No More “Poor Head Control”

What does it really mean when a therapist describes a child as having “poor head control”—or “good head control,” for that matter? Head control is far more than simply balancing the cranium on the spine; it is a foundational skill that supports countless other functional abilities. In typical development, head control emerges along a predictable trajectory, but when a child falls behind on early milestones, it is often the first area of concern.

Despite its importance, head control is notoriously difficult to define, quantify, and qualify. There is no standardized rubric to guide clinicians, yet most rely on an intuitive sense of what “poor” looks like. But is this intuition sufficient for clinical evaluation, interprofessional communication, insurance documentation, and research?

A crucial starting point is recognizing that head control exists along a continuum—spinal stability is only the first step. Beyond motor responses, head control is influenced by dynamic challenges, environmental complexity, task demands, and the generation of forces necessary to support movement.

This presentation introduces an updated framework and explores a multi-dimensional rubric designed to help clinicians rate, track, and plan interventions for head control. The rubric captures the continuum from absence of control to successful completion of complex movements, providing a reliable tool for therapy services that integrate equine movement.