody Language Test administered by another
agency.
C Started pUblic school aphasia program and continued in this program throughout
study.
o
Increased individual speech therapy to five times a week.
E
First baseline data obtained
for this study.
a gain of nearly 2 years in the next
F
Started occupational therapy.
22 weeks, followed by an unex-
plained decline, then a slight recov-
ery placing him about I year and 3
months above the baseline data.
G
Individual speech therapy reduced to two times a week.
H
Individual speech therapy discontinued.
The contribution of the first attempt
at individual speech therapy to this
language comprehension growth
cannot be determined because A was
discharged for noncooperation, but
it is not likely that those 15 weeks of
speech therapy were the major in-
fluence on language growth.
Case B received either private
school instruction with emphasis
on speech, or private individual
speech therapy. or both, for 47 weeks
before starting occupational ther-
apy. During that time his scores
showed a growth of I year. During
the year that occupational therapy
was added to a speech therapy or
special instruction program, he
gained more than 2 years in
scores, even though the pri va te
speech therapy was discontinued at
the 13th week of occupational
therapy.
Case C's language comprehension
response to occupational therapy is
obscured by the fact that he started
speech therapy 2 weeks after start-
ing occupational therapy. Thus his
3-year language comprehension
growth during I year of occupa-
tional therapy reflects both influen-
ces, which may account for the
slightly more rapid rise of his curve
than tha t of the other children (Fig-
ure 5).
Case D, the most severely impaired
child, received 30 weeks of individ-
ual, private speech therapy, three
sessions per week, before starting
occupational therapy. She had also
been enrolled in the public school
aphasia program for 10 weeks.
During the 25 weeks between initial
language testing and starting occu-
pational therapy. her language
comprehension scores showed a de-
cline, possibly reflecting chance
factors in testing as well as poor
response to speech therapy and spe-
cial instruction. During the year of
occupational therapy those scores
showed a 2Yi-year gain.
It is reasonable to conclude that
occupational therapy, using sensory
integration procedures, facilitated
language comprehension growth in
at least three of the four children.
Various constella tions of sensory
integrative dysfunction could not
be definitely associated with differ-
ent rates of growth because the rates
are too similar, but it is noted that
the two children with the most
severe and extensive somatosensory
processing disorder made excellent
gains, whereas case A, with a min-
imal integrative problem, gained
less.
e hange l:n Expressive Language.
None of the expressive language
tests used in this study yielded an
age-equivalent score. For these tests,
changes in raw and percentile scores
were used to roughly compare the
growth curves of the four children.
Case A showed relatively little
change in expressive language as
measured for this study, although
388 June 1981, Volume 35, No.6

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Figure 5

Fitted curves of scores on language comprehension tests of Cases A, B, C, and D.

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10

RELATIVE lD

16

22

START OF

OCCUPATlONAL THERAPY

28

34

40

46

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clinical impression was that he changed more than the formal test performance indicated. C showed a slightly greater gain, but Band D made excellent gains and definitely greater ones than did A and C. B's baseline scores on the CELl hovered around the first percentile, but his scores reached a high of the 62nd percentile within the year of occu- pational therapy. His articulation also improved from a score of 75 to 96 percent intelligibility on the Weiss Articulation Test.

Discussion

Sensory integration procedures are expected to ha ve a generalized effect on brain function resulting not only in the increased ability to use cogni- tive potential, but also the ability to organize purposeful interaction with the social-emotional environ- ment and the physical world. Gains in all of these areas were seen in each child and all may have con- tributed to the increased rate of growth in language comprehension test scores as well. Taking the lan- guage comprehension test requires a certain level of ability to organize behavior, a problem for all four clients. The child must sit and be attentive, must respond to an ex- aminer, then finally, associate audi- tory and visual stimuli. Speaking requires an even higher level of ability to organize behavior. Although occupational therapy

cannot be credited with all the changes in growth rate, it may have contributed to the child's general- ized ability to organize behavior in a way that speech therapy and in- struction did not. Neurobiological and clinical research, as well as comparison of the four children in this study, direct attention to the role of the vestibular system in both \ auditory processing and speech production. All four clients sought and received considerable vestibu- lar stimulation within the context of purposeful activity. The two children who originally tested as having a shortened duration of elic- ited vestibular postrotary nystag- mus showed greater gains in expres- SIve language than did the other two. This finding suggests a defi- nite relationship between expressive la nguage development a nd vestibu- lar processing. These observations lead to the hypothesis that vestibular sensory input and responses during therapy that tend to organize the input will promote a udi tory processi ng in those centers associated with the vestibular system. In cases in which depressed postrotary nystagmus indicates deficits in vestibular sys- tem functioning, sensory integra- tion therapy may facilitate vestibu- lar system functioning as well as any speech and language mecha- nisms dependent on that system. The fact that change in expressive

language could be associated with the occupational therapy in some cases but not others suggests that some language development prob-

lems may reflect disorder in neural systems that are not particularly dependent upon currently known vestibular or other soma tosensory processing mechanisms. Neurobiological research on lower animals and their evolution

by which

vestibular and auditory input can interact and influence sensory pro- cessingin lower animals. Thereisa long phyletic history of structural and functional association between the acoustic and vestibular systems, both in the initial formation of the systems and in the early organiza- tion of their mechanisms in the medulla and pons (15). Cell "Group Y" of the vestibular nuclear com- plex in the brain stem receives fibers from the saccular nerve. While the projections from this cell group are not exactly known, Gacek (16) re- ports that preliminary evidence indicates a possible projection back to the dorsal cochlear nucleus. Sarnat and Netsky (15) suggest tha t the inferior colliculus, which is primarily an acoustic processing center, may serve as one correlation center for auditory, tactile, and. possibly, vibratory impulses. Phy- logeny links the saccule with vibra- tion that can be interpreted as sound (15). One study on guinea pigs (17) found single semicircular canal stimulation excited 33 percent of units recorded in the inferior collic- ulus and its brachium. Fifteen per- cent of the units were inhibited by the stimulation. The authors found these results in agreement with sim- ilar da ta on ca ts and prima tes. A great deal of acoustic and semi- circular canal sensory input con- verges in the medial geniculate body of many animals. including pri-

indica tes several means

The American Journal of Occupational Therapy

389

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mates. Troiani, Petrosini, and Pal- lestrini (17) found that, in the guin- ea pig, 94
mates. Troiani, Petrosini, and Pal-
lestrini (17) found that, in the guin-
ea pig, 94 percent of the recorded
medial geniculate body units re-
sponded to canal stimulation, and
of those responsive units, 87 percent
also responded to acoustic stimuli.
Only a few units responded to
acoustic stimuli only. Fredrickson
and Schwarz (18) suggest that the
medial geniculate body, usually
considered primarily an auditory
processing center, may also be a ves-
tibular center. Fibers terminating
within the thalamic-vestibular-
cortical relay nucleus pass through
the medial geniculate body which
also receives vestibular input from
other routes. The noncortical areas
of vestibular and acoustic sensory
convergence may serve an Impor-
tant function in the auditory pro-
cessing necessary for acquiring lan-
guage comprehension.
Auditory processing, enhanced by
vestibular input, may have improved
in all four study cases and, conse-
quently, assisted in language com-
prehension in each case. That such
enhancement may not account for
expressive language growth is sug-
gested by discrepancies in speech
development among the four clients.
Some of the expressive language
gains migh t be explained by the
concept of the brain operating on
the basis of functional systems, with
many different areas or complex
mechanisms of the brain contribut-
ing to the system that enables the
development and production of
speech. The hypothesis that one of
those contributing mechanisms
involves a type of vestibular sensory
input is consistent with the find-
ings of this study. Cases Band D,
who had depressed duration nys-
tagmus, showed appreciable ex-
pressive language gains whereas
cases A and C, without depressed
nystagmus following rotation in
both directions showed little lan-
guage gains that could confidently
be attributed only to the sensory
integration procedures. Case A's
lack of progress in speech indicates
that other neurolinguistic mecha-
nisms may be involved and may
seriously in terfere with speech ac-
quisition, resulting in failure to
respond to therapy designed to affect
somatosensory and vestibular mech-
anisms. Of the four clients, case A
demonstrated the least evidence of
vestibular or somatosensory deficit.
Center's symposium, November 9,
1980, and at the American Occupa-'
tional Therapy Association's
Annual Conference in March 1981.
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hypotheses:
processing dysfunction in learning
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Acknowledgments
17. Troiani D, Petrosini L, Pallestrini EA:
The authors appreciate the help of
L. Diane Parham for reviewing the
manuscript. The study was partially
supported by the Center for the
Study of Sensory Integrative Dys-
function and was presented at that
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390 June 1981, Volume 35, No.6

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