Head control is the first motor milestone to be achieved in early life. Good head control lays the foundation for the development and refinement of other milestones. It also enables the child to explore the environment effectively in play and to develop more advanced skills. Thus attaining head control is frequently used as the starting point in therapeutic intervention for the children with cerebral palsy or other developmental disabilities by the pediatric occupational therapist. It also very important to have good neck control before the age of two year because if child dont develop good neck vontrol before the age of two year then developemnent of ambulatory capability in child became remote pssiblity.

1. DR. MOHD. QADEER
THERAPIST IN CHARGE ,SAMVEDNA TRUST
ALLAHABAD [U.P.] – 9415215394
www.samvednatrust.com
Fb:samvednatrust.cerebralpalsy
Youtube:jjain999
https://www.youtube.com/channel/UC5h-gRf8sFpf-k60_kwyrgg
Therapeutic Technique to improve
neck holding in cerebral palsy

2. Introduction
Developmental milestones reflect the growth and
integration of the central nervous system in the child.
 Head control is the first motor milestone to be
achieved.
Good head control lays the foundation for the
development and refinement of other milestones.
 It also enables the child to explore the environment
effectively in play and to develop more advanced
skills.

3. Definition & importance
Brenneman (1999) defined head control as the ability to keep
the head aligned with respect to gravity
Bobath (1980) describes head control as the ability to
maintain head in space face vertical and mouth horizontal
 Scherzer (1990) recognize that lack of head control is often
the first sign of abnormality in children with atypical
development .
Thus, attaining head control is frequently used as the starting
point in therapeutic intervention for the children with cerebral
palsy or other developmental disabilities by the pediatric
occupational therapist (Kramer, 1992) .

4. Cont.
Detail evaluation of the quality of
posture, movement in three positions:
prone, supine, and supported sitting is
must before starting any therapy.

5. CLINICAL SCALE FOR HEAD CONTROL IN
PRONE
Grade 0 no response
Grade 1(immature response): unable to lift and hold
(sustain) the head upright.
Grade 2 (partial response): lacks in either lifting or
holding (sustain) the head upright.
Grade 3 (mature response): ability to lift and hold
(sustain) the head upright.
The responses in each position tend to progress from immature responses
towards mature responses. Grade zero specifies the immature responses
and grade three specifies the mature responses in each of the three
positions

6. Precaution during Mx
No Collar
No Range of movement exercise
Do not encourage sitting for neck control
Do not use Pediatric ball therapy for hydrocephalus baby
Don’t encourage other activity till you have fair neck
control

7. Therapeutic technique

8.  Pulling the shoulder blades forward as you lift
him up.
 Press firmly on the muscles on each side of the backbone and slowly bring
your hand from her neck toward her hips.
 You can also do taping & stimulation of para-vertebral muscle

9. Floor Based Supine

13. PRONE POSITION

16. SUPINE TO SIDE LYING

17. Moving a child with head control from prone to
sitting

18. Moving a child with head control from sitting to
prone

21. INTEGRATION OF HEAD UP IN TO DAILY
LIFE

24. Conclusion
We should have detail evaluation of developmental milestone
Brain mature in Cephalo-caudal direction so neck holding
came first then trunk control and extremity maturity came in
last
We should not encourage other activity till the child have fair
neck control
It is very important to have neck holding before the age of 2
year for future development of ambulatory capability
Sensory feed back, stimulation & proper posture is the key in
management of immature neck holding
Kangaroo care in infancy is excellent way to improve neck
holding in early infancy

25. For more info
Visit www.samvednatrust.com &
www.trishlaortho.com
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