Head Control

Good head control enhances peripheral vision. Things like depth perception and eye-hand coordination are enhanced when desirable head positioning is maintained. The opportunity for learning is also enhanced. To achieve optimal head control it is necessary that muscle groups in the neck, trunk and arms are strengthened. The most effective, non-invasive way to strengthen neck muscles and back extensors of a child with physical impairments is to place him in a mobile prone stander (with large wheels that he can easily reach to propel) and allow him to chase after playmates. The simple act of self- propelling requires use of the arm, back and neck muscles.

For many children with impaired motor skills, the most difficult task can be maintaining functional control of the head. After all, the head is a rather large orb that is precariously perched on a small pedestal called the neck. The child must be allowed to have a good peripheral field of vision and be able to twist and turn his head at will. Development of eye-hand co-ordination requires optimal head strength/control.

To attain optimal head control you must begin by properly positioning and supporting the pelvic girdle, the main hinge of the body. From the waist down stability and postural alignment are paramount. From the waist up, optimal "controlled" range of motion of the trunk, head and upper limbs are of primary concern. The key is to first identify postural irregularities and then strategically place positioning supports to minimize the effects of specific undesirable postural tendencies while simultaneously allowing therapeutically desirable activities to occur.

For instance, if a child has a tendency to lean his head to the right, a simple sensory pad on the right side of the head may be all that is necessary to minimize the head leaning. If poor head control is due to low muscle tone that allows the child's trunk to lean, more than sensory input may be required. Dynamic (spring loaded) padded supports located at the right side of the trunk and at left side of the hip may be necessary to minimize the child's tendency to lean right. It is equally important to loosen the postural controls for the left side of the trunk and head to allow the child to lean in the opposite direction and develop the range of motion on the weaker left side.

A child with pronounced muscle tone (or involuntary spasticity) is able to relax when properly supported while standing in a manner that is both comfortable and secure. If proper dynamic postural controls are incorporated during playtime activities, the child will remain relaxed for longer periods because the activity they are engaged in is both desirable and fun. After about five to ten minutes a caregiver may be able to manually manipulate the child's torso and/or pelvis into even better alignment. As the child relaxes the positioning supports become more of a sensory input, a gentle reminder for the child to adjust himself to maintain the most desirable posture.

Even for a child that is incapable of physically self propelling, introducing movement while standing stimulates the senses and causes increased awareness of surroundings. Pulling a child with special needs across uneven surfaces such as a lawn or school playground while in a wheelstand is an excellent vestibular activity. As the head moves about it constantly works (strengthening) to remain centered over the shoulders. Leave a child standing stationary and in a matter of a just few minutes you can literally watch the head position diminish. This is primarily due to boredom.