Welcome to your
Your easy guide to carrying out and scoring to SATCo!
The Basics of SATCo SATCo Part 1
Watch a practical demonstration SATCo Part 2
Download the SATCo Essentials: Principles and Practice of SATCo
Scoring the SATCo Part 3
Download the SATCo Essentials: Scoring the SATCo
Download the (A4 size) SATCo Score Sheet
Download the (Letter size) SATCo Score Sheet
Why not use the normal sitting posture for SATCo?
- How do you define ‘normal sitting’?
- How do you compare one child’s normal sitting posture with that of another child?
Normal sitting does not provide a reproducible and consistent posture.
But an aligned sitting posture would work!
Aligned sitting may have ears, shoulders and hips aligned but there is no information about the spinal/trunk profile.
As you see in the above video ‘SATCo Part 1’, a marked postural (i.e. not fixed) thoracic kyphosis or lumbar lordosis – or both – can exist in an aligned posture.
The neutral vertical posture (NVP) brings the spine/trunk as flat as possible, accounting for age. This neutral vertical posture is
We can compare the NVP before and after therapy, between children, between children of different racial backgrounds. We can’t do this with aligned sitting as it omits vital trunk profile information.
And, most importantly, gaining control of the head and trunk can only be achieved effectively using the neutral vertical posture. Movement away from neutral is possible in all directions anatomically possible. This is the ideal start point and is the essence of
Of course, a child can learn function and movement in any posture and this requires control…
…but if the child starts and ends in, for example, a flexed trunk posture, that is what they will learn to do better! Move in flexion!
Is this really what you want?
If not, then investigate Targeted Training – it could be just what you need to help children in your care.
Hear what people say about SATCo…………
A Research Physical Therapist in the USA talks about how SATCo has influenced her work
A movement scientist gives an overview of SATCo
A physiotherapist in Spain shares her research on transcultural translation of SATCo
Dr Tania Sakanaka and Professor Ian Loram of Manchester Metropolitan University, UK, look to the future of SATCo
‘Videos with kind consent of Dr Mindy Silva of the Wired Collective’
Securing the pelvis for SATCo
The original method of using pelvis stabilising straps attached to a therapy bench was proposed in Butler et al. Refinement, reliability, and validity of the segmental assessment of trunk control, Pediatr Phys Ther 22, 246, (2010). A potential problem with this is that it requires straps to be fastened to an existing therapy bench and this may present problems with local Medical Device Regulations. The solution proposed below should overcome regulatory problems and provide better stabilisation of the pelvis.
N.B. Before implementing any design based on these proposals you are advised to check that it is within your scope of practice and that it complies with any local regulations that might apply.
What you need to achieve
To stabilise the pelvis effectively, you need to apply a near horizontal force to each of the Anterior Superior Iliac Spines (yellow arrow) and to the Sacrum (purple arrow). These two points are not at the same horizontal level, with the sacrum slightly lower.
N.B. These represent two of the forces required for orthotic three-point fixation. The third force will be generated by friction at the level of the seat surface.
Potential Solution (Schematic)
Use a regular therapy bench that is preferably seat height adjustable so that children or adults of various heights/leg lengths can have their feet resting on the floor. A range of footrests would provide an alternative for a non-adjustable bench.
Take a rigid bar that is long enough to be more than the hip width of your largest client. To ensure that the pelvis is stabilised this bar should be sufficiently rigid that it will not significantly bend or distort when the straps are tensioned (It doesn’t have to be circular).
Wrap two straps around this bar, spaced apart. Pass these straps around the bench seat so that the bar hangs horizontally and slightly loosely at the back of the bench and secure the straps (e.g. buckle).
Two sets of pelvic straps are needed, both having an adjustable easy release fastener. Yoga straps or similar work well.
The first strap attaches near the central point of the rear bar and passes under the seat before emerging between the legs, passes over one thigh, then round the back of the pelvis and over the other thigh before being passed under the seat again and is attached to the rear bar adjacent to the origin.
The second strap passes round the front of the child and attaches to the rear bar in two places.
Since regulations and availability of potential components will vary across territories this proposal does not represent a final design. Each provider will need to satisfy themselves that their solution complies with local conditions.
In particular design decisions will be needed in the following areas :-
- Rigidity and strength of the rigid bar
- Type of straps to be used
- Type of quick release fastener used with the straps
- Positioning of the fasteners
- Method of adjusting strap lengths
A hard copy of this SATCO straps document can be downloaded here – Download
If you have found these SATCo straps suggestions helpful, please consider making a small donation to OPTIMI
by visiting our donations page DONATE or by direct bank transfer
BACS: Account Name: OPTIMI, Sort Code 089299, Account Number 65885529 00
SATCo and SP&R-co: which test does what and which do I need?
The Segmental Assessment of Trunk Control (SATCo) has been in clinical use since 1997, and was originally devised to evaluate Targeted Training. It was refined, with further reliability and validation, in 2010*.
The Seated Postural & Reaching Control Test in Cerebral Palsy (SP&R-co) was developed to address perceived problems with the SATCo. The SATCo forms the basis of the SP&R-co, retaining the use of the vertical posture and segmental approach. The SP&R-co was published in 2020.
The SATCo provides an in-depth analysis of head and trunk vertical postural control. This is achieved by a segmental approach and assessment of static, active and reactive control elements. The resulting information identifies the topmost (most cephalo) segment at which each of static, active and reactive control require control training, giving both a record of control status and a clear direction of therapy strategy.
“The SP&R-co test provides clinicians with an individualized quantitative profile of
seated postural and reaching control. The test can guide clinicians to pinpoint the most impaired trunk subregion and objectively target the postural dimension/s that require further therapeutic training.”
The authors of the SP&R-co identified limitations in the SATCo, their principal stated problems being:
- The SATCo is not quantified
- Evaluation of the SATCo static dimension at a bare-minimum time period of 5 seconds, “is unlikely to detect control deficits”
- SATCo does not examine the proactive dimension—the ability to control posture during destabilizing voluntary movements (i.e., reaching actions) that demand anticipatory postural adjustments.
Taking each of these identified SATCo limitations in turn
- Lack of quantified outcome
The SP&R-co adds a timing element to the static, proactive and reactive dimensions, but not to the active dimension
- Bare-minimum static control period of 5 seconds
The SP&R-co adds increases this period to 20 seconds
- Lack of assessment of the proactive dimension
This is included in the SP&R-co
Observations on these adjustments and additions
- Addition of a timing element to the SP&R-co to provide a quantified test
The timed elements, such as static control of 20 seconds, are converted to scores e.g. achievement of 20 seconds or more = 2, up to 20 seconds = 1, unable = 0. This is no longer a true numerical score.
The orientation element is also scored as 0, 1 or 2, where 2 is the full score. A score of 1 is given if, for example, antero-posterior head/trunk movements “are excessive”. This would usually be understood as a subjective component and not a true numerical score. This tolerance of ‘excessive’ movement with a score of 1 suggests that the biomechanics of trunk control has not been fully explored. SATCo does not credit excess trunk movement.
True quantitative data is measured: what has been presented in the SP&R-co more resembles categorical data and not a quantified test
- Increasing the static control period from 5 to 20 seconds in the SP&R-co
This was changed in the SP&R-co to increase the likelihood of detecting control deficits by presenting a longer challenge.
The SATCo is validated for infants and children with neuromotor disability. Will a 2 year old maintain a static, hands free posture for 20 seconds?
More important is the question of the relationship between static control and function. The reason for testing a child (SATCo or SP&R-co) is to plan intervention to improve function. The question should perhaps be ‘What is the relative relationship between functional skills (e.g. sitting hands supporting or sitting hands free) and a static control test at a given trunk segment that lasted for 5 or for 20 seconds?’
Whether the increase in time from 5 to 20 seconds is necessary or helpful is unknown without research into the static control timing / functional skills relationship
- Addition of the proactive dimension in the SP&R-co
This involves a fast reaching task at 45 degrees right and left and straight, repeated unilaterally and with both hands. It requires the child to touch the toy, with the bimanual task only gaining full score if both hands touch simultaneously.
This requires understanding and cooperation by the child and the SP&R-co acknowledges that not all children will be able to perform the test.
This dimension adds information about anticipatory postural adjustments for those children who can understand and comply with the instructions. Since the test is directed towards intervention planning, a therapy programme could perhaps include such training irrespective of inclusion completion of the proactive test.
So which test to select?
The SATCo is a clear, simple and biomechanically sound test of segmental trunk control.
The SP&R-co introduces additional elements which make the test and subsequent test analysis longer and more complex. However, the proactive component could provide helpful information for those children able to complete this dimension.
Make your choice!
N.B. Much of the important theoretical information is explored on our learning pages. You can purchase access to these by REGISTERING your interest and following the links.
* Butler PB, Saavedra S, Sofranac M, Jarvis SE, Woollacott MH. (2010) ‘Refinement, Reliability, and Validity of the Segmental Assessment of Trunk Control’. Pediatric Physical Therapy 22(3):246-257. Winner of the Toby Long Award for the best manuscript published in Paediatric Physical Therapy, 2010.
**Santamaria V, Rachwani J, Saussez G, Bleyenheuft Y, Dutkowsky J, Gordon AM, Woollacott MH. (2020) ‘The Seated Postural & Reaching Control Test in Cerebral Palsy: A Validation Study’. Physical & Occupational Therapy In Pediatrics, 40(4):441-469.
The 5 day challenge
A number of participants posed questions during the 5 Day Challenge and some are answered below.
Questions you have asked about SATCo
The questions and answers are shown below. You can select the questions by clicking on the dots at the bottom or by using the Left and Right arrows that appear when you hover over the green area.
The ‘standard’ SATCo posture is trunk upright (Neutral Vertical Posture), hips and knees at 90 degrees and feet supported. There are two exceptions to this:
If a child or infant is not yet weight-bearing, the feet remain free of support.
The second is if a child pushes hard on their feet during the SATCo to try and gain extension. The easy answer to this problem is don’t provide a surface for the feet to push on!
Remember, we are not testing a sitting posture or normal sitting position. It is a very specific Neutral Vertical Posture that most children use easily and regularly but which enables movement in all directions around the mid-point. If a child then gains this control, they will be able to use a variety of sitting postures.
The segments have been designated by joint movement characteristics i.e. the joints comprising each SATCo head/trunk segment all have the same predominant movement characteristics.
Fewer segments would probably miss this element and could introduce some confusion if different predominant movement characteristics are present.
More segments could be challenging to identify, especially in small infants!
The assets of SATCo and TT are the neutral vertical posture and the segmental approach. These combine well with many other therapy approaches, and it thus a ‘tool in the box’.
But once you understand the rationale of the NVP and the segmental approach, it can be difficult to set it to one side! It just starts to influence your thinking as this logic will not go away…!
This tactile messaging may be part of your therapy strategy but just know when to stop! And if you don’t need to touch/support a child, why are you doing it? Let the child learn without your input…
SATCo was introduced as an assessment tool to determine where Targeted Training should focus and then to measure outcomes.
The child has full active control of (uppermost) segments and equipment control of the lower segments. There are no trunk segments that are not either supported or with active control. Your work has shown that the dynamic trunk supports can provide stability.
This ‘immediate functional improvement’ strategy forms part of the teaching on the Optimi website (Foundation Learning Module II). It is not TT as such but is an extension of the principles.
I read this question as ‘which posture is selected for TT, sitting or standing, and why?’ The answer may surprise you- it doesn’t matter! What does matter for TT is that the child can be held securely in the NVP with the topmost support at the segment you have determined from your SATCo.
The reality is that the seated position makes a neutral pelvic posture much easier to hold securely than does standing. Try it out with a child or two! The Leckey SATCo bench has a specially designed pelvic cradle to secure the neutral pelvic posture and this then makes getting the NVP of all segments above much easier. [Note: I worked with Leckey on the design of the Leckey SATCo bench and Leckey Squiggles TT but remain fully independent of Leckey and receive no funding e.g. per item sold.]
The SATCo is done in the seated posture as it is a reliably reproducible posture. Targeted Training (TT) can be done with the child seated or in a standing position but, in either posture, the head and trunk must be in the NVP to ensure the learning that takes place is what is intended. Remember, it is the NVP that is being trained and sitting or standing depends on what is available to you, equipment wise and if that posture can be reliably supported and gradually ‘released’ (top support moving caudally over time as control is gained.)
Why does the Squiggles TT stander use standing if the seated posture holds the pelvic position more reliably? Because Leckey already had the basics of a stander with which to work (you just would not credit the cost and complexity involved in bringing a new design to market!) so working with this existing basis was sensible. We ensured that all the TT attributes were included, for example, the ability to be able to adjust the overall final posture in space (tilt) to ensure that the child’s individual neuromuscular system and the stander were ‘as one’ and the child given the optimal start point. It is not just ‘a stander’. (And in answer to another question, standing in abduction is just fine for trunk control TT.)
Starting on the SATCo bench is not viable unless you can provide manual support where needed for TT sessions (unless training lumbar control where the pelvic cradle will provide the necessary support). You will probably need a stander (or bench with a pelvic and a chest support) and need to ensure you can achieve a true NVP (not just ‘upright’) and really firm support especially at the chest support. Touch and close (Velcro) fabric straps will not really do it but can be made firmer. But just be careful what you do with equipment and don’t start making major alterations to the structure. If anything should go wrong, you will be liable. (All this is covered in Optimi) Please ask if you wish!
But with small children and infants, much can be achieved without special equipment! Sit baby/child on mom’s knee and mom holds the child as you have shown them – and bouncing games (mom jiggling her knee) give a great, fun input that works!
I hope this has clarified things for you.