Neonatal vertical suspension

Vertical suspension measures the strength of the neonate's shoulder girdle. The examiner holds the infant in an upright position by placing the hands under the arms and around the chest with the feet unsupported. In infants with decreased tone of the shoulder girdle (shown in the inset of an abnormal response), the infant begins to slip through the examiner's hands and the legs are extended. Vertical suspension is also helpful in evaluating for subtle increases in muscle tone in the lower extremities. In the presence of lower extremity hypertonicity, there may be adduction at the hips combined with hyperextension at the knees and ankles. The lower extremities may appear to cross over each other (scissoring posture).