BRIEF

The Effectiveness of Self-Initiated

Vestibular Stimulation in Producing
Speech Sounds in an Autistic Child
Teresa C. Ray
LornaJean King
Temple Grandin

Observations of children duringoccupational therapy at the Centerfor Neu-

rodevelopmental Studies made by therapists using sensory integration tech-
niques indicate that spontaneous vocalizations oftenincrease duringvestibu-
lar stimulation. This effect appears to be mostpronounced in autistic children
with motor problems and is most likely to occur when the children are
smiling and enjoying the stimulation. Previous research with retarded chil-
dren has shownsmall increases in vocal responses aftervestibular stimulation
(Kantner, Kantner, & Clark, 1982; Magrun, Ottenbacher, McCue, & Keefe,

Teresa C. Ray, MA,OTR, is Senior Stafflberapist at the Center for Neu-

rodevelopmental Studies, Inc., Phoenix, Arizona.
LomaJean King, OTR, FAOTA, is Director of the Center for Neurode-
velopmental Studies, Inc., 8434 North 39th Avenue, Phoenix, Arizona
85051.
Temple Grandin, MS, is a doctoral candidate at the University of
Illinois, Urbana.

Key Words: autism • cerebellum • sensory Integration. vestibular stimulation

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 mE OCCUPATIONAL 1lIERAPY JOURNAL OF RESEARCH 8:3 187

1981). The purpose of the present study was to determine the effect of
vestibular stimulation on the vocalizations of an autistic child.
The subject selected was a 9-year-old boy with a confirmed psychiatric
diagnosis of autism. Clinical diagnosis revealed dyspraxia, dysarthric speech,
low muscle tone, and sluggish activity level. His medical history revealed
delivery complications, vomiting, frequentear infections, and sleepproblems.
Hearing was adequate for speech. The electroencephalograph (EEG), com-
puterized axial tomography (CAT) scan, and spinalfluid were within normal
limits. Speech had begun to develop normally and had stopped at 21 months.
Receptive language was good, but he could utter only three recognizable
words at the start of the experiment. Whenexcited he screamedor emitted
loud sustained vowel sounds. Evaluations by the schoolpsychologist indicated
that he functioned at the levelof a 2- to 3-year-old in motor skills and social-
ization and at the level of a 1- to 2-year-old in language skills. His cognitive
functioning appeared to be at the level of a 1- to 2-year-old. The subject
attends the Developmental Day School, a privateschool for autistic children
at the Center for Neurodevelopmental Studies. Prior to the study he had
receivedsensory integration therapyfor 5 months, duringwhich he actively
sought vestibular stimulation.

MEmOD
Vestibular stimulation was provided by a Southpaw Model PS-IBOO platform
swing with a bouncer attachment. The child initiated and controlled the
motionof the swing by pushinghis feet against the floor. Each testingperiod
was divided into three parts: 5-minute pre- and poststimulation periods and a
5-minute stimulation period. Testing, supervised by therapists who had pre-
viously workedwith the child, wasconductedin a familiar therapyroom once
daily for 17 days over a 4-week period. The swing was removed during the
pre- andpoststimulation periods. The therapist did not interactwith the child
during the investigation except to tell him that he had permission to use the
swing. Vestibular stimulation was initiated and continued by the subject pro-
pelling himself in a consistent counterclockwise orbital pattern during the
entire 5-minute period.The subject had had many previousexperienceswith
the platform swing duringregular therapysessions. During the 4·weekperiod
of the study, he continued to receive sensory integration therapy in addition
to the experimental period each day.
During each I5-minutetestingperiod,the subjectwasaudiorecorded.The
percentage of time spent in vocalization and verbalization combined was
calculated for each stimulation period and averaged eachweek.Verbalizations
were distinguished by the ability of the child's music and speech therapists
jointlyto understand specific words; vocalizations were consideredanything

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188 RAY, KING, GRANDIN

else that the child emitted during the stimulation periods. The time spent
vocalizing and verbalizing was recorded both during the testing period and
later by the above therapists as they listened to the audiotape.

RESULTS
The percentage of vocalizations was significantly greater during the time the
child was using the swing than it was during the pre- and poststimulation
periods (see Figures 1 and 2). In addition, during the 4-week experiment the
subject spontaneously acquired 13 new words.

DISCUSSION AND IMPLICATIONS

Autopsy data from the brains of autistic children have revealed lower than
normal Purkinje cell counts in the cerebellum (Ritvo et al., 1986). That Pur-
kinje cells are sensitive to environmental stimulation is shown by the results
of a study by Floeter and Greenough ( 1979), which found that monkeys raised
in groups had Purkinje cells with larger dendritic trees than monkeys raised in
pairs or in isolation. The vocal response of autistic children to vestibular
stimulation gives substance to the idea that there may be a possible connec-

20
17.0
17.5

15

12.5
-...
c
u
0 10
~
7.5

2.5

0
Before During After
Vestibular Vestibular Vestibular
Stimulation Stimulation Stimulation
Figure 1. Percentage of time spent vocalizing averaged over 4 weeks

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 rns OCCUPATIONAL mERAPY JOURNAL OF RESEARCH 8:3 189

30
26.0
D Before Vestibular Stimulation
25 ~ During Vestibular Stimulation
- After Vestibular Stimulation

-e
c
eu
eu
20

15
13.0
17.0

l:l..
11.0

10

0
Week 1 Week 2 Week 3 Week 4
Figure 2. Percentage of time spent vocalizing averaged by week

tion between cerebellar abnormalities and speech difficulties in such children.

Furthermore, Rekate, Grubb, Aram, Hahn, and Ratcheson (1985) found that
acute bilateral damage to the cerebellum caused temporary speech loss even
in nonautistic children, all of whom had severely dysarthric speech while
recovering. Our observations that autistic children with more overt motor
problems have a greater vocal response during vestibular stimulation than
those with less obvious motor problems may be further evidence that speech
abnormalities are related to cerebellar dysfunction.
The substantial effect of self-initiated vestibular stimulation on vocaliza-
tions, if it can be replicated with other subjects, might provide a way to break
through the barrier to oral language that characterizes autistic children, par-
ticularly if, as in the study just described, the child is encouraged to speak
during the stimulation as well as after.
As with all single-case studies, it is difficult to generalize these findings to
other subjects. Another limitation in this particular study was that interrater
reliability data were not computed for the outcome factor. Despite these
limitations, the study demonstrates the need for more research to substantiate
our preliminary findings on the beneficial effects of self-initiated vestibular
stimulation on language development. In such research, tape recordings of
children during vestibular stimulation could be compared to recordings be-
fore and after stimulation. Children with recognizable speech could be video
recorded in a question-and-answer session with the therapist to determine
rate and fluency of speech. Articulation could be measured by audiotape
recordings of single words either read or modeled by the therapist during
stimulation and compared with sessions of no stimulation. Although the sub-

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190 RAY, KING, GRANDIN

ject in our study propelled himself in a consistent pattern, the rate and type
of vestibularstimulationmayneed to be controlled in other studies;or several
types and rates of vestibular stimulation could be compared to determine
what produces the best performance.

Acknowledgments
We wish to thank Valerie Bryan, OT&, and Nancy Park, OT&, for their many
hours of work collecting data.

REFERENCES
Floeter,M. K., & Greenough, W.T. (1979). Cerebellarplasticity: Modification
of Purkinje cell structure by differential rearing of monkeys. Science, 206,
227-229.
Kantner, R M., Kantner, B., & Clark, D.L (1982). Vestibular stimulationeffect
on language development in mentallyretarded children. American foumal
ofOccupational Therapy, 36, 36--41.
Magrun, M. W., Ottenbacher, K., McCue, S., & Keefe, R (1981). The effect of
vestibular stimulation on spontaneous use of verbal language in develop-
mentally delayed children. American Journal of Occupational Therapy,
35, 101-104.
Rekate, H.L, Grubb, R L., Aram, D.M., Hahn, }.F., & Ratcheson, R A. (1985).
Muteness of cerebellar origin. Archives ofNeurology, 42, 697~98.
Ritvo, E. R, Freeman, B.}., Scheibel, A. B., Duong, Tai Hung, Robinson, H.,
Guthrie,D., & Ritvo, A. (1986). LowerPurkinjecell counts in the cerebella
of four autistic subjects. American Journal of Psychiatry, 143, 862-866.

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