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Enhancing the Clinical Identification of Sensory Integration Challenges in Children: Age-Based Modeling of the EASI
Shao-Hsia Chang1, Nan-Ying Yu2
1Shao-Hsia Chang, PhD, is Professor, Department of Occupational Therapy, I-Shou University, Kaohsiung, Taiwan.
Importance:
Sensory integration (SI) typically follows a normal sequence of development. Its evaluation is crucial for evidence-based interventions.
Objective:
To examine the relationship between age and performance on the Evaluation in Ayres Sensory Integration (EASI) vestibular and proprioceptive tests and to compare linear and nonlinear models.
Design:
Normative data from the EASI tests were collected and used for model-building to characterize age effects on SI abilities.
Setting:
Laboratory in Taiwan.
Participants:
Children (N = 209) ages 3-12 yr.
Outcomes And Measures:
Occupational therapists (N = 23) from various regions of Taiwan collected data from typically developing children. Linear and nonlinear (quadratic and hyperbolic) models were used to examine the relationship between age and test performance.
Results:
Linear models accounted for 36%-43% of the variance in vestibular and proprioceptive test performance. Nonlinear models performed slightly better, explaining 42%-48% of the variance. The sum of squared errors was lower for nonlinear models (2,943-3,832) than for linear models (3,944-4,223). The hyperbolic model generally showed the highest R2 (explained variance) and the lowest root-mean-square error of approximation, except for the Joint Position test, where it did not outperform the other models.
Conclusions And Relevance:
We developed a clinically applicable system for assessing vestibular and proprioceptive functions. The results showed marked developmental improvements, especially between ages 7 and 9 yr. The findings suggest that occupational therapists can use a hyperbolic model with EASI vestibular and proprioceptive tests to better identify SI challenges, which supports the development of evidence-based intervention plans. Plain-Language Summary: Sensory integration plays a vital role in children's typical development and tends to follow a predictable pattern as they grow. The Evaluation in Ayres Sensory Integration (EASI) is a tool that is used to assess children's sensory, motor, and motor planning skills. This study focused specifically on the vestibular and proprioceptive tests. The vestibular system in the inner ear maintains balance, posture, head position, and keeps our eyes stable during movement. Proprioception lets us sense limb position without seeing them. We assessed 209 children between the ages 3 and 12 years to explore how performance on these tests changes with age. We compared two types of models: (1) a linear model (which assumes steady, constant growth) and (2) a nonlinear model (which allows for more complex growth patterns). The results showed that the nonlinear hyperbolic model better captured how children's vestibular and proprioceptive abilities develop over time. One key finding was that these skills improved most noticeably between the ages of 7 and 9 years. We developed a clinical decision support system using the EASI vestibular and proprioceptive tests. For occupational therapists, this means that applying a hyperbolic model to interpret test results may lead to more accurate identification of sensory integration difficulties. This enhanced approach can guide the development of evidence-based intervention plans.
