REFERENCES
American Occupational Therapy Association (1988). Efficacy data brief: Research
supports efficacy of sensory integration procedures. 3, 5.
American Academy of Pediatrics, Committee on Public Education (2001) Children,
Adolescents, and Television. Pediatrics Vol 107 (2). 423-426. This policy statement
describes negative effects of television viewing as violent or aggressive behaviour,
substance use, sexual activity, obesity or poor body image, and decreased school
performance. This study recommends no TV or videogames for toddlers under the age of
2, and a limit of 1-2 hours per day for children.
Autism Society America (2003) Facts and Statistics. Autism Spectrum Disorder.
www.autismsociety.org/site/PageServer?pagename=FactsStats. This article states that
autism is the fastest growing developmental disability with 2003 prevalence of 0.7% with
a 1017% annual growth.
Ayres, A.J. (1972). Sensory integration and learning disorders. Los Angeles: Western
Psychological Services.
Ayres, A (1979) Sensory Integration and the Child. Western Psychological Services,
California.
CaseSmith, J. (1993). The relationship among sensory motor components, fine motor
skills, and functional performance in preschool children. American Journal of
Occupational Therapy, 49, 645651.
Bonney, M. (1992) Understanding and assessing handwriting difficulties: Perspectives
from the literature. The Australian Occupational Therapy Journal, 39, 3.
Bragdon, A and Gamon D (2000) Brains That Work A Little Bit Differently: Recent
Discoveries About Common Brain Diversities. Allen D. Bragdon Publishers Inc, The
Brain Wave Centre, MA. Authors explore ten brain phenomena including lefthandedness,
dyslexia, ADHD, perfect pitch, SAD, Autism, alcoholism, déjà vu, photographic memory
and synesthesia. Fascinating!
Braswell J and Rine R (2006) Evidence that Vestibular Hypofunction Affects Reading
Acuity in Children. International Journal of Pediatric Otorhinolaryngology Vol 70 Issue
11, 19571965. Study results found that reading acuity scores were significantly worse in
children with vestibular hypofunction, and that reading acuity scores correlated with
dynamic not static visual acuity scores. This reports high lights that gaze instability due
to vestibular hypofunction affects reading ability in young children.
Braswell J and Rine R (2006) Preliminary Evidene of Improved Gaze Stability Following
Exercise in Two Children with Vestibular Hypofunction. International Journal of
Pediatric Otorhinolaryngology Vol 70 Issue 11, 19671973. This study found that
visualvestibular exercises improved critical print size and reading acuity.
CaseSmith, J. (1996). Fine motor outcomes in preschool children who receive
occupational therapy services. American Journal of Occupational Therapy, 50(2),5260.
CaseSmith, J., Allen, A., & Pratt, P. (1996). Occupational therapy for children (3rd ed.).
St. Louis, MO: Mosby.
CaseSmith, J. (2002). Chapman, L. & Wedell, K. (1972). Perceptual motor abilities and
reversal errors in children’s handwriting. Journal of Learning Disabilities, 5 (6), 510.
Chu,1997. (1997). Occupational therapy for children with handwriting difficulties: A
framework for evaluation and treatment. British Journal of Occupational Therapy, 60
(12), 514520.
CaseSmith J (2007) Effectiveness of schoolbased occupational therapy intervention on
handwriting. American Journal of Occupational Therapy ;56 (1):1725
OBJECTIVE: This study investigated the effects of schoolbased occupational therapy
services on students' handwriting. METHOD: Students 7 to 10 years of age with poor
handwriting legibility who received direct occupational therapy services (n = 29) were
compared with students who did not receive services (n = 9) on handwriting legibility and
speed and associated performance components. Visualmotor, visualperception, inhand
manipulation, and handwriting legibility and speed were measured at the beginning and
end of the academic year. The intervention group received a mean of 16.4 sessions and
528 min of direct occupational therapy services during the school year. According to the
therapists, visualmotor skills and handwriting practice were emphasized most in
intervention. RESULTS: Students in the intervention group showed significant increases
in inhand manipulation and position in space scores. They also improved more in
handwriting legibility scores than the students in the comparison group. Fifteen students
in the intervention group demonstrated greater than 90% legibility at the end of the school year.
On average, legibility increased by 14.2% in the students who received services and by 5.8% in
the students who did not receive services. Speed increased slightly more in the students who
did not receive services. CONCLUSION: Students who received occupational therapy services
demonstrated improved letter legibility, but speed and numeral legibility did not
demonstrate positive intervention effects.
CaseSmith J (2007) Effects of occupational therapy services on fine motor and
functional performance in preschool children. American Journal of Occupational Therapy
;54 (4):37280 PURPOSE: This study examined how performance components and
variables in intervention influenced fine motor and functional outcomes in preschool
children. METHOD: In a sample of 44 preschoolaged children with fine motor delays
who received occupational therapy services, eight fine motor and functional performance
assessments were administered at the beginning and end of the academic year. Data on
the format and intervention activities of each occupational therapy session were recorded
for 8 months. RESULTS: The children received a mean of 23 sessions, in both individual
and group format. Most of the sessions (81%) used fine motor activities; 29% addressed
peer interaction, and 16% addressed play skills. Visual motor outcomes were influenced
by the number of intervention sessions and percent of sessions with play goals. Fine
motor outcomes were most influenced by the therapists' emphasis on play and peer
interaction goals; functional outcomes were influenced by number of
sessions and percent of sessions that specifically addressed selfcare goals.
CONCLUSION: The influence of play on therapy outcomes suggests that a focus on play
in intervention activities can enhance fine motor and visual motor performance.
Christakis D, Zimmerman F, DiGiuseppe and McCarty C (2004) Early Television
Exposure and Subsequent Attentional Problems in Children. Pediatrics Bol 113, 708-
713. This study reports that for every one hour of television watched per day, there is a
10% increase in attention problems by the age of 7 years.
Copley, J., & Ziviani, J (1990). Kinesthetic sensitivity and handwriting ability in grade
one children. Australian Occupational Therapy Journal, 37, 3943.
Cornhill, H. & CaseSmith, J. (1996). Factors that influence good and poor handwriting.
American Journal of Occupational Therapy, 50 (9), 732738.
Cotman C, Berchtold N and Christie L (2007) Exercise Builds Brain Health: Key Roles
of Growth Factor Cascades and Inflammation. Trends in Neuroscience Vol 30 No 9,
464-472. This research profiles how exercise improves cerebral vascular perfusion,
increases the production of neurogenic growth factor , and decreases inflammation with
subsequent increase in the number and length of survival of nerve cells in the
hippocampal region, implicated in learning and memory. This article also shows the
positivie effects of exercise on reducing depression.
Effectiveness of schoolbased occupational therapy intervention on handwriting. The
American Journal of Occupational Therapy, 56 (1), 1725.
Cermak, S.A. & Henderson, A. (1989). The efficacy of sensory integration procedures.
Sensory Integration Quarterly Newsletter, XVII, (4).
Cermak, S.A. & Henderson, A. (1990). The efficacy of sensory integration procedures.
Sensory Integration Quarterly Newsletter, XVIII, (1).
Clark, F. & Pierce, D. (1988). Synopsis of pediatric occupational therapy effectiveness.
Sensory Integration News, 16(2).Cook, T.D. & Campbell, D.T. (1979).
Quasiexperimentation: Design and analysis issues for field settings. Boston: Houghton
Mifflin. Densem, J.F., Nuhall, G.A., Bushnell, J., &Horn, J. (1989). Effectiveness of a
sensory integrative therapy program for children with perceptual motor difficulties.
Journal of Learning Disabilities, 22 (4), 22129.
Fairbairn, M. L. & Davidson, I. F. W. K. (1993). Teachers’ perceptions of the role and
effectiveness of occupational therapists in schools. Canadian Journal of occupational
therapy, 60, 185191.
Fisher, A.G. & Bundy, A.C. (1991). The interpretation process. In A.G. Fisher, E.A.
Murray & A.C. Bundy (Eds.), Sensory integration: Theory and practice. Philadelphia:
F.A. Davis Co.
Goetz, J. & LeCompte, M. (1984). Ethnography and qualitative design in educational
research. NewYork: Academic Press.
Graham, S. (1983). The effect of selfinstructional procedures on LD students’
handwriting performance. Learning Disability Quarterly, 6, 231234.
Hannaford, Carla (1997) The Dominance Factor: How Knowing Your Dominant Eye,
Ear, Brain, Hand, and Foot Can Improve Your Learning. Great River Books Publishing,
Utah. This book explores the linkages between the side of the body we favor for seeing,
hearing, touching, and moving, and the way we think, learn, work, play and relate to
others. Hannaford describes 32 dominance profiles and how each profile relates to
learning and behavior styles.
Graham S, Harris K, Mason L, Fink-Chorzempa B, Moran S, Saddler B (2008) How Do
Primary Grade Teachers Teach Handwriting? A National Survey. To be published in
Reading and Writing: An Interdisciplinary Journal. This US study report that 90% of US
primary school teachers college education did not adequately prepare them to provide
lessons in penmanship, and therefore do not devote much time to teaching printing.
Teachers spend an average 14 minutes per day teaching handwriting, far less than the 45
minutes per day spent in the 60’s and 70’s, and slightly less than 15 minutes per day
mandated in the 80’s. Text books offer less methods and methods for student evaluation
are inconsistent and non-standardized. 100% of the 169 primary teachers who
participated in this study reported they thought printing should be taught as a separate
subject.
Hall L and CaseSmith J (2007) The Effect of Sound Based Intervention on Children With
Sensory Processing Disorders and VisualMotor Delays. American Journal of
Occupational Therapy Vol 61 No 2, 209215. Results of this study indicate that a
therapeutic listening program and sensory diet significantly improved participants scores
on the Sensory Profile, with parents reporting improvement in their children’s behaviours
related to sensory processing. This information validated use of therapeutic sound in the
Zone’in Program.
Henderson, A. & Pehoski, C. (1995). Hand function in the child: Foundations for
remediation. St. Louise, MO: Mosby publishing.
Hillman C, Erickson K and Kramer A (2008) Be Smart, Exercise Your Heart: Exercise
Effects of Brain and Cognition. Nature Reviews Neuroscience Vol 9 5865. This article
profiles the following studies: achievement in standardized test of reading and math was
positively correlated with physical fitness scores; social isolation reduced positive effects
of exercise on hippocampal neurogensis; exercise training improved depression;
cognitive, physical and social engagement decreased the risk of dementia.
Hofler D and Kooyman M (1996) Attachment Transition, Addiction and Therapeutic
Bonding – An Integrative Approach. Journal of Substance Abuse Treatment Vol 13 No 6,
511519. This article profiles the concept that addiction is a maladaptive attachment
transition and results from a fear of intimacy, and states the clinical implication of using
therapeutic bonding as a treatment intervention.
Hosseini, M. (2000). Thesis Research. The effectiveness of occupational therapy
intervention to improve the handwriting performance of individuals with sensory
motor problems who demonstrate severe handwriting difficulties. Queen’s
University.
STUDY DESIGN: An experimental multiple base-line single subject design consisting of
5 subjects was used. The design involved the systematic collection of repeated
measurements of a behavioural response (writing) over time, usually at frequent and
regular intervals. In a multiple A-B design there were two phases: baseline phase (A)
prior to treatment and intervention phase B during treatment. The same measurements
were gathered at regular intervals over both phases. METHOD: Sensory Motor
Performance components of handwriting and ergonomic factors were assessed. A battery
of OT non-standardized and standardized tools, including sub-sections of SIPT were used
to assess underlying factors leading to writing difficulties. Children’s Handwriting
Evaluation Scale was used to assess children’s handwriting performance. Standardized
tests utilized had high reliability and validity ratios. The treatment intervention was over
8 treatment sessions once every two weeks. OT follow up programs which were carried
out at children’s homes and schools formed an important part of the intervention.
Systematic monitoring programs were in place to ensure therapist’s adherence to time
frames and treatment programs and to determine whether or not the subjects were
following the OT follow up programs. The intervention was based on sensory integration,
sensory motor, cognitive and behavioural approaches. To determine the effectiveness of
OT intervention, visual, statistical, and clinical data analysis were used. A substantial rate
for inter-rater reliability was achieved. Graphic representations of children’s quality and
speed of writing were provided to display children’s performance during baseline and
intervention phases. RESULTS: The results of the research showed that occupational
therapy intervention is effective to improve the quality of handwriting performance in
children with handwriting difficulties. Support for findings, discussion on type of
intervention, methodology, clinical implications, study limitations and implications for
future research were discussed.
Kimball, J. (1988). The emphasis is on integration, not sensory. American Journal on
Mental Retardation. 92(5), 423424.
Koomar, J.A. & Bundy, A.C. (1991). The art and science of creating direct intervention
from theory. In A.G. Fisher, E.A. Murray & A.C. Bundy (Eds.), Sensory integration:
Theory and practice. Philadelphia: F.A. Davis Co.
Landhuis C, Poulton R, Welch D and Hancox R (2007) Does Childhood Television
Viewing lead to Attentional Problems in Adolescence? Pediatrics Bol 120, 352-537.
This study found that not only does childhood television viewing contribute to attention
problems in adolescence, but that the effects may be long lasting.
Learning Disabilities Association of British Columbia – Fact Sheet Statistics (2007)
Learning Disabilities Fact Sheet. www.ldav.ca/info.html. This document states that 15%
of the elementary population has learning disabilities, with reading deficits the most
prevalent condition. 35% of the learning disabled population will drop out of school, 60%
will receive treatment for substance abuse, and they will have twice the unemployment
rate of the nondisabled population. Parham L, Cohn E, Spitzer S, Koomar J, Miller L,
Burke J, BrettGreen B, Mailloux Z, MayBenson T, Smith Roley S, Schaaf R, Schoen S,
Summers C (2007) Fidelity in Sensory Integration Intervention Research.
Leah H, CaseSmith J (2007) The effect of soundbased intervention on children with
sensory processing disorders and visualmotor delays. American Journal of Occupational
Therapy;61 (2):20915.
This study investigated the effects of a sensory diet and therapeutic listening intervention
program, directed by an occupational therapist and implemented by parents, on children
with sensory processing disorders (SPD) and visualmotor delays. A convenience sample
was used of 10 participants, ages 5 to 11 years, with SPD and visualmotor delays. In the
first phase, each participant completed a 4 week sensory diet program, then an 8week
therapeuticlistening and sensory diet program. The Sensory Profile was completed by the
participants' parents before and after both study phases. The DrawAPerson test,
Developmental Test of Visual Motor Integration (VMI), and Evaluation Tool of
Children's Handwriting (ETCH) were administered before and after each phase. Over 12
weeks, the participants exhibited significant improvement on the Sensory Profile,
increasing a mean of 71 points. Parents reported improvements in their children's
behaviors related to sensory processing. Scores on the VMI visual and ETCH legibility
scales also improved more during the therapeutic listening phase. Therapeutic listening
combined with a sensory diet appears effective in improving behaviors related to sensory
processing in children with SPD and visualmotor impairments.
Lockhart, J.& Law, M, (1994). The effectiveness of multisensory writing program for
improving cursive writing ability in children with sensorimotor difficulties. Canadian
Journal of Occupational Therapy, 61 (4), 206214.
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case illustration. American Journal of Occupational Therapy. 34, 263267.
MalloyMiller, T., Platajko, H., & Anstett, B. (1995). Handwriting error patterns of
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258267.
May-Benson M, Koomer J (2007) Identifying Gravitational Insecurity in Children: A
Pilot Study. American Journal of Occupational Therapy Vol 61 No 2, 142-147. This
study reports that the GI Assessment is a promising clinical tool for objectively
identifying children with gravitational insecurity.
Miller L, Anzalone M, lane S, Cermak S, and Osten E (2007) Concept Evolution in
Sensory Integratin: A proposed Nosology for Diagnosis. American Journal of
Occupational Therapy Bol 61 No2, 135140.
Miller, LJ & Kinnealey, M (1993), Sensory Integration International, 21(2), 1,3,57.
Originally published in 1993 by Sensory Integration International, Volume XXI, Number
2. Reprinted with permission.
Miller L, Anzalone M, Lane S, Cermak S, and Osten E (2007) Concept Evolution in
Sensory Integration: A Proposed Nosology for Diagnosis. American Journal of
Occupational Therapy Vol 61 No 2, 135140. This article defines terminology for Sensory
Processing Disorder diagnosis for eventual inclusion in the Diagnostic and Statistical
Manual V, as described in the Zone’in Workshop.
Miller L, Coll J and Schoen S (2007) A Randomized Controlled Pilot Study of the
Effectiveness of Occupational Therapy for Children with Sensory Modulation Disorder.
American Journal of Occupational Therapy Vol 61 No 2, 228238. Children diagnosed
with Sensory Processing Disorder made significant gains following a sensory integration
approach on goal attainment scaling and on the Attention subtest and the
Cognitive/Social composite of the Leiter International Performance ScaleRevised.
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www.help4adhd.org/en/about/statistics. This report states that 7% of elementary children
have a diagnosis of ADHD, with 61% of these children also having learning disabilities.
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Parham L, Cohen E, Spitzer S, Koomar J, Miller L, Burke J, BrettGreen B, Mailloux Z,
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Sensory Integration Intervention Research. American Journal of Occupational Therapy
Vol 61 No 2, 216227. This article describes identification of 10 core sensory integration
intervention elements, with subsequent review of 34 sensory integration studies showing
only one core element was addressed in all studies. These results show that validity of
sensory integration outcome studies is threatened by week fidelity in regard to
therapeutic process.
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children spend on average 6.5 hours per day of combined media use (TV, Videogames,
computers), and 32% of 2-7 year olds and 65% if 8-18 year olds have TV’s in their
bedrooms.
Rogers J, CaseSmith J (2007), Relationships between handwriting and keyboarding
performance of sixthgrade students. American Journal of Occupational Therapy ;56
(1):349 OBJECTIVES: This study examined the relationships between sixth-grade
students' handwriting speed and legibility and their keyboarding speed and error rate. A
second purpose was to examine how well handwriting performance discriminates
students as slow or fast in computer keyboarding. METHOD: After participation in a
school-required keyboarding class, 40 sixth-grade students were asked to copy a
familiar poem using handwriting and keyboarding. Handwriting legibility and speed and
keyboarding speed and errors were measured. Relationships among these variables were
analyzed using Pearson product-moment correlations and discriminant analysis.
RESULTS: Keyboarding speed correlated with handwriting legibility (n = 38, r =.361, p= .026),
suggesting that handwriting performance accounts for 12% to 13% of the
variance in keyboarding performance. Handwriting speed and legibility together
accurately categorized 71% of students as slow or fast in keyboarding. On average,
students were able to keyboard faster than handwrite. Of the 20 slowest handwriters, 75%
achieved more text production with keyboarding than with handwriting. CONCLUSION:
Keyboarding performance demonstrated low to moderate correlation with handwriting
performance, suggesting that these forms of written expression require distinctly different
skills. Most students who were slow at handwriting or had poor legibility increased the
quantity and overall legibility of text they produced with a keyboard. These results
suggest that keyboarding has the potential to increase and improve a student's written
output.
Schaaf R and McKeon Nightlinger, K (2007) Occupational Therapy Using a Sensory
Integrative Approach: A Case Study of Effectiveness. American Journal of Occupational
Therapy Vol 61 No 2, 239246.
Schaaf R, McKeon Nightlinger M (2007), Occupational therapy using a sensory
integrative: a case study of effectiveness. American Journal of Occupational Therapy Vol
61 No 2, 239246. A single case study design. Poor sensory processing indicates
improvement in goal attainment and behaviour with OT using a SI approach.
Schneck, C.M. (1991). Comparison of pencilgrip patterns in first graders with good and
poor writing skills. American Journal of Occupational Therapy, 45, 701706
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Children with Attention Deficit Hyperactivity Disorder. Therapy Balls Versus Chairs.
American Journal of Occupational Therapy Vol 57 No 5, 534-541. This research found
that use of therapy balls for students with ADHD facilitates in-seat behaviour and legible
word productivity.
Statistics Canada (2006). Time Spent with Family During a Typical Workday, 1986 to
2006. This study reports that parents spend an average 3.5 minutes per week in
meaningful conversation with their children.
Tomcheck S and Dunn W (2007) Senosry Processing in Children with and without
Autism: A Comparative Study Using the Short Sensory Profile. American Journal of
Occapational Therapy Vol 61, No 2, 190-200. This study reports that 95% of sample of
281 chidlren with Autism Spectrum Disorder demonstrated some degree of sensory
processing dysfunction on the Short Sensory Profile, with greatest differences reported on
the Underresponsive/seeks Sensation, Auditory Filtering and Tactile Sensitivity Sections.
Tseng, M.H. & Cermak, S.A (1993). The influence of ergonomic factors and
perceptualmotor abilities on handwriting performance. American Journal of Occupational
Therapy, 74 (10), 919926.
Tseng, M.H. & Mourray, E.A. (1994). Differences in perceptual motor measures in
children with good and poor handwriting. Occupational Therapy Journal of Research
(14)1.
Wells, M.E., & Smith, D.W. (1983). Reduction of selfinjurious behavior in
mentally retarded persons using sensory integrative techniques. American Journal of
Mental Deficiency. 87, 664666.
Tsuzuku T. and Kaga K. (1992) Delayed Motor Function and Results of Vestibular
Function Tests in Children with Inner Ear Anomalies. International Journal of Pediatric
Otorhinolaryngology Vol 23 Issue 3, 261-268. This study reports that children with
vestibular impairment demonstrated delayed motor function, supporting Dr. jean Ayres
findings that the vestibular system is the foundation for bilateral and ocular coordination
and development of postural tone.
Waldman M, Nicholson S and Adilov N (2006). Does Television Cause Autism? Conell
University, New York. This study showed that heavy TV use prior to age 3 years
positively corresponds to increase in prevalence of Autism.
Weil, M.J., & Cunningham, S.J. (1994). Relationship between visual motor and
handwriting skills of children in kindergarten. American Journal of Occupational therapy
48, 982988.
Welch M. MD (1989) Holding Time. Published by Simon and Schoester, New York. In
this fascinating book written by Dr. Marhta Welch, child psychiatrist and president of
mothering Center and Cos Bob, Connecticut describes a technique called “forced
holding”, where the mother holds the child close to her on her lap, as if she were nursing
the child, and doesn’t let go! Even if the child squirms and screams, the mothr hangs
onto the child, maintaining essential eye contact and repearing to the child “I love you
over and over again”. While this technique has met mixed reviews, it does offer
interesting information regarding the mother child connection, and offers families with
Autism and alternative technique for establishing bonding. The technique should only be
attempted in the presence of a trained therapist.
Williams M and Shellenbergers S (1995) How Does Your Engine Run? Therapy Works
Inc, New Mexico.
American Occupational Therapy Association (1988). Efficacy data brief: Research
supports efficacy of sensory integration procedures. 3, 5.
American Academy of Pediatrics, Committee on Public Education (2001) Children,
Adolescents, and Television. Pediatrics Vol 107 (2). 423-426. This policy statement
describes negative effects of television viewing as violent or aggressive behaviour,
substance use, sexual activity, obesity or poor body image, and decreased school
performance. This study recommends no TV or videogames for toddlers under the age of
2, and a limit of 1-2 hours per day for children.
Autism Society America (2003) Facts and Statistics. Autism Spectrum Disorder.
www.autismsociety.org/site/PageServer?pagename=FactsStats. This article states that
autism is the fastest growing developmental disability with 2003 prevalence of 0.7% with
a 1017% annual growth.
Ayres, A.J. (1972). Sensory integration and learning disorders. Los Angeles: Western
Psychological Services.
Ayres, A (1979) Sensory Integration and the Child. Western Psychological Services,
California.
CaseSmith, J. (1993). The relationship among sensory motor components, fine motor
skills, and functional performance in preschool children. American Journal of
Occupational Therapy, 49, 645651.
Bonney, M. (1992) Understanding and assessing handwriting difficulties: Perspectives
from the literature. The Australian Occupational Therapy Journal, 39, 3.
Bragdon, A and Gamon D (2000) Brains That Work A Little Bit Differently: Recent
Discoveries About Common Brain Diversities. Allen D. Bragdon Publishers Inc, The
Brain Wave Centre, MA. Authors explore ten brain phenomena including lefthandedness,
dyslexia, ADHD, perfect pitch, SAD, Autism, alcoholism, déjà vu, photographic memory
and synesthesia. Fascinating!
Braswell J and Rine R (2006) Evidence that Vestibular Hypofunction Affects Reading
Acuity in Children. International Journal of Pediatric Otorhinolaryngology Vol 70 Issue
11, 19571965. Study results found that reading acuity scores were significantly worse in
children with vestibular hypofunction, and that reading acuity scores correlated with
dynamic not static visual acuity scores. This reports high lights that gaze instability due
to vestibular hypofunction affects reading ability in young children.
Braswell J and Rine R (2006) Preliminary Evidene of Improved Gaze Stability Following
Exercise in Two Children with Vestibular Hypofunction. International Journal of
Pediatric Otorhinolaryngology Vol 70 Issue 11, 19671973. This study found that
visualvestibular exercises improved critical print size and reading acuity.
CaseSmith, J. (1996). Fine motor outcomes in preschool children who receive
occupational therapy services. American Journal of Occupational Therapy, 50(2),5260.
CaseSmith, J., Allen, A., & Pratt, P. (1996). Occupational therapy for children (3rd ed.).
St. Louis, MO: Mosby.
CaseSmith, J. (2002). Chapman, L. & Wedell, K. (1972). Perceptual motor abilities and
reversal errors in children’s handwriting. Journal of Learning Disabilities, 5 (6), 510.
Chu,1997. (1997). Occupational therapy for children with handwriting difficulties: A
framework for evaluation and treatment. British Journal of Occupational Therapy, 60
(12), 514520.
CaseSmith J (2007) Effectiveness of schoolbased occupational therapy intervention on
handwriting. American Journal of Occupational Therapy ;56 (1):1725
OBJECTIVE: This study investigated the effects of schoolbased occupational therapy
services on students' handwriting. METHOD: Students 7 to 10 years of age with poor
handwriting legibility who received direct occupational therapy services (n = 29) were
compared with students who did not receive services (n = 9) on handwriting legibility and
speed and associated performance components. Visualmotor, visualperception, inhand
manipulation, and handwriting legibility and speed were measured at the beginning and
end of the academic year. The intervention group received a mean of 16.4 sessions and
528 min of direct occupational therapy services during the school year. According to the
therapists, visualmotor skills and handwriting practice were emphasized most in
intervention. RESULTS: Students in the intervention group showed significant increases
in inhand manipulation and position in space scores. They also improved more in
handwriting legibility scores than the students in the comparison group. Fifteen students
in the intervention group demonstrated greater than 90% legibility at the end of the school year.
On average, legibility increased by 14.2% in the students who received services and by 5.8% in
the students who did not receive services. Speed increased slightly more in the students who
did not receive services. CONCLUSION: Students who received occupational therapy services
demonstrated improved letter legibility, but speed and numeral legibility did not
demonstrate positive intervention effects.
CaseSmith J (2007) Effects of occupational therapy services on fine motor and
functional performance in preschool children. American Journal of Occupational Therapy
;54 (4):37280 PURPOSE: This study examined how performance components and
variables in intervention influenced fine motor and functional outcomes in preschool
children. METHOD: In a sample of 44 preschoolaged children with fine motor delays
who received occupational therapy services, eight fine motor and functional performance
assessments were administered at the beginning and end of the academic year. Data on
the format and intervention activities of each occupational therapy session were recorded
for 8 months. RESULTS: The children received a mean of 23 sessions, in both individual
and group format. Most of the sessions (81%) used fine motor activities; 29% addressed
peer interaction, and 16% addressed play skills. Visual motor outcomes were influenced
by the number of intervention sessions and percent of sessions with play goals. Fine
motor outcomes were most influenced by the therapists' emphasis on play and peer
interaction goals; functional outcomes were influenced by number of
sessions and percent of sessions that specifically addressed selfcare goals.
CONCLUSION: The influence of play on therapy outcomes suggests that a focus on play
in intervention activities can enhance fine motor and visual motor performance.
Christakis D, Zimmerman F, DiGiuseppe and McCarty C (2004) Early Television
Exposure and Subsequent Attentional Problems in Children. Pediatrics Bol 113, 708-
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10% increase in attention problems by the age of 7 years.
Copley, J., & Ziviani, J (1990). Kinesthetic sensitivity and handwriting ability in grade
one children. Australian Occupational Therapy Journal, 37, 3943.
Cornhill, H. & CaseSmith, J. (1996). Factors that influence good and poor handwriting.
American Journal of Occupational Therapy, 50 (9), 732738.
Cotman C, Berchtold N and Christie L (2007) Exercise Builds Brain Health: Key Roles
of Growth Factor Cascades and Inflammation. Trends in Neuroscience Vol 30 No 9,
464-472. This research profiles how exercise improves cerebral vascular perfusion,
increases the production of neurogenic growth factor , and decreases inflammation with
subsequent increase in the number and length of survival of nerve cells in the
hippocampal region, implicated in learning and memory. This article also shows the
positivie effects of exercise on reducing depression.
Effectiveness of schoolbased occupational therapy intervention on handwriting. The
American Journal of Occupational Therapy, 56 (1), 1725.
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Sensory Integration Quarterly Newsletter, XVII, (4).
Cermak, S.A. & Henderson, A. (1990). The efficacy of sensory integration procedures.
Sensory Integration Quarterly Newsletter, XVIII, (1).
Clark, F. & Pierce, D. (1988). Synopsis of pediatric occupational therapy effectiveness.
Sensory Integration News, 16(2).Cook, T.D. & Campbell, D.T. (1979).
Quasiexperimentation: Design and analysis issues for field settings. Boston: Houghton
Mifflin. Densem, J.F., Nuhall, G.A., Bushnell, J., &Horn, J. (1989). Effectiveness of a
sensory integrative therapy program for children with perceptual motor difficulties.
Journal of Learning Disabilities, 22 (4), 22129.
Fairbairn, M. L. & Davidson, I. F. W. K. (1993). Teachers’ perceptions of the role and
effectiveness of occupational therapists in schools. Canadian Journal of occupational
therapy, 60, 185191.
Fisher, A.G. & Bundy, A.C. (1991). The interpretation process. In A.G. Fisher, E.A.
Murray & A.C. Bundy (Eds.), Sensory integration: Theory and practice. Philadelphia:
F.A. Davis Co.
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Graham, S. (1983). The effect of selfinstructional procedures on LD students’
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Ear, Brain, Hand, and Foot Can Improve Your Learning. Great River Books Publishing,
Utah. This book explores the linkages between the side of the body we favor for seeing,
hearing, touching, and moving, and the way we think, learn, work, play and relate to
others. Hannaford describes 32 dominance profiles and how each profile relates to
learning and behavior styles.
Graham S, Harris K, Mason L, Fink-Chorzempa B, Moran S, Saddler B (2008) How Do
Primary Grade Teachers Teach Handwriting? A National Survey. To be published in
Reading and Writing: An Interdisciplinary Journal. This US study report that 90% of US
primary school teachers college education did not adequately prepare them to provide
lessons in penmanship, and therefore do not devote much time to teaching printing.
Teachers spend an average 14 minutes per day teaching handwriting, far less than the 45
minutes per day spent in the 60’s and 70’s, and slightly less than 15 minutes per day
mandated in the 80’s. Text books offer less methods and methods for student evaluation
are inconsistent and non-standardized. 100% of the 169 primary teachers who
participated in this study reported they thought printing should be taught as a separate
subject.
Hall L and CaseSmith J (2007) The Effect of Sound Based Intervention on Children With
Sensory Processing Disorders and VisualMotor Delays. American Journal of
Occupational Therapy Vol 61 No 2, 209215. Results of this study indicate that a
therapeutic listening program and sensory diet significantly improved participants scores
on the Sensory Profile, with parents reporting improvement in their children’s behaviours
related to sensory processing. This information validated use of therapeutic sound in the
Zone’in Program.
Henderson, A. & Pehoski, C. (1995). Hand function in the child: Foundations for
remediation. St. Louise, MO: Mosby publishing.
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Effects of Brain and Cognition. Nature Reviews Neuroscience Vol 9 5865. This article
profiles the following studies: achievement in standardized test of reading and math was
positively correlated with physical fitness scores; social isolation reduced positive effects
of exercise on hippocampal neurogensis; exercise training improved depression;
cognitive, physical and social engagement decreased the risk of dementia.
Hofler D and Kooyman M (1996) Attachment Transition, Addiction and Therapeutic
Bonding – An Integrative Approach. Journal of Substance Abuse Treatment Vol 13 No 6,
511519. This article profiles the concept that addiction is a maladaptive attachment
transition and results from a fear of intimacy, and states the clinical implication of using
therapeutic bonding as a treatment intervention.
Hosseini, M. (2000). Thesis Research. The effectiveness of occupational therapy
intervention to improve the handwriting performance of individuals with sensory
motor problems who demonstrate severe handwriting difficulties. Queen’s
University.
STUDY DESIGN: An experimental multiple base-line single subject design consisting of
5 subjects was used. The design involved the systematic collection of repeated
measurements of a behavioural response (writing) over time, usually at frequent and
regular intervals. In a multiple A-B design there were two phases: baseline phase (A)
prior to treatment and intervention phase B during treatment. The same measurements
were gathered at regular intervals over both phases. METHOD: Sensory Motor
Performance components of handwriting and ergonomic factors were assessed. A battery
of OT non-standardized and standardized tools, including sub-sections of SIPT were used
to assess underlying factors leading to writing difficulties. Children’s Handwriting
Evaluation Scale was used to assess children’s handwriting performance. Standardized
tests utilized had high reliability and validity ratios. The treatment intervention was over
8 treatment sessions once every two weeks. OT follow up programs which were carried
out at children’s homes and schools formed an important part of the intervention.
Systematic monitoring programs were in place to ensure therapist’s adherence to time
frames and treatment programs and to determine whether or not the subjects were
following the OT follow up programs. The intervention was based on sensory integration,
sensory motor, cognitive and behavioural approaches. To determine the effectiveness of
OT intervention, visual, statistical, and clinical data analysis were used. A substantial rate
for inter-rater reliability was achieved. Graphic representations of children’s quality and
speed of writing were provided to display children’s performance during baseline and
intervention phases. RESULTS: The results of the research showed that occupational
therapy intervention is effective to improve the quality of handwriting performance in
children with handwriting difficulties. Support for findings, discussion on type of
intervention, methodology, clinical implications, study limitations and implications for
future research were discussed.
Kimball, J. (1988). The emphasis is on integration, not sensory. American Journal on
Mental Retardation. 92(5), 423424.
Koomar, J.A. & Bundy, A.C. (1991). The art and science of creating direct intervention
from theory. In A.G. Fisher, E.A. Murray & A.C. Bundy (Eds.), Sensory integration:
Theory and practice. Philadelphia: F.A. Davis Co.
Landhuis C, Poulton R, Welch D and Hancox R (2007) Does Childhood Television
Viewing lead to Attentional Problems in Adolescence? Pediatrics Bol 120, 352-537.
This study found that not only does childhood television viewing contribute to attention
problems in adolescence, but that the effects may be long lasting.
Learning Disabilities Association of British Columbia – Fact Sheet Statistics (2007)
Learning Disabilities Fact Sheet. www.ldav.ca/info.html. This document states that 15%
of the elementary population has learning disabilities, with reading deficits the most
prevalent condition. 35% of the learning disabled population will drop out of school, 60%
will receive treatment for substance abuse, and they will have twice the unemployment
rate of the nondisabled population. Parham L, Cohn E, Spitzer S, Koomar J, Miller L,
Burke J, BrettGreen B, Mailloux Z, MayBenson T, Smith Roley S, Schaaf R, Schoen S,
Summers C (2007) Fidelity in Sensory Integration Intervention Research.
Leah H, CaseSmith J (2007) The effect of soundbased intervention on children with
sensory processing disorders and visualmotor delays. American Journal of Occupational
Therapy;61 (2):20915.
This study investigated the effects of a sensory diet and therapeutic listening intervention
program, directed by an occupational therapist and implemented by parents, on children
with sensory processing disorders (SPD) and visualmotor delays. A convenience sample
was used of 10 participants, ages 5 to 11 years, with SPD and visualmotor delays. In the
first phase, each participant completed a 4 week sensory diet program, then an 8week
therapeuticlistening and sensory diet program. The Sensory Profile was completed by the
participants' parents before and after both study phases. The DrawAPerson test,
Developmental Test of Visual Motor Integration (VMI), and Evaluation Tool of
Children's Handwriting (ETCH) were administered before and after each phase. Over 12
weeks, the participants exhibited significant improvement on the Sensory Profile,
increasing a mean of 71 points. Parents reported improvements in their children's
behaviors related to sensory processing. Scores on the VMI visual and ETCH legibility
scales also improved more during the therapeutic listening phase. Therapeutic listening
combined with a sensory diet appears effective in improving behaviors related to sensory
processing in children with SPD and visualmotor impairments.
Lockhart, J.& Law, M, (1994). The effectiveness of multisensory writing program for
improving cursive writing ability in children with sensorimotor difficulties. Canadian
Journal of Occupational Therapy, 61 (4), 206214.
Madsen, P.S. & Conte, J.R. (1980). Single subject research in occupational therapy: A
case illustration. American Journal of Occupational Therapy. 34, 263267.
MalloyMiller, T., Platajko, H., & Anstett, B. (1995). Handwriting error patterns of
children with mild motor difficulties. Canadian Journal of Occupational Therapy, 62 (5),
258267.
May-Benson M, Koomer J (2007) Identifying Gravitational Insecurity in Children: A
Pilot Study. American Journal of Occupational Therapy Vol 61 No 2, 142-147. This
study reports that the GI Assessment is a promising clinical tool for objectively
identifying children with gravitational insecurity.
Miller L, Anzalone M, lane S, Cermak S, and Osten E (2007) Concept Evolution in
Sensory Integratin: A proposed Nosology for Diagnosis. American Journal of
Occupational Therapy Bol 61 No2, 135140.
Miller, LJ & Kinnealey, M (1993), Sensory Integration International, 21(2), 1,3,57.
Originally published in 1993 by Sensory Integration International, Volume XXI, Number
2. Reprinted with permission.
Miller L, Anzalone M, Lane S, Cermak S, and Osten E (2007) Concept Evolution in
Sensory Integration: A Proposed Nosology for Diagnosis. American Journal of
Occupational Therapy Vol 61 No 2, 135140. This article defines terminology for Sensory
Processing Disorder diagnosis for eventual inclusion in the Diagnostic and Statistical
Manual V, as described in the Zone’in Workshop.
Miller L, Coll J and Schoen S (2007) A Randomized Controlled Pilot Study of the
Effectiveness of Occupational Therapy for Children with Sensory Modulation Disorder.
American Journal of Occupational Therapy Vol 61 No 2, 228238. Children diagnosed
with Sensory Processing Disorder made significant gains following a sensory integration
approach on goal attainment scaling and on the Attention subtest and the
Cognitive/Social composite of the Leiter International Performance ScaleRevised.
National Resource Center on ADHD – Statistical Prevalence (2007) About ADHD.
www.help4adhd.org/en/about/statistics. This report states that 7% of elementary children
have a diagnosis of ADHD, with 61% of these children also having learning disabilities.
Niehues, A.N., Bundy, A.C., Mattingly, C.F., & Lawlor, M.C. (1991). Making a
difference: Occupational therapy in the public schools. The Occupational Therapy
Journal of Research, 11(4), 195212.
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in elementaryage children. American Journal of Occupational Therapy, 44 (2), 111116.
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(1982). Sensory integration therapy: Affect or effect? American Journal of Occupational
Therapy. 36, 571578.
Ottenbacher, K. (1991). Research in sensory integration: Empirical perceptions and
progress. In A.G. Fisher, E.A. Murray & A.C. Bundy (Eds.), Sensory integration: Theory
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(1981). The effects of a clinically applied program of vestibular stimulation on the
neuromotor performance of children with severe developmental disability. Physical And
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occupational therapy. Graithersburg, M.D: Aspen Publication.
Parham L, Cohen E, Spitzer S, Koomar J, Miller L, Burke J, BrettGreen B, Mailloux Z,
Many Benson T, Smith Roley S, Schaaf R, Schoen S, SummersC (2007), Fidelity in
Sensory Integration Intervention Research. American Journal of Occupational Therapy
Vol 61 No 2, 216227. This article describes identification of 10 core sensory integration
intervention elements, with subsequent review of 34 sensory integration studies showing
only one core element was addressed in all studies. These results show that validity of
sensory integration outcome studies is threatened by week fidelity in regard to
therapeutic process.
Pelligrini A. and Bohn C. (2005) the Role of Recess in Children’s Cognitivie
Performance and School Adjustment. Education Researcher Vol 34 No 1, 13-19. This
study reports that providing breaks over the course of a child’s school day enhances their
ability to attend and learn, this study also reports that kingartener’s playground social
behaviours was significant factor in first grade achievement, and discussed that the
playground may be the only areas where “latch-key” kids get to socialize with their peers.
Rine R, Braswell J, Fisher D, Joyce K, Kalar K, and Shaffer M. (2004) Improvement of
Motor Development and Postural Control Following Intervention in Children with
Sensorineural Hearing Loss and Vestibular Impairment. International Journal of
Pediatric Otorhinolaryngology Vol 68 Issue 9.1141-1148. This study showed that motor
development scores increased significantly in children with sensory neural hearing loss
and vestibular impairment following balance, visual land somatosensory training. This
study substantiates that impaired vestibular development affects postural and motor
ability.
Roberts D, Foehr U, Rideout V, Brodie M (1999) Kids and Media at the New
Mellennnium: A Comprehensive National Analysis of Children’s Media Use. The
Henry J Kaiser Family Foundation Report, California. This report documents that
children spend on average 6.5 hours per day of combined media use (TV, Videogames,
computers), and 32% of 2-7 year olds and 65% if 8-18 year olds have TV’s in their
bedrooms.
Rogers J, CaseSmith J (2007), Relationships between handwriting and keyboarding
performance of sixthgrade students. American Journal of Occupational Therapy ;56
(1):349 OBJECTIVES: This study examined the relationships between sixth-grade
students' handwriting speed and legibility and their keyboarding speed and error rate. A
second purpose was to examine how well handwriting performance discriminates
students as slow or fast in computer keyboarding. METHOD: After participation in a
school-required keyboarding class, 40 sixth-grade students were asked to copy a
familiar poem using handwriting and keyboarding. Handwriting legibility and speed and
keyboarding speed and errors were measured. Relationships among these variables were
analyzed using Pearson product-moment correlations and discriminant analysis.
RESULTS: Keyboarding speed correlated with handwriting legibility (n = 38, r =.361, p= .026),
suggesting that handwriting performance accounts for 12% to 13% of the
variance in keyboarding performance. Handwriting speed and legibility together
accurately categorized 71% of students as slow or fast in keyboarding. On average,
students were able to keyboard faster than handwrite. Of the 20 slowest handwriters, 75%
achieved more text production with keyboarding than with handwriting. CONCLUSION:
Keyboarding performance demonstrated low to moderate correlation with handwriting
performance, suggesting that these forms of written expression require distinctly different
skills. Most students who were slow at handwriting or had poor legibility increased the
quantity and overall legibility of text they produced with a keyboard. These results
suggest that keyboarding has the potential to increase and improve a student's written
output.
Schaaf R and McKeon Nightlinger, K (2007) Occupational Therapy Using a Sensory
Integrative Approach: A Case Study of Effectiveness. American Journal of Occupational
Therapy Vol 61 No 2, 239246.
Schaaf R, McKeon Nightlinger M (2007), Occupational therapy using a sensory
integrative: a case study of effectiveness. American Journal of Occupational Therapy Vol
61 No 2, 239246. A single case study design. Poor sensory processing indicates
improvement in goal attainment and behaviour with OT using a SI approach.
Schneck, C.M. (1991). Comparison of pencilgrip patterns in first graders with good and
poor writing skills. American Journal of Occupational Therapy, 45, 701706
Smith, E. R. (1989). Ergonomics and the occupational therapist. In S. Hertfelder & C.
Gwin (Eds.), Work in progress: Occupational therapy in work programs (pp. 127155).
Rockville, MD: American Occupational Therapy Association.
Schilling D, Washington K, Billingsley F and Deitz J (2003) Classroom Seating for
Children with Attention Deficit Hyperactivity Disorder. Therapy Balls Versus Chairs.
American Journal of Occupational Therapy Vol 57 No 5, 534-541. This research found
that use of therapy balls for students with ADHD facilitates in-seat behaviour and legible
word productivity.
Statistics Canada (2006). Time Spent with Family During a Typical Workday, 1986 to
2006. This study reports that parents spend an average 3.5 minutes per week in
meaningful conversation with their children.
Tomcheck S and Dunn W (2007) Senosry Processing in Children with and without
Autism: A Comparative Study Using the Short Sensory Profile. American Journal of
Occapational Therapy Vol 61, No 2, 190-200. This study reports that 95% of sample of
281 chidlren with Autism Spectrum Disorder demonstrated some degree of sensory
processing dysfunction on the Short Sensory Profile, with greatest differences reported on
the Underresponsive/seeks Sensation, Auditory Filtering and Tactile Sensitivity Sections.
Tseng, M.H. & Cermak, S.A (1993). The influence of ergonomic factors and
perceptualmotor abilities on handwriting performance. American Journal of Occupational
Therapy, 74 (10), 919926.
Tseng, M.H. & Mourray, E.A. (1994). Differences in perceptual motor measures in
children with good and poor handwriting. Occupational Therapy Journal of Research
(14)1.
Wells, M.E., & Smith, D.W. (1983). Reduction of selfinjurious behavior in
mentally retarded persons using sensory integrative techniques. American Journal of
Mental Deficiency. 87, 664666.
Tsuzuku T. and Kaga K. (1992) Delayed Motor Function and Results of Vestibular
Function Tests in Children with Inner Ear Anomalies. International Journal of Pediatric
Otorhinolaryngology Vol 23 Issue 3, 261-268. This study reports that children with
vestibular impairment demonstrated delayed motor function, supporting Dr. jean Ayres
findings that the vestibular system is the foundation for bilateral and ocular coordination
and development of postural tone.
Waldman M, Nicholson S and Adilov N (2006). Does Television Cause Autism? Conell
University, New York. This study showed that heavy TV use prior to age 3 years
positively corresponds to increase in prevalence of Autism.
Weil, M.J., & Cunningham, S.J. (1994). Relationship between visual motor and
handwriting skills of children in kindergarten. American Journal of Occupational therapy
48, 982988.
Welch M. MD (1989) Holding Time. Published by Simon and Schoester, New York. In
this fascinating book written by Dr. Marhta Welch, child psychiatrist and president of
mothering Center and Cos Bob, Connecticut describes a technique called “forced
holding”, where the mother holds the child close to her on her lap, as if she were nursing
the child, and doesn’t let go! Even if the child squirms and screams, the mothr hangs
onto the child, maintaining essential eye contact and repearing to the child “I love you
over and over again”. While this technique has met mixed reviews, it does offer
interesting information regarding the mother child connection, and offers families with
Autism and alternative technique for establishing bonding. The technique should only be
attempted in the presence of a trained therapist.
Williams M and Shellenbergers S (1995) How Does Your Engine Run? Therapy Works
Inc, New Mexico.
