ALBERTA INFANT MOTOR SCALE Record Booklet Yeor_Month Day Nome. Date of Assessment __L_Z_J Identification Number Date of sith L_Z/ Braminer___Chronclogicai age LZ / Prace of Assessment______________ Corrected age L_Z 7 Previous tems Items Credited Subscale | Credited in Window Score Prone : a supine sit Stond J Total Score Percentile Comer verre vccceseeeeserecseces Comments/RecommendationsAlberta Infant Motor Scale Cece ee eeceeeeeesoes STUDY # Prone Mobily Prone Lying (1) ~ Prone tying (2) - PRONE a 5 Pmscocatnen cr Forearm Suppo (1) Heodtogo lareneadioger, = (}Y Z Ucentolod weight hits TAES Ua ega mmaicly Forearm Suppod (2) Cc anton head nna EE | Rasoies an ‘Snoton \ ‘SUPINE Supine tyra 1) Supine ying @) Prmioogical tenon, i Hands to Knees reeemedin OTE sy Supine Lying (4) ‘oven "Segments none Supine Lying (2 ~ a o.teereee— sad ton tower nw Nerathgoy ae SITTING Sana arene sing win Pultost a Propped Ams OS (Chin tuck: head i ine sine a sor einai neadin wine sag STANDING (May hove intermittent . on Tpensivecteen odoin wh body Seer soeReaching from Extended Arm Support Forearm Suppot Roling Prone to Supine ‘Without Rotation Arps econo. rege cneet se ~ toler wig CVn? NLP Pro's Neverect oms eset note by Jos 1th rt ) Hands to Feet Roling Supine to Prone > \Wiinout Rotation Aa Cconmantniessi Oy Polne met preont ae Latest hea toning ‘Removes arena J Active Extension nasi etansen ‘a FourPoint Kneeing ( ean cai eed evar woe Roling Prone to Supine with Rotation Roting Supine to Prone with Rotation AL oe Unsustoined siting win Unsustainod site ‘Aum Suppor Sting Witnout ‘Ac Suppot Weight shit Unsustoined Sting Rech with Sting without Ration ‘Arm Support (1) inating seapye atticton oe) 3 Saket Weg nt ten ‘connofmantan poston" Fomurk propped Cannat be la clone oe ie Stringepencienty Someten Ting ey f Seen Supported stonding ) Seasberncverent ot ogtped Selving Reciprocal Creeping (1) Four Point Kneeling (2) Ae Wy , & G 7 cocson ers Pe OE I con tet naenpatiog a Sting to FourPoet Sting winout ting to Pr Kneeling Asm Support (2) Sadoremor Me ; Sen adhe cnet has nangeaee, eee eon ag Seaeces Pulstosna — cusng Contoted towerne faeces fuzpateastonana Ging cosa eT pasta orton oN Bonistoncs { 7S teitkoeeing 2 *, + aed pats nth | 23 re secs ; : patos is Weare see nese, Sistosoo BlaynottonCusng With stance Alone Beaton Eoty Stopping ‘Stanaing fom Meanes Sauat Standing trom ‘Quoctuped Postion adtistotegPercentile Ranks * Oo 1 2 3 4 5 6 7 8 9 10 41 12 13 14 15 16 17 18 19.) Te Th TATA 55 10 75 012 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 7f ‘AGE (MONTHS) —— 5TH 10TH =---- 25TH “60TH ——75TH —— sOTH AIMS SCORE