No More “Poor Head Control”

Session Description:
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.

Intended Audience:
This course is an intermediate course for therapists (PT, PTA, OT, COTA, SLP, and SLPA). 

Learning Outcomes: 

• Explain head control as a developmental continuum and its foundational role in functional skills.

• Recognize key factors that influence head control, including task complexity, environmental demands, and movement forces.

• Use multi-dimensional rubric to assess and guide interventions for head control, including applications in therapy with equine movement.

Presenter Biography:

Susie Rehr is the Executive Director of Special Strides and has been a physical therapist for 38 years. She has provided physical therapy services to the pediatric population integrating hippotherapy treatment principles for the past 27 years. Quality care, clinical education, educational presentations, published writing, and national involvement are hallmarks of her career. She has presented 6 different times at the AHA conferences since 2011 on a variety of topics such as clinical education, postural control, and breathing, EMR’s, and postural responses to equine movement. She has written numerous articles for the Hippotherapy Magazine as well as serving as the editor for 7 years. Clinical education, academic presentations and guest lectures at several universities round out her presentation background. From 2011- 2017 Susie was on the Board of Directors of AHA, Inc. as the Treasurer and later the Vice President. Over the past 9 years, she has developed educational materials for adaptive riding instructors to enable them to explore the world of (dis)abilities. May 2023 Susie earned her Master of Science in Organizational Leadership. June 2024 Susie co-founded a new educational company Dynamic Foundations in Practice.

Co-Presenter Biography:

Jane Burrows PT, DPT, HPCS is the Director of Facilities Management at Special Strides in New Jersey. She brings her 50 years of broad experience to bear on the development of educational materials and resources for therapists utilizing equine movement as a clinical intervention. After earning her Hippotherapy Clinical Specialist credentials in 2010, she proceeded to lead the American Hippotherapy Association (AHA) as President in 2015. Jane has made presentations at AHA conferences since 2015 and PATH conferences since 2016. She is a contributing author to Hippotherapy Magazine in a continuing series on equine health and training. Jane is an APTA credentialed clinical instructor and together with Susie Rehr has co-authored and presented courses on various topics including sensory integration, cerebral palsy, and autism spectrum disorder. In 2024 she co-founded an educational company, Dynamic Foundations in Practice. Jane is one of the key researchers involved in the development of the Weight-carrying Capacity Assessment Protocol (WtCAP).

Presenter Disclosure:

Financial: Jane Burrow and Susie Rehr are independent contractors for AHA, Inc. and does not receive a fee from AHA, Inc. for instructional services.

Non-Financial: Jane Burrow and Susie Rehr are members of the AHA, Inc.