Measuring head control changes after utilization of the headpod™ in children with poor head control
When gross motor milestones of children with cerebral palsy (CP) lag years behind their chronological age, gross motor progress often plateaus and further advancement is slow and limited. Head control is a key milestone that influences the development of other milestones. This study investigated the effectiveness of an innovative new device called the Headpod™. This dynamic head support system, designed to assist with poor head control was introduced to the United States in 2013. There is limited evidence to support use of this device to date.
This study was a quasi-experimental, one-way repeated measures design. Participants were evaluated before and after 3 months and 6 months of Headpod™ use, 15 minutes, 3 times per day (45 total minutes per day). Head control without the device was measured via 5-minute video recordings. Video-based analysis determined the amount of active time, in seconds, the children could hold their head upright against gravity to participate in an activity and the number of head bobs.
There were 14 participants enrolled. Participants ranged from 3 to 11 years of age (6 males, 8 females). Twelve had CP and 2 had other non-progressive neurological diagnoses. All participants were severely physically involved and classified as having a Gross Motor Functional Classification System (GMFCS) level of V. Overall, there was a 43% attrition rate. The Friedman ANOVA was used to compare active time and head bobs over the 6-month period to determine if there was a statistically significant difference between the mean ranks. While there was no difference in head bobs, results indicated a significant time effect on active time, χ2 (2) = 8.00, p=.018. Active times were higher at 6 months (Mdn=286.5 s) compared to 3 months (Mdn=209.5 s) and at baseline (Mdn=166.0 s). The Wilcoxon signed-rank test indicated a difference between the baseline and 6 months, and between 3 and 6 months (p <.05). A post hoc effect size was calculated and yielded very large treatment effects for active time (Cohen’s d=2.570 and 1.476, respectively). Positive results from participant caregivers on a 15-point Global Rating of Change (GROC) scale supported the very large treatment effect size.
While most clinicians and researchers believe that children with severe and profound involvement are unable to improve after infancy, a belief supported by predictive GMFCS reference curves, this study suggests otherwise in terms of active time head control. According to the ICF model, improvement in body structure and function, such as head control, can influence participation and activity, and ultimately one’s quality of life. Even small improvements in head control may benefit the child’s social, educational, recreational, self-care, and self-esteem domains. Six months of Headpod™ use, 45 minutes/day, appears to have a very large effect on active head control and thus merits a large-scale random controlled trial.