Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

DoreenBartlett,PTPhD
Professor,SchoolofPhysicalTherapy,
WesternUniversity,London,Ontario
CPAClinicalTeleconferenceProgram:PediatricDivision
October8,2014,12 1pmEasternTime
1

Objectives
Bytheendofthisteleconference,youwillbeableto:
y DescribekeypointsinadministeringandscoringtheAIMS
y Proposesolutionstosomecommonpitfallsinscoring
y InterpretAIMSpercentilescoresandexplainthemto
familiesandotherserviceproviders
y JustifyuseoftheoriginalAIMSnormsbasedonresultsof
arecentlycompletednationalstudy

AlbertaInfantMotorScale
y Publishedin
y MotorAssessmentoftheDevelopingInfant
y
y

MarthaC.Piper&JohannaDarrah
PhiladelphiaPA,WBSaunders;1994

y Note:Illustrationsonslides10,1617,20,25,29and59

arefromthebook

Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

ClinicalUses
y Reliablyandvalidlyassessesthegrossmotorabilitiesof

infantsfrom0to18months(ageofindependentwalking)
y Evaluatesweightbearing,posture,andantigravity

movementsofinfant
y Publishedin1994andispresentlyusedinternationallyfor

clinicalandresearchpurposes

Identification(Discrimination)

y Identifiesinfantswhoaredelayedatpresenttime
y Noindicationoffutureperformance

IdentificationofInfants 18months
y Typicallydeveloping
y Delayedwithtypicalpatternsofmovements
y Delayedwithatypicalpatternsofmovement

Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

Evaluation
y Evaluateschangesovertime
y Responsiveness

EvaluationofInfantsWhoAre
y Typicallydeveloping
y Delayedwithimmaturebuttypicalpatternsof

movements

AIMSCANNOTbeUsedto
y Evaluatechildrenwithcerebralpalsyovertimebecause

childrenwithCPmayusedifferentmovementpatterns
thanaredepictedintheAIMStobefunctional

Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

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InterventionPlanning
y Delayedinfantswithimmaturebuttypicalpatternsof

movement

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

Education
y Academicprograms
y ParentsandCaregivers
y Earlyinterventionconsultants

13

AIMSAdministration:Observational
Approach
y Focusesonspontaneousmovements
y Emphasizespositiveaspectsofmotorabilities
y Minimalhandlingandpositioning
y Evaluatesaninfantsmovementincontext

14

AIMSConsistsof58Items

21prone
9supine
12sit
16stand

15

Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

16

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NumberofTrials
y Nominimumormaximumnumber
y Needadequateopportunitytodemonstrateentire

movementrepertoire
y Ifanitemisnotobservedwithin30minutes,conclude

notinrepertoire

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

AIMSdoesNOTContain
y Timeditems
y Isolatedtestingofmuscletone,primitivereflexes,head

control
y Testingpositionssuchasventralsuspension,vertical

suspension

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20

Scoring
y Scoreafterobservationofinfant
y Scoreobserved/notobserved

ONO

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

Observed=Assessorseestheitem
y Noassumptionsaboutpreviousmotorabilities
y Noparentalreport

22

ScoreSheet
y Linedrawingforeachitemwithkeydescriptorsof

posturesand/orantigravitymovements

23

ScoreAfterObservingInfant
ForEachSubscale
y Identifytheleastmatureobserveditem
y Identifythemostmatureobserveditem
y Itemsbetweenthesetwoitemsrepresenttheinfants

motorwindow
y ScoreeachiteminthewindowaseitherObserved(O)or

NotObserved(NO)

24

Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

25

ComputingtheScore
y Creditonepointforeachitempriortotheleastmature

observeditem
y Creditonepointtoeachobserveditemwithintheinfants

motorwindow
y Sumthepointsforeachsubscale
y Sumthefoursubscalescorestocomputeatotalscore

26

PlottingtheScores
y Fromthepercentilegraph
y Fromthetable(AppendixII)

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

Graph
y Locatetheinfantsageonthexaxis
y LocateAIMStotalscoreonyaxis
y Locatepercentilerankattheintersectionoflinesdrawn

fromthesetwopoints

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29

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

Caution!
y Dontstartwindowtoofarback
y Readthedescriptorscarefullyonthescoresheet they

areyourguide
y Youreallyneedthemanual detaileditemdescriptions
y Donttakeparentreport
y Nonobservedisokayinthemotorwindowbutnoscore

isnot
y Allsubscalesneedatleastoneitemmarked
y Anoteaboutbilateralitems
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Whatstheappropriateinterpretation?

32

LongitudinalStabilityofInfantGross
MotorDevelopment
y Darrah etal.EarlyHumanDevelopment.1998;52:169

180

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

MeanScore

Infant23(FullTerm)
100
90
80
70
60
50
40
30
20
10
0

Age(Months)

34

MeanScore

Infant68(PreTerm)
100
90
80
70
60
50
40
30
20
10
0

Age(Months)
35

MeanScore

Infant68(PreTerm)
100
90
80
70
60
50
40
30
20
10
0

Age(Months)
36

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

PercentileInterpretation
y Thinkofalargewindowoftypicaldevelopment(may

evengobelowthecutoff)
y Theexactpercentiletellsyouwherethechildsscorerank

comparedtothechildreninthesameagegrouping(by
month)intheAIMSnormativedata
y Theresearchsuggeststhatthat80thpercentileisnot
betterthanthe25thpercentile
y Ifaninfantsscoreisbelowthecutoffyouneedtofigure
outwhy theinfantcanstillhavetypicaldevelopment
37

ParentsInterpretation
Parentsoftenassume:
y Apercentileisequivalenttoapercentmark
y Higherisbetter
y Theydontlikeaverage!
y Whatisaverage?

38

Onemorecaution
y Dontextrapolateaninfantscoretodetermineamotor

ageormotorquotient,evenwhenaphysicianwantsone!

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

AvalidationofAIMSNormativeData

JohannaDarrah
DoreenBartlett
ThierryLacaze
WilliamAvison
40

Whydidweconductthisstudy?
y Thenormativedatawere18yearsold
y SomeconcernthattheSIDSbacktosleepcampaignhas

affectedinfantgrossmotordevelopment,especially
pronedevelopment
y OriginalnormsweredevelopedfromAlbertadataandwe
wanttocapturetheethnoculturaldiversityof
contemporaryCanadiandemographics

41

Howdidweconductthestudy?
y Involved6centerswithethnoculturaldiversity

(Vancouver,Edmonton,Winnipeg,Toronto,Montreal,and
Halifax)
y Aimedtorecruit844infantsintotal
y Aimedtoassess675infants,ageofassessmentrandomly
assignedacrossthefullagespectrum
y AssuredthatVisibleMinoritiesandAboriginalinfants
wereproportionallyrepresentedaccordingtoStatistics
Canadainformation
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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

2006StatsCanada
TotalpopulationCanada

31,241,030

Totalvisibleminority
population
Black

5,068,090
783,795

2.5

SouthAsian

1,262,865

4.0

Chinese

1,216,570

3.9

239,935

0.8

Filipino

410,695

1.3

LatinAmerican

304,425

1.0

Other

849,805

2.7

1,172,785

3.8

SouthEastAsian

Aboriginalpopulation

16.2

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PlannedRecruitment
Vancouver Edmonton Winnipeg
VisMin
Aboriginal

50(40)

18(14)

16(13)

Toronto
50(41)

11(9)

23(18)

White

90(72)

112(90)

101(81)

90(72)

TOTAL

140(112)

141(113)

FulltermInfants
3436weeks
<34weeks

Montreal

Halifax

TOTAL

18(14)

8(6)

124(99) 133(106)

140(112) 140(113) 142(113) 141(112)

160
(128)
34(27)
650
(520)
844
(675)

776
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44

RecruitmentProcess
Researchnurse:
y Identifiedeligiblefamilies
y Providedfamilywithbrochure
y Determinedfamilysinterest
y Ifinterested,providedthemwithinformationsheettofill
in
y Collectedinformationsheetandfaxedittoproject
coordinator(oneEast,oneWest)

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

InformationCollected
y Parentsethnicbackground,usingquestionsfromStats

Canada
y Infantsbirthdate,sex,gestationalage
y ContactInformation

Wecontactedeachfamilywithin2weeksofcollecting
informationtotellthemmoreaboutthestudyandatwhat
agetheirinfantwouldbeassessed.
46

AssessmentProcess
y Remindersofassessmentdate
y 2therapiststrainedasassessorsineachcity
y Oneassessmentofeachinfant
y Projectcoordinatorcalculatedtotalscoreandpercentile

rank
y Assessmenttimeswerecoordinatedbetweentherapists

andfamilies aimingforasregularascheduleaspossible
y Consentprocesswasdifferentforeachsite,dependingon

Ethicsrequirements
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Analyses
y Preliminaryanalysiswasdonetocomparetheorderand

ageofemergenceofrollingpronetosupine(P8P12)and
supinetoprone(S8S9)betweenthenewdataandthe
originalnormativedata
y Forthemainanalysis,astatisticianusedscaling
methodologytocomparenewdatatooriginalnormative
data

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

OriginalNormativeSample
y IdentifiedatbirththroughtheDivisionofVitalStatistics,

DepartmentofHealth,Alberta,Canada
y Clustersampleofhealthunitsofvarioussizes;stratified

randomsamplingforsex
y 2002infants,eachassessedonceattheirlocalhealth

unit,distributedfrombirthto19months

49

PreliminarySample
y Onlychildrenlessthan36weeksofage
y Newdata:351infants(53%boys)
y Originalnormativedata:1114infants(51%boys)

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Results:OrderofEmergence(ranks)
Item

Original Sample
(N=1114)

Contemporary Sample
(N=351)

Prone8

1.5

Prone12

Supine8

1.5

Supine9

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

Results:AgeofEmergence(weeks)
Item

Original Sample
(N=1114)

Contemporary Sample
(N=351)

Prone8

28.7

27.8

Prone12

32.2

32.6

Supine8

27.7

27.4

Supine9

31.5

31.6

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Conclusion:PreliminaryAnalysis
y Thereisnomeaningfuldifferenceineitherorderorageof

emergenceofrollingfromsupinetoprone,withor
withoutrotation,ofcontemporaryinfants,comparedto
thoseassessedmorethan20yearsago

53

FullNewlyCollectedSample
y 868infantsrecruited
y 650infantsassessed(52%boys)
y 19.4%visiblyminority
y 3.2%Aboriginal
y 8.7%preterm(443436weeks;13<34weeks)

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

Results:MainAnalyses
y 43itemsmetthecriterionofarangeof10 90%of

infantscreditedwiththeitem
y Mostitemsdifferedby2weeksorlessintheageatwhich

50%passedtheitem
y Averageagedifferencewas0.7week

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Results:Relationshipbetweendatasets

y Pearsonsr=0.99
56

Results:Differenceinpercentilerank
valuesbetweendatasets
y Nomeaningfuldifferencesweredetected

57

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Alberta Infant Motor Scale: A Clinical

Refresher and Update

Wednesday, October 8, 2014

Conclusion:MainAnalysis
y TheoriginalnormativedataoftheAIMSremain

appropriatetointerprettheresultsofanAIMS
assessment
y Theminorobserveddifferencesbetweenthedatasetsdo
notaffecteitherresearchorclinicaldecisionsbasedon
percentilerankscalculatedtothenearestweek

58

Summary
y Infantmotordevelopmentcanbeestimatedreliablyand

validlyusingthekeyitemdescriptorsontheAIMSscore
sheet,thedetaileditemdescriptorsintheAIMSmanual,
andtherecommendedmethodsofadministration
y Thephenomenonofinfantmotordevelopmentisrobust
(boththesequenceandtiming);hencetheoriginalAIMS
normscanbeusedwithconfidencetointerpretraw
scoresofcurrentCanadianinfants

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QuestionsorComments?

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