142
Enhancing the Sensory Integration of Aphasic Students
Karen Pamelia DePauw, MS
Impairments in intersensory integration have long been thought to characterize many learning disabled children. The late Herbert Birch noted in his seminal research that humans unlike other animals lack acutely sensitive facilities. The importance of intersensory integration has been assumed in numerous remedial programs. Some have aimed to improve the integration process, others to emphasize the child's intact modality — although the modality concept has not been supported by research (see Tarver & Dawson, January 1978). This article points to the efficacy of intersensory training. —G.M.S. This study investigated the value of a sensorimotor program to the sensory integration of aphasic students. The sensorimotor program, designed to enhance sensory integration, utilized sensory stimulation through motor activities. The relationship of change between three groups, one experimental and two control, was investigated. The experimental group received the sensorimotor program 20 minutes daily for seven months during the school year. One control group received only a remedial physical education program and the other control group received neither program. The statistical evidence shows a significant trend towards improved sensory integration after a sensorimotor program.
S
ensory integration, the ability to organize sensory information for later use, occurs at all levels of the nervous system (Ayres 1972b) and is related to the ability to learn (Ayres 1972a, 1972b). In recent years,
increased interest has been shown in the area of sensory integration. Ayres (1972a) has studied its relationship to learning disorders, and only recently it has been studied with respect to other specific exceptionalities. Ayres has proposed a neural behavior theory to assist the child with learning deficits. She stated at a conference that the "end result of poor sensory integration is perceptual problems" and that "one needs to process sensory input adequately for the brain to develop normally." Studies of sensory deprivation and infant stimulation, along with basic neurophysiology (Moore 1969), verify the need for and benefits derived from sensory stimulation. Ayres theorizes that the sensory integrative process results in perception (see Anderson 1971) and other synthesis of sensory data that enable man to interact effectively with the environment. This individual-environment interaction is a part
Volume 11, Number 3, March 1978 Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
29
143 of learning. Moore (1969) defined learning as the process of integrating sensory information for motor output. Briefly, Ayres contends that enhancing sensory integration will make learning easier. Sensory integration, enhanced by a program of sensory stimulation and motor activities, can aid in the development of the more commonly known perceptual-motor activities (Anderson 1971, Bell 1972, Heckelman 1969). No studies have yet dealt with the sensory integration and preschool aphasia. Aphasia, being a specific type of learning disorder, is an impairment or dysfunction of one's language system, which may stem from neurological defects, organic damage to central brain structure (Osgood 1963), or brain damage (Eisenson 1954). Aphasia, as defined by the California Educational Code, is a "severe disability in the comprehension and/or expression of language, not due to deafness, mental retardation, or autism." This study was undertaken to investigate the value for preschool aphasic students of sensorimotor experiences designed to enhance sensory integration.
SUBJECTS The total population of 42 students, 34 males and 8 females, enrolled at three sites of the Los Angeles County aphasia program, served as subjects. Intact classes at each site were designated as the experimental group, control group 1 (CI) and control group 2 (C2). Due to attrition, only 11 students in the experimental group, six in control group 1, and seven in control group 2 were pretested and posttested. The aphasic students at these three sites were designated preschool aphasics and were as similar in age and disability as could be educationally determined. They were classified aphasic by formal assessment and diagnostic work-ups according to the California Educational Code, section 3760. 30
PROCEDURE The subjects were pretested in November 1973, and posttested in June 1974. On each occasion, the subjects were given a part of the Southern California Sensory Integration Test (SCSIT). The Perceptual-Motor tests of the SCSIT consist of six subtests: Imitation of Postures, Crossing Midline of Body, Bilateral Motor Coordination, Right-Left Discrimination, Standing Balance — Eyes Open, and Standing Balance — Eyes Closed. Some clinical observations were also made of the experimental group. These observations consisted of evaluating the degree of inhibition of the tonic labyrinthine reflex and the appearance and duration of nystagmus. Both of these observations are a part of the neurodevelopmental observations, closely associated with sensory integration, identified by Ayres (1972b). During the seven-month period between testing, the experimental group received a program of sensorimotor experiences within their remedial physical education program; control group 1 received a regular remedial physical education program, and control group 2 received neither program. The students in the experimental group, in a class of six, received their program 20 minutes daily for the seven months of investigation. With the assistance of an aide and classroom teacher, several stations of activities were in progress at the same time. Stations were designed so the students could reach a specified level of competency before proceeding to the next, more difficult task. The activities proceeded from simple to complex with the addition of new activities and deletion of primary ones. Reinforcement and practice of basic activities was assured through the structure of activities and daily procedures. The sensorimotor program consisted of two main components — sensory stimulation and motor activity. Many of the sensoriJournal of Learning Disabilities
Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
144 I
TABLE
I. The t-scores obtained
by the direct difference Experimental group
~~f£ I
I
Imitation of postures
9
Crossing midline
9
Bilateral motor coordination
t -4.66***
method.
Control group 1 d[
t
Control group 2 dl
_f
5
-2.80**
5
2.15
-.18
5
-.18
5
-.81
9
-2.63**
5
0
5
.73
Right-left discrimination
8
.47
3
-.51
1
.10
Standing balance — eyes open
9
-1.18
5
-1.92
5
-.29
Standing balance — eyes closed
9
-.41
5
-.12
5
-.24
Crossing midline — uncrossed items: right hand
9
-.90
5
.10
5
.68
Crossing midline — uncrossed items: left hand
9
-3.82***
5
.79
5
.51
Crossing midline — crossed items: right hand
9
-1.77
5
.53
5
.35
Crossing midline — crossed items: left hand
9
-1.85*
5
.61
5
.27
Motor accuracy — more accurate hand
9
1.10
Motor accuracy — more accurate hand: adjusted score
9
.32
Motor accuracy — less accurate hand
9
-1.43
Motor accuracy — less accurate hand: adjusted score
9
-1.47
\ 0 5 level ".025 level ***.005 level
motor experiences were taken from the activities suggested for remediation of a sensorimotor dysfunction described by Ayres (1972b) and Kuzienga (nd). The sensorimotor program consisted of activities designed to stimulate the tactile, vestibular and proprioceptive systems, motor planning ability, bilateral integration, postural and equilibrium responses, visual form and space perception, and motor development.
RESULTS The scores obtained were compared by the use of the student's f-score by direct differ-
ence method, utilizing a repeated measures design. The Mann-Whitney (/-test was used to analyze the difference between the means of the three groups taken two at a time. Because the sample was small, the Mann-Whitney U-test was selected in preference to comparisons based upon the student's f-score. Table I shows the f-scores obtained by the direct difference method for the three groups. This method compared the difference between the pretest and posttest scores. As shown, significant differences were found between these scores on four tests for the experimental group. CI improved significantly on one test, and C2
Volume 11, Number 3, March 1978 Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
31
145 TABLE
II. U-scores of the
experimental group vs. control
group. Experimental vs. control group 2
Experimental vs. control group 1
I
m,
IT1:
U
mi
m2
U
Imitation of postures
6
17
-22.00***
7
17
8.00***
Crossing midline
6
17
5.00***
7
17
Bilateral motor coordination
6
15
-24.00***
7
15
8.00***
Right-left discrimination
5
17
-17.00***
4
17
-9.00***
Standing balance — eyes open
6
17
11.00***
7
17
10.00***
Standing balance — eyes closed
6
17
-14.00***
7
17
3.00***
Crossing midline — uncrossed items: right hand
6
17
-9.00***
7
17
23.00**
Crossing midline — uncrossed items: left hand
6
17
-11.00***
7
17
21.00**
Crossing midline — crossed items: right hand
6
17
-13.00***
7
17
27.00*
Crossing midline — crossed items: left hand
6
17
-3.00***
7
17
37.00
*.05 **.02
***.Q1
did not improve significantly on any test. The Mann-Whitney U-test was used to determine whether there was a significant difference between the groups at the time of pretesting. From the results of the MannWhitney U-test, the groups were not significantly different at the pretest except on one test. The experimental and control group 2 differed at the .02 level, with the mean of control group 2 higher than the mean of the experimental group. It is interesting to note that the two groups were not significantly different at the time of posttesting (see Table II). Table II shows the [/-scores of the experimental group vs. each of the control groups on the standard scores. The experimental group differed significantly to at least the .05 level from control group 2 on all but two tests, and differed significantly to 32
36.00
the .01 level from control group 1 on all tests. From the tables, it appears that there was significant change between pretest and posttest scores of the experimental group, and that there was a significant difference between the experimental and control groups after the seven-month period. Clinical observations made of the experimental group indicated two things: (1) the aphasic students showed below normal integration of the tonic labyrinthine reflex, and (2) abnormal modulation of vestibular stimulation as measured by the appearance and duration of nystagmus.
DISCUSSION Aphasic students may exhibit perceptual dysfunction (Eisenson 1954), auditory language dysfunction (Eisenson 1972), Journal of Learning Disabilities
Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
146 motor impairment (Roberson 1972, Myklebust 1971), and intellectual inefficiency (Eisenson 1972). Thus, they need a special program to enhance their sensory integrative abilities, to facilitate neurological development, to improve motor development, and to ameliorate perceptual deficit. The primary focus of this study was upon the value of sensorimotor experiences to aphasic students. From the results of the clinical observations and the below7 average scores on the SCSIT, it appears that aphasic students exhibit characteristics of sensory integrative dysfunction and would benefit from a sensorimotor program designed to enhance sensory integrative ability. Note that only a part of the SCSIT was administered, and to identify specifically the area of sensory integrative dysfunction, the entire test battery of the SCSIT and the Southern California Postrotary Nystagmus Test should be administered and clinical observations made. Further investigation of these observations and other clinical observations of aphasic students is indicated by the results. Also noted, but inconclusive, was an increase in spontaneous language during and after the sensorimotor program. Another study could pursue this observation. From the results of the standardized testing, improvement was seen in the experimental group after a sensorimotor program, although the improvement reached significant levels on only four of the tests. This finding would indicate that the sensorimotor program, given only to the experimental group, could be responsible for the changes. The [/-test scores also indicate that the difference between the experimental and control groups on the means of the tests was significant. The results indicate a definite trend toward improvement, as measured by the SCSIT, of aphasic students' sensory integration
after a sensorimotor program. The results provide evidence that the sensorimotor program had value and some significant success in improving the sensory integration of aphasic students. Further research, however, is indicated. Studies wTith similar or different designs would add more data to the increasing pool of knowled*ge of sensory integration and could more specifically delineate the role of sensory integration and the value of a sensorimotor program for aphasic students. ABOUT THE
AUTHOR
Karen Pamelia DePauw was a developmental and remedial physical education teacher for the Los Angeles County Public Schools. In addition, she is clinic director for the Educational Studies Center for Adapted Physical Education and assistant professor in the Department of Physical Education at California State University, Los Angeles, Calif. 90034. REFERENCES Anderson, M.: The identification, diagnosis, and remediation of sensorimotor dysfunction in primary school children with implication for physical education at the primary level Foundations and Practices in Perceptual Motor Learning — A Quest for Understanding. Washington, D.C.. American Association of Health, Physical Education, and Recreation, 1971. Ayres, A.}.: Improving academic scores through sensory integration. Journal of Learning Disabilities, 1972,5(6):338-343.a Ayres, A.J.: Sensory Integration and Learning Disorders. Los Angeles: Western Psychological Services, 1972. b Bell, V.L.: Sensorimotor learning: From Research to Teaching. Pacific Palisades, Calif..Goody ear PtiblishingCo., 1972. Eisenson, J.: Aphasia in Children. San Francisco: Harper itRow, 1972. Eisenson, J.: Examining for Aphasia. New York: Psychological Corporation, 1954. Heckelman, R.G.: Sensory-motor sequencing experiences in learning. Teaching through Sensory-Motor Experiences. San Rafael, Calif.: Academic Therapy Publications, 1969. Kuzienga, J., and Willbarger, P.: Activities for the Remediation of Sensorimotor Dysfunction in Primary School Children, Title III, ESEA Project. Goleta, Calif.: Goleta Union School District, nd. Moore, J.: Neuroanatomy Simplified. Dubuque, Iowa: Kendall Hunt Publishing, 1969. Myklebust, H.R.: Childhood aphasia: An evolving concept. Handbook of Speech Pathology and Audiology. New York: Appelton-Century-Crofts, 1971. Osgood, C.E., and Miron, M. (Eds.): Approaches to the Study of Aphasia. Urbana, III: University of Illinois Press, 1963. Roberson, D.D.: An Investigation of the Motor Ability of Aphasic Children. Unpublished masters thesis, California State University, Long Beach, 1972.
Volume 11, Number 3, March 1978 Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
33
Enhancing the Sensory Integration of Aphasic Students
Karen Pamelia DePauw, MS
Impairments in intersensory integration have long been thought to characterize many learning disabled children. The late Herbert Birch noted in his seminal research that humans unlike other animals lack acutely sensitive facilities. The importance of intersensory integration has been assumed in numerous remedial programs. Some have aimed to improve the integration process, others to emphasize the child's intact modality — although the modality concept has not been supported by research (see Tarver & Dawson, January 1978). This article points to the efficacy of intersensory training. —G.M.S. This study investigated the value of a sensorimotor program to the sensory integration of aphasic students. The sensorimotor program, designed to enhance sensory integration, utilized sensory stimulation through motor activities. The relationship of change between three groups, one experimental and two control, was investigated. The experimental group received the sensorimotor program 20 minutes daily for seven months during the school year. One control group received only a remedial physical education program and the other control group received neither program. The statistical evidence shows a significant trend towards improved sensory integration after a sensorimotor program.
S
ensory integration, the ability to organize sensory information for later use, occurs at all levels of the nervous system (Ayres 1972b) and is related to the ability to learn (Ayres 1972a, 1972b). In recent years,
increased interest has been shown in the area of sensory integration. Ayres (1972a) has studied its relationship to learning disorders, and only recently it has been studied with respect to other specific exceptionalities. Ayres has proposed a neural behavior theory to assist the child with learning deficits. She stated at a conference that the "end result of poor sensory integration is perceptual problems" and that "one needs to process sensory input adequately for the brain to develop normally." Studies of sensory deprivation and infant stimulation, along with basic neurophysiology (Moore 1969), verify the need for and benefits derived from sensory stimulation. Ayres theorizes that the sensory integrative process results in perception (see Anderson 1971) and other synthesis of sensory data that enable man to interact effectively with the environment. This individual-environment interaction is a part
Volume 11, Number 3, March 1978 Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
29
143 of learning. Moore (1969) defined learning as the process of integrating sensory information for motor output. Briefly, Ayres contends that enhancing sensory integration will make learning easier. Sensory integration, enhanced by a program of sensory stimulation and motor activities, can aid in the development of the more commonly known perceptual-motor activities (Anderson 1971, Bell 1972, Heckelman 1969). No studies have yet dealt with the sensory integration and preschool aphasia. Aphasia, being a specific type of learning disorder, is an impairment or dysfunction of one's language system, which may stem from neurological defects, organic damage to central brain structure (Osgood 1963), or brain damage (Eisenson 1954). Aphasia, as defined by the California Educational Code, is a "severe disability in the comprehension and/or expression of language, not due to deafness, mental retardation, or autism." This study was undertaken to investigate the value for preschool aphasic students of sensorimotor experiences designed to enhance sensory integration.
SUBJECTS The total population of 42 students, 34 males and 8 females, enrolled at three sites of the Los Angeles County aphasia program, served as subjects. Intact classes at each site were designated as the experimental group, control group 1 (CI) and control group 2 (C2). Due to attrition, only 11 students in the experimental group, six in control group 1, and seven in control group 2 were pretested and posttested. The aphasic students at these three sites were designated preschool aphasics and were as similar in age and disability as could be educationally determined. They were classified aphasic by formal assessment and diagnostic work-ups according to the California Educational Code, section 3760. 30
PROCEDURE The subjects were pretested in November 1973, and posttested in June 1974. On each occasion, the subjects were given a part of the Southern California Sensory Integration Test (SCSIT). The Perceptual-Motor tests of the SCSIT consist of six subtests: Imitation of Postures, Crossing Midline of Body, Bilateral Motor Coordination, Right-Left Discrimination, Standing Balance — Eyes Open, and Standing Balance — Eyes Closed. Some clinical observations were also made of the experimental group. These observations consisted of evaluating the degree of inhibition of the tonic labyrinthine reflex and the appearance and duration of nystagmus. Both of these observations are a part of the neurodevelopmental observations, closely associated with sensory integration, identified by Ayres (1972b). During the seven-month period between testing, the experimental group received a program of sensorimotor experiences within their remedial physical education program; control group 1 received a regular remedial physical education program, and control group 2 received neither program. The students in the experimental group, in a class of six, received their program 20 minutes daily for the seven months of investigation. With the assistance of an aide and classroom teacher, several stations of activities were in progress at the same time. Stations were designed so the students could reach a specified level of competency before proceeding to the next, more difficult task. The activities proceeded from simple to complex with the addition of new activities and deletion of primary ones. Reinforcement and practice of basic activities was assured through the structure of activities and daily procedures. The sensorimotor program consisted of two main components — sensory stimulation and motor activity. Many of the sensoriJournal of Learning Disabilities
Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
144 I
TABLE
I. The t-scores obtained
by the direct difference Experimental group
~~f£ I
I
Imitation of postures
9
Crossing midline
9
Bilateral motor coordination
t -4.66***
method.
Control group 1 d[
t
Control group 2 dl
_f
5
-2.80**
5
2.15
-.18
5
-.18
5
-.81
9
-2.63**
5
0
5
.73
Right-left discrimination
8
.47
3
-.51
1
.10
Standing balance — eyes open
9
-1.18
5
-1.92
5
-.29
Standing balance — eyes closed
9
-.41
5
-.12
5
-.24
Crossing midline — uncrossed items: right hand
9
-.90
5
.10
5
.68
Crossing midline — uncrossed items: left hand
9
-3.82***
5
.79
5
.51
Crossing midline — crossed items: right hand
9
-1.77
5
.53
5
.35
Crossing midline — crossed items: left hand
9
-1.85*
5
.61
5
.27
Motor accuracy — more accurate hand
9
1.10
Motor accuracy — more accurate hand: adjusted score
9
.32
Motor accuracy — less accurate hand
9
-1.43
Motor accuracy — less accurate hand: adjusted score
9
-1.47
\ 0 5 level ".025 level ***.005 level
motor experiences were taken from the activities suggested for remediation of a sensorimotor dysfunction described by Ayres (1972b) and Kuzienga (nd). The sensorimotor program consisted of activities designed to stimulate the tactile, vestibular and proprioceptive systems, motor planning ability, bilateral integration, postural and equilibrium responses, visual form and space perception, and motor development.
RESULTS The scores obtained were compared by the use of the student's f-score by direct differ-
ence method, utilizing a repeated measures design. The Mann-Whitney (/-test was used to analyze the difference between the means of the three groups taken two at a time. Because the sample was small, the Mann-Whitney U-test was selected in preference to comparisons based upon the student's f-score. Table I shows the f-scores obtained by the direct difference method for the three groups. This method compared the difference between the pretest and posttest scores. As shown, significant differences were found between these scores on four tests for the experimental group. CI improved significantly on one test, and C2
Volume 11, Number 3, March 1978 Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
31
145 TABLE
II. U-scores of the
experimental group vs. control
group. Experimental vs. control group 2
Experimental vs. control group 1
I
m,
IT1:
U
mi
m2
U
Imitation of postures
6
17
-22.00***
7
17
8.00***
Crossing midline
6
17
5.00***
7
17
Bilateral motor coordination
6
15
-24.00***
7
15
8.00***
Right-left discrimination
5
17
-17.00***
4
17
-9.00***
Standing balance — eyes open
6
17
11.00***
7
17
10.00***
Standing balance — eyes closed
6
17
-14.00***
7
17
3.00***
Crossing midline — uncrossed items: right hand
6
17
-9.00***
7
17
23.00**
Crossing midline — uncrossed items: left hand
6
17
-11.00***
7
17
21.00**
Crossing midline — crossed items: right hand
6
17
-13.00***
7
17
27.00*
Crossing midline — crossed items: left hand
6
17
-3.00***
7
17
37.00
*.05 **.02
***.Q1
did not improve significantly on any test. The Mann-Whitney U-test was used to determine whether there was a significant difference between the groups at the time of pretesting. From the results of the MannWhitney U-test, the groups were not significantly different at the pretest except on one test. The experimental and control group 2 differed at the .02 level, with the mean of control group 2 higher than the mean of the experimental group. It is interesting to note that the two groups were not significantly different at the time of posttesting (see Table II). Table II shows the [/-scores of the experimental group vs. each of the control groups on the standard scores. The experimental group differed significantly to at least the .05 level from control group 2 on all but two tests, and differed significantly to 32
36.00
the .01 level from control group 1 on all tests. From the tables, it appears that there was significant change between pretest and posttest scores of the experimental group, and that there was a significant difference between the experimental and control groups after the seven-month period. Clinical observations made of the experimental group indicated two things: (1) the aphasic students showed below normal integration of the tonic labyrinthine reflex, and (2) abnormal modulation of vestibular stimulation as measured by the appearance and duration of nystagmus.
DISCUSSION Aphasic students may exhibit perceptual dysfunction (Eisenson 1954), auditory language dysfunction (Eisenson 1972), Journal of Learning Disabilities
Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
146 motor impairment (Roberson 1972, Myklebust 1971), and intellectual inefficiency (Eisenson 1972). Thus, they need a special program to enhance their sensory integrative abilities, to facilitate neurological development, to improve motor development, and to ameliorate perceptual deficit. The primary focus of this study was upon the value of sensorimotor experiences to aphasic students. From the results of the clinical observations and the below7 average scores on the SCSIT, it appears that aphasic students exhibit characteristics of sensory integrative dysfunction and would benefit from a sensorimotor program designed to enhance sensory integrative ability. Note that only a part of the SCSIT was administered, and to identify specifically the area of sensory integrative dysfunction, the entire test battery of the SCSIT and the Southern California Postrotary Nystagmus Test should be administered and clinical observations made. Further investigation of these observations and other clinical observations of aphasic students is indicated by the results. Also noted, but inconclusive, was an increase in spontaneous language during and after the sensorimotor program. Another study could pursue this observation. From the results of the standardized testing, improvement was seen in the experimental group after a sensorimotor program, although the improvement reached significant levels on only four of the tests. This finding would indicate that the sensorimotor program, given only to the experimental group, could be responsible for the changes. The [/-test scores also indicate that the difference between the experimental and control groups on the means of the tests was significant. The results indicate a definite trend toward improvement, as measured by the SCSIT, of aphasic students' sensory integration
after a sensorimotor program. The results provide evidence that the sensorimotor program had value and some significant success in improving the sensory integration of aphasic students. Further research, however, is indicated. Studies wTith similar or different designs would add more data to the increasing pool of knowled*ge of sensory integration and could more specifically delineate the role of sensory integration and the value of a sensorimotor program for aphasic students. ABOUT THE
AUTHOR
Karen Pamelia DePauw was a developmental and remedial physical education teacher for the Los Angeles County Public Schools. In addition, she is clinic director for the Educational Studies Center for Adapted Physical Education and assistant professor in the Department of Physical Education at California State University, Los Angeles, Calif. 90034. REFERENCES Anderson, M.: The identification, diagnosis, and remediation of sensorimotor dysfunction in primary school children with implication for physical education at the primary level Foundations and Practices in Perceptual Motor Learning — A Quest for Understanding. Washington, D.C.. American Association of Health, Physical Education, and Recreation, 1971. Ayres, A.}.: Improving academic scores through sensory integration. Journal of Learning Disabilities, 1972,5(6):338-343.a Ayres, A.J.: Sensory Integration and Learning Disorders. Los Angeles: Western Psychological Services, 1972. b Bell, V.L.: Sensorimotor learning: From Research to Teaching. Pacific Palisades, Calif..Goody ear PtiblishingCo., 1972. Eisenson, J.: Aphasia in Children. San Francisco: Harper itRow, 1972. Eisenson, J.: Examining for Aphasia. New York: Psychological Corporation, 1954. Heckelman, R.G.: Sensory-motor sequencing experiences in learning. Teaching through Sensory-Motor Experiences. San Rafael, Calif.: Academic Therapy Publications, 1969. Kuzienga, J., and Willbarger, P.: Activities for the Remediation of Sensorimotor Dysfunction in Primary School Children, Title III, ESEA Project. Goleta, Calif.: Goleta Union School District, nd. Moore, J.: Neuroanatomy Simplified. Dubuque, Iowa: Kendall Hunt Publishing, 1969. Myklebust, H.R.: Childhood aphasia: An evolving concept. Handbook of Speech Pathology and Audiology. New York: Appelton-Century-Crofts, 1971. Osgood, C.E., and Miron, M. (Eds.): Approaches to the Study of Aphasia. Urbana, III: University of Illinois Press, 1963. Roberson, D.D.: An Investigation of the Motor Ability of Aphasic Children. Unpublished masters thesis, California State University, Long Beach, 1972.
Volume 11, Number 3, March 1978 Downloaded from ldx.sagepub.com at WESTERN MICHIGAN UNIVERSITY on April 2, 2015
33
