Review

A systematic review
of the clinimetric
properties of
neuromotor
assessments for
preterm infants during
the first year of life
Alicia J Spittle* MSc BPhysio, Victorian Infant Brain Studies;
Lex W Doyle MD FRACP, Department of Obstetrics and
Gynecology, University of Melbourne;
Roslyn N Boyd PhD MSc (Physiotherapy) BAppSc BSc Pgrad
(Biomechanics), Victorian Infant Brain Studies, Murdoch
Childrens Research Institute, Melbourne, Australia.
*Correspondence to first author at Victorian Infant Brain
Studies, Murdoch Childrens Research Institute, 2nd Floor,
Royal Childrens Hospital, Flemington Road, Parkville,
Melbourne, Australia 3052. E-mail: alicia.spittle@rch.org.au
DOI: 10.1111/j.1469-8749.2008.02025.x
Published online 8th January 2008
This systematic review evaluates assessments used to
discriminate, predict, or evaluate the motor development of
preterm infants during the first year of life. Eighteen
assessments were identified; nine met the inclusion criteria.
The Alberta Infant Motor Scale (AIMS), Bayley Scale of
Infant and Toddler Development Version III, Peabody
Developmental Motor Scales Version 2, Test of Infant Motor
Performance (TIMP), and Toddler and Infant Motor
Examination have good discriminative validity when
examined in large populations. The AIMS, Prechtls
Assessment of General Movements (GMs), Neuro Sensory
Motor Development Assessment (NSMDA), and TIMP were
designed for preterm infants and are able to detect more
subtle changes in movement quality. The best predictive
assessment tools are age dependent: GMs, the Movement
Assessment of Infants, and TIMP are strongest in early
infancy (age 4mo or less) and the AIMS and NSMDA are
better at older ages (812mo). The TIMP is the only tool that
has demonstrated a difference between groups in response to
intervention in two randomized controlled trials. The AIMS,
TIMP, and GMs demonstrated the highest levels of overall
reliability (interrater and intrarater intraclass correlation
coefficient or >0.85). Selection of motor assessment tools
during the first year of life for infants born preterm will
depend on the intended purpose of their use for
discrimination, prediction, and/or evaluation.

See end of paper for list of abbreviations.

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With survival rates of preterm and low-birthweight infants

improving, there is an increase in the number of these infants
with motor impairments later in life, ranging from developmental coordination disorder to cerebral palsy (CP).1 In
2006, the American Academy of Pediatrics published guidelines for the follow-up of preterm infants and recommended
that all children with a very low birthweight (birthweight
<1500g) should have a structured, age-appropriate neuromotor examination at least twice during the first year of life.2
Infant neuromotor examinations are performed for a variety of purposes, including discriminating between infants
who have motor dysfunction and those who are developing
typically (discriminative tool), predicting which infants will
have future motor problems from current performance (predictive tool), and evaluating changes over time (evaluative
tool).3 There is a growing body of evidence that the first year of
an infants life is a critical period of brain development.4 The
process of neuronal differentiation, which includes the formation of dendrites and axons, and the production of neurotransmitters and synapses, is particularly active in the few
months before and after term.5 Myelination begins during the
second trimester and is most rapid in the first year of life, and
the process continues up to 30 years of age.4 It is, therefore,
important that infants with motor dysfunction are identified
early so that appropriate interventions can be implemented.
Early neuromotor assessments can be challenging because
motor development in the first year of life is rapid and extensive and is influenced by biological, environmental, and social
factors.6 Repeated assessments may reveal widely different

scores that represent random variation in performance across

testing sessions, rather than real change in performance.7

Furthermore, preterm infants have been shown to have different motor trajectories from those of infants born at term,

Table I: Characteristics of infant motor assessments

Assessment
tool (y)

Primary
purpose

Other
purposes

Age
range

Type
of test

Normative
sample

Domains
tested

Components tested

AIMS
(1994)

Discriminative

Predictive,
evaluative

018mo

Norm

2202 infants from

Alberta, Canada

Gross motor

Weight bearing, posture,

and antigravity movement

BSITD-III
(2005)

Discriminative

Predictive,
evaluative

142mo

Norm

1700 infants from

USA

Gross motor,
fine motor

Gross motor and fine motor tasks

GMs
(2004)

Discriminative,
predictive

Evaluative

Preterm
birth to 4mo

Criterion

NA

Gross motor

Spontaneous movement
and neurological integrity

MAI
(1980)
movement

Discriminative

Predictive,
evaluative

012mo

Criterion

NA

Gross motor,
fine motor

Muscle tone, reflexes, automatic

reactions, and volitional

NSMDA
(1989)

Discriminative,
predictive

Evaluative

1mo6y

Criterion

NA

Gross motor,
fine motor

Gross motor, fine motor,

neurological, primitive reflexes,
postural reactions, and motor
responses to sensory input

PDMS-2
(2000)

Discriminative,
predictive,
evaluative

05y

Norm

2003 infants from

USA and Canada

Gross motor,
fine motor

Reflexes, stationary, locomotion,

object manipulation, grasping,
and visual motor integration

PFMAI
(2000)

Discriminative

Evaluative

212mo

Criterion

NA

Gross motor,
fine motor

Posture and fine motor

control and function

TIMP
(2005)

Discriminative,
evaluative

Predictive

32wks PMA
to 4mo

Norm

990 infants at risk of

poor neurological
outcome from USA

Gross motor

Observation of movement and

elicited items to assess postural
control and function

442mo

Norm

TIME
Discriminative,
(1994)
evaluative
social/emotional
abilities, functional performance,

731 typically Gross motor,

Mobility, stability, motor
developing and
fine motor organization, and
144 motor-delayed
children from USA

and atypical movement

AIMS, Alberta Infant Motor Scale;15 BSITD-III, Bayley Scales of Infant and Toddler Development Version III;37 GMs, General Movements
Assessment;23 MAI, Movement Assessment of Infants;38 NSDMA, Neuro Sensory Motor Development Assessment;24 PDMS-2, Peabody
Developmental Motor Scale Version 2;25 PFMAI, Posture and Fine Motor Assessment of Infants;26 TIMP, Test of Infant Motor Performance;39
TIME, Toddler and Infant Motor Examination;28 PMA, post-menstrual age; NA, not applicable.

Table II: Excluded infant motor assessments

Reason excluded
Neonatal developmental assessment

Infant developmental assessment

Assessment tool
Dubowitz Neurological Assessment of the Preterm and Full-term Newborn Infant40
Neonatal Intensive Care Unit Network Neurobehavioral Scale41
Revised Gesell Developmental Schedules42
Griffith General Cognitive Index,43,Denver II44
Pediatric Evaluation of Disability Inventory45
Battelle Developmental Inventory46

Neurological assessment
Manual not published

Infant Neurological International Battery47

Structured Observation of Motor Performance48

Review 255

which may result in the motor development of preterm infants

incorrectly being labeled as abnormal.8 These variations in
motor development over the first year can be for a variety of
reasons, including behaviours learned during long periods
in neonatal intensive care and alterations to brain development caused by exposure to the ex utero environment during critical periods of brain development. This results in
infants who have less flexed postures and are more extended
than infants born at term.1 A standardized assessment tool
appropriate for preterm infants that has a consistent set of

procedures for administering and scoring an assessment

should, therefore, be used to ensure that all individuals are
assessed under similar conditions. Longitudinal assessments,
rather than a single assessment, are more predictive because
they give information on developmental progression including monitoring peaks, plateaux, and, in some cases, regression of infants.9,10 For this reason, it is important to ensure
that assessment tools can be used at more than one time
point in the infants development.
The major types of standardized test are norm-referenced

Table III: Clinical utility of included infant assessment tools

Assessment
tool

Time to administer
(min)

Test procedure

Manual/equipment

AIMS

1030

Observation of infant in prone,

supine, sitting, and standing

Comprehensive manual and score sheets (US $80)

No special equipment

BSITD-III

2060

Therapist administers items in

standardized procedure

Comprehensive manual/kit (US $300)

Test kit provides most equipment

GMs

1030

Infants spontaneous movements

with no stimulation are filmed and
scoring completed from videotape

Comprehensive manual with DVD (US $80)

Special equipment (video)

MAI

3060

Therapist observes and

administers items

Manual
No special equipment

NSMDA

1030

Therapist observes and

administers items

Basic manual (US $20)

Specific toys required but easily accessible

PDMS-2

3060

Therapist administers items in

standardized procedure

Comprehensive manual/test kit (US $945)

Test kit provides most equipment

PFMAI

2530

Therapist administers elicited

items in standardized procedure

Manual (US $63)

No special equipment

TIMP

2040

Therapist observes infant and

then administers elicited items
in standardized procedure

Comprehensive manual/test (US $60)

Test provides equipment

TIME

1555

Therapist observes infant and

parent/caregiver is used to
encourage movement

Comprehensive manual/test kit (US $417)

Test kit provides most equipment

AIMS, Alberta Infant Motor Scale;15 BSITD-III, Bayley Scales of Infant and Toddler Development Version III;37 GMs, General Movements
Assessment;23 MAI, Movement Assessment of Infants;38 NSDMA, Neuro Sensory Motor Development Assessment;24 PDMS-2, Peabody
Developmental Motor Scale Version 2;25 PFMAI, Posture and Fine Motor Assessment of Infants;26 TIMP, Test of Infant Motor Performance;39
TIME, Toddler and Infant Motor Examination.28

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and criterion-referenced measures.11 Norm-referenced tests

measure the performance of a person in relation to a specific
population. Raw scores from these tests are meaningless by
themselves and need to be compared with a population.
When using norm-referenced assessments it is important to
consider the characteristics of the reference population, as
motor development may vary across different social and ethnic populations.12 Criterion-referenced tests have criteria or
a minimum competence that must be reached to score an
item or pass the test. The criterion test contrasts the childs

performance with the test content rather than a population.

Some tests are referenced both by norm and by criterion.
Infant motor examinations vary with the age of the child
and the theoretical construct of the assessment tool.13 Some
assessment tools involve observation of the infants movement repertoire with minimal or no handling, whereas others
include neurological examination (assessment of reflexes,
muscle tone, postural reactions). Traditionally, motor assessments are based on the neuromaturational framework, which
assumes that the rate and sequence of motor development

Table III: continued

Training

Scoring

Interpretation of scores

Not required

4 subscales prone (21 items), supine (9 items), sitting (12 items),

and standing (16 items). Score given to all observed items within
window and all items below the window

Raw scores
Centile ranks
Age equivalent
Growth scores

Required unless
psychologist
(2d course)

Motor scale gross (72 items) and fine motor (66 items) subscales.
Binary score for each item with reverse and discontinue rules

Raw scores
Composite scores
Centile ranks
Age equivalent
Growth scores

Required (45d
training with
GMs Trust)

Movements classified as normal or abnormal (poor repertoire,

cramped synchronized or chaotic) from preterm up to 6wks.
During fidgety period from 9 to 20wks movement classified
as present, abnormal, or absent

Individual developmental
trajectory
Optimality score

Not required

Scores development as normal, minimal problems, or specific

problems. Risk profiles for 4 and 8mo

Raw scores
Risk scores

Not required

Criteria given for items in 6 subscales: gross motor, fine motor,

neurological, postural control, primitive movement patterns,
and sensory motor. Items scored as abnormal, suspicious,
normal for age

Raw scores
Age equivalents
Functional scores

Not required

Criteria given for items in 6 subscales: reflexes (8 items),

stationary (30 items), locomotion (89 items), object
manipulation (24 items), grasping (26 items),
visualmotor integration (72 items)

Raw scores
Age equivalents
Centile ranks
Standard scores for subtests

Not required

PFMAI-I (06mo): 18 posture and 21 fine motor items,

PFMAI-II (612mo): 13 posture and 17 fine motor items

Raw scores
Classification of infants motor
development as typical, at-risk,
or delayed

42 items: 13 dichotomous observed items and

29 elicited items on 47-level rating scale

Raw scores
Age equivalent scores
Centile ranks
Growth scores

Subtests include mobility, motor organization, stability,

functional performance, and social/emotional abilities.
Scoring differs for subtests

Raw scores
Scaled scores
Age equivalent scores
Centile ranks
Growth scores

Instructional DVD
available for selfeducation

Not required

Review 257

are invariant and that the acquisition of motor skills reflects

the hierarchical order of the central nervous system.14 The
environment is considered to have little impact on the performance of motor tasks in this framework.15 More recently,
assessment tools have been developed that use alternative
theories of motor development such as the dynamic systems
theory, in which the development of motor skills is considered to emerge through the interaction of multiple subsystems and is dependent on the context of the task.14 Assessments
that incorporate dynamic systems theory measure functional
capacity and consider the environmental influences to support the infants best performance. The theoretical framework should be considered when choosing an assessment
because it will influence the conclusions that can be made
from the results.
There have been several reviews of newborn examinations
and preschool assessments; however, to our knowledge there
have been no recent systematic reviews of the clinimetric
properties of infant motor assessment tools.16,17 The aim of
this review was to systematically identify and evaluate standardized assessments that are used to discriminate, predict,
or evaluate the motor development of preterm infants within
the first year of life. For the purpose of this review, motor dysfunction or delay will be referred to as atypical development
rather than abnormal development because the latter term
is ambiguous and does not always equate to abnormal motor
function at a later age.8
Method
SEARCH STRATEGY

A comprehensive search was undertaken of computerized

databases including Medline Advanced (1966 to February
2007), CINAHL (1982 to February 2007), PsycINFO (1966 to
February 2007), and EMBASE (1988 to February 2007). The
search strategy included the MeSH terms and text words for
(premature infant OR low-birthweight infant) AND (outcome assessment OR psychomotor performance OR psychomotor disorders OR cerebral palsy OR developmental
coordination disorder OR movement disorders OR motor
skill disorders). After this search, additional searches were
performed using the names of each identified assessment
tool and their authors .
INCLUSION CRITERIA

Assessment tools were included if they met all of the following

criteria: (1) discriminative, predictive, or evaluative of motor
development up to 12 months of age, corrected for prematurity; (2) appropriate for use with preterm infants (less than 37
weeks gestational age); (3) standardized assessment procedure; and (4) criterion-referenced or norm-referenced test.
EXCLUSION CRITERIA

Assessment tools were excluded if they met any of the following

criteria: (1) not published in English; (2) did not primarily assess
motor development (examination tools and developmental
assessments for newborn infants were excluded from this
review, because motor development is only one component
of these assessments and other comprehensive reviews have
been completed); and (3) primarily intended for screening.
DATA EXTRACTION

The titles and abstracts were screened by the first author.

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Two authors (AS, RB) then reviewed one key paper for each
measure, selected on the basis that adequate detail was provided for the determination of inclusion. Assessments were
included after agreement by both raters, and conflicting viewpoints were discussed until consensus was reached.
A modified version of the Outcome Measures Rating Form18
was used to collect information on the characteristics, clinical
utility, and psychometric properties of the included assessment tools. Characteristics of the assessment tools that were
documented included the primary purpose of the tool, whether
it was discriminative, predictive, or evaluative, and age range
for use, standardization samples, and domains tested.17,19
Psychometric properties included information on the
validity and reliability of the assessment tools. Validity is the
extent to which an assessment is measuring what it is intended to measure.20 There are several different aspects to validity, including content, construct, criterion and discriminative
validity, and responsiveness.3,20,21 Content validity refers to
the extent to which measurement covers all the important
aspects or domains it is supposed to measure and is usually
dependent on a panel of experts and literature reviews.11
Construct validity is considered when there are no criteria
against which to evaluate the measure; instead the measure
is compared with current theories and models of the construct. Criterion validity examines the agreement between
the assessment tool and a gold standard tool used to evaluate the same construct. Criterion validity is usually divided
into concurrent validity (correlation between the measurement tool and an alternative, equivalent measurement used
at the same time) and predictive validity (accuracy of a measurement tool to predict future outcome, such as CP),
depending on whether the criteria refer to current or future
assessment. Evaluative validity or responsiveness refers to
the ability of an evaluative measure to detect minimal clinically important change over time.19 Sensitivity refers to the
ability for a test to detect someone with a condition (e.g.
motor delay) when it is present. Specificity refers to the ability of a test to correctly identify those infants without a condition (e.g. normal motor development).19
Reliability describes the extent to which a test is dependable, stable, and consistent when repeated under identical
conditions.21 Testretest reliability refers to the relative stability
of the assessment over time. Intrarater reliability is a component of testretest reliability because it assesses the degree to
which an assessment yields similar results when the same rater
scores the examination at different times in the absence of
growth or interventions. Interrater reliability assesses the
degree to which an assessment yields similar results for the
same individual at the same time with more than one rater.
Internal consistency is defined as the extent to which the items
of a test work together to measure a specific variable.20
Appropriate statistics for measuring inter- and intrarater reliability are intraclass correlation coefficient (ICC) or , not percentage of agreement between raters or Pearsons
correlation.21 Studies in which only the percentage of agreement was reported were excluded. Measures of 0.80 or above
were considered excellent, 0.6 to 0.79 as adequate, and less
than 0.60 as poor for reported ICC and statistics.18
Results
Eighteen motor assessment tools were identified by the search
strategy, of which nine met all the predefined inclusion criteria

on further examination. The nine included studies are the

Alberta Infant Motor Scale (AIMS),15 Bayley Scale of Infant and

Toddler Development Version III (BSITD-III),22 Prechtls

Assessment of General Movements (GMs),23 Movement

Table IV: Evidence of content, construct, and concurrent validity

Assessment tool

Content

Construct

Concurrent

Literature review15
Expert panel
Mailout to 291 members of
Canadian Physiotherapy
Association Pilot study
to test feasibility

Multidimensional scaling, item

response theory and Guttman scaling15
Scores increase with age49
Rasch analysis demonstrated items
ordered by increasing difficulty50
Preterm infants have lower scores
than term infants12
Discriminates between normal, suspect,
and abnormal development (n=60)51

Typically developing infants (n=103)

013mo: BSID-II r=0.97
013mo: PDMS r=0.99
At-risk infants (n=68)
013mo: BSID-II r=0.93
013mo: PDMS r=0.9515
Preterm infants (n=41)
6mo: BSID-II r=0.78
12mo: BSID-II r=0.9052

Literature review22
Expert panel
Pilot, national try-out, and
standardization studies

Factor analysis22
Scores increase with age
Children with cerebral palsy and high
risk of motor problems have lower
mean scores than controls

Typically developing infants (n=102)

142mo: BSID-II r=0.6022
Typically developing infants (n=81)
242mo: PDMS-2 Total Motor r=0.55

GMs

Experts in field23

Theory supported by ultrasound studies23

Discriminates between infants with
cerebral lesions and controls (n=22)53
Discriminates between normal and
abnormal movements in term and
preterm infants (n=130)54

Term infants with HIE (n=58)

04mo: neurological exam
%agree=788355
Preterm infants (n=66)
04mo: neurological exam
%agree=8056

MAI

Literature review57
Risk scores based
on at risk infants57

Discriminates between normal and

abnormal development in preterm
infants (n=35)38
Does not discriminate between normal
and atypical development in healthy
term infants (n=50)58

Preterm and term infants (n=246)

4mo: BSID r=0.6359

NSMDA

Literature review24
Developed by experts in field

Factor analysis 60
Consistency of results over time24
Discriminates between normal and
abnormal development (n=148)60
Preterm infants with IUGR score lower
than normal-birthweight preterm infants
(n=198)61

Low-birthweight infants (n=148)

24mo: No significant difference
between NSDMA and paediatricians
classification 2=0.0860

PDMS-2

Literature review25
Hierarchical sequence

Factor analysis25
Sensitive to age-related change
Infants with disabilities score lower than
infants with no motor problems (n=65)

Typically developing infants (n=30)

111mo: PDMS-1 Gross Motor r=0.84,
Fine Motor r=0.9025

Based upon literature26

Criterion-referenced cut-off
scores based on
term infants (n=185)

Rasch analysis26
Sensitive to age-related change
Discriminates between term and
preterm infants

Typically developing infants (n=32)

26mo: PDMS Gross Motor r=0.83,
Fine Motor r=0.6726

Expert panel39
Literature review
Elicited items occurred during
caregiver interactions62
Pilot studies and revision of content

Rasch analysis39
Sensitive to age-related change63
Infants with medical risk factors
score lower than peers
Discriminates between infants with
low and high risk of motor problems63

Term and preterm infants (n=90)

3mo: AIMS r=0.6464

AIMS

BSITD-III

PFMAI

TIMP

BSID, Bayley Scales of Infant Development Version I;65 BSID-II, Bayley Scales of Infant Development Version II;66 %agree, percentage agreement;
HIE, hypoxicischemic encephalopathy; r, Pearsons correlation coefficient; Sens, sensitivity; Spec, specificity; IUGR, intrauterine growth
retardation; AIMS, Alberta Infant Motor Scale;15 BSITD-III, Bayley Scales of Infant and Toddler Development Version III;37 GMs, General
Movements Assessment;23 MAI, Movement Assessment of Infants;38 NSDMA, Neuro Sensory Motor Development Assessment;24 PDMS-2,
Peabody Developmental Motor Scale Version 2;25 PFMAI, Posture and Fine Motor Assessment of Infants;26 TIMP, Test of Infant Motor
Performance;39 TIME, Toddler and Infant Motor Examination.28

Review 259

Table IV: continued

Assessment tool
TIME

Content

Construct

Concurrent

Literature review28
Expert panels
2 pilot and try-out studies

Factor analysis28
Sensitive to age-related change
Rasch analysis
Discriminates between children with
and without motor delays

Typically developing (n=731) and

delayed infants (n=153)
4m3.5y: physician/therapist
classification of development (%)
Mobility Scale Sens=94, Spec=86;
Stability Scale Sens=91, Spec=90;
Atypical Scale Sens=97, Spec=99

Table V: Evidence of predictive validity

Assessment
tool
AIMS

BSITD-III
GMs

MAI

Outcome assessment

Sample
characteristics

Age at
outcome

Age at initial
assessment

Sensitivity
(95% CI)

Specificity
(95% CI)

Correlation
(Pearsons r)

Paediatrician classification
of normal/suspicious
(n=142) vs abnormal
development (n=22)67
BSID-II PDI52

Preterm and
term infants
(n=164)

18mo

77.3b

81.7b

86.4b

93.0b

Preterm infants
(n=41)

12mo

4mo
(10th centile)a
8mo
(5th centile)a
6mo

0.56 (BSID-II
PDI)

Cerebral palsy (n=19)

or mental retardationc
(n=2)10
Cerebral palsy or
DQ<85)(n=60)54

Preterm infants 1236mo 2662wks PMA

(n=29)

100 (NA)

59.1 (38.579.6)

24mo 4660wks PCA

0.95 (89.491.00)

0.96 (90.96100)

Cerebral palsy or
DQ<85(n=18)55

Preterm and
term infants
(n=130)
Term infants
(n=58)

Cerebral palsy or
DQ<85(n=31)56

Preterm infants
(n=65)

Cerebral palsy or
DQ<85(n=11)68

IUGR and term

control (n=62)

24mo 3842wks PCA

4347wks PCA
4856wks PCA
24mo
2837wks
3842wks
4365wks
24mo
Term
4951wks PCA
5456wks PCA

0.94b
0.94b
0.94b
90.6b
100 (NA)
96.2100b
83.33 (62.241.00)
1.00d (NA)
1.00d (NA)

0.59b
0.86b
0.83b
57.6 b
64.5b
74.298.8b
80.00 (68.991.09)
1.00d (NA)
93.0d (84.91.00)

4mo (8 total
risk score)a

73.5 (58.788.4)

62.7 (53.971.4)

18mo 4mo (10 total

risk score)a
8mo (10 total
risk score)a
18mo 4mo (>9 total
risk score)a
8mo (>9 total
risk score)a

83.3 (68.498.4)

78.2 (90.699.8)

96.0 (88.8100)

64.5 (55.473.7)

72.7b

93.0b

0.67 (BSID
PDI)
0.68 (BSID
PDI)

95.5b

80.3b

4mo

0.360.37
(BSID PDI)

4mo (>9 total

risk score)a

0.63b

0.53b

Cerebral palsy
(n=34)69
Cerebral palsy or
DQ <70 (n=27)32

Paediatrician
classification normal/
suspicious (n=142)
abnormal development
(n=22)67
BSID PDI59

BSID MDI70

Preterm and
term infants
(n=152)
Preterm and
term infants
(n=160)
Preterm and
term infants
(n=164)

38y

Preterm and 1224mo

term infants
(n=246)
Term infant at
24mo
at social risk
(n=134)

aCut-off score for normal versus atypical motor development; bvalue cannot be calculated from published data; cUK usage: learning disability;
dabnormal and absent fidgety movements were combined. DQ, Developmental Quotient; PDI, Psycho Motor Index; MDI, Mental Development
Index; BOTMP, BruniniksOseretsky Test of Motor Proficiency; PDMS GMQ, Peabody Developmental Motor Scales Gross Motor Quotient;
PMA, post-menstrual age; CA, corrected age; , no study identified; NA, not applicable; AIMS, Alberta Infant Motor Scale;15 BSITD-III, Bayley
Scales of Infant and Toddler Development Version III;37 GMs, General Movements Assessment;23 MAI, Movement Assessment of Infants;38
NSDMA, Neuro Sensory Motor Development Assessment;24 PDMS-2, Peabody Developmental Motor Scale Version 2;25 PFMAI, Posture and
Fine Motor Assessment of Infants;26 TIMP, Test of Infant Motor Performance;39 TIME, Toddler and Infant Motor Examination.28

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Assessment of Infants (MAI), Neuro Sensory Motor

Development Assessment (NSMDA),24 Peabody Developmental Motor Scales Version 2 (PDMS-2),25 Posture and Fine
Motor Assessment of Infants (PFMAI),26 Test of Infant Motor
Performance (TIMP)27 and Toddler and Infant Motor
Examination (TIME).28 The characteristics of all nine included
assessments are summarized in Table I. Two neonatal assessments and seven infant assessments were excluded because
they did not primarily measure motor development or had no
published manual. The reasons for exclusion are listed in
Table II.
CHARACTERISTICS OF INCLUDED STUDIES

All the assessment tools included discriminate the motor

development of infants as being normal or atypical, with the
AIMS, BSITD-III, PDMS-2, TIMP, and TIME comparing development with a norm-referenced group. The standardization
samples for the norm-referenced tools consisted of infants
born in the USA and/or Canada. The age ranges of the tests
were variable; no assessment tool was able to assess a
preterm infant from birth to 12 months after term. The TIMP
and GMs are the only tools appropriate for use before term,

but they can only be used up to approximately 4 months after

term. Many of the other assessment tools are appropriate for
use from 1 to 12 months of age, but their validity varies
depending on the age of the infant at assessment.
CLINICAL UTILITY

Clinical utility is summarized in Table III. The time to administer assessments varied both between assessments and within assessments depending on the age of the infant, with most
assessments being longer as the infant grew older, with the
exception of GMs. The shortest assessments were the AIMS
and GMs; the BSITD-III, PDMS-2, and TIME were more complex and time-consuming. The AIMS and GMs assessments
involve minimal handling in comparison with other assessments. The TIME involves interaction and handling by the
primary caregiver, which may lead to a more accurate performance of the childs abilities. Most assessment tools can be
used by a variety of health professionals; however, it is
important for these professionals to have an understanding
of preterm motor development and handling of infants, and,
when appropriate, of test statistics. Some assessments
require specific training, such as GMs and the BSITD-III,

Table V: continued
Assessment Outcome assessment
tool
NSMDA

PDMS-2

Paediatrician
classification of
development60

Paediatrician
classification of
normal/suspicious
(n=142) vs abnormal
development (n=22)67

PFMAI
TIMP

AIMS scores below

5th centile (n=19 at 6mo,
14 at 9mo, and 12 at 12mo)71

Sample
characteristics

Age at
outcome

Age at initial
assessment

Sensitivity
(95% CI)

Specificity
(95% CI)

Correlation
(Pearsons r)

Low-birthweight
infants (n=148)

24mo

1mo (25% below

average)a
4mo (25% below
average)a
8mo (25% below
average)a
12mo (25% below
average)a

68.8b

72.6b

80.0b

56.9b

82.4b

83.7b

58.8b

93.3b

4mo (6th
centile)a
8mo (6th
centile)a

36.1b

93.8b

91.7b

52.3b

Preterm and
term infants
(n=164)

18mo

Preterm and
term infants
(n=96)71

6mo

32wk PMA
4mo CA (z score
0.5SD)a

62.5 (43.181.9)

77.4 (67.087.8)

0.370.67

(AIMS centile)
91.7 (76.0100)

75.7 (65.785.8)

9mo
12mo

4592 (b)

32wks PMA
4mo CA (z score
1.6SD)a
45y
1mo (z score
0.5SD)a
2mo (z score
0.5SD)a
3mo (z score
0.5SD)a

50.0 (15.685.7)

0.200.56
(AIMS centile)
6878 (b)
0.320.55
(AIMS

centile)
Motor delay on BOTMP
(n=8)72
Gross motor delay
(PDMS DQ>70)
(n=12)73

TIME

Preterm and
term infants
(n=35)72
Preterm and
term infants
(n=61)

5.75y

100 (b) 0.36 (BOTMP

score)

33 (1947)

94 (87100)

50 (3565)

86 (7696)

72 (5983)

91 (8399)

0.43 (PDMS
GMQ)
0.42 (PDMS
GMQ)
0.65 (PDMS
GMQ)

Review 261

which require both time and expense.

VALIDITY

The primary purpose of the assessment tool needs to be considered when examining validity. Evidence of content, construct and concurrent validity is summarized in Table IV. All
assessment tools had adequate content validity and construct validity. However, the the BSITD-III reports that
infants born at less than 37 weeks gestational age do not
score significantly lower than term infants on the gross
motor scale, which may limit its use in detecting minimal
motor problems with preterm infants. The concurrent validity of the AIMS, BSITD-III, GMs, MAI, NSMDA, PDMS-2,
PFMAI, TIMP, and TIME has been reported in relation to

another motor assessment or paediatrician classification of

normal or atypical development. The predictive validity of
the assessment tools is summarized in Table V. The predictive
validity is dependent on the age of assessment: GMs have the
greatest combination of sensitivity and specificity in the first
months of life, and the AIMS and NSDMA in the later months.
RESPONSIVENESS

All tools report that they are appropriate for assessing change
over time or in response to intervention. However, there have
been few validation studies. TIMP has been used in two randomized controlled trials of intervention and has demonstrated a significant difference between groups.29,30 The AIMS and
GMs have also been used as outcome assessments in trials of

Table VI: Reliability of assessment tools

Testretest

Intrarater

Interrater

Internal consistency (Cronbachs )

018mo (n=210)
ICC=0.9915

018mo (n=195)
ICC=0.9915
318mo (n=45)
ICC=0.980.9952

018mo (n=253)
ICC=0.99715
318mo (n=41)
ICC=0.970.9952
012mo (n=14)
ICC=0.989974

018mo (n=unclear)
r2 = 0.9949

24m (n=50) FM
r=0.67, GM r=0.77
913m (n=50) FM
r=0.86, GM r=0.8622

112mo norm. pop. (n=1700) FM

r=0.770.89, GM r=0.8694
112mo atypical (n=688) FM
r=0.900.92, GM r=0.930.96

GMs

NA

326wks (n=20)
=1.0023

Term (n=30) =0.8475

020wks (n=19) =0.9276
020wks (n=27) =0.8477
020wks (n=16) =0.9178

NA

MAI

4mo (n=53) r=0.7679

4mo (n=53) r=0.7279

NSMDA

124mo (n=NR) r=0.8024

PDMS-2

211mo (n=20) FMQ

r=0.73, GMQ r=0.84,
TMQ r=0.8925

336mo (n=60) FMQ

r=0.98, GMQ=0.97,
TMQ=0.9625
45y (n=6) TMC
ICC=0.91673

011mo FMQ =0.96, GMQ = 0.97,

TMQ= 0.9825

26mo (n=13) posture

=0.97, FM=0.99
612mo (n=18) posture
=0.98, FM=0.9626

06mo (n=59) posture scale=0.97,

FM =0.9926
612mo (n=126) posture=0.95,
FM =0.9626

TIMP

34wk PCA4mo (n=108)

r=0.8980

Age not specified

(n=21) ICC=0.989930

Age not specified

(n=21) ICC=0.9530

TIME

441mo (n=33)
r=0.960.9928

441mo (n=33)
r=0.960.9928
835mo (n=10)
r=0.981.0081

242mo (n=31)
r=0.899928

06mo (n=NR) =0.799328

712mo (n=NR) =0.889728

Assessment
tool
AIMS

BSITD-III

PFMAI

PMA, post-menstrual age; NA, not applicable; ICC, intraclass correlation coefficient; FM, fine motor; GM, gross motor; TM, total motor; Q,
quotient; , no study identified; NR, not reported; AIMS, Alberta Infant Motor Scale;15 BSITD-III, Bayley Scales of Infant and Toddler
Development Version III;37 GMs, General Movements Assessment;23 MAI, Movement Assessment of Infants;38 NSDMA, Neuro Sensory Motor
Development Assessment;24 PDMS-2, Peabody Developmental Motor Scale Version 2;25 PFMAI, Posture and Fine Motor Assessment of
Infants;26 TIMP, Test of Infant Motor Performance;39 TIME, Toddler and Infant Motor Examination.28

262

Developmental Medicine & Child Neurology 2008, 50: 254266

intervention; however, no difference was reported between

groups.23,31 It is unclear from these studies whether the intervention was not effective or whether the tool was not sensitive
enough to detect change.
RELIABILITY

Studies of the reliability of the assessment tools are summarized in Table VI. Studies of the BSITD-III, MAI, NSMDA,
PDMS-2, and TIME reported correlations only (Pearsons r),
which does not take into account systematic differences
between assessors. The testretest reliability of the AIMS is
reported to be excellent with the use of appropriate statistical methods. Intrarater reliability for the AIMS, GMs, and
TIMP is excellent, as is the interrater reliability of the AIMS,
GMs, MAI, and TIMP. Internal consistency has been studied
with the AIMS, BSITD-III, PDMS-2, and PFMAI. Rasch analysis
has been used to examine consistency of items for the TIMP.
Discussion
The nine assessment tools identified in this systematic
review are all appropriate for measuring motor development
of preterm infants, although each tool has its advantages and
disadvantages. The most important step in identifying the
best tool is for the clinician or researcher to identify the purpose of the assessment and then choose a test that has been
validated as a discriminative, predictive, or evaluative tool.
Many assessments report that they are appropriate to use for
more than one purpose; however, they do not have the validity studies to support their claims.
The clinical utility of assessment tools should be taken into
account with the validity and reliability of the tool. Some tools
such as GMs and the BSITD-III require standardized training
and may be costly, although this may improve the reliability
and validity of the assessments. This may be particularly
important in research when one intervention is being compared with another. GMs have the best predictive validity for
CP and are considered to be a quick, inexpensive, and nonintrusive assessment; however, the cost of initial training
needs to be considered because the trainer may have to travel
overseas to attend a course. Some clinicians may require an
easily accessible tool that requires little training. The AIMS has
the advantage of being easily administered in the clinical setting, which may make the instrument more feasible for therapists to use in follow-up clinics because of the minimal
handling and time needed to conduct the assessment, while
having strong correlation with the BSID-II and PDMS.
Norm-referenced tools are useful for comparing an
infants motor development with that of a large sample.
Traditionally, these tools have examined the ability of an
infant to achieve a task and compare the childs achievement
with a large sample representative of a population. All the
assessments in this review take into account the way in which
the infant performs the task to varying degrees, and the tasks
are both qualitative and quantitative in nature. However,
some tools, such as the BSITD-III, are more quantitative and
may not be sensitive enough to detect the subtle changes in
quality of movement that are seen with preterm infants.
These subtle changes in movement quality may lead to
enhanced balance and coordination at later ages.
Preterm infants have been shown to have different patterns
of motor development from those of term infants, but the
long-term implications of altered patterns of development are

not fully understood. This is demonstrated in the study by van

Haastert and colleagues, in which preterm infants (gestational
age <32wks) had significantly lower scores at all ages on the
AIMS.12 Although these preterm infants do not have typical
motor development, they have variation in motor development that may not necessarily be abnormal.8 For this reason,
criterion-referenced tools designed specifically for preterm
infants to discriminate between typical and atypical development or tools that have normative data for infants at risk of
developmental problems may be more appropriate, depending on the purpose of assessment. GMs, the NSDMA, MAI, and
PFMAI are all criterion-referenced tests which seek to discriminate between normal and abnormal motor development. The
NSMDA has the advantage of discriminating between normal
motor function and minimal, mild, moderate, and severe
motor dysfunction. The PDMS-2, TIMP, and TIME have a larger
than normal proportion of infants at risk of developmental
problems in their normative samples.
Although discriminative assessments are designed to classify current motor performance, knowledge of their predictive value and stability over time is useful in determining
which infants require early intervention and informing caregivers of assessment results. Both the AIMS and MAI have
shown that up to 30% of healthy term infants perform outside the cut-off for normal development at one point in time,
despite having a normal outcome. Longitudinal assessments
are recommended to improve the validity of assessments,
because no assessment correctly identifies all children as
having normal or atypical motor development with a single
assessment. Multiple assessments are also recommended
because infants with transient neuromotor abnormalities
during the first year are at greater risk of developmental
coordination disorders at school age.32
Variation in development over the first year of life is inherent in normal development, but it can make prediction difficult.33 Many assessment tools have improved predictive
value as the child gets older, because children may be free
from neurological signs of dysfunction at an early age but
when the complexity of neurological function increases with
age, deficits may become apparent.34 However, it may not be
appropriate to wait, because intervention is thought to be
most beneficial when begun as early as possible.6 The plasticity of the infants brain, particularly in the first years of life,
can lead to changes in brain function and may explain why
we can never predict outcome with 100% accuracy. The prediction of later problems early in life tends to be most effective for severe disabilities such as CP. More subtle
developmental problems can be difficult to predict early in
life because environmental, social, and biological interactions may have more of an influence on long-term outcome
than for infants with more severe disabilities.35 For example,
a preterm infant who has been in hospital for many months
may have delayed motor development as a result of lack of
experience to move in the hospital environment rather than
as a result of a neurological deficit.
The concurrent and predictive validities for some assessments were not measured with a criterion standard tool.
Many studies used physicians judgments of developmental
delay to establish validity, despite the greater accuracy of
standardized assessment tools.36 However, it is not clear
which motor assessment tool should be considered the criterion standard.

Review 263

It is important for outcome measurements to be sensitive

to measure change; however, there is no consensus on how
this should be assessed.21 Individual changes in the rate of
motor development cannot necessarily indicate the success of
intervention because change may be due to the natural history
and variability of the rate of development of motor skills, and,
therefore, large randomized controlled trials are needed in
the research of interventions.7 One of the most important considerations when assessing the effects of interventions is
whether the sample is large enough to allow a clinically important effect size to be detected. From a clinical viewpoint, individuals and organizations will need to decide what they
consider to be acceptable levels of change when assessing an
infants response to an intervention, and they should be
encouraged to use multiple longitudinal assessments.
Research on infant assessment tools has focused on discriminative and predictive validity, with limited evidence on the
ability of the measurement tool to evaluate change. Future
research should focus on validating assessment tools that document change so that the efficacy of intervention programmes
in the first year of life can be evaluated. Many studies have
looked only at the prediction of CP or of abnormal motor
development up to 2 years of age, with very few studies looking
at the long-term correlation with standardized motor assessments. Although long-term follow-up studies can be timely and
costly, further studies are needed for preterm infants that correlate early motor assessments with later motor outcome at
school age to improve our knowledge of what is a significant
variation in motor development for a preterm infant.
Conclusion
Preterm infants develop differently from infants born at
term. However, this does not mean that all preterm infants
will have motor problems but rather that assessments appropriate for preterm infants are needed. There is no assessment tool that can take into account all the multiple variables
that influence motor development, such as social, environment, and health factors. Norm-referenced tools can be useful to compare the infants development with other infants of
the same age. The AIMS demonstrated the best psychometric
properties and clinical utility of these tools.
However, because preterm infants have different gross
motor developmental trajectories on the AIMS from those of
term infants in the first 18 months of life, it is useful to also have
a criterion tool designed specifically for predicting abnormal
motor development, such as the NSMDA or TIMP.12 GMs have
the best combination of sensitivity and specificity for predicting CP in the early months, whereas the AIMS and NSMDA are
the best predictors of atypical motor development in the later
months. The TIMP is the only tool to demonstrate adequate
evaluative validity, and along with the AIMS has demonstrated
the best reliability. The TIMP and GMs are the only tools appropriate for use before term.
In clinical practice, we would recommend using more
than one assessment tool to meet the needs of an assessment. For example, in the period before term and in early
infancy the use of both GMs and the TIMP, and for the period
from 4 to 12 months corrected age the use of the AIMS and
NSDMA, will ensure that one has appropriate predicative,
discriminative, and evaluative assessments. Longitudinal
motor assessments are recommended, to improve the predictive and discriminative validity.

264

Developmental Medicine & Child Neurology 2008, 50: 254266

Accepted for publication 30th August 2007.

Acknowledgements
We acknowledge support from the National Health Medical Council
(Australia) Public Health Postgraduate Scholarship for AS, an NHMRC
Post Doctoral Hospital Training Fellowship for RB, and an NHMRC
Project grant (ID 284512).
References
1. Bracewell M, Marlow N. Patterns of motor disability in very preterm
children. Ment Retard Dev Disabil Res Rev 2002; 8: 24148.
2. Wang CJ, McGlynn EA, Brook RH, et al. Quality-of-care indicators
for the neurodevelopmental follow-up of very low birth weight
children: results of an expert panel process. Pediatrics 2006;
117: 208092.
3. Kirshner B, Guyatt G. A methodological framework for assessing
health indices. J Chronic Dis 1985; 38: 2736.
4. Vaccarino FM, Ment LR. Injury and repair in the developing brain.
Arch Dis Child Fetal Neonatal Ed 2004; 89: F19092.
5. Hadders-Algra M. The neuromotor examination of the preschool
child and its prognostic significance. Ment Retard Dev Disabil
Res Rev 2005; 11: 18088.
6. Johnson S, Marlow N. Developmental screen or developmental
testing? Early Hum Dev 2006; 82: 17383.
7. Darrah J, Redfern L, Maguire T, Beaulne AP, Watt J. Intra-individual
stability of rate of gross motor development in full-term infants.
Early Hum Dev 1998; 52: 16979.
8. Rosenbaum P. Variation and abnormality: recognizing the
differences. J Pediatr 2006; 149: 59394.
9. Barbosa VM, Campbell SK, Sheftel D, Singh J, Beligere N.
Longitudinal performance of infants with cerebral palsy on the
Test of Infant Motor Performance and on the Alberta Infant Motor
Scale. Phys Occup Ther Pediatr 2003; 23: 729.
10. Ferrari F, Cioni G, Prechtl HF. Qualitative changes of general
movements in preterm infants with brain lesions. Early Hum
Dev 1990; 23: 193231.
11. Levine ME, Carey WB, Crocker AC, Gross RT.
DevelopmentalBehavioral Pediatrics. 3rd edn. Philadelphia:
W B Saunders, 1999.
12. van Haastert IC, de Vries LS, Helders PJ, Jongmans MJ. Early
gross motor development of preterm infants according to the
Alberta Infant Motor Scale. J Pediatr 2006; 149: 61722.
13. Long TM, Tieman B. Review of two recently published
measurement tools: the AIMS and the T.I.M.E. Pediat Phys Ther
1998; 10: 6266.
14. Case-Smith J. Analysis of current motor development theory and
recently published infant motor assessments. Inf Young
Children 1996 9: 2941.
15. Piper MC, Darrah J. Motor Assessment of the Developing Infant.
Philadelphia: W B Saunders, 1994.
16. Majnemer A, Mazer B. Neurologic evaluation of the newborn
infant: definition and psychometric properties. Dev Med Child
Neurol 1998; 40: 708715.
17. Tieman BL, Palisano RJ, Sutlive AC. () Assessment of motor
development and function in preschool children. Ment Retard
Dev Disabil Res Rev 2005; 11: 18996.
18. Law M. Outcome Measures Rating Form.
www.canchild.ca/Portals/0/outcomes/pdf/measrate.pdf
(accessed 19th October 2007).
19. Guyatt G, Walter S, Norman G. Measuring change over time:
assessing the usefulness of evaluative instruments. J Chronic Dis
1987; 40: 17178.
20. Waters E, Maher E. Assessing quality of life. In: Elliott E, Moyer V,
editors. Evidence-Based Pediatrics and Child Health. 2nd edn.
London: BMJ Books, 2004: 99110.
21. McDowell I, Newell C. Measuring Health: A Guide to Rating
Scales and Questionnaires. 2nd edn. New York: OUP; 1996.
22. Bayley N. Bayley Scales of Infant and Toddler Development. 3rd
edn. San Antonio: Harcourt Assessment, 2005.
23. Einspieler C, Prechtl HF, Bos AF, Ferrari F, Cioni G. Prechtls
Method on the Qualitative Assessment of General Movements
in Preterm, Term and Young Infants. Clinics in Developmental
Medicine No. 167. London: Mac Keith Press, 2004.
24. Burns YR, Ensbey RM, Norrie MA. The Neuro-Sensory Motor
Development Assessment part 1: development and
administration of the test. Aust J Physiother 1989; 35: 14157.

25. Folio MR, Fewell RR. Peabody Developmental Scales. 2nd edn.
Austin: Pro-ed, 2000.
26. Case-Smith J, Bigsby R. Posture and Fine Motor Assessment of
Infants. San Antonio, TX: Therapy Skill Builders, 2000.
27. Campbell SK. The Test of Infant Motor Performance: Test Users
Manual Version 1.4. Chicago: Infant Motor Performance Scales,
LLC, 2001.
28. Miller LJ, Roid GH. The TIME Toddler and Infant Motor
Evaluation: A Standardized Assessment. Tucson, AZ: Therapy
Skill Builders, 1994.
29. Girolami GL, Campbell SK. Efficacy of a neuro-developmental
treatment program to improve motor control in infants born
prematurely. Pediat Phys Ther 1994; 6: 17584.
30. Lekskulchai R, Cole J. Effect of a developmental program on
motor performance in infants born preterm. Aust J Physiother
2001; 47: 16976.
31. Cameron EC, Maehle V, Reid J. The effects of an early physical
therapy intervention for very preterm, very low birth weight
infants: a randomized controlled clinical trial. Pediat Phys Ther
2005; 17: 10719.
32. Swanson MW, Bennett FC, Shy KK, Whitfield MF. Identification
of neurodevelopmental abnormality at four and eight months by
the movement assessment of infants. Dev Med Child Neurol
1992; 34: 32137.
33. Touwen BC. How normal is variable, or how variable is normal?
Early Hum Dev 1993; 34: 112.
34. Hadders-Algra M. Evaluation of motor function in young infants
by means of assessment of general movements: a review. Pediat
Phys Ther 2001; 13: 2736.
35. Salt A, Redshaw M. Neurodevelopmental follow-up after
preterm birth: follow up after two years. Early Hum Dev 2006;
82: 18597.
36. De Kleine MJK, Nijhuis-Van Der Sanden MWG, Den Ouden AL. Is
paediatric assessment of motor development of very preterm
and low-birthweight children appropriate? Acta Paediatr 2006;
95: 120208.
37. Bayley N. Bayley Scales of Infant and Toddler Development. 3rd
edn. San Antonio: Harcourt Assessment, 2005.
38. Chandler LS, Andrews MS, Swanson MW, Larson AH. Movement
Assessment of Infants: A Manual. Washington: Rolling Bay;
1980.
39. Campbell SK. The Test of Infant Motor Performance. Test Users
Manual Version 2.0. Chicago: Infant Motor Performance Scales,
LLC, 2005.
40. Dubowitz L, Dubowitz V, Mercuri E. The Neurological
Assessment of the Preterm & Full-term Newborn Infant. Clinics
in Developmental Medicine No. 148. 2nd edn. London: Mac
Keith Press, 1999.
41. Lester BM, Tronick EZ. History and description of the Neonatal
Intensive Care Unit Network Neurobehavioral Scale. Pediatrics
2004; 113: 63440.
42. Knobloch H, Stevens F, Malone AF. Manual of Developmental
Diagnosis: the Adminstration and Interpretation of the Revised
Gesell and Amartuda Developmental and Neurologic
Examination. Houston, TX: Gesell Developmental Materials,
1987.
43. Griffiths R. The Abilities of Young Children: A Comprehensive
System of Mental Measurement for the First Eight Years.
London: Child Development Research Center, 1970.
44. Frankenburg WK, Dodds J, Archer P. Denver II. Denver: Denver
Developmental Materials, 1990.
45. Berg M, Jahnsen R, Froslie KF, Hussain A. Reliability of the PEDI.
Phys Occup Ther Pediatr 2005; 24: 6177.
46. Newborg J, Stock JR, Wnek L. Battelle Developmental
Inventory. Allen, TX: DLM Teaching Resources, 1984.
47. DeGangi G. Critique of the Infanib: the Infant Neurological
International Battery. Phys Occup Ther Pediatr 1995;
14: 10920.
48. Persson K, Stromberg B. Structured observation of motor
performance (SOMP-I) applied to preterm and full term infants
who needed neonatal intensive care. A cross-sectional analysis
of progress and quality of motor performance at ages 010
months. Early Hum Dev 1995; 43: 20524.
49. Piper MC, Pinnell LE, Darrah J, Maguire T, Byrne PJ.
Construction and validation of the Alberta Infant Motor Scale
(AIMS). Can J Publ Health 1992; 83: S4650.

50. Liao PM, Campbell SK. Examination of the item structure of the
Alberta Infant Motor Scale. Pediat Phys Ther 2004 16: 318.
51. Bartlett DJ, Fanning JEK. Use of the Alberta Infant Motor Scale to
characterize the motor development of infants born preterm at
eight months corrected age. Phys Occup Ther Pediatr 2003;
23: 3145.
52. Jeng S, Yau KT, Chen L, Hsiao S. Alberta Infant Motor Scale:
reliability and validity when used on preterm infants in Taiwan.
Phys Ther 2000; 80: 16878.
53. Guzzetta A, Mercuri E, Rapisardi G, et al. General movements
detect early signs of hemiplegia in term infants with neonatal
cerebral infarction. Neuropediatrics 2003; 34: 616.
54. Prechtl HF, Einspieler C, Cioni G, Bos AF, Ferrari F, Sontheimer
D. An early marker for neurological deficits after perinatal brain
lesions. Lancet 1997; 349: 136163.
55. Cioni G, Prechtl HF, Ferrari F, Paolicelli PB, Einspieler C, Roversi
MF. Which better predicts later outcome in full-term infants:
quality of general movements or neurological examination?
Early Hum Dev 1997; 50: 7185.
56. Cioni G, Ferrari F, Einspieler C, Paolicelli PB, Barbani MT, Prechtl
HF. Comparison between observation of spontaneous
movements and neurologic examination in preterm infants.
J Pediatr 1997; 130: 70411.
57. Chandler L. Screening for movement dysfunction in infancy.
Phys Occup Ther Pediatr 1986; 6: 17190.
58. Swanson MW. Neuromotor assessment of low-birth weight
infants with normal developmental outcome. Dev Med Child
Neurol 1989; 31: 2728.
59. Harris SR, Swanson MW, Andrews MS, et al. Predictive validity of
the Movement Assessment of Infants. J Dev Behav Pediatr
1984; 5: 336342.
60. Burns YR, Ensbey RM, Norrie MA. The Neuro Sensory Motor
Developmental Assessment Part II: Predictive and concurrent
validity. Aust J Physiother 1989; 35: 15157.
61. Connors JM, OCallaghan MJ, Burns YR, Gray PH, Tudehope DI,
Mohay H, Rogers YM. The influence of growth on development
outcome in extremely low birthweight infants at 2 years of age.
J Paediatr Child Health 1999; 35: 3741.
62. Murney ME, Campbell SK. The ecological relevance of the Test of
Infant Motor Performance elicited scale items. Phys Ther 1998;
78: 47989.
63. Campbell SK, Kolobe TH, Osten ET, Lenke M, Girolami GL.
Construct validity of the test of infant motor performance. Phys
Ther 1995; 75: 58596.
64. Campbell SK, Kolobe THA. Concurrent validity of the Test of
Infant Motor Performance with the Alberta Infant Motor Scale.
Pediat Phys Ther 2000; 12: 29.
65. Bayley N. Bayley Scales of Infant Development. New York: The
Psychological Corporation, 1969.
66. Bayley N. The Bayley Scales of Infant Development. 2nd edn.
New York: The Psychological Corporation, 1993.
67. Darrah J, Piper MC, Watt J. Assessment of gross motor skills of atrisk infants: predictive validity of the Alberta Infant Motor Scale.
Dev Med Child Neurol 1998; 40: 49591.
68. Zuk L, Harel S, Leitner Y, Fattal-Valevski A. Neonatal general
movements: an early predictor for neurodevelopmental
outcome in infants with intrauterine growth retardation. J Child
Neurol 2004; 19: 1418.
69. Harris SR. Early detection of cerebral palsy: sensitivity and
specificity of two motor assessment tools. J Perinatol 1987
7: 1115.
70. Rose-Jacobs R, Cabral H, Beeghly M, Brown ER, Frank DA. The
Movement Assessment of Infants (MAI) as a predictor of twoyear neurodevelopmental outcome for infants born at term who
are at social risk. Pediat Phys Ther 2004; 16: 21221.
71. Campbell SK, Kolobe TH, Wright BD, Linacre JM. Validity of the
Test of Infant Motor Performance for prediction of 6-, 9- and 12month scores on the Alberta Infant Motor Scale. Dev Med Child
Neurol 2002; 44: 26372.
72. Flegel J, Kolobe TH. Predictive validity of the test of infant motor
performance as measured by the BruininksOseretsky test of
motor proficiency at school age. Phys Ther 2002; 82: 76271.
73. Kolobe TH, Bulanda M, Susman L. Predicting motor outcome at
preschool age for infants tested at 7, 30, 60, and 90 days after
term age using the Test of Infant Motor Performance. Phys Ther
2004; 82: 114456.

Review 265

74. Blanchard Y, Neilan E, Busanich J, Garavuso L, Klimas D.

Interrater reliability of early intervention providers scoring the
Alberta Infant Motor Scale. Pediat Phys Ther 2004; 16: 1318.
75. van Kranen-Mastenbroek V, van Oostenbrugge R, Palmans L, et
al. Inter- and intra-observer agreement in the assessment of the
quality of spontaneous movements in the newborn. Brain Dev
1992; 14: 28993.
76. Bos AF, van Loon AJ, Hadders-Algra M, Martijn A, Okken A,
Prechtl HF. Spontaneous motility in preterm, small-forgestational age infants. II. Qualitative aspects. Early Hum Dev
1997; 50: 13147.
77. Bos AF, Martijn A, Okken A, Prechtl HF. Quality of general
movements in preterm infants with transient periventricular
echodensities. Acta Paediatr 1998; 87: 32835.
78. Cioni G, Bos AF, Einspieler C, et al. Early neurological signs in
preterm infants with unilateral intraparenchymal echodensity.
Neuropediatrics 2000; 31: 24051.
79. Harris SR, Haley SM, Tada WL, Swanson MW. Reliability of
observational measures of the Movement Assessment of Infants.
Phys Ther 1984; 64: 47177.
80. Campbell SK. Testretest reliability of the Test of Infant Motor
Performance. Pediat Phys Ther 1999; 11: 6066.

81. Rahlin M, Rheault W, Cech D. Evaluation of the primary subtests

of toddler and infant motor evaluation: implications for clinical
practice in pediatric physical therapy. Pediat Phys Ther 2003;
15: 17683.

List of abbreviations
AIMS
BSITD-III
GMs
MAI
NSMDA
PDMS-2
PFMAI
TIME
TIMP

Alberta Infant Motor Scale

Bayley Scale of Infant and Toddler Development
Version III
Prechtls Assessment of General Movements
Movement Assessment of Infants
Neuro Sensory Motor Development Assessment
Peabody Developmental Motor Scales Version 2
Posture and Fine Motor Assessment of Infants
Toddler and Infant Motor Examination
Test of Infant Motor Performance

Pediatric Developmental Specialist in NeuroMotor Rehabilitation

Glenrose Rehabilitation and Stollery Childrens Hospitals
Department of Pediatrics, University of Alberta
Edmonton, Alberta, Canada
The Section of Pediatric Neurosciences at the University of Alberta invites applications for the academic
position in Pediatric Neuromotor Rehabilitation. The successful applicant would join a well-established
Developmental Pediatrics Program with comprehensive inpatient and outpatient services for children with
complex disabilities.
The Department of Pediatrics at the Stollery Childrens and Glenrose Rehabilitation Hospitals, service a
complete range of pediatric subspecialties and is the tertiary and quaternary childrens hospital for
Northern Alberta, with a population base of over 1.5 million people. Pediatric Neurosciences offers a full
range of sub-specialties, and is a particular focus for growth within the Department. Pediatric Physiatrists
and Developmental Pediatricians within the division of Neurodevelopmental Pediatrics have strong
affiliations, and active clinical and research collaborations with the Department of Physical Medicine and
Rehabilitation, Pediatric Neurology, Pediatric Surgery, and the Faculty of Rehabilitation. Substantial
infrastructure is currently available to the successful candidate through already established programs
within the hospitals and outreaching to the community and schools. Research support is also available
through a number of government, foundation and institutional resources, unique to the province of Alberta.
These include the Glenrose and Stollery Hospital Foundations, the Alberta Heritage Foundation for
Medical Research, the Women and Childrens Health Research Institute, the Integrated Centre for Care
Advancement through Research, the Alberta Centre for Child, Family and Community Research.
Full-time funded positions are available through the Department of Pediatrics and Child Health, within our
current, very competitive, alternate funding program (AFP). Successful candidates will have a clear
interest in an academic career with experience in the area of childhood neuromotor and developmental
disabilities. Academic responsibilities include resident and medical student education, contributing to the
development of the Division of Neurodevelopmental Pediatrics and participating in research activities.
Candidates with either a clinical research or basic research background are encouraged to apply. This
position is open to Pediatric Physiatrists, Developmental Pediatricians or specialists in rehabilitation
medicine with expertise in the care of children.
Alberta is the fastest growing province in Canada, with the most rapidly expanding birth rate in the country.
It is the only province that is debt free and financially secure. The Department of Pediatrics, the Glenrose
Rehabilitation Hospital and the Stollery Childrens Hospital have been rapidly expanding in the last 5 years
and continue to recruit to programs of excellence in a host of areas, with the Pediatric Neurosciences a
priority. The city of Edmonton has an excellent school system, beautiful river valley and friendly people.
Close to mountains and lakes, the city offers numerous outdoor activities and a vibrant arts and cultural
scene.
Interested applicants should forward their curriculum vitae, along with a cover letter and the names and
contact information of 3 references to:
Jerome Y. Yager MD
Professor and Head
Section of Pediatric Neurosciences
Department of Pediatrics
University of Alberta
Room 7317A Aberhart Centre One
11402 University Avenue NW
Edmonton, Alberta, Canada, T6G 2J3
Email:
jyager@ualberta.ca
Fax:
(780) 407-8283

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