As clinicians, we know through handling children with special needs just how essential trunk control is for function. From stabilising the head to enable a child to catch someone’s attention to providing the strong base for distal function in the arms and hands, trunk control is the foundation of many activities of daily living. But what is the best way to assess for it and what use is an assessment in guiding our practice anyway?
Therapists frequently use motor scales to assess, but when it comes to the trunk, these scales lack specificity, treating the trunk as one unit, and ignore the multi-segmental nature of the spine. Trunk control is simply inferred from other skills such as ‘the ability to sit with or without hand support’. Also, the ‘score’, although helpful in benchmarking ability, doesn’t provide specific information to guide therapeutic intervention. Yet this is the information which we want to know.
So when I learnt from Dr Penny Butler founder of The Movement Centre, Oswestry, about a technique which would not just determine the level of trunk control, but also direct therapeutic intervention, I was all ears. The Segmented Assessment of Trunk Control (SATCo) has been guiding my thinking ever since. Whether it is setting up a seating system, discussing the potential for toileting or advising on a course of Targeted Training, SATCo gives valuable insight.
What is SATCo?
SATCo is a validated outcome measure which determines the topmost (most cephalo) segment at which control of the upright posture is poor or not demonstrated, i.e. it is currently being learnt. The SATCo divides the spine into six segments which are identified by anatomical markers, for example mid thoracic segment is from T3 to T7.
How is SATCo assessment performed?
The child is sat on a therapy bench, pelvis stabilized (by hands or harness) while firm manual support given directly beneath the segment being tested. Support gradually moves down to test each segment in turn for static, active and reactive control.
The tricky bit... Care must be taken that the child isn’t sneaking some extra support by holding a toy or bracing on the testers’ hands. The spine must also be in ‘neutral vertical’ posture i.e. completely upright, and neither flexed, extended, or rotated. In this neutral position all muscle groups are ready to respond and appropriate neurological control can kick in. Lots of distraction and clowning around by the adults help with this part.
The clever bit… The SATCo score can be used to guide function or direct therapy. For example, since children are seated for long periods, the height of the lateral supports on a wheelchair or seating system should be set at the level of control which is already gained. This way function is maximised, and the child can concentrate on education or play. Or the score could be used to determine whether lower abdominal muscles have started to develop, and toilet training has potential for success. Alternatively, a score could be exploited to prescribe a course of Targeted Training therapy whereby supports in a specialized dynamic standing frame are set lower than control to target the level of the spine to be ‘trained’. Research suggests this can bring life-changing improvements to the child however, the benefits of Targeted Training are for another day and another blog.
- Butler PB, Saavedra S, Sofranac M, Jarvis SE, Woollacott MH. Refinement, Reliability, and Validity of the Segmental Assessment of Trunk Control. Pediatric Physical Therapy. 2010; 22(3):246-257. Winner of the Toby Long Award for the best manuscript published in Paediatric Physical Therapy, 2010.
- Butler PB, Major RE. The learning of motor control. Biomechanical considerations. Physiotherapy. 1992; 78(1): 1-6.
- Pin TW, Butler PB, Shum S L-F. Targeted Training in managing children with poor trunk control: 4 Case Reports. Pediatr Phys Ther. 2018;30:E8–E1.
- Saavedra S, Woollacott M, van Donkelaar P. Effects of postural support on eye hand interactions across development Exp Brain Res. 2007; 180(3): 557–567