The Head Control Scale: Development, inter-rater reliability, and utility

Jodi Thomas, Amy Armstrong-Heimsoth, Roy St Laurent

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


PURPOSE: This study introduces a new scale for the assessment of head control called the Head Control Scale (HCS). The purpose of this study was to establish interrater reliability of the HCS and to determine its usefulness in a clinical setting. METHODS: The HCS assesses head control in four positions (prone, supine, pull to sit, and supported sitting) on a 0-4 rating scale. The authors used both a focus group and pilot testing to refine the scale to its final version, which was then used to assess interrater reliability. Twenty-six therapists used the HCS to evaluate head control of five subjects of varying ages and abilities who were videotaped spending 30-40 seconds in each position. Participants also completed a post-rating survey. RESULTS: Fleiss's weighted kappa coefficient is excellent for the prone (0.82), pull to sit (0.83), and sitting (0.88) positions as well as for the scale overall (kappa = 0.91). It can be described as fair to good for supine (kappa = 0.68). CONCLUSIONS: The HCS has high interrater reliability and users report it to be a needed tool, applicable to clinical practice, and easy to use. IMPLICATIONS: The results of this study indicate that the HCS has great potential for clinical use.

Original languageEnglish (US)
Pages (from-to)295-303
Number of pages9
JournalJournal of Pediatric Rehabilitation Medicine
Issue number3
StatePublished - 2019


  • Head control
  • assessment
  • scale

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation


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