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elationship of the Southern Ca ifornia Sensory Integration Tests, the Southern California Postrotary NystagOlus Test, and Clinical Observations AccoDlpanying TheOl to Evaluations in Otolaryngo ogy, Ophtha lllology, and Audiology: Two Descriptive Case Studies (auditory sequential memory, research, sensory integration, testing procedures, vestibular system) Charlotte Brasic Royeen George Lesinski Sharon Ciani A prelzmmary investzgation was conducted into the relatlOnshzp of the Southern Califorma Sensory Integration Tests (SCSIT), the Southern Californza Postrotary Nystagmus Test (SCPNT), and c/imcal obsenmtions accompanymg these tests to evaluations in otolaryngology, ophthalmology, and audiology. The subjects were Iwo children with vestibularly based sensory integratme dysfunction. The results revealed that David Schneider there was no agreement between the results of the SCPNT and the otolaryngologzcal evaluation. There was some agreement between the ophthalmology evaluatzon and the clzmcal observaizons accompanying the SCSIT. Both subiects scored poorly m two areas of auditory process mg. Possible reasons for these results are discussed as well as implicatzons for occupational therapy research and practice. The Amerzcan Journal of Occupational Therapy Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930553/ on 06/12/2017 Terms of Use: http://AOTA.org/terms 443 heSouthern California Sensory Integration Tests (SCSIT), the Southern California Poslrotary Nystagmus Test (SCPNT), and clinical observations accompanying these tests have been developed by Ayres as a method of evaluating sensory integrative dysfunction in learning-disabled children (I, 2). These diagnostic procedures are derived from Ayres' theory of sensory integration as proposed in her book, Sensory Integration and Learning Disorders (3). A few researchers, such as Ottenbacher (4, 5) and DeGangi (6) have attempted to clarify and identify characteristics of sensory integrative dysfunction in children. Other researchers have begun empirical examinations by correlating the SCSIT to other tests (7). Kimball (8), correlating the SCSIT to the Bender-Gestalt, found that, T Charlotte Brasic Royeen, M.S., OTR, was a Graduate Fellow in Occupational Therapy, Program in Occupational Therapy, Washington University, School of Medlcme, St. Louis, Missouri, when this investigation was conducted. She IS now an instructor, Howard Umversity, Washington, DC. George Lesinski, M.D., is Associate Professor of Otolarynology and Maxillofanal Surgery, UniverSIty of Cincinnati Medical Center, Cincinnati, 0 hlO. Sharon Ciam, M.A., is Assistant Professor of Cllmcal Audiology, University of Cmcinnal1 Medical Center, Cincmnati, Ohio. DaVId Schneider, M.D., IS an ophthalmologist, Resident, University of Cmcmnati Medical Center, Cincmnati, Ohio. 444 since the Bender-Gestalt could predictchildren's performance only for certain components of the SCSIT, the Bender-Gestalt might effectively serve as a screening device for sensory integrative dysfunction if observations of the child's postural mechanisms were included. Some investigators have related the SCSIT, or components of it, to particular disabilities (7). To ill ustrate, Stilwell and others, studied postrotary nystagmus (measured by a procedure based upon the SCPNT) as a function of communication disorders (9). It was found that hyporeactive nystagmus related to disorders of articula tion and language. Other researchers, using the SCSIT as a basis for occupational therapy procedures, compared the relationship between occupational therapy and physical therapy test scores (10). They concluded that each discipline's evaluation was important. With regard to the SCSIT, however, there is an apparent lack of cooperative research among disciplines interested in the learningdisabled child. Consequently, it is often difficult to relate characteristics of sensory integrative dysfunction, measured by the SCSIT, the SCPNT, and clinical observations accompanying these tests, to data from other professionals. Moreover, areas for further research may be defined more clearly with an interdisciplinary approach to the evaluation of sensory integrative dysfunction in the learning-disabled child. Therefore, researchers need to investigate the relationship of results of the SCSIT, the SCPNT, and clinical observations accompanying these tests to the results of other evaluations. Ayres (II, 12) concl uded tha t particular forms of vestibular system dysfunction, characterized by hyporeactive nystagmus, could be ameli- orated by sensory integrative treatment. In consideration of the importance of a diagnosis of vestibularly based sensory integrative dysfunction (as revealed by the SCSIT, the SCPNT, and clinical observations), the medical specialty of otolaryngology should be incl uded in an interdisciplinary evaluation. Otolaryngologists have long been involved in testing of the vestibular system, particularly since Baranay first introduced the spinning test in 1907 (13). More recently, otolaryngologists use caloric testing with electronystagmography during evaluation of the vestibular system (14). A study by Mathog compared normal and abnormal adult male's performance during caloric and sinusoidal evaluation of the vestibular system (14). He found that use of the sinusoidal test, in addition to caloric testing, revealed a more complete understanding of the vestibular system than caloric testing alone. Therefore, in order to further examine occupational therapy procedures that theoretically examine vestibular system function, the SCPNT and clinical observations of hypersenitivity to movement and gravitational insecurity will be compared to results obtained from an otolaryngological examination. Rotational stimulation of the horizontal semicircular canal. which occurs during any spinning test, excites neurons in the eat's hypoglossei nuclei and nuclei within the reticular formation near the abducens nucleus; these regions are thought to be important in oculormotor control (15). Since components of the SCSIT evaluate visual perception and somE' of the clinical observations accompanying the SCSIT evaluate visual-motor integration, ophthalmology could be used to further examine the SCSIT. July 1981, Volume 35, No.7 Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930553/ on 06/12/2017 Terms of Use: http://AOTA.org/terms Table 1 SCSIT Standard Scores (s.s.) for Subjects Subject 1 Age: 6 yr, 11 mo, 21 days Test Subject 2 Age: 10 yr, 1 mo, 24 days 5.5. Test 5.S. Manual Form Perception -1.5 Standing Balance: Eyes Closed Crossing Midline -1.3 Localization of Tactile Stimuli' below -4.0 Crossing Midline: Crossed -1.3 Standing Balance: Eyes Open' -2.5 Localization of Tactile Stimuli -1.1 Space Visualization -2.5 Motor Accuracy: Left -0.9 Design Copy -1.6 Standing Balance: Eyes Closed -0.9 Imitation of Postures' -1.2 Finger Identification -0.5 Crossing Midline' -1.1 G raphesthesia -0.5 Finger Identification' -1.1 Standing Balance: Eyes Open -0.2 Graphesthesia' -0.8 unable!O perform Position in Space -0.1 Motor Accuracy; Left" -0.7 Motor Accuracy: Right +0.0 Bilateral Motor Coordination' -0.7 Kinesthesia +0.0 Crossing Midline; Crossed' -0.5 Bilateral Motor Coordination +0.0 Figure Ground -0.4 Space Visualization ;-0.0 Kinesthesia' -0.2 Imitation of Postures +0.3 Manual Form Perception' -0.1 Double Tactile Stimuli +0.5 Right Left Discrimination' +0.0 Design Copy +0.9 Motor Accuracy; Right' ...0.1 Figure Ground ;-1.2 Double Tactile Stimuli' +0.2 Position in Space +1.0 'Indicates that the score was reported according to how a child aged 8 years-11 months (the ceiling age on these tests) would score; such scores falling in the low average range or below suggest deficit areas in a child aged 10 years-1 month. Tht>refore, results dt>rived from tht> SCSIT and clinical observations will be compared toresultsobtained during an ophthalmological exam. Audiology is a third area particulelrly relevant to theSCSIT, SCPNT, and the clinical observations accompanying the tests. Ayres (16) used an audiologic test, dichotic lis- tening. with the SCSIT to study ear advantage in learning-disabled children. Sht> found that children with Imv right-left t>ar ratios were more likely to have language difficulty elnd Jess likely to have ~omat osensory problems (16). In additional. Ayres routinely used the dichotic listening test as a diagnos- tic tool to supplement the SCSIT. the SCPNT, and clinical observations accompanying these tests (17). Consequently. audiology was the third discipline chosen to assess the results of a sensory integrative evaluation. Initial investigation into therelationship of the SCSIT. the SCPNT, and tht> clinical observations accompanying thest> tests to evaluations in otolaryngology, ophthalmology. and audiology will bt> explored by studying' two descriptive case studies. Methods SubJects. Two leelrning-disabled children were subjects. Subject I was referred to occupational therapy because his first grade teacher felt he was distractible, with problems in visual tracking and language skills. Subject 2 was referred to occupational therapy because a psychological evaluation revealed possible sensory integrillive dysfunction. The parents, who had initially sought help wht>n informed that ht> would not pass fifth grade; felt him to be distractible, passive, and immature. An occupational therap) t>valuation indicating vestibularly based sensory integrative dysfunction WelS a criterion for subject sekctjon. The subjt>cts' scores on tht> SCSIT are presentt>d in Tablt> 1. Finally, parental consent toallow their child to participate in extensivt> and somewhat time-consuming testing was another critt>rion for subject se]ection. Procedure. Subjects were scheduled for evaluations in otolaryngology. ophthalmology, and audiology. EXCt>PI [or occupational therapy. testing occurred over a 2week period. Occupational therapy evaluations occurred 5 months (subject I) and 2 months (subject 2) The American Ioumal of Occupational Therapy Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930553/ on 06/12/2017 Terms of Use: http://AOTA.org/terms 445 before the testing period. Table 2 presents the specialty area, apparatus used, and method of eval ua tion. Limitations of the Study. Since the current study merely initiates preliminary investigation into the SCSIT, the SCPNT, and the clinical observations accompanying these tests, two subjects were used. As such, only tentative conclusions can be made. Inter-rater reliability was not computed on the more subjective testing procedures employed by the different examiners. However. each occupational therapy evaluation was performed by a therapist certified in sensory integration, and each of the other disci pltne's eva Iuations were performed by licensed professionals. Analysis of the Data involvement such asjerky eye tracking, relatively gross tracking and midline cogwheeling. The right eye has a persistent pupillary membrane, which has created a mild amblyopia. Consequently, the subject cannot use both eyes together well. Audiology (8/14/79): During 60 trials of the Berlin Dichotic Consonant Vowel Test presented in the simultaneous condition, the subject answered correctly 44 times with 29 right ear responses and 15 left ear responses. The Staggered Spondaic ''''ord Test, the Speech-in-Noise Test, and the test of Impedance Audiometry were within normal limits. However, the subject displayed LOtal inability to perform during; the Wepman and Morency Test of Auditory Sequential Memory. Results (Subject 1) Occupational therapy (3127/79): Inadequate specialization of the cerebral hemispheres was indicated by Space Vi'iualization Contralateral Hand Use Score of 27, lack of agreement for preferred hand and eye. and marginal skill in the preferred hand. Vestibular system dysfunction was indicated by hyporeactive nystagmus (SCPNT S.s. :: -1.8), coupled with poor prone extension, and bilaterally involved postural mechanisms. Evidence indicates poor tactile discrimination and poor bilateral integration as well as poor ocular-motor control. Otolaryngology (8/1/79): There is no significant spontaneous or horizontal gaze nystagmus. DixHallpike and position testing were entirely normal. Hot and cold caloric testing shovvs no significant reduced vestibular response or directional preponderance. This is essentially a normal ENG. Ophthalmolog:v (8/1/79): There are signs of minimal neurological 446 Results (Subject 2). Occupat1Onai therapy (6/23/79): Developmental dyspraxia was indicated by a below normal score on Imitation of Postures, Design Copy S.s. of -1.6, and marginal skill in use of both hands on Motor Accuracy. Such dyspraxia originated from poor integration of tactile and vestibular information evidenced by the following. Three of the five tactile tests were significantly low and the other two were questionable. Difficulty in processing vestibular information was evidenced by gravitational insecurity, intolerance to spinning during the SCPNT (he would not complete the test after spinning to the left), inability to perform Standing Balance wi th Eyes Closed, and duration of nystagmus on the SCPNT of 6 seconds after spinning to the left. The subject was tactually defensive, had poor bilateral motor coordination, poor visual spatial skills, poor ocular motor control, and inadequate hemIspheric specialization indicated by a Contralateral Hand Use 'icore on Space Visualization of 26. Otolaryngology (8/9/79): ENG testing shows no significant spontaneous horizontal gaze nystagmus. St<:lndard position testing and Dix H llpike position testing were negative. Optokinetics and pendular tracking were symmetrical. Hot and cold caloric testing demonstrated no significant reduced vestibular response or directional preponderance. This was essentially a normal ENG. Ophthalmology (8/1179): Normal ocular pursuits were observed. Some skipping of the midline while tracking wi th the eyes was eviden t, but this was within normal limits. Mild esophoria was noted, also within normal limits. Difficulty with visual acuity was noted with the Snellen Eye Chart. Audiology (8/7/79): During 60 trials of the Berline Dichotic Consonant Vowel Test in the simultaneous condition, the subject answered correctly 48 times with 22 right ear responses and 26 left ear responses, indicating a left ear advantage. The subject could not perform the Staggered Spondaic Word Test, which indicates a problem with competing type stimuli. He performed twice as poorly with his left ear <:IS he did with his right. Speech-in-Noi.'ie Test and Impedance Audiometry were within normal limits. The subject was definitely lacking in the ability LO perform the Wepman and Morency Auditory Memory Test. Discussion Relationship of the SCPNT and Clmlcal Observations to the OtoLaryngology EvaluatIOn. Inspection of the data from the evaluations in occupational therapy and oLOi<:lryng010gy reveals contradictory infor- July 1981, Volume 35, No.7 Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930553/ on 06/12/2017 Terms of Use: http://AOTA.org/terms Table 2 Specialty Area, Apparatus Used and Method of Evaluation Specially Area Apparatus Used Method of Evaluation Occupational Therapy (1, 2, 3, 17) SCSIT Test Kit SCPNT Spinning Board SCPNT Angle Guide stop watch Southern California Sensory Integration Tests Southern California Postrotary Nystagmus Test Clinical observations of muscle tone, reflex development, ocular and oral motor contrOl, eyes and hand preference and movement through space Developmental history Otolaryngology (18,19,20) Electronystagmographic equipment Film projector and films for optokinetic testing Irrigation equipment and temperature controlled water reservoir for caloric stimulation Lights mounted in the ceiling for eye tracking for calibration Spontaneous nystagmus (eyes open and eyes closed) Standard position testing. Dix Hallpike position testing Pendular tracking Optokinetic nystagmus Warm and cold caloric testing Ophthalmology (21) Snellen Eye Chart Ophthalmoscope Snellen Chart of Visual Acuity Ophthalmoscopic examination Clinical observations of eye tracing and convergence History of visual performance Audiology (20, 22) Grason Stadler Sudiometer 1701 Berlin Dichotic Consonant Vowel Test Staggered Spondaic Word Test Speech in Noise Test Impedance Audiometry Wepman and Morency Auditory Memory Span Test mation. The SCPNTevaluation on subject I revealed hyporeactive nystagmus (-1,8 s,s,), whereas the otolaryngology evaluation determined the subject'S nystagmic response as within normal limits, Similarly. the SCPt\'T and clinical observations revealed Subject 2 as hypersensitive to movement. gravitationally insecure and demonstratll1g a questionable nystagmic response (6 ,ec). whereas the oLOlaryng'o)ogy eval uation found the nystagmic response within normal limits, Consideration of the tests may give insight ect I) and 2 months (subject 2) before the testing period, Table 2 presents the specialty area, apparatus used, and method of evaluation, LzmitatlOns of the Study, Since the current study merely initiates preliminary investigation into the SCSI ,the SCPt fT, and the clinical observations accompanying these tests. two subjects were used, As such, only tentatiVt' conclusions c<ln be made, Differences in test mechanics should be considered. The SCPNT. like the Baranay spinning tesL. stimulates both of the subject's edrs simultaneously, but limits caloric stim ula tion to one ear at a time (20), The SCPt\'T illlows for visual fixation ,,,ith the subject's eyes opt'n and the subject positioned in a light room, Conversely, ENG recorded nystagmus during caloric stimulation allows for removal of visual fixation by having the subject close his eyes while positioned in a dilrkened room; th is allows for a greil ter and more easily measured nystagmus (20). The SCPNT has the subjecl perform no concentration task a nd therefore allows for cen tra I suppression of n) stagmus, During oto]aryngologicill examination, in The American Journal of Occupational Thempy Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930553/ on 06/12/2017 Terms of Use: http://AOTA.org/terms 447 order to minimize central suppression of nystagmus, the subject is instructed to perform a concentration task aloud (20). Consequently, the combination of differences in test mechanics may account for the discrepant results between evaluations in occupational therapy and otolaryngology. The SCPNT measures duration of nystagmus, whereas electronystagraphy during caloric stimulation measures amplitude of nystagmus. During occupational therapy clinical observations, the subjEct's physiological and emotional responses to movement are monitored. These aspects are not monitored during the otolaryngological examination. Thus, it may be thatduring occupational therapy clinical observations of a subject's emotional and physiological responses to movement, different aspects of vestibular system functioning are considered which are as important as the nystagmic response for diagnosis of vestibular dysfunction (23). Differences in the normative sample must also be considerEd as possible reasons for differences in the occupational therapy and otolaryngology test results. The results of the occupational therapy Evaluation were com pared to norms developed by Ayres and replicated by Royeen for children aged five through nine. (2, 24). Inspection of some of the research from which otolaryngology derives normatiVe' data revealed the youngest subject to be 19 (25). ConsequEntly. the otolaryngological evaluation uses adult norms as a rderence, whereas the occupational therapy evaluation uses children's norms. This difference may account for thE discrEpancy bet ween the eval ua tion results in occupational therapy and otolarvngology. Finally, the following statemEnt 448 implies the possibility of caloricrota tional dissocia tion. Occasionally, the calonc and rotational test results do not agree. For example, there may be a rotational directional preponderance but not a caloric directional preponderance; or there may be a caloric bilateral weakness but normally intense rota.tional nystagmus. Animal experiments suggest that such caloric-rotational dissociation may b(' a central sign. However, this possibility has not been systematzcally studied in humans. (25, p 750) M. H. Stroud found that caloric abnormalities persisted longEr than postrotary abnormalities (caloricrotational dissociation) when brainstem lesions were performed on cats (26). It is provisionally hypothesized that a similar phenomenon, dissociation or lack of agreement between caloric and spinning tests, may also occur in learning-disabled children and hence, explain why the results were discrepant between the otolaryngology and occupational therapyevaluations. In additional. it should be noted that the duration of nystagmus as measured by the SCPNT may, in fact, have no direetcorrelation with the vestibular system. Rather, it may reflect the subject's state of central alerting. anxiety, visual acuity, and ability to visually fixate and suppress nystagmus more accura tel y than it directly measures vestibular system integrity. The need for continued research in this area is the major conclusion drawn from this discussion regarding the discrepancy betWEen the evaluation results in occupational thera py and otolaryngology. A study with a large enough sample toallow for statistical analysis investigating the correlation between caloric test- ing and the SCPNT is needed. Also, research investigating the reliability of the SCPNT with a learningdisabled population needs to be conducted in order to determine if central alerting and anxiety of the subject significantly affeer the SCPNT's reliability. In conjunction with otolaryngologists, occupational therapy researchers may develop normative data and operationally define procedurES for measurement of hypersensitivity to movement (physiological response) and gravitational insecurity (emotional response) to movemen t. Finally, norms for children teqed by caloric stimulation may be further developed Relationship of the SCS1T and Clinica.l ObseriJatzons to the Ophthalmology Eva luations. Genera]] y, there was agreement between the occupational therapy and ophthalmology evaluation concerning Subject I, and disagreement between the evaluations concerning Subjecr 2. Occupational therapy clinical observations of Subject I revealed poor ocular motor control as evidenced by his inability to smoothly cross the midline with his eyes. In addition, the ophthalmological Evaluation revealed that the subject could not smoothly track an object across the horizontal plane with his eyes, and that the subject was probably ambloyopic due to a persistant pupillary membrane in his right eye. However, consideration of the evaluation results of Subject 2 disclosed the following discrepancies between the occupational therapy and ophthalmology evaluations. First, occupational therapy clinical observations revealed that the subJect frequently manifested a midline skip while tracking an object with his eyes. Ophthalmology evaluation revealed that the subject July 1981, Volume 35, No.7 Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930553/ on 06/12/2017 Terms of Use: http://AOTA.org/terms manifested a midline skip but judged the problem to be within normal limits. Second, the occupationaltherapy clinical observations found poor overall quality of the subject's eye tracking. The ophthalmology evaluation found the subject's eye tracking ability within normal limits. Third, occupational therapists clinically observed that Subject 2 had difficulty with eye convergence. Conversely, the ophthalmologist determined that the subject's eye convergence was within normal limits. Of additional interest was the tentative finding by the ophthalmologist that Subject 2's visual acuity was depressed; a full eye examination was prescribed. Upon hearing this, the subject's mother commented. ''I'm surprised, he is always the first one to read the road signs." It ma y be tha t the su bject's very poor visual spatial skills, as indicated during occupational therapy evaluation of a Space Visualization s.s. of -2.5, affected his ability to perform visual acuity tasks as tested by the ophthalmologists. One explanation for the discrepancies in evaluations by the opthalmologist and occupational therapist can be testing error by the occupational therapist. Or, it may be that the lack of standardized norms and consequent use of clinical judgment by the occupational therapist and the ophthalmologist allowed them to view the phenomenon differently. What one professional considers abnormal may be considered normal by the other. Thus, it may be that in working with a population of learningdisabled children, occupational therapists are evaluating and judging very subtle problems, whereas, the ophthalmologist may be evaluating from a reference point of pathology and disease. Additionally, many learning-disabled children are inconsistent in their responses and rna y vary in performance from da y to da y. Such fl uctua tion in performance migh t accoun t for the discrepancy. Unfortunately, none of these explanations can be appraised empirically due to the lack of experimental data on the subject. Instead, opera tiona II y defined proced ures of ocular performance in children may offer more objective and meaningful information. Relationship of the SCSIT, the SCPl\ T, and Clzmcal Observations Accompanyzng These Tests to the Audzology EvaluatlOn. Among the auditory tests administered, both subjects performed poorest during the Wepman and Morency test of Auditory Sequentiall\1emory. Subject I could not perform the task at all and Subject 2 scored well below minus I standard deviation. In considera tion of this, and in consideration of the possible vestibular system dysfunction common to each subject, the correlation between vestibular system functioning and auditory sequential memory abilities needs further investigation. The possibility of such a correlation is especially important in consideration of recent research by Fishbein (27). He discovered that young, learning-disabled children with relatively strong auditory memory skills benefited most from an intervention program using braille as a tactual modality for language instruction. Those learning-disabled children not benefiting from such an in terven tion program migh t display signs of possible vestibular system dysfunction in conjunction with poor auditory sequenlJal memory. The other auditory test that was atypical for both subjects was the Berlin Dichotic Consonant Vowel Test, which is a form of a dichotic listening test. Subject one obtained a righ t to left ear ra tio of 1.9. This is a very high score tha t can be considered abnormal (28). Subject 2 obtained left to right ear ratio of l.l, which indicated atypicallateralization of language (17). Results of the Berlin Dichotic Consonant Vowel Test on Subject 2 are similar to the findings of Pettit and Helms, who reportedthatchildren with language disorders do not have lateralized cerebral dominance for language (29). In spite of these findings, the experimental nature of the dichotic listening test must be remembered; however, its possible value as a clinical tool must not be underestimated. This sentiment is summarized as follows: Although the dzchotlc listening testzs primarzly a research tool with lillie practical application, limited longitudinal testing, and considerable controversy regarding its interpretation, theoretically it provides a measure of assymetry of ear perception. Dichotzc lzstemng represents a new approach for investigating hemispheric specialization and its development in children. (30, p 28) Again, consideration of the possible vestibular system dysfunction common to both subjects, the correlation between vestibular system functioning and the dichotic listening test, reflecting lateralization of language, needs to be further investiga ted. Implications for Occupational Therapy In reflecting upon the results of the two descriptive case studies. twO implications for occupational therapists are evident. First. occupational reports delineating the results The Amerzcan Journal of Occupational Therapy Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930553/ on 06/12/2017 Terms of Use: http://AOTA.org/terms 449 of evaluations must necessarily incl ude the speci fica tion of the procedures used. Therapists should understand the tests and clinical observations they use, as well as somewhat understand tests used by those in other disciplines. Therefore, when our findings do not corroborate with the findings of other disciplines, therapists can begin to understand why. Second, therapists need todevelop continued collaborative research with other disciplines. Many of the areas targeted for future research may be best investigated by an interdisciplinary team. Only by dfec- REFERENCES Ayres AJ: Southern California Sensory Integration Test Manual, Los Angeles: Western Psychological Services, 1972 2. Ayres AJ: Southern California Postrotary Nystagmus Test Manual, Los Angeles: Western Psychological Services, 1975 3. Ayres AJ: Sensory Integration and Learning Disorders, Los Angeles: Western Psychological Services, 1973 4.0ttenbacher K: Identifying vestibular system processing in the learning-disabled child. Am J Oceup Ther 32: 217221,1978 5. Ottenbacher K, Watson PJ. Short MA: Association between nystagmus and hyporesponsivity and behavioral problems In learning-disabled children.Am JOccup Ther33:317-322, 1979 6. DeGangi GA, Berk RA, Larsen LA: The measurement of vestibularly based functions in pre-school children. Am J Occup Ther 34:452-459,1980 7. Price A, Gilfoyle E, Myers C (Editors): Research in Sensory Integration, Rockville, MD: American Occupational Therapy Association, 1976 8. Kimball JG: The Southern California Sensory Integration Tests (Ayres) and the Bender-Gestalt: A correlative study. Am J Oceup Ther 31 : 294-298, 1977 9 Stilwell JM, Crowe TK, McCallum L W: Postrotary nystagmus duration as a function of communication disorders. Am J Oceup Ther 32: 222-228, 1978 10. Foppe KB, Brooks C, Gersten JW, Maxwell S: The relationship between occupational therapy and physical therapy test scores in children with learning disabilities Am J Occup Ther 30 163-166,1976 450 tive communication and research with other disciplines can occupational therapists achieve their maximum potential. Summary This preliminary study investigated the relationship between the results of two SCSIT's with the results of evaluations in the areas of otolaryngology, ophthalmology, and audiology. Generally. there was little agreement between the evaluation results of otolaryngology and occupational therapy. Occupational therapists and ophthalmologists were in partia I agreement over the 11. Ayres AJ: The Effect of Sensory Integrative Therapy on Learning Disabled Children: The Final Report of a Research Project, Los Angeles: Center for the Study of Sensory Integrative Dysfunction and University of Southern California, 1976 12.Ayres AJ: Learning disorders and the vestibular system Learning Disabi/11' 18-29, 1978 13 Krynycky A, Mattuci KF: Electronystomography in the examination of the dizzy patient. Ear, Nose Throat J 58: 41-51, 1979 14. Mathog RH: Testing of the vestibular system by sinusoidal ang ular acceleration.Acta Otolaryngol74: 96-103, 1972 15. Fukushima Y, Igusa Y, Yoshida K: Characteristics of responses of medial brain stem neurons to horizontal head angular acceleration and electrical stimulation of the labyrinth in the cat. Brain Res 120: 564-570, 1977 16. Ayres AJ: Dichotic listening performance in learning disabled children. Am J Occup Ther 31' 441-446, 1977 17. Ayres AJ: Interpreting the Southern California Sensory Integration. Tests, Los Angeles: Western Psychological Services, 1976 18 Ransome J, Holden H, Bull TR (Editors): Recent Advances il1 Otolaryngology, Edinburgh and London: Churchill Livingston, 1973, Chapters 7 and 8 19. Ballinger JJ (Editor): Diseases of the Nose, Throat and Ear, Philadelphia: Lea and Febiger, 1977, Chapter 43 20 Bradford LJ (Editor): Physiologic Measures of the Audio-Vestibular System, New York: Academic Press, 1975, Chapter 3 results. Considering the results of audiology and occupational therapy evaluations, particular tests in audiology were atypical for both subjects. Reasons for the lack of agreemen t bet ween eva I ua tions 'were discussed. Areas of future research to help resolve the discrepancies were delineated. Finally, implications for occupational therapy were presented. Acknowledgmen ts Appreciation is extended to Elizabeth NewcombeI', OTR, M.Ed., for assistance in testing and data analYSIS. 21. Walsh T J: Neuro-ophthalmology: Clinical Signs and Symptoms, Philadelphia: Lea and Febiger, 1978, Chapters 9,10 and 23 22. Keith RW (Editor): Central Auditory Dysfunction, New York: Grune and Stratton, 1977, Chapters 1,4,6, and 7 23. Katz J (Editor): Handbook of Clinical Audiology, Baltimore: Williams and Wilkins, 1972, pp 480-490 24. Royeen C B: Investigation of the testretest reliability of the Southern California postrotary nystagmus test. Am J Occup Ther 34: 37 -39: Addendum 34: 215,1980 25. Coats AC: Vestibulometry. In Diseases of the Nose, Throat and Ear, JJ Ballinger (Editor). Philadelphia: Lea and Febiger, 1977, pp 725-755 26.Stroud MH, Marovitz WF, Ley ton OC: Vestibular dysfunction after midline lesions in the b rai n stem of the cat. Ann Otolaryngol80: 750-758, 1971 27. Fishbein HD: Braille-phonics: A new technique for aiding the reading disabled, J Learning Disabil 12: 69-73, 1979 28. Ayres AJ: Cluster analysis of measu res of sensory integration. Am J Occup Ther31: 362-366, 1977 29. Pettit JM, Helms SB: Hemispheric language dominance of language-disordered, articulation disordered, and normal children. J Learning Disabil 12: 12-17,1979 30. Kawar M: The effects of sensorimotor therapy on children with learning disabilities. In Research in Sensory Integrative Development, A Price, E Gilfoyle, C Myers, Editors. Rockville, MD: American Occupational Therapy Association, 1976 July 1981, Volume 35, No.7 Downloaded From: http://ajot.aota.org/pdfaccess.ashx?url=/data/journals/ajot/930553/ on 06/12/2017 Terms of Use: http://AOTA.org/terms