Recognizing Early Motor Delays

A Comparison Examination of 4 Month Old Infants

Typical Atypical
• Exhibits midline and • Displays asymmetry of
symmetry of head, eyes, head and extremities, with
arms and legs head tilted and body curved
• Does not show a balance
Supine

• Shows visual engagement

and reaches out against between extension and
gravity flexion
• Moves extremities randomly,
• Demonstrates frequent but without expected
antigravity extremity antigravity movement
movement, dissociating • Is not visually engaged
from a more stable trunk and does not track object

• Uses upper arm and • Exhibits sluggishness in

dissociated lower extremities
Sidelying

top arm during facilitated roll

to assist in facilitated roll
• Sustains sidelying posture with • Does not sustain sidelying
a balance of trunk flexor and posture; has inadequate
extensor muscles control in position
• Lifts head and upper trunk off • Cannot lift head and upper
the surface in preparation for trunk off support surface
independent rolling

• Brings shoulders and • Has flexed hips which shifts

upper arms forward with weight forward while
elbows in front of keeping elbows behind
shoulders
• Shows progression shoulders
Prone

toward lower extremity • Uses only neck extension

extension and adduction instead of forearm weight
• Moves arms forward to bearing; head lifting is
reach for an object; turns unsustained
head freely to follow object • Does not have the
• Displays extensor activity capability to shift weight
into the lumbar spine onto lower extremities

• Maintains head in
• Demonstrates head-lag
midline without head-lag
Pull to Sit

and cannot sustain head

and with good chin tuck
lifting once upright
• Lifts legs and activates
• Does not pull with arms;
trunk muscles to assist in
no upper extremity
maneuver
participation
• Pulls forward with both
• Appears not to anticipate
arms and abdominals to
movement toward sitting
assist further in pull to sit
 Recognizing Early Motor Delays
A Comparison Examination of 4 Month Old Infants
Typical Atypical
• Shows good head control
and chin tuck, with head
in midline • Does not sustain head
• Requires support only at lifting; cannot turn head to
look side-to-side
Sitting

hips and pelvis; has

extension to mid-thoracic • Must be held high under
spine the armpits for support
• Begins to move in • Uses extremity posturing
anterior-posterior planes to compensate for decreased
and comes back from proximal strength
forward flexion at the hips
into upright sitting
Horizontal Suspension

• Able to keep neck and trunk

extended with head upright • Able to hold head up briefly
to 45 degrees, steady and but cannot maintain it in
in midline midline
• Shows trunk extension into • Cannot sustain thoracic
lumbar spine and scapular trunk extension and does
adduction not show hip extension
• Freely moves arms and legs • Cannot maintain trunk
extension while moving
arms and legs
Protective Extension

• Unable to sustain strong

• Displays extension neck, trunk and hip
through neck, trunk and extension during forward
hips that is maintained tilting
during forward tilting • Uses excessive asymmetry
• Cannot bring arms fully and flexed arms to sustain
forward to surface
because they are being extension to avoid hitting
used to sustain extension his head

• Requires support in the

• Keeps hips just behind
upper thoracic area to
shoulders
sustain standing
Standing

• Has active extension into

• Intermittent extension
lower thoracic and
used to produce head lifting
lumbar spine, but no full
• Shoulders remain well
hip extension
forward of hips
• Can sustain standing
• Lacks adequate hip and
posture; requires minimal
trunk control for sustained
support at lower trunk to
weight bearing
aid in balance

For more information please contact

Pathways Awareness
Toll-free (800) 955-2445 · Fax (888) 795-5884 · TTY (800) 326-8154
http://www.pathwaysawareness.org · friends@pathwaysawareness.org
Copy freely, do not change. Must acknowledge Pathways Awareness.