A Task Oriented Approach to Assessment and Training of Infant Sitting

Original Editor - Pam Versfeld
Top Contributors - Robin Tacchetti and Jess Bell

The Purpose of Assessment of Infant Sitting[edit | edit source]

The assessment of infant sitting tends to serve one of two purposes:

  1. It identifies how far along the sitting developmental trajectory the infant has progressed. Two commonly used tests to assess sitting progress are the Segmental Assessment of Trunk Control (SATCo) and Alberta Infant Motor Scale (AIMS).
  2. It helps identify what an infant can and can't do at the present time. It highlights why an infant is having difficulties with sitting and what can be done to improve their sitting abilities.

The Segmental Assessment of Trunk Control (SATCo)[edit | edit source]

The SATCo is a clinical assessment of a child’s ability to maintain an upright head and trunk posture when manual support is provided at progressively lower levels of the trunk.[1][2] With the infant sitting on a bench, manual support at the shoulder girdle is used to assess head control, followed by support at the level of axillae, the inferior scapula, lower ribs, below the ribs, pelvis and finally, no support.

The child is seated on a sitting bench and their pelvis is fixed in a vertical position by a strap. The therapist supports the trunk at different levels. For each trunk segmental level, static, active and reactive control are scored as present, absent or not tested (NT).

  • Static control is credited if the child can maintain a neutral trunk posture above the level of hand support;
  • Active control is credited if the child can maintain a neutral posture during head movement;
  • Reactive control is credited if the trunk above the support remains stable during an external perturbation (a nudge).

The SATCo has been shown to be a reliable and valid clinical measure of trunk control in typically developing infants, as well as children with neuromotor disability.

Full instructions for using the SATCo are provided in the SATCo Clinical Workbook.

Alberta Infant Motor Scale (AIMS)[edit | edit source]

The AIMS assesses the maturation of an infant's gross motor skills from term (40 weeks post conception) to 18 months of age.

  • It consist of four subscales: supine, prone, sitting, standing
    • Each subscale has a set of items that describe increasing levels of maturation of a developmental task.
  • Each item is accompanied by a graph depicting the percentage of infants in the normative sample for each age category that received credit for the particular item.
  • Studies using AIMS normative data to evaluate its validity in different countries have shown some differences in the age at which infants achieve different items.[3][4]

The sequence of items in the sitting scale of the AIMS provides a useful reference for identifying an infant’s progress along the trajectory of unsupported sitting. They include:

Guidelines for assessment and intervention using a dynamic systems and task-oriented approach[edit | edit source]

The assessment of sitting will usually be one part of a therapy session that starts with meeting and greeting the child, the family and other carers, and having a conversation about the family’s expectations and goals for the session. This family-therapist conversation will then identify the developmental tasks that will be selected for assessment and training during the therapy session and for planning the home programme.[5]

A dynamic systems, task-oriented and intensive approach to intervention advocated in this course is informed by two sources:

  1. The International Clinical Practice Guideline for Early Intervention for Children Aged 0 to 2 Years with or at risk for CP[6]
  2. The  GAME protocol for early intervention

The GAME protocol for early intervention[edit | edit source]

The GAME intervention is based on the principles of active motor learning, family-centred care, parent coaching and environmental enrichment. Intervention is customised to the parent's goals and enrichment style and the child’s motor ability.[7][8]

The dynamic systems, task-oriented and intensive training approach to intervention is informed by six ideas:

  1. Family-centred care and the involvement of parents in selecting goals and providing opportunities to practise movement skills is essential to success.[9] [10]
  2. Therapy should always start with the infant's present abilities - consider what they can do at this present time moment; how does this create an opportunity for learning to do more?[11]
  3. An emphasis on training intensity, repetition and many daily opportunities for practising a task in a variety of contexts.[6]
  4. Self-initiated action and the exploration of the possibilities for doing things support and enhance motor learning.[12]
  5. Intrinisic motivation, curiosity, and the drive to explore and interact with people and objects support learning new movement skills.[13]
  6. Promoting enjoyable and meaningful social interaction and communication is central to intervention and it supports the learning of motor tasks.

Resources[edit | edit source]

References[edit | edit source]

  1. Sangkarit N, Siritaratiwat W, Bennett S, Tapanya W. Factors Associating with the Segmental Postural Control during Sitting in Moderate-to-Late Preterm Infants via Longitudinal Study. Children. 2021 Sep 26;8(10):851.
  2. Pin TW, Butler PB, Cheung HM, Shum SL. Relationship between segmental trunk control and gross motor development in typically developing infants aged from 4 to 12 months: a pilot study. BMC pediatrics. 2019 Dec;19(1):1-9.
  3. van Iersel PA, la Bastide-van Gemert S, Wu YC, Hadders-Algra M. Alberta Infant Motor Scale: Cross-cultural analysis of gross motor development in Dutch and Canadian infants and introduction of Dutch norms. Early Human Development. 2020 Dec 1;151:105239.
  4. Gontijo AP, de Melo Mambrini JV, Mancini MC. Cross-country validity of the Alberta Infant Motor Scale using a Brazilian sample. Brazilian Journal of Physical Therapy. 2021 Jul 1;25(4):444-9.
  5. Baldwin P, King G, Evans J, McDougall S, Tucker MA, Servais M. Solution-focused coaching in pediatric rehabilitation: an integrated model for practice. Physical & occupational therapy in pediatrics. 2013 Nov 1;33(4):467-83.
  6. 6.0 6.1 Morgan C, Fetters L, Adde L, Badawi N, Bancale A, Boyd RN, Chorna O, Cioni G, Damiano DL, Darrah J, De Vries LS. Early intervention for children aged 0 to 2 years with or at high risk of cerebral palsy: international clinical practice guideline based on systematic reviews. JAMA pediatrics. 2021 Aug 1;175(8):846-58.
  7. Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. GAME (Goals-Activity-Motor Enrichment): protocol of a single blind randomised controlled trial of motor training, parent education and environmental enrichment for infants at high risk of cerebral palsy. BMC neurology. 2014 Dec;14(1):1-9.
  8. Morgan C, Novak I, Dale RC, Guzzetta A, Badawi N. Single blind randomised controlled trial of GAME (Goals⿿ Activity⿿ Motor Enrichment) in infants at high risk of cerebral palsy. Research in Developmental Disabilities. 2016 Aug 1;55:256-67.
  9. King G, Williams L, Hahn Goldberg S. Family‐oriented services in pediatric rehabilitation: A scoping review and framework to promote parent and family wellness. Child: care, health and development. 2017 May;43(3):334-47.
  10. An M, Palisano RJ, Yi CH, Chiarello LA, Dunst CJ, Gracely EJ. Effects of a collaborative intervention process on parent empowerment and child performance: A randomized controlled trial. Physical & Occupational Therapy in Pediatrics. 2019 Jan 2;39(1):1-5.
  11. Baldwin P, King G, Evans J, McDougall S, Tucker MA, Servais M. Solution-focused coaching in pediatric rehabilitation: an integrated model for practice. Physical & occupational therapy in pediatrics. 2013 Nov 1;33(4):467-83.
  12. Corbetta D, DiMercurio A, Wiener RF, Connell JP, Clark M. How perception and action fosters exploration and selection in infant skill acquisition. Advances in child development and behavior. 2018 Jan 1;55:1-29.
  13. Atun-Einy O, Berger SE, Scher A. Assessing motivation to move and its relationship to motor development in infancy. Infant Behavior and Development. 2013 Jun 1;36(3):457-69.