Abstract
Primary Author and Speaker: Amy Armstrong-Heimsoth
Additional Authors and Speakers: Ashley Sinnappan
Contributing Authors: Jodi Thomas, Roy St. Laurent
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 (Shumway-Cook & Woollacott, 2012). Difficulties with obtaining and maintaining head control is a common finding in children with conditions such as cerebral palsy (CP) and may be one of the first signs that a child is not developing typically (Barbosa, Campbell, Smith, & Berbaum, 2005). Because of the importance of head control, it is often a skill targeted by therapists for interventions. Assessing head control is often done through gross motor standardized assessment or subjective observation. Commonly used assessments include the Gross Motor Function Measure, the Test of Infant Motor Performance, and the Bayley Scales of Infant and Toddler Development. The GMFM and the Bayley are reliable and valid assessment tools (Moore, Johnson, Haider, Hennessy, & Marlow, 2012) when used according to standardization protocol. However, the proportion of test items related to head control is often so small that detecting improvements in head control is difficult. Currently, there is no validated, reliable, widely-implemented instrument to assess head control in an objective manner that is practical, accessible, and easy to use. 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.
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. A convenience sample of raters was recruited by emails to local clinic owners to study the final version. 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.
Fleiss’s weighted kappa coefficient was utilized; interrater reliability 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). With the exception of HCS Supine, with a kappa of 0.68--falling in the fair to good range--all of the remaining HCS sections (and overall) have a kappa coefficient that would be categorized as excellent agreement.
Lack of available assessments for the measurement of head control leaves therapists with limited options for baseline measurements and documenting outcomes of interventions. With the importance of head control development, objective evidence-based resources are needed to document progress for children with atypical development. Current standardized assessment tools are often not as useful for children with severe delays or highly discrepant gross motor development and are not sensitive enough to detect minor change. The authors designed the HCS with this population in mind to allow the objective assessment of head control. Additionally, there is no uniform, widely accepted means of objectively assessing head control for researchers conducting studies on head control. The HCS is important to pediatric practice. It fills gaps in currently available assessments, improves documentation by providing an outcome measurement tool, provides means for consistency in reporting of gains, and quantifiable data in assessing/documenting head control. In addition to excellent interrater reliability, the HCS scale appears to have high clinical utility, whereby it can be reliably used and is brief enough to be utilized regularly in practice.
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Moore, T., Johnson, S., Haider, S., Hennessy, E., & Marlow, N. (2012). Relationship between test scores using the second and third editions of the Bayley Scales in extremely preterm children. The Journal of Pediatrics, 160(4), 553-558. https://doi.org/10.1016/j.jpeds.2011.09.047
Shumway-Cook, A., & Woollacott, M. H. (2012). Motor control: Translating research into clinical practice (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.