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ALBERTA INFANT MOTOR SCALE Record Booklet : Yeor Month Day Nome ___________ pote or assessment [_7/ Identifcotion Number Date of Bith Sxaminer____ Chronological Age Place of Assessment Conected Age Previousitems | terms Credited subscale Credited in Window Score Prone supine sit Stand Totatscore [__] te Pome e rere cece escenerecscsccee Comments/Recommendations Alberta Infant Motor Scale Pee eee cercecerccccccescccecescces v rene Moi STUDY | esa uiaen Proomion et C yD) ¢, PRONE || CSCI) Ferenc ee Pryiogial xin S&P Boowsehnasnoudes Forearm SUPPOTT C1) Head eso Seeetiee or : vem See ito Wes ae GO a SL sion eegaiita a AOS oe Seraeeromne eae a SUPINE Supine Lying <1) im GRuBo— sprevynao CS) Ex) meee, OLS) Hero Kren Se eccmee sine yg i jcc exis SS Sr — Sed ieee tate ‘Sone SITING a sweat puttost pba me GS ; woe SD (HBX. cmepotnne cree ea =" STANDING]| suoporeasionaing (supported stanaing 2) = se) (2 aA LA Ky Th ig y Roane ines ton \icbie movement ctege Ichi fin Fourront kneoing (0) ‘tended rm suppor Renee Ou meine 3G \ Rolling Prone to Supine ee G \Wanout Rteton Aetwo weight ent fom ) seecnr oaks ) ee a cape each wan es : Lefer wean ne CW sD grains poaren p ™ Prot Rolling Prone to thong Movement nam Supine with Rotaton mort ea Ea Seiwacewn Gehl) ROR eine winrar ana Honds fo Feet Rolling Supine to Prone Wine Rorcton Sudereons ES Fron wah Raton 2 PEED Ny FAG conngtiiesn Y Petre matty eosent ‘rection — sii — ee ae waa) Patsiae nan oni Booch wih sting with Ungstoines Weight Sitin Sting winos Reean sem aopper Sting Winout Weeeredsing «=| Amarecrt Seamer imaupoon Am sj A ye oY 2 (So =) az, Sapuorertcten saa eat wpeeees NTA: ae FREESE” siniapenany Sacer Se, ey Tago eee, Supooried stoning 9 pe \f} Ye Soran macemon ati

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