Segmental Assessment of Trunk Control (SATCo)

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Original Editor - Lauren Heydenrych

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Objective

The objective of the Segmental Assessment of Trunk Control (SATCo) is to provide a detailed assessment of trunk control, identifying:

1. The highest segmental level at which intervention must be targeted.
2. And the optimal level of support needed by the individual.

It is an assessment tool and outcome measure which provides a "close definition of the level at which trunk control difficulties present and leads to a 'level by level' treatment to the development of trunk control" (Butler et al, 2010).

The development of the SATCo has been specifically designed as part of the Targeted Training (TT) approach. TT itself is a therapeutic strategy developed by Penny Butler and Richard Major to improve the functional abilities of children with problems of movement control through improving control of upright posture.

Intended Population

SATCo has initially been developed for infants and children with neuromotor developmental impairments.

Children as young as 4 months have been included in studies using the SATCo. There has been no maximum age given to which this test can be administered, although once an individual has gained full active trunk control, the administration of the SATCo becomes difficult to perform. This owing to the fact that children with full trunk control are often difficult to contain on the assessment bench.

Method of Use

SATCo is performed in the clinical setting or at home.

It examines postural control in a sitting position by a gradual reduction of support under three different conditions.

The three conditions are:

• Static control - Maintaining a neutral vertical posture with no movement.
• Active control - Maintaining a neutral vertical posture with voluntary head movements or arm movements.
• Reactive control - A recovery of the neutral vertical posture after a disturbance of balance caused by a nudge.

The support is provided at six distinct levels or segments, moving cephalo-caudally, starting at the shoulder girdle and ending without any support given.

These levels are:

Note: Reactive control is not tested at the head. Simply the static and active control.

Anatomical level	Manual support
C7	Shoulders
T1-3	Axillae
T3-7	Inferior scapulae
T7-T11	Lower ribs
T12-L3	Below ribs
L4-S5	Pelvis
Full trunk	No support

Set-up

The following is a description of assessors needed and positioning required.

A minimum of two testers are required:

• One to support the trunk

• Another to a) monitor the child's posture, b)monitor the child's hand and arm position and c) provide nudges for the reactive component of SATCo.

The child to be tested wears only a nappy or shorts as the trunk need to be clearly observed.

Child's position:

• Seated on a bench. Pelvis is stabilised by support system. Feet supported (age dependent).
• Head is central with eyes looking forward. The chin is neither protracted nor retracted.
• Shoulder girdle is neither protracted nor retracted.
• Hands and arms are free from contact with own body or any external support, including a toy being held in both hands or linking hands together.
• Spinal profile should be normal for age with no joints at end of range.
• Pelvis in neutral.
• Hip and knee angles both at 90°
• Feet supported if age appropriate.

Important to remember: The head and body is to be kept in a neutral vertical posture both above and below manual support provided.

Scoring

The way in which the SATCo is delivered and scored:

Control in each segment is recorded as present (tick mark) or absent (- or x). There is no in-between.

To score in Static control, both head and trunk need to be held in neutral vertical posture for 5 seconds.

To score in Active control, neutral vertical posture needs to be held while turning head 45° and/ or reaching to both left and right.

To score in Reactive control, maintenance of neutral vertical posure or a quick return to neutral vertical posture is required following a brisk nudge.

The brisk nudge is large enough to perturb posture. When testing reactive control, a brisk nudge is given to:

• The top of the sternum
• C7/ T1
• Left and right acromion (laterally) in turn.

A child may score static, active and reactive all on the same level/ segment, or on differing levels. The level/ segment at which control is not demonstrated is where control learning should commence.

Evidence

Reliability

Both inter-rater and intra-rater reliability are good With a study done with both term and preterm (age corrected) infants between 4 to 9 months, the interclass correlation (ICC) scored ≥ 0.8 .

Moderate to good correlation was also found when comparing the SATCo against other motor assessments.

Validity

Construct validity seems dependent on age and postural demands. For example, with young infants below the age of 8 months, the SATCo is not able to differentiate between preterm and term infants. The hypothesis here is that before 8 months both groups of infants have similar postural demands, being primarily reclined. It is further recommended that studies are performed with a greater sample size and over longer follow-up to verify this hypothesis.

Responsiveness

Good responsiveness was demonstrated in SATCo testing of infants between 4 and 9 months.