Recognizing Early Motor Delays

A Comparison Examination of 2 Month Old Infants

Typical Atypical
• Maintains head in midline • May show more asymmetrical
for brief periods movement with predominance
of head to one side; or strong
• Locates objects visually and
Supine

asymmetrical tonic neck reflex

tracks from left to right (ATNR)
• Begins to show antigravity • Difficulty visually tracking, may
movements of upper and only track to one side or only
lower extremities to midline
• Not yet able to reach and • Decreased ability to generate
grasp toys upper and lower extremity
antigravity movements
• Longer periods of inactivity

• Able to lift head and upper trunk • May be unable to right head
during facilitated roll, showing
Sidelying

during facilitated rolling

lateral headrighting
• Begins to balance activity of • May look more competent in
trunk flexor and extensor sidelying, therefore important
muscles to observe baby in all eight
• Ability to change from positions
predominant use of flexors to
use of extensors as position
requires

• Head lifting to 45 degrees

and extension through
upper thoracic spine • Posture looks more like a
• Hips and knees begin to newborn; infant does not
move from flexed show hip extension; hips and
Prone

“newborn” posture into knees remain in flexed

extended, abducted abducted posture.
position, which allows head
and trunk lifting • No independent head lifting;
• Elbows typically not directly can move head only with
under the shoulders until assistance
3 months

• Head-lag is typical until • May exhibit head-lag

the infant is about 15 through the entire pull to
sit maneuver.
Pull to Sit

degrees from upright.

• Uses shoulder elevation • Poor head control when in
and elbow flexion to assist upright sitting
• Able to engage neck • Little muscle activity in
muscles to sustain midline the upper extremities or
head control when upright cervical spine
• Good extension through • When upright, rounding
the cervical and upper of the thoracic and lumbar
thoracic spine spine
 Recognizing Early Motor Delays
A Comparison Examination of 2 Month Old Infants
Typical Atypical

• Head is aligned with ear

directly over the shoulder • Needs more support to
• Holds and sustains sustain sitting posture
Sitting

posture with assistance • Inability to achieve and sustain

• Head turning may or may head lifting in upright position
not be present at • Little to no antigravity arm
2 months, but should be activity
seen by 3 months
Horizontal Suspension

• Able to activate adequate

neck and trunk extension to • Difficulty or inability to
sustain posture activate neck or upper
• Can maintain brief periods of thoracic extensors to lift head
head control, but may not be • May try to use arm and leg
able to hold the head in movements to sustain
midline posture
Protective Extension

• Aware of being tilted

forward; increases head
and neck extension • Unable to generate
• Will not be fully able to antigravity head and trunk
bring arms forward for full activity
protective response
protection until 6 months

• Able to sustain weight on

lower extremities with
Standing

support at the trunk • May support little if any

• Typically shows weight on feet
intermittent bouts of • Little or no intermittent
extension and flexion muscle activity to attain or
• Good vertical alignment maintain standing
from head through trunk
and feet

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