RATIONALE: Individuals with gravitational insecurity (GI) display a strong fear of actions that are generally not fear inducing, that is, leaning backward, climbing a ladder, traveling by plane, taking feet off the ground, or changing head positions. These behaviors are often misunderstood, and sufferers may be labeled as having emotional difficulties, phobias, or anxiety (May-Benson & Koomar, 2007). Although proposed by Ayres to be a vestibular dysfunction related to anxiety, these aspects of GI have not been well studied.

DESIGN: Descriptive, quantitative study

PARTICIPANTS: A deidentified database of records for 1,832 adults and adolescents, ages 13–95 yr, on the Adult/Adolescent Sensory History (ASH) was used. Participants were typically functioning adults with a small percentage (<10%) having identified or suspected sensory processing disorder (SPD) and a smaller percentage having autism spectrum disorder. All had no self-reported neurological motor coordination problems or mental health diagnoses involving psychosis. Anxiety and depression were allowed.

MEASURES: The ASH is a 163-item self-report questionnaire for individuals between ages 13 and 98 yr. A 9-item subscore for GI is calculated as well as subscores for visual–spatial skills, movement (vestibular processing), anxiety, and driving a car. Mild and severe levels of GI were identified in the development of the ASH. Items are rated on a 5-point Likert scale (1 = never, 5 = always), with higher scores indicating greater dysfunction. It has established interrater and test–retest reliability and discriminant validity.

METHOD: This study involves secondary analysis of previously collected deidentified data. Original participants completed the ASH online survey or paper questionnaires as part of several previous studies on the ASH.

ANALYSIS: Frequencies and score distribution determined incidence of GI problems. Pearson correlations examined relationships between GI subscore and other scores on the ASH. Paired t tests examined differences between groups.

RESULTS: In the overall sample, 19.1% had mild GI and 2.2% had definite GI. Incidence varied by diagnostic group, with 34% of those with SPD having mild GI and 10% having severe GI. Individuals with reported anxiety disorder had 32.7% mild GI and 4.7% severe GI. Women had significantly more severe GI at p = .001. Significant age differences (p < .000) between the young group (13–21 yr) and old group (≥65 yr) found more old adults had mild GI. GI problems significantly associated (p < .000) with driving a car (r = .53), motor planning (r =.37), anxiety (r = .335), movement (vestibular functioning; r = .66) and visual–spatial skills (r = .40). Relationships were generally stronger within specific diagnostic groups.

DISCUSSION: This study found that a large portion of individuals demonstrate at least some fear responses to movement activities not considered fear inducing by most people. These fear responses are moderately significantly related to anxiety, vestibular dysfunction, motor planning and visual–spatial skills and support clinical and theoretical observations of GI as well as the relation of GI to functional skills such as driving.

IMPACT STATEMENT: This study contributes significant information on an aspect of occupational therapy practice that has not been well studied or understood. It supports that occupational therapists should evaluate individuals for even mild GI problems and that individuals with anxiety are at risk for having GI, presenting an underserved population for occupational therapy practice

May-Benson, T., & Koomar, J. (2007). Identifying gravitational insecurity in children: A pilot study. American Journal of Occupational Therapy, 61, 142–147. http://dx.doi.org/10.5014/ajot.61.2.142