Head control in normal and Cerebral Palsy Children

Dr. Manal R. Salim

Head control in normal children 

1^st month:

Supine:While in the waking state 4 the flexion position prevails in small infant, the head tends to be slightly turned to one side, the body follows the turn as one block

Prone: able to raise head momentarily

Pulling up from supine: head hang toward back, as soon as the vertical, supported sitting is attained head falls forward and totters from side to the other.

2^nd month:

flexion position is still demonstrated

Prone: child is able to raise thorax area

Pulling up from supine: the child is already quite good at pulling the head up and forward, while upright sitting the head falls slightly forward

3^rd month:

       Supine: infant can lie symmetrically on its back and move itself to both sides.

Prone: child lies symmetrically on surface, lifts head up 45 degrees support through lower arms is not yet stable the head can be laid from side to another and can be moved some times child fall over while doing this

Pulling up from supine: Head control not quite stable but he helps head accompanies the body, still totters slightly to and from in the upright child head no longer falls forward, backward or sideways.

Upright position: in the upright position the trunk is more stable, but the back is not yet fully extended. If the child is held at the waist and tilted somewhat to one side, the child head is already capable of repositioning itself horizontally in space quite nicely, despite the fact that it is sometimes quite slow and not really symmetrical.

4^th month:

          Supine: infant lie symmetrical and turns to both sides, hold head in mid position

Prone: it lifts head up to 90 degree, and support itself quite nicely on lower arms

Pulling up from supine: the child helps the individual pulling upward and demonstrates good head control.

Sitting: The child head is stable and held in midline position to the trunk. When sitting the child is not yet stable, and the back is hunched.

5^th month:

          Prone:  head lifted easily to 90 and is stable, good lower arm support, redistribution of weight to release one arm head moved from right to left.

Pulling up from supine: the infants helps when being pulled head control is quite good the head can be pulled quite nicely and can then be turned to the side.

6^th month :

           Prone: infant support on lower limbs and display good sense of balance

Pulling up into sitting: helps puller, good head support siting: supported, support can be removed fo a brief period

Head control in Cerebral palsy children

Prone development

Postural fixation of the head when lying prone (0-3 months) on fore arms (3 months), on hands and knees (6 months) during crawling, half kneeling hand support (9-11 months) or in the bear walk (12 months) in normal developmental levels

Counterpoising of the head takes place in activities which include head turn and head movements whilst holding the head up against gravity.

 Stages in prone development some common problems:

• Dislike of prone position because of breathing difficulty. *inability to turn head and free nose, inability to lift head up

• Excessive flexion creating discomfort in prone.

• Delayed development in head control, rising up on fore arms, taking weight on fore arms.

• Abnormal performance e.g. asymmetrical head raise, raising on one fore arm only,  asymmetrical stabilization on elbows

• Independent head raising is usually associated with flexion in the arms but extension of the back and especially of the legs into adduction internal rotation.

• In normal babies the leg extension (especially at the next developmental level is associated with abduction and external rotation.

Supine development

0-3 stages in supine development some common problems:

• Delay in gradual overcoming of head lag on pull to sitting.

• Excessive extension of either head, shoulder girdle retraction, back and legs or all of them.

• Persistent head turning to one side may occur.

• Reflex reactions including Moro reaction, asymmetrical tonic neck reflex. May persist which will affect head control development and prevent the precedence of normal postural mechanisms

4-6 stages in supine development some common problems:

• Delay in acquisition of symmetry, in keeping the head in the center.

• Delay in the disappearance of the head lag and in acquiring ability to raise the head off the bed.

Sitting development

• Postural fixation of the head and trunk normally developed 3-6 months and independent by 9 months

• Head and trunk righting or rising from sitting, leaning or slumped forward backward… normally developed between 3-12 months depending upon the positions and support given to the child

stages in sitting development some common problems:

• Delay in lifting the head up if held fully supported in a sitting position, in holding the head steady (head lag in pull to sit)

• Abnormal performance of vertical head control. The head is held in an asymmetrical posture either laterally flexed, rotated or both Arms, trunk and legs may be in infantile postures or another abnormal postures.

• Stiff extension so that the child cannot be flexed into the sitting position unless special methods are used.