8/8/2019 Hot Topics 4 Months

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Recognizing Early Motor Delays

A Comparison Examination of 4 Month Old Infant

Typical

   S  u  p   i  n  e

Atypical

• Exhibits midline and

symmetry of head, eyes,

arms and legs• Shows visual engagement

and reaches out against

gravity

• Demonstrates frequent

antigravity extremity

movement, dissociating

from a more stable trunk

   S   i   d  e   l  y   i  n  g

• Uses upper arm and

dissociated lower extremitiesto assist in facilitated roll• Sustains sidelying posture with

a balance of trunk flexor andextensor muscles

• Lifts head and upper trunk off the surface in preparation for independent rolling

   P  r  o  n  e

• Brings shoulders andupper arms forward withelbows in front of shoulders

• Shows progressiontoward lower extremityextension and adduction

• Moves arms forward toreach for an object; turnshead freely to follow object

• Displays extensor activityinto the lumbar spine

   P  u   l   l    t  o

   S   i   t

• Maintains head in

midline without head-lag

and with good chin tuck

• Lifts legs and activates

trunk muscles to assist in

maneuver 

• Pulls forward with both

arms and abdominals to

assist further in pull to sit

• Displays asymmetry of head and extremities, with

head tilted and body curved• Does not show a balance

between extension andflexion

• Moves extremities randomly,but without expectedantigravity movement

• Is not visually engagedand does not track object

• Exhibits sluggishness in

top arm during facilitated roll• Does not sustain sidelying

posture; has inadequate

control in position

• Cannot lift head and upper 

trunk off support surface

• Has flexed hips which shifts

weight forward while

keeping elbows behind

shoulders

• Uses only neck extension

instead of forearm weight

bearing; head lifting is

unsustained

• Does not have the

capability to shift weight

onto lower extremities

• Demonstrates head-lag

and cannot sustain head

lifting once upright

• Does not pull with arms;

no upper extremity

participation

• Appears not to anticipate

movement toward sitting

8/8/2019 Hot Topics 4 Months

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Recognizing Early Motor Delays

A Comparison Examination of 4 Month Old Infants

Typical

       S       i      t      t       i     n     g

Atypical

• Shows good head controland chin tuck, with headin midline

• Requires support only athips and pelvis; hasextension to mid-thoracic

spine• Begins to move in

anterior-posterior planesand comes back fromforward flexion at the hipsinto upright sitting

   H  o  r   i  z  o  n   t  a   l    S

  u  s  p  e  n  s   i  o  n

• Able to keep neck and trunkextended with head uprightto 45 degrees, steady andin midline

• Shows trunk extension intolumbar spine and scapular 

adduction• Freely moves arms and legs

   P  r  o   t  e  c   t   i  v  e   E

  x   t  e  n  s   i  o  n

• Displays extensionthrough neck, trunk andhips that is maintained

during forward tilting• Cannot bring arms fully

forward to surfacebecause they are beingused to sustain extension

       S      t     a     n       d       i     n     g

• Keeps hips just behindshoulders

• Has active extension into

lower thoracic andlumbar spine, but no fullhip extension

• Can sustain standingposture; requires minimalsupport at lower trunk toaid in balance

• Does not sustain headlifting; cannot turn head tolook side-to-side

• Must be held high under 

the armpits for support• Uses extremity posturingto compensate for decreasedproximal strength

• Able to hold head up brieflybut cannot maintain it inmidline

• Cannot sustain thoracictrunk extension and does

not show hip extension• Cannot maintain trunkextension while movingarms and legs

• Unable to sustain strong

neck, trunk and hip

extension during forward

tilting

• Uses excessive asymmetry

and flexed arms to sustain

extension to avoid hitting

his head

• Requires support in theupper thoracic area tosustain standing

• Intermittent extensionused to produce head lifting

• Shoulders remain wellforward of hips

• Lacks adequate hip andtrunk control for sustainedweight bearing

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