A Task Oriented Approach to Assessment and Training of Infant Sitting

Assessing infant sitting often serves one of two purposes:

1. It determines how far the baby is progressing on the sitting developmental trajectory. Two commonly used tests to assess progress in sitting are the Segmental Assessment of Trunk Control (SATCo) and the Alberta Infant Movement Scale (AIMS).
2. It helps determine what the baby can and cannot do at the moment. It highlights why babies have trouble sitting and what can be done to improve their ability to sit.

Sectional Assessment of Mainline Control (SATCo)

The SATCo is a clinical assessment of a child’s ability to maintain an upright head and trunk position while manual support is provided at progressively lower levels of the trunk. [1][2] Manual support at the shoulder straps is used to assess head control when the infant is seated on a bench Then the lower shoulder blades are supported at armpit level, the lower ribs are under the pelvis, and finally unsupported.

The child sits on a bench with their pelvis strapped in a vertical position. The therapist supports the torso at different levels. Static active and reactive controls were scored as present absent or not tested (NT) for each trunk segment level.

• Static control is considered if the child can maintain a neutral trunk position above the level of hand support;
• Active control is considered if the child can maintain a neutral posture during head movements;
• Response control is considered if the torso above the support remains stable during the external disturbance (nudge).

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

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

Alberta Infant Motor Scale (AIMS)

AIMS assesses the maturity of gross motor skills in infants from term (40 weeks after conception) to 18 months of age.

• It consists of four subscales: Supine Prone Sitting Stand
  • Each subscale has a set of items that describe increasing levels of sophistication on developmental tasks.
• Each item is accompanied by a graph depicting the percentage of infants in the standard sample for each age category who earned points for the specific item.
• Studies using AIMS normative data to assess its effectiveness in different countries have shown some differences in the age at which infants receive different programs. [3] [4]

The order of items in the AIMS Sitting Scale provides a useful reference for identifying an infant’s progress on an unsupported sitting trajectory. They include:

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  Sitting with external support

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• Unsustained sitting with arm support

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• Pull to sit

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• Sustained sitting with arm support

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• Sitting intermittently and continuously without arm support

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• Reach with rotation

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• Transition to prone and four-point kneeling

Guidelines for Assessment and Intervention Using a Dynamic Systems and Task-Oriented Approach

A sitting assessment is often part of the treatment process, which begins with a meeting and greeting with the child, family and other caregivers, followed by a conversation about the family’s expectations and goals for treatment. This family therapist conversation will determine Developmental tasks will be selected during treatment for assessment and training and planning of family plans. [5]

The dynamic systems task-oriented and intensive intervention approach advocated in this course has two sources:

1. International clinical practice guidelines for early intervention for children aged 0 to 2 years with or at risk of cerebral palsy [6]
2. GAME Protocol for Early Intervention

The GAME protocol for early intervention

The GAME intervention is based on the principles of active motor learning, parent guidance in family-centred care, and environmental enrichment. Interventions are customized based on the goals and enrichment styles of the parents and the motor abilities of the child. [7] [8]

The Dynamic Systems task-oriented and intensive training intervention approach is delivered by six ideas:

1. Family-centered care and parental involvement in choosing goals and providing opportunities to practice motor skills are critical to success. [9] [10]
2. Therapy should always start with the baby’s current capabilities – thinking about what they can do in the moment; how does this create an opportunity for learning to do more? [11]
3. Emphasis on training intensity repetitions and many daily opportunities to practice tasks in a variety of situations. [6]
4. Spontaneous action and the exploration of possibilities to do things support and enhance motor learning. [12]
5. Intrinsic motivation Curiosity and the drive to explore and interact with people and objects support the learning of new motor skills. [13]
6. Facilitating pleasant and meaningful social interactions and exchanges is at the heart of the intervention, which supports learning of motor tasks.