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J Thomas1, A Armstrong-Heimsoth2, R St. Laurent3
1Texas Woman's University, Physical Therapy, Dallas, United States, 2Northern Arizona University, Occupational Therapy, Phoenix, United States, 3Northern Arizona University, Mathematics & Statistics, Flagstaff, United States
Background: The ability to control the head is a vital component of motor development and is one of the first skills an infant attains. Delays and deficits in the development of head control can interfere with subsequent motor milestones. Additionally, the development of head control is an indicator of a maturing neurological system and is required for the proper integration of vision and righting reflexes.
Because of the importance of head control as a developmental milestone upon which future movement and sensory integration is dependent, it is often targeted by therapists for interventions. However, little is known about how therapists assess head control of a pediatric patient in an initial evaluation or when monitoring progress. Anecdotal evidence suggests it is largely done subjectively, using descriptors or as portions of other standardized assessments.
Because of the importance of head control as a developmental milestone upon which future movement and sensory integration is dependent, it is often targeted by therapists for interventions. However, little is known about how therapists assess head control of a pediatric patient in an initial evaluation or when monitoring progress. Anecdotal evidence suggests it is largely done subjectively, using descriptors or as portions of other standardized assessments.
Purpose: This study introduces a new scale for the assessment of head control called the Head Control Scale (HCS). The purpose of this study was to establish interrater reliability of the HCS and to determine its usefulness in a clinical setting.
Methods: The HCS assesses head control in four positions (prone, supine, pull to sit, and supported sitting) on a 0-4 rating scale. The authors used both a focus group and pilot testing to refine the scale to its final version, which was then used to assess interrater reliability. Twenty-six therapists used the HCS to evaluate head control of five subjects of varying ages and abilities who were videotaped spending 30-40 seconds in each position. Participants also completed a post-rating survey.
Results: Fleiss’s weighted kappa coefficient is excellent for the prone (.82), pull to sit (.83), and sitting (.88) positions as well as for the scale overall (kappa=.91). It can be described as fair to good for supine (kappa=.68).
Conclusion(s): The HCS has high interrater reliability and users report it to be a needed tool, applicable to clinical practice, and easy to use.
Implications: The results of this study (and other ongoing studies of the HCS) will be helpful to clinicians by providing a standard, objective means to assess head control. This can assist in designing intervention strategies, assessing progress, assessing readiness for adaptive equipment, and can be used in research.
Funding, acknowledgements: No funding acknowledgments.
Keywords: head control, assessment tool
Topic: Paediatrics
Did this work require ethics approval? No
Institution: Northern Arizona University
Committee: NAU Institutional Review Board
Reason: IRB committee declared the study exempt from requiring approval due to its minimal involvement with human subjects.
All authors, affiliations and abstracts have been published as submitted.
