2. Background to the work
Clinical discussions as part of new product development

3. What we wanted to know What is head control?
What influences the typical development of head control?
What is the impact of a delay?
How might this knowledge affect our clinical practice, especially postural management?

4. Search Strategy Database Search Term(s) Hits Dedupe & Limit* Review
Final no. of papers
Google Scholar
head control
head control AND cerebral palsy
children with cerebral palsy AND head stability
development of head control 13
OVID:
Medline
PsychInfo
AMED
Embase
EBM Reviews
(using AND with other search terms yielded no results)
867
333* 35 26
Other
Reference lists 7
TOTAL 46

5. So, what is head control?
Not a single, stand-alone definition of head control could be found!

6. The typical development of head control
First sideward head movements seen at 7.5 – 8 weeks
Rotational, forward and rearward movements by 11 weeks
Einspieler et al, 2008; Lee & Galloway, 2012

7. Head to the side in supine, midline when crying Midline by 2 months Dramatic changes between 2-3 months
De Lima-Alvarez et al, 2014; Einspieler et al, 2008

8. Basic level of head control
Clinically often considered to be the neutral head position when an infant is held upright Continues to develop for a long time
Lee & Galloway, 2012; Saavedra et al, 2010

9. Purpose of head control Saavedra et al, 2012
“The task for the young infant is to stabilise the head in space over an inherently unstable, multi-segmented column using an array of overlapping muscles.”

10. De Lima-Alvarez et al, 2014; Einspieler et al, 2008; de Saldanha Simon et al, 2014; Lee & Galloway, 2012; Butler et al, 2007

11. Neuromotor development and its influence on head control
Three month transformation of neural functions:
Increase in neck muscle strength
Chin tuck in supine with improved alignment
Inhibition of neck righting reflex
De Lima-Alvarez et al, 2014; Einspieler et al, 2008

12. Sensory development and its influence on head control
Three month transformation of
neural functions:
Vision and visual attention
Binocular vision
Gaze control – pursuit and compensation
Einspieler et al, 2008; Bertenthal & von Hofsten, 1998; Porro et al, 2005

13. Cultural norms and their influence on head control
Western cultures – supine positioning
Awake prone positioning and ‘active handling’
Lee & Galloway, 2012; Ratliff-Schaub et al, 2001; Perez-Machado & Rodriguez-Fuentes, 2013

14. When children have CP, consider…
Neuromotor development
Sensory development – particularly eyesight
Cultural and family norms
Function – drooling and feeding

15. So, what can we do? Closer assessment of head control
Intervention in supine and prone positions
Sensory stimulation

16. So, what can we do?
Consider other evidence-based interventions e.g. GAME or CIMT:
“Task specific motor training-based early intervention (eg CIMT) is recommended as the new paradigm of care for CP because it induces neuroplasticity and produces functional gains.”
Novak et al, 2017

17. And what about postural management?
Midline positioning of the head or head supports may reduce vision and / or hearing

18. And what about postural management?
Tilt-in-space and/or recline may have an impact on a child’s sensory experience and ability to feed safely.

19. And what about postural management?
Don’t provide too much trunk support – it inhibits the quality of available movements.

20. To conclude…head control is:
A complex topic
There are no absolute answers
We need to assess more (using a wider range of multi-disciplinary colleagues
Provide early and continued intervention, but not too much physical support
Focus on individual need
Use eclectic therapeutic approaches