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An Examination of the Relationships Between Motor

and Process Skills and Scores on the Sensory Profile


Barbara Prudhomme White, Shelley Mulligan,
Kristen Merrill, Janet Wright

KEY WORDS
Assessment of Motor Process Skills
(AMPS)
motor skills
pediatric
process skills
sensory integration
sensory processing
Sensory Profile

OBJECTIVE. This quasi-experimental study sought to determine whether children with possible sensory
processing deficits, as measured by the Sensory Profile, performed less well on an occupational performance
measure compared to children with typical Sensory Profile scores.

METHOD. Sixty-eight children were administered both the Assessment of Motor Process Skills (AMPS) and
the Sensory Profile. After the assessments were completed, children were divided into two groups based on
their Sensory Profile scores.
RESULTS. Independent t tests indicated statistically significant differences between groups on the AMPS
ADL [Activities of Daily Living] Motor and ADL Process measures (p < .05), with the children with atypical Sensory Profile scores showing more functional difficulties. Correlations revealed significant relationships among
the measures.
CONCLUSION. The results suggest that children identified with sensory processing deficits on the Sensory
Profile are likely to experience some challenges in performing everyday occupations.
White, B. P., Mulligan, S., Merrill, K., & Wright, J. (2007). An examination of the relationships between motor and process
skills and scores on the Sensory Profile. American Journal of Occupational Therapy, 61, 154160.

Barbara Prudhomme White, PhD, OTR/L, is


Associate Professor, University of New Hampshire,
Durham.
Shelley Mulligan, PhD, OTR/L, is Associate Professor, Department of Occupational Therapy, Hewitt Hall,
4 Library Way, University of New Hampshire, Durham,
NH 03824; shelley.mulligan@unh.edu.
Kristen Merrill, MS, OTR/L, is Early Intervention
TherapistEaster Seals, Manchester, NH.
Janet Wright, MS, OTR/L, is Director, KidzPlay
Developmental Therapy, Londonderry, NH.

ediatric occupational therapists routinely administer sensory history questionnaires, or measures of behaviors associated with sensory processing, when evaluating children who have school-related problems, difficulties with activities of
daily living (ADLs), or problems related to underlying neurodevelopmental processes (Johnson-Ecker & Parham, 2000). In clinical practice, assumptions are often
made that sensory processing problems contribute to difficulties in functional performance at home, school, or other community settings. However, little evidence
is available in the literature regarding the relationships between behaviors associated with sensory processing abilities and functional skills (Dunn, 2001; Dunn &
Westman, 1997). Therefore, the purposes of this study were (a) to determine
whether children with behaviors associated with atypical sensory processing as
measured by the Sensory Profile (Dunn, 1999) differed from children who were
typically developing on a measure of functional occupational performance, the
Assessment of Motor and Process Skills (AMPS; Fisher, 2003), and (b) to explore
possible relationships between the occupational performance measure and an
assessment of sensory processing behaviors.
Sensory processing involves the registration and modulation of sensory information, as well as the internal organization of the sensory input, so human beings
can execute successful adaptive responses to situational demands and thus engage
meaningfully in daily occupations (Humphry, 2002). Adaptive behaviors are purposeful and goal-directed and enable individuals to overcome challenges and to
learn new skills. One assumption of sensory integration theory is that producing an

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March/April 2007, Volume 61, Number 2

adaptive behavior enhances sensory integration in an individual (Bundy & Murray, 2002) and therefore promotes
ones ability to meet environmental demands and increase
functional performance. When children demonstrate
behaviors associated with sensory integration dysfunction, it
is hypothesized that they encounter sensory experiences
from the environment through a brain that is disorganized
or limited in its ability to process and integrate the sensory
information (Bundy & Murray, 2002). Therefore, as children with sensory processing deficits engage in school tasks,
play, or ADLs, they may experience difficulty, an awareness
of personal inefficacy, lack of control, or dissatisfaction with
their performance (Mulligan, 1996). Prevalence of sensory
processing disorders (SPD) has recently been estimated to
include approximately 5% to 13% of children in the United
States, based on a large sample of kindergarten children
(Ahn, Miller, Milberger, & McIntosh, 2004). Sensory processing disturbances also have been associated with common
neurodevelopmental and behavioral disorders such as attention disorders (Mulligan, 1996) and pervasive developmental disorders (Kientz & Dunn, 1997).
Numerous assessments have been designed specifically
to measure behaviors and skills associated with sensory processing or sensory integration functions, such as the Sensory
Integration and Praxis Tests (Ayres, 1989) and the Sensory
Profile (Dunn, 1999). The Sensory Profile was selected for
the current study because it is psychometrically sound;
quick to administer, score, and interpret; and, most important, because it was designed specifically to measure childrens sensory processing abilities that support or interfere
with functional performance (Dunn, 1999, p. 3). Because
sensory processing is a neurological process that cannot be
measured directly, caregivers are asked to rate child behaviors believed to be associated with sensory processing. Use
of the Sensory Profile, then, reflects our assumption that the
behaviors rated (whether typical or atypical) are associated
with sensory processing. However, these behaviors also may
result from emotional factors such as anxiety or temperament rather than, or in addition to, sensory processing
problems (Miller, Reisman, McIntosh, & Simon, 2001).
Occupational performance can be defined as ones ability to engage in meaningful actions related to work, play,
and daily living tasks, in relevant contexts (Fisher, 2003).
Occupational therapy theories emphasize the importance
for us as humans to engage in meaningful occupations and
establish satisfying roles and routines. Thus, occupational
therapists evaluate the occupational performance of their
clients and provide intervention in the context of what is
meaningful to clients as individuals.
Relatively few studies have documented and specifically
described relations between occupational performance and

sensory processing abilities, although this connection


appears to be well accepted clinically (Dunn, 1997).
Parham and Mailloux (2005) reported that sensory processing problems often are associated with decreased social
skills, immature play skills, impaired self-concept, decreased
fine and gross motor skills, and difficulties performing daily
living skills. Bundy (2002); Burleigh, McIntosh, and
Thompson (2002); and Dunn (1999) described the difficulties of children with sensory processing problems at
school. Yochman, Parush, and Ornoy (2004) suggested that
successful occupational performance of children with attention disorders often is adversely affected by the comorbidity
of what they interpret as atypical sensory processing. A case
report by Dunbar (1999) described the challenges of a 3year-old child with SPD as including difficulties with performing daily living skills and with participating successfully at preschool. Dunbar stressed the importance of early
detection of sensory processing problems because of the
potential impact they may have on the development of selfhelp and other functional skills. Baranek et al. (2002) studied children with Fragile X syndrome and also found that
within this population there were relationships between
sensory processing abilities and occupational performance.
Occupational therapists have assumed that behaviors
commonly associated with sensory processing dysfunction
affect a childs occupational performance and have developed specific treatment strategies based on this assumption.
This study was designed to examine this assumption. The
specific hypotheses were that (a) children with atypical sensory processing behaviors as measured by the Sensory Profile would perform less competently in ADL Process and
ADL Motor measures, as measured by the AMPS, when
compared with same-age peers without sensory processing
concerns, and (b) relationships exist between AMPS performance measures and Sensory Profile scores of children with
and without atypical sensory processing.

Study Methods
Participants
The investigators recruited, primarily through convenience
sampling, 68 children between ages 5 and 13 years. Participants were recruited from personal contacts of the
researchers and from two private occupational therapy clinics to obtain a sample consisting of approximately equal
numbers of children who were typically developing and
children with SPD. Children with considerable physical or
cognitive disabilities were excluded from this study. Parents
who expressed interest in participating were contacted by
one of three researchers and screened for exclusion criteria.

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155

Instrumentation

Responses, and Sensory Processing Related to Endurance/


Tone. The last three categories reflect socialemotional
responses related to sensory processing: Emotional/Social
Responses, Behavioral Outcomes of Sensory Processing,
and Thresholds for Response. In addition to scores generated for these categories, the test provides 9 Sensory Profile
Factor scores that represent sensory processing styles: Sensory Seeking, Emotional Reactivity, Low Endurance/Tone,
Oral Sensory Sensitivity, Inattention/Distractibility, Poor
Registration, Sensory Sensitivity, Sedentary, and Fine
Motor/Perceptual (Dunn, 1999). Sensory category and factor scores are interpreted based on the normative data as
being either typical performance (within 1 standard deviation from the mean), probable difference (between 1 and
2 standard deviations below the mean), or within the definite difference range (more than 2 standard deviations
below the mean) (Dunn, 1999).

Sensory Profile

Assessment of Motor and Process Skills

The Sensory Profile (Dunn, 1999) was used to measure


behaviors associated with sensory processing abilities. The
Sensory Profiles normative data was based on a sample of
1,115 children who were typically developing. The tool has
been researched with children and adults (Dunn, 1999),
with acceptable measures for internal inconsistency and
interrater reliability. Studies supporting its construct and
content validity are reported in the test manual. Using a 5point Likert scale ranging from never to always, parents
or caregivers rate the frequency of their childs behavior in
response to 125 items or behavioral statements perceived to
represent 14 different sensory processing functions (Dunn,
1999). The Sensory Profile quantifies behaviors associated
with sensory processing problems and provides a tool for
consistent measurement of parental perception of these
behaviors (Kientz & Dunn, 1997). Six of the categories
defined by Dunn relate to sensory processing areas: Auditory Processing, Visual Processing, Vestibular Processing,
Touch Processing, Multi-Sensory Processing, and Oral Sensory Processing. Five categories relate to sensory modulation: Modulation Related to Body Position and Movement,
Modulation of Movement Affecting Activity Level, Modulation of Sensory Input Affecting Emotional Responses,
Modulation of Visual Input Affecting Emotional

The AMPS (Fisher, 2003) is a standardized, performancebased assessment that evaluates the quality of an individuals
performance of real-life tasks and guides intervention.
Occupational therapists using the AMPS assume that a persons motivation or purpose to perform tasks is based on
meaning and cultural relevancy; therefore, the persons
function is maximized when performing a chosen task.
Meaning can be defined as the significance to the individual of a task that provides a source of motivation for performance. Purpose relates to a persons intended goal and
reason for doing a task, which helps organize performance
(Fisher, 2003).
The AMPS contains 83 different standardized personal
and domestic ADLs, which range in difficulty from simple
to complex, and is appropriate for persons from ages 3 to
99 years (Fisher, 2003). ADL tasks include self-care or personal activities of daily living (PADLs) and domestic or
instrumental activities of daily living (IADLs) (e.g., home
maintenance, meal preparation, laundry management).
Typically, PADL tasks are easier and are reserved for children younger than age 6 years, or persons who are frail or
have physical disabilities (Fisher, 2003). Examples of both
PADL and IADL tasks include making a sandwich with
meat, cheese, or peanut butter and jelly; making ones bed;
vacuuming; and donning socks and shoes. The AMPS currently has normative data on more than 100,000 individuals, including children (personal communication from
AMPS International, May 2005). Moreover, the AMPS has
been researched extensively with various population groups
and has been found to be sensitive in detecting problems
with efficiency, safety, and quality of performance in ADLs
(Bray, Fisher, & Duran, 2001; Fisher, 2003; Puderbaugh &

Forty-six (68%) of the children were boys; 22 (32%) were


girls. Ninety-five percent of the children were Caucasian.
All lived in the northeastern United States, within a 50-mile
radius of each other, and within middle-class to uppermiddle-class neighborhoods. The study was approved by
an institutional review board for human subject participation, and all participants signed informed consent or
assent forms.
Demographic data by group assignment are presented
in Table 1. A slightly greater number of children fell into
the Atypical Sensory Processing group (n = 38) than the
Typical Sensory Processing group (n = 30), and a slightly
greater number of participants were boys (68%). There
were no significant age differences between groups.

Table 1. Participant Characteristics


Groups
Total Group (N = 68)
Atypical Sensory Processing
Group (n = 38)
Typical Sensory Processing
Group (n = 30)

Boys

Girls

Mean Age (SD)

46 (68%)

22 (32%)

26

12

20

10

7.9 (2.25)
Range 413 years
7.8 (2.42)
Range 413 years
7.9 (2.09)
Range 512 years

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March/April 2007, Volume 61, Number 2

Fisher, 1992). Recently, White and Mulligan (2005) used


the AMPS with children from ages 5 to 13 years and found
it sensitive to detecting behaviors associated with attentional problems. Standardized ability measures are
obtained for ADL Motor Skills and ADL Process Skills and
are interpreted based on a normative range for different age
groups.

Evaluation Procedures
Approximately 80% of the children were assessed in their
homes, and 20% were assessed in a kitchen area designed to
approximate a home environment located at either a university clinic or a private clinic setting. Approximately equal
numbers of children with and without sensory processing
differences were assessed in each location. Assessment locations were based on participant choice and proximity to one
of the three examiners. All three examiners were AMPS
trained and calibrated and were licensed occupational therapists with 6 to more than 20 years of clinical experience
with this population. One examiner worked at a private
clinic and contributed 40% of the assessments to the study,
another worked in a school and contributed 50% of the
assessments, and the third examiner worked in a university
setting and contributed 10%. Each examiner assessed
nearly equal numbers of children with and without atypical
sensory processing behaviors. To remain as unbiased as possible, parents were asked not to discuss any child concerns
with each examiner before the assessment. While a parent
completed the Sensory Profile questionnaire, the child participated in the AMPS, which was administered according
to the standardized protocol described in the AMPS manual. Each child, along with his or her parent, was interviewed before evaluation to determine which AMPS tasks
were most familiar and most often a part of the childs daily
routines. Once 5 to 6 tasks were established, the child was
asked to choose 2 tasks on which he or she agreed to be
assessed. Each AMPS assessment period lasted about 2025
min, or 1015 min per task.
Once data were collected, Sensory Profiles were scored
by the examiner or a trained research assistant and entered
into the database. The AMPS was scored by each therapist
separately using AMPS scoring software, and resulting ability measures were placed in the database. Data were combined and children were assigned to one of two groups after
the scoring of the assessments, based on their Sensory Profile scores. Group 1 (Sensory ProfileAtypical) included
children who had at least 4/14 sensory areas scored as
Probable Difference (which are scores falling between 1
and 2 standard deviations below the mean) or at least 2/14
areas scored as Definite Difference (scores falling more

than 2 standard deviation below the mean). All other children were placed in Group 2 (Sensory ProfileTypical). Criteria for the Sensory ProfileAtypical group were largely
based on the clinical expertise and judgment of the
researchers, who believed that such scores would reflect
children with sensory processing differences, and from supporting data available on the Sensory Profile related to
scores of children with and without disabilities. Currently
no specific diagnostic criteria exist for children with SPD.

Results
Statistical analyses were computed using SPSS 9.0 software
(SPSS Inc., Chicago). Results were considered significant a
priori at p = < .05. The mean age for Group 1 (n = 38 atypical Sensory Processing group) was 7.76 years (SD = 2.42),
and the mean age for Group 2 (n = 30 typical Sensory Processing group) was 7.9 years (SD = 2.09). An independent
t test revealed no significant differences between the groups
regarding age.
To address the first purpose of the study, a group comparison analysis was conducted using a one-tailed independent t test. Justification for a one-tailed t test was based on
theory and clinical evidence that lower Sensory Profile
scores in children would be associated with more functional
difficulties. As expected, the atypical group scored significantly lower (mean Logit = .08, SD = .68) on the
AMPS ADL Process measure than the typical group (mean
Logit = .45, SD = .28), t(66) = 2.11, p = .024. The atypical group also scored significantly lower (mean Logit = 1.29,
SD = .52) on the AMPS ADL Motor measure than the
typical group (mean Logit = 1.58, SD = .29), t(66) = 2.08,
p = .025.
To examine possible relations among the 14 Sensory
Profile category scores, the 9 Sensory Profile Factor scores,
and the AMPS ADL Process and Motor measures, Spearmans rho correlation coefficients were computed. The purpose of this analysis was to explore possible links that would
help interpret how different sensory tendencies might influence motor and process skills associated with occupation.
Because of the small number of participants, any conclusions from this analysis should be interpreted as preliminary. The correlations are reported in Tables 2 and 3.
Of the Sensory Profile Factor scores, the AMPS ADL
Motor measure correlated most highly with the Fine
Motor/Perceptual Factor (r = .5), the Sensory Sensitivity
Factor (r = .44), and the Low Endurance/Tone Factor (r =
.39). Of the Sensory Processing Areas, the AMPS ADL
Motor measure correlated significantly with all sensory
areas except Oral Sensory, although all of the correlations
were weak, with r values ranging from .28 to .31. Of these,

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Table 2. Correlations Among AMPS ADL Motor and Process


Measures and Sensory Profile Factor Scores

Table 3. Correlations: AMPS ADL Motor and Process Measures


and Sensory Profile Area Scores

Sensory Profile Factors

Sensory Profile Factors

ADL Motor

Factor 1Sensory Seeking


Factor 2Emotionally Reactive
Factor 3Low Endurance/Tone
Factor 4Oral Sensitivity
Factor 5Inattention/Distractibility

NS
NS
.39**
NS
.30*

Factor 6Poor Registration


Factor 7Sensory Sensitivity
Factor 8Sedentary
Factor 9Fine Motor/Perceptual

.30*
.44*
NS
.5*

ADL Process
NS
NS
NS
NS
.23
(p = .06)
NS
NS
NS
NS

Note. AMPS = Assessment of Motor and Process Skills (Fisher, 2003);


ADL = activities of daily living; NS = not significant.
*p < .05. **p < .01.

the strongest relation was with the vestibular area, as would


be expected, because this sensory system is most closely
associated with movement and motor performance (Bundy
& Murray, 2002; Mulligan, 1996).
Six of eight Sensory Modulation and Behavior and
Emotional Response variables correlated significantly with
the AMPS ADL Motor measure. The strongest relations
were among Modulation of Endurance/Tone (r = .39),
Modulation of Body Position and Movement (r = .40),
Visual Input Affecting Emotional Responses and Activity
Level (r = .35), and Behavioral Outcomes (r = .35). Fewer
significant relationships were identified between the AMPS
ADL Process measure and the Sensory Profile variables. No
significant correlations were obtained between the Sensory
Processing Factor scores and the AMPS ADL process measure, although the Inattention/Distractibility factorthe
factor that theoretically seems to be most closely related to
process skills (White & Mulligan, 2005)yielded the highest r value (.23) and approached statistical significance. Two
Sensory Processing areas yielded significant correlations
with the AMPS ADL Process measure, although the relationships were weak: Visual (r = .25) and Multi-Sensory (r =
.29). Possibly these sensory processing areas include a
higher-level cognitive, mental, or executive component
than does the processing of more primitive sensory systems
such as the tactile and vestibular systems. Therefore, it was
not surprising that Visual and Multi-Sensory were the areas
more closely associated with the AMPS ADL Process skill
measure, which presumably measures a degree of executive
function ability (White & Mulligan, 2005).

Discussion
The findings of this study support the hypothesis that
behaviors thought to reflect sensory processing abilities are
associated with everyday occupational performance. This
study also suggests that children who exhibit atypical sen-

Sensory Processing Areas


AAuditory
BVisual
CVestibular
DTouch
EMulti-Sensory
FOral Sensory
Sensory Modulation Areas
GEndurance/Tone
HBody Position and Movement
IMovement Affecting Activity Level
JSensory Input Affecting Emotional
Responses
KVisual Input Affecting Emotional
Responses and Activity Level
Behavior and Emotional Responses
LEmotional/Social
MBehavioral Outcomes
NItems Indicating Thresholds for
Responses

ADL Motor

ADL Process

.28*
.28*
.31*
.28*
.29*
NS

NS
.25*
NS
NS
.29*
NS

.39**
.40**
NS

NS
NS
NS

.30*

NS

.35*

NS

NS
.35**

NS
NS

.33**

NS

Note. AMPS = Assessment of Motor and Process Skills (Fisher, 2003);


ADL = activities of daily living; NS = not significant.
*p < .05. **p < .01.

sory processing behaviors as assessed by the Sensory Profile


appear likely to demonstrate difficulties with occupational
performance, at least regarding their ability to perform
PADLs and IADLs. Therefore, clinically, occupational
therapists impressions and concerns regarding the impact
of sensory processing skills on performance may indeed be
valid. These results suggest that it is important for children
with possible atypical sensory processing to be assessed for
potential problems regarding their ability to perform daily
occupations and functional tasks. Further, the AMPS
appears to be an effective occupational performance measure for children with sensory integration or sensory processing deficits and one that could be used both in research
and clinically as a functional outcome measure after intervention. It is important to note, however, that children
with behaviors reflective of sensory processing problems
are often complex and have coexisting conditions such as
motor coordination or attention problems. Therefore,
problems with occupational performance are likely due to
a combination of factors rather than solely sensory processing concerns or differences.
Correlation analyses identified statistically significant
relations between some aspects of sensory processing and
areas of occupational performance. In particular, motor
skills that enable successful completion of meaningful, functional tasks appear to be related more to sensory processing
abilities than do process skills such as attention and organization. Skills that tap into the physical aspects between person and objectsfor example, bending, stabilizing, hand

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March/April 2007, Volume 61, Number 2

grasping, holding, coordinating, and manipulating, as well


as modulating movement and forceare most likely supported by efficient sensory processing and the integration of
basic sensory systems such as the visual, vestibular, and tactile systems.
Some limitations must be considered in the interpretations of this studys results. First, a relatively small, convenient sample of primarily Caucasian children was used;
therefore, the sample may not adequately represent the population of children with and without sensory processing
dysfunction. Thus, generalizability of the study results is
limited. Second, the categorization of children as typical
versus atypical sensory processors was made based on clinical judgment of the Sensory Profile scores because, at the
time this study was conducted, no specific diagnostic cutoff criteria existed on the Sensory Profile for children with
sensory integration disorders. Further research is necessary
to develop and confirm specific diagnostic criteria, guidelines, and protocols to properly diagnose children with SPD
for both clinical and research purposes. This research is currently under way (see Miller, Cermak, Lane, Anzalone, &
Koomar, 2004).
Despite these limitations, the results suggest that an
evaluation of a childs behaviors reflective of sensory processing skills may indicate the degree to which the child can
also successfully perform everyday PADL and IADL occupations and vice versa. Furthermore, the results suggest that
motor skills enabling children to perform functional tasks
may possibly be related to some underlying sensory processing abilities. It follows then, that for many children who
are experiencing difficulty with daily occupations (e.g.,
completing schoolwork and basic self-care tasks), occupational therapy interventions to address underlying sensory
processing concerns may be a useful strategy. Finally,
because the AMPS could detect subtle differences in occupational performances between children with and without
sensory processing concerns, the effects of intervention for
behaviors associated with sensory processing deficits may
possibly be measured using the AMPS. The AMPS is
designed for repeated evaluation and is sensitive to detecting change in performance. In occupational therapy, few
options exist for documenting changes in functional performance in people with sensory processing problems. The
AMPS used in this study, as well as its school versionthe
School AMPS (Fisher, Bryze, Hume, & Griswold, 2005),
which measures performance in school-related tasks in the
classroommay be useful for clinicians wanting an objective, functional measure of occupational performance for
documentation purposes, as well as for researchers interested in conducting efficacy studies of occupational therapy
interventions.

Acknowledgments
The authors thank the children and families who participated in this study.
A portion of this study was completed in partial fulfillment of a masters degree from the University of New
Hampshire (third author).

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By Mary Jane Youngstrom, MS, OTR, FAOTA

pplies user-friendly interactive technology to orient you to the


concepts and language presented in the Framework. Case studies
provide opportunities to apply these concepts to common
practice situations. Learn to differentiate the various aspects included in
the occupational therapy domain; recognize the content addressed and actions
taken in each step of the occupational therapy process; identify how the
Frameworks domain aspects and terminology can be applied during the
occupational therapy process; and more. The text Occupational Therapy
Practice Framework: Domain and Process is required for taking this course.

Course only:
Order # OL29-J
$90 AOTA Members
$128 Nonmembers

Better Together!
Save 15%!
Course and Text:
Order #OL29K-J
$101.15 AOTA Members
$144.50 Nonmembers

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group discounts!

Earn .5 AOTA CEUs (5 NBCOT PDUs/5 contact hours).


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March/April 2007, Volume 61, Number 2