Influence of Sensory Integration
Procedures on
Language Developlllent
(aphasia, apraxia, vestibular disorder)
A. Jean Ayres
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 of the four
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
Downloaded from http://ajot.aota.org on 08/28/2021 Terms of use: http://AOTA.org/terms
Zoe Mailloux
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.
n an early study (I) of the effect of
I sensory integra tion 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
The American Journal of Occupational Therapy
study gave rise to the hypothesis
that some aspect of language devel-
opment depended upon the matu-
ration and processing of somato-
sensory and vestibu lar input and the
generalized capacity to make adap-
tive responses.
Since the initial study, interest in
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.
383
 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 Ki nesthesia unable to test +1.0 SD -2.7 SD unable
senses and language development Manual Form Perception +1.6 SD -3.2 SD -1.4 SD -2.2 SD
has continued. Furthermore, other Mean of FI, LTS -1.1 SD -2.0 SD -1.3 SD -3.0 SD
researchers have provided support Imitation of Postures -1.1 SD -0.7 SD -0.1 SD -1.4SD
for this hypothesis. de Quiros (2), Mean of SB:O, SB:C +1.6 SD -20 SD -2.5 SD -2.8 SD
for example, linked vestibular Mean of MAC-R, right
hyporeflexia to language and learn- and left hands -0.9 SD -2.4 SD +0.2 SD -4.0 SD
ing disorders. Stilwell, Crowe, and SCPNT duration -0.1 SD -1.2 SD -0.3 SD -1.9 SD
McCallum found a statistically sig- SCPNT quality irregular irregular directional irregular
preponderance
nificant frequency of shortened-
Eye pursuits adequate poor poor poor
duration postrotary nystagmus
Equilibrium reactions adequate poor poor poor
among children with communica-
Total body flexion poor adequate poor poor
tion disorders. They proposed that
Prone extension good poor adequate adequate
the "development of the language
Motor sequencing 35 45 29 21
center is in some way dependent on
Praxis on verbal command 31 27 22 31
previous, as well as ongoing, sub-
cortical sensory integration." (3, p
Space Visualization (SV), Figure-Ground (FG), Position in Space (PS). Design Copying
226) In a sample of 15 dysphasic (DC), Finger Identification (FI), Localization of Tactile Stimuli (LTS), Standing Balance:
children, Rider (4) found a signifi- Eyes Open (SB:O), Standing Balance: Eyes Closed (SB:C), Motor Accuracy-Revised
cant number of abnormal postural (MAC-R), Postrotary Nystagmus (SCPNT), Standard Deviation (SD).
responses. Her study further sup-
ports the notion that vestibular and
somatosensory dysfunction may children with language disorders. generate, rather than to test,
underlie some language disorders, Through an in-depth study of four hypotheses.
particularly when viewed in light of young aphasic children, answers to
Ottenbacher's report (5) of strong the following questions were Method
relationships between some postur- sought: Can a change in the rate of Subjects. The three boys (cases A, B,
al responses and duration of postro- acquisition of language compre- and C) in this study were diagnosed
tary nystagmus, hence, and indirect hension and verbal expression be at other agencies as aphasic without
relationship between the vestibular observed when occupational ther- other complications. The one girl
system and language development. apy, using sensory integration pro- in the study (case D) was also diag-
Educationally handicapped chil- cedures, is introduced into the in- nosed aphasic, but was considered
dren with evidence of vestibular tervention program of aphasic to be slow in development in all
dysfunction have been shown to children? Will the change iI} growth other areas as well. At the start of the
respond to sensory integra tion pro- rate be similar for both receptive study, ages ranged from 4 years 0
cedures with academic gains (6). If and expressive language? Will some months for case A, to 5 years 3
some children with language defi- aphasic children respond better than months for case D. Each child's age
cits also exhibit evidence of vestibu- others to the therapy? If so, can the at the beginning of the study is
lar and concomitant somatosensory parameters that differentiate the shown in Figures I through 4.
dysfunction, as the literature sug- good and poor respondents be iden- The sensory integrative charac-
gests, it would seem reasonable to tified? These questions were ad- teristics of these children were
expect them also to respond posi- dressed by single case experimental defined through the administration
tively to sensory integration pro- study of each child, focusing on the of the Southern California Sensory
cedures. nature of sensory integrative status Integration Tests (SCSIT) (7), the
and the course of expressive and Southern California Postrotary
Purpose of the Study recepti ve language developmen t Nystagmus Test (SCPNT) (8), clin-
The purpose of this study was to throughout a year of individual ical observa tions of postural and
identify change in patterns of lan- occupational therapy, two 50- ocular responses, and two praxis
guage developmen t associa ted wi th minute sessions per week, using tests constructed by the authors for
the institution of sensory integra- sensory integration methods. The research purposes.
tion methods of therapy among overall objective of the study was to 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 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 y cases on these constructed and
Downloaded from http://ajot.aota.org on 08/28/2021 Terms of use: http://AOTA.org/terms
Figure 1
Scores on language comprehension tests and constructed language expression test
(Case A)
CASE A (AGE 4 -0)
5-0 W
z
4-8 iil(I) W'"
«
OJ
§~~
z~o
~(I)!l<
(I) of
WII:
3-4 130! i~
,'~"'o, ,==,~m
:: .--!,
-45 -39 -33 -9 -3 I 4 10 16 22 28 34 40 46 52 58
WEEKS RELATIVE TO START OF OCCUPATIONAL Tl-iERAPY
, I •• i i
A 8 C OE F G H
EVENTS RELEVANT TO LANGUAGE DEVELOPMENT
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.
all other tests measuring aspects of processing tactile and vestibular
sensory integration is shown in input, in visual and manual form
Table I. Of the four children, case perception, and in motor planning
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 playing characteristics of the ves-
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 gathered, he could only imi-
were left-handed. Typical of good ta te, not ini tiate, speech. After about
verbal expressions after 9 months of 9 months of therapy, a typical sen-
therapy were two-word phrases such tence was, "You're a-a' pider woman
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 treatments. The absences were in-
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-
The American Journal of OccupatIonal Therapy 385
 Figure 2
Scores on language comprehension tests, Carrow Elicited Language Inventory, and
Weiss Articulation Test (Case B)
CASE B (AGE 4 -7)
5'8
5-4

~ Ul 5-0

!Q f!= 4-8
WZ
I: 0 4·4
~::< larly severe around the mouth. She
a.. I 4-0
1§l£ 3-8 was considered left-handed by her
UL;'j
w>- 3·4 family, whose members were all
:3~Z- right-handed, but her right-hand
~w
Z~ 2-8
<t<t
..J 2-4
3-0

J time-adjusted raw score on the

Motor Accuracy-Revised test was
more accurate than that of her left
-48 ·42 -12 ·6 1 7 13 19 25 31 37 43 49 55 hand. A typical sentence after 9
WEEKS RELATIVE TO START OF OCCUPAmNAL THERAPY months of therapy was, "I wan don
AS C D E F G H
EVENTS RELEVANT TO
piwow," for "I don't want a pil-
LANGl$>.GE DEVELOPMENT low." She was absent for 3 of the 96
Event Legend: 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 miners at other agencies had pre-
another agency.
viously assessed the language com-
C Began private, individual speech therapy, which continued to event H. prehension of each child, using a
D Scored an average of 2 years, 8 months on Auditory Reception and Auditory variety of instruments. On referral
Association of Illinois Test of Psycholinguistic Abilities administered by another to occupational therapy, further
agency.
baseline data on receptive language
E First of four baseline data collections. 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. for Auditory Comprehension of
Language by Elizabeth Carrow (12).
H Individual speech therapy discontinued.
The test requires the child to pick
one of three pictures in response to a
mus. The mean duration of five could imitate the examiner's posi- word or phrase said by the examiner.
testings following rotation to the tions adequately but sequencing In some instances the child's score
righ twas 6 seconds or -I .1 standard motor acts (a function usually at- fell below the lowest age equivalent
deviations (S.D.) below the mean tributed to the left cerebral hemi- norms given. In these cases the age
for 5-year-old children, and follow- sphere) was difficult for him, and he equivalence of the numerical score
ing rotation to the left, it was 11.2 performed poorly in following ver- was extrapolated. This test was also
seconds or +0.2 S.D. Using the for- bal commands to assume certain given to each client at periodic
mula of ]ongkees (9) and NOlTe (10) positions. Inadequate modulation intervals during the year of receiv-
for computing directional prepon- of vestibular input was inferred from ing occupational therapy to assess
derance in adults, case C showed 30 his definite gravitational insecur- change in language comprehension
percent preponderance. This ity. After about 9 months of ther- capacity. Frequency of testing and
amount, considered significant by apy, speech was still only partially age equivalents of scores obtained
these authors, ProbCi.bly indicates a intelligible and there was much on all audi tory comprehension test-
lateralized brain problem. The jargon. A typical sentence was ings are shown in Figures I through
hyporeflexia was not in the direc- "Mumbers I swing," meaning he 4.
tion most expected of a left-hemi- was going to swing a given number Both baseline data and measure-
sphere problem, but according to of times. His absences from 23 of the ment of change in expressive lan-
Baloh and Honrubia (II), prepon- 100 scheduled treatments were inter- guage were obtained on cases Band
derance may be either toward or mittent. C with the Carrow Elicited Lan-
away from the lesion. A possible The most neurologically impaired guage Inventory (CELl) (13). In this
indication of a left-hemisphere of these children, case D, showed test the child repeats increasingly
problem might be found in com- generalized sensory integrative dys- complex sentences spoken by the
paring case C's performance on function, with vestibular and so- examiner, and the number of errors
Imitation of Postures test and two matosensory processing defici ts, is tallied. Poorly articulated words
constructed tests of praxis with those hyperactivity, and distractibility. are considered correct as -long as
of the other three children. Case C Tactile defensiveness was particu- they are intelligible. If unintelligi-

386 June 1981, Volume 35, No.6

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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
Downloaded from http://ajot.aota.org on 08/28/2021 Terms of use: http://AOTA.org/terms
Figure 3
Scores on lang uage comprehension tests and Carrow Elicited Language Inventory
(Case C)
CASE C (AGE 4 -10)
6-8
6-4
Z 6-0
o if)
~~ 5-8
wZ COMPREHENSION
IO 5-4
w~
0::, 5-0
0.. if)
~o:: 4-8
0<l:
U w
w>- 4-4
~~ 4-0
ELICITED
LANGUAGE
:::J
~t5 3-8
:J <l: 3-4
3-0
-26 -9 -3 I 4 10 16- 22 28 34 40 46 52
WEEKS RELATIVE TO START OF OCCUPATIONAL 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
the most simple or passive activity 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 timing of the various events
the most trouble organizing her and testing was counted by weeks
behavior, and therapy of necessity forward and back from the week of
initially focused on helping her to the first session of sensory integra-
engage in any purposeful task that tion therapy, identified in Figures 1
would hold her attention for a 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- superimposed on a single graph
sion age score assigned by agencies (Figure 5).
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 The rate of change was remarkably
and periodic scores on an expressive similar among all for the first 22
language test: 4. an indication of weeks of therapy. The fact that
the timing of events significant to instruments other than the Carrow
The American Journal of Occupational Therapy 387

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
a gain of nearly 2 years in the next
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.
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
388http://ajot.aota.org
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on 08/28/2021 Terms of use: http://AOTA.org/terms
Figure 4
Scores on language comprehension tests and -constructed language expression test
(Case D)
CASE 0 (AGE 5-3)
6-0 w
z
Z :J
O(fl 5-8 w
Vl
ViI «
zr- 5-4 CD
wZ
IO 5-0
W:::E
0:,
4-8
o..(fl
:::Eo:
O~ 4-4
U w
w>- 4-0
0Z
~- 3-8
::J
0W
Z0 3'4
~~
..J
-30 -24 -9 -3 1 4 10 16 22 28 34 40 46 52
WEEKS 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.
F Started occupational therapy.
G Individual speech therapy reduced to two times a week.
H Individual speech therapy discontinued.
speech therapy 2 weeks after start- It is reasonable to conclude that
ing occupational therapy. Thus his occupational therapy, using sensory
3-year language comprehension integration procedures, facilitated
growth during I year of occupa- language comprehension growth in
tional therapy reflects both influen- at least three of the four children.
ces, which may account for the Various constella tions of sensory
slightly more rapid rise of his curve integrative dysfunction could not
than tha t of the other children (Fig- be definitely associated with differ-
ure 5). ent rates of growth because the rates
Case D, the most severely impaired are too similar, but it is noted that
child, received 30 weeks of individ- the two children with the most
ual, private speech therapy, three severe and extensive somatosensory
sessions per week, before starting processing disorder made excellent
occupational therapy. She had also gains, whereas case A, with a min-
been enrolled in the public school imal integrative problem, gained
aphasia program for 10 weeks. less.
During the 25 weeks between initial e hange l:n Expressive Language.
language testing and starting occu- None of the expressive language
pational therapy. her language tests used in this study yielded an
comprehension scores showed a de- age-equivalent score. For these tests,
cline, possibly reflecting chance changes in raw and percentile scores
factors in testing as well as poor were used to roughly compare the
response to speech therapy and spe- growth curves of the four children.
cial instruction. During the year of Case A showed relatively little
occupational therapy those scores change in expressive language as
showed a 2Yi-year gain. measured for this study, although
 Figure 5
Fitted curves of scores on language comprehension tests of Cases A, B, C, and D.

6-4 >-
0-
6-0
...'"'"
I
Z 5-8 0-

Q", lE ...J

~~ 5-4 " ;:!

II! 0
Wz 5·0
(50 \i
0- language could be associated with
0:: ="
:J
4-8 U
CL'
="lQ 4 -4
U
o the occupational therapy in some
8~ 4-0 ~~€ 0
cases but not others suggests that
w>-
3~ 3-8 --- --- some language development prob-
<!lW 3-4 lems may reflect disorder in neural
z<!l
:3<! 3·0 systems that are not particularly
2- 8 dependent upon currently known
2-4
vestibular or other soma tosensory
-45 -39 -33 -Z1 ·21 ·15 -9 -3 I 4 10 16 22 28 34 40 46 52 58 processing mechanisms.
WEEKS RELATIVE lD START OF
OCCUPATlONAL THERAPY Neurobiological research on
lower animals and their evolution
indica tes several means by which
clinical impression was that he cannot be credited with all the vestibular and auditory input can
changed more than the formal test changes in growth rate, it may have interact and influence sensory pro-
performance indicated. C showed a contributed to the child's general- cessingin lower animals. Thereisa
slightly greater gain, but Band D ized ability to organize behavior in a long phyletic history of structural
made excellent gains and definitely way that speech therapy and in- and functional association between
greater ones than did A and C. B's struction did not. Neurobiological the acoustic and vestibular systems,
baseline scores on the CELl hovered and clinical research, as well as both in the initial formation of the
around the first percentile, but his comparison of the four children in systems and in the early organiza-
scores reached a high of the 62nd this study, direct attention to the tion of their mechanisms in the
percentile within the year of occu- role of the vestibular system in both \ medulla and pons (15). Cell "Group
pational therapy. His articulation auditory processing and speech Y" of the vestibular nuclear com-
also improved from a score of 75 to production. All four clients sought plex in the brain stem receives fibers
96 percent intelligibility on the and received considerable vestibu- from the saccular nerve. While the
Weiss Articulation Test. lar stimulation within the context projections from this cell group are
of purposeful activity. The two not exactly known, Gacek (16) re-
Discussion children who originally tested as ports that preliminary evidence
Sensory integration procedures are having a shortened duration of elic- indicates a possible projection back
expected to ha ve a generalized effect ited vestibular postrotary nystag- to the dorsal cochlear nucleus.
on brain function resulting not only mus showed greater gains in expres- Sarnat and Netsky (15) suggest
in the increased ability to use cogni- SIve language than did the other tha t the inferior colliculus, which is
tive potential, but also the ability to two. This finding suggests a defi- primarily an acoustic processing
organize purposeful interaction nite relationship between expressive center, may serve as one correlation
with the social-emotional environ- la nguage development a nd vestibu- center for auditory, tactile, and.
ment and the physical world. Gains lar processing. possibly, vibratory impulses. Phy-
in all of these areas were seen in These observations lead to the logeny links the saccule with vibra-
each child and all may have con- hypothesis that vestibular sensory tion that can be interpreted as sound
tributed to the increased rate of input and responses during therapy (15). One study on guinea pigs (17)
growth in language comprehension that tend to organize the input will found single semicircular canal
test scores as well. Taking the lan- promote a udi tory processi ng in stimulation excited 33 percent of
guage comprehension test requires those centers associated with the units recorded in the inferior collic-
a certain level of ability to organize vestibular system. In cases in which ulus and its brachium. Fifteen per-
behavior, a problem for all four depressed postrotary nystagmus cent of the units were inhibited by
clients. The child must sit and be indicates deficits in vestibular sys- the stimulation. The authors found
attentive, must respond to an ex- tem functioning, sensory integra- these results in agreement with sim-
aminer, then finally, associate audi- tion therapy may facilitate vestibu- ilar da ta on ca ts and prima tes.
tory and visual stimuli. Speaking lar system functioning as well as A great deal of acoustic and semi-
requires an even higher level of any speech and language mecha- circular canal sensory input con-
ability to organize behavior. nisms dependent on that system. verges in the medial geniculate body
Although occupational therapy The fact that change in expressive of many animals. including pri-

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 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
390http://ajot.aota.org
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on 08/28/2021 Terms of use: http://AOTA.org/terms
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.
Concluding Hypotheses
This study generates the following
hypotheses:
I. Occupational therapy, employ-
ing sensory integration procedures,
will facilitate language compre-
hension of young aphasic children
who have minimal-to-severe sensory
processing disorders. The less the
somatic and vestibular involvement,
the less gain may be expected.
2. Occupational therapy, employ-
ing sensory integration procedures,
will facilitate language expression
in young aphasic children with
moderate to severe somatosensory
processing disorder and attenuated
postrotary nystagmus. Up to a cer-
tain point, the child with a more
severe neurological impairment may
be a better candidate initially for
occupational therapy than for spe-
cial instruction and even classical
speech therapy.
Only through further research
can these hypotheses be tested and
findings from these cases be gen-
eralized.
Acknowledgments
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
Center's symposium, November 9,
1980, and at the American Occupa-'
tional Therapy Association's
Annual Conference in March 1981.
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