Methods for Assessing Infant Motor Development: Scales and Tests (Overview for Parents and Clinicians)

Written by

Anna Kushnir

Why we raised this topic

One of the most important rehabilitation programs used at the Elita Rehabilitation Center is Early Rehabilitation, specifically designed for children from three months to one year. Its main goal is to improve motor and psycho-emotional development during the very first months of a child’s life.

A recent scientific discussion held on August 1 was dedicated to our youngest patients. Researchers and clinicians reviewed methods used to assess motor development in infants. This topic was chosen not only to help select the best test for a research study, but also with a view to possible use in everyday clinical practice.

We decided this topic is relevant enough to share the presentation from the discussion with you. It will be especially interesting and useful for specialists who work with infants—pediatricians, neonatologists, and neurologists.

Who needs motor development assessment – and why

Motor development assessment helps to:

describe the child’s current level of motor skills in relation to age
identify risks or atypical movement patterns (screening)
track changes over time during observation or interventions (where the tool is intended for this)
standardize observations across different specialists (pediatrician, neurologist, physical therapist, etc.)

Important: this material is an informational overview of tools. Interpretation of results and decisions about next steps are the responsibility of the clinician.

Quick age-based navigation

Birth to 20 weeks: Prechtl General Movements Assessment
0–5 months: Test of Infant Motor Performance (TIMP)
0–12 months: Movement Assessment for Infants (MAI)
2.5–12.5 months: Harris Infant Neuromotor Scale
0–18 months: Alberta Infant Motor Scale (AIMS), Infant Motor Profile
2–24 months: Hammersmith Infant Neurological Examination (HINE)
Wider age range (often used in early childhood as well): TIME, Bayley, Peabody, NSMDA

Quick Comparison of Motor Development Assessment Tools

Tool	Age (as in the presentation)	Format	Duration	Training (as in the presentation)	Focus
Prechtl General Movements Assessment	birth to 20 weeks	video	3–5 min recording + analysis	specialized training	quality of spontaneous movements, prognosis
Test of Infant Motor Performance (TIMP)	0–5 months	observation	20–40 min	self-learning may be possible	assessment/prognosis
Movement Assessment for Infants (MAI)	0–12 months	examination + analysis	60 min	not required	diagnosis/effectiveness
Harris Infant Neuromotor Scale	2.5–12.5 months	observation + testing	15–30 min	—	mainly screening
Alberta Infant Motor Scale (AIMS)	0–18 months	observation	10–30 min	not required	diagnosis / effectiveness
Infant Motor Profile	3–18 months	15-min video	video analysis	specialized training	diagnosis/effectiveness
HINE	2–24 months	clinical exam	10–15 min	certification not required	screening + prognosis
TIME	4–42 months	exam + parent interview	15–55 min	not required	diagnosis/prognosis
Bayley	1–42 months	items + interview + norms	20–60 min	training required	diagnosis / effectiveness
Peabody (PDMS-2)	0–5 years	items	30–60 min	not required	tasks/observation
NSMDA	1 month–6 years	tasks / observation	10–30 min	—	assessment, not for measuring effectiveness

Methods from birth to 12 months

Prechtl General Movements Assessment

What does it assess? – Quality of the child’s spontaneous movements; identification of missing or abnormal movements.
How is it performed? – Analysis of a video of spontaneous movements recorded for 3–5 minutes.
When is it used? – From birth to 20 weeks.
Advantages: – High specificity and sensitivity for predicting the development of cerebral palsy.
Limitations: – Specialized training is required.

Example of an image used for Prechtl general movements assessment.

Example of a video fragment used for Prechtl general movements assessment.

Test of Infant Motor Performance (TIMP)

What does it assess? – 42 items = 13 items (spontaneous movements) + 29 items (postural control and movements in different positions).
How is it performed? – 20–40 minutes of observation based on defined items.
When is it used? – From 0 to 5 months.
Advantages: – Can be used for diagnosis, prognosis, and evaluation of effectiveness. Self-learning may be possible with a training disc.
Limitations: – Low sensitivity for infants under 3 months.

Example of the Test of Infant Motor Performance.

Response to an auditory stimulus

No response
Listening or movements without turning the head toward the stimulus
Attempt to lift the head
Lifting and turning the head toward the midline
Lifting and turning the head to the opposite side
Lifting the head 45–90 degrees, attempting to search for the sound
Lifting and turning the head toward the stimulus side to search for the sound

Movement Assessment for Infants (MAI)

What does it assess? – Muscle tone, primitive reflexes, automatisms, and voluntary movements.
How is it performed? – A 60-minute assessment and analysis (30 minutes assessment + 30 minutes analysis).
When is it used?– From 0 to 12 months.
Advantages: – For assessing and predicting motor development. Training is not required.
Limitations: – Developed for premature infants.

Harris Infant Neuromotor Scale

What does it assess? – Possible motor or cognitive developmental impairments in infants at risk.
How is it performed? – 15–30 minutes of observation, testing, and analysis of results.
When is it used? – 2.5–12.5 months.
Advantages: – Reliability and validity. Takes little time. Easy to use.
Limitations: – Used more for screening than for prognosis or evaluation of treatment effectiveness.

Items of the Harris Infant Neuromotor Scale

Testing method	Cognitive or behavioral development items	Motor development items
Observation	• Behavior and interaction • Presence of stereotyped behavior	• Mobility (supine)• Neck extension (supine)• Eye muscle control• Head position (prone)• Upper limb position (prone)• Head position (sitting)• Trunk position (sitting)• Mobility skills• Hand position• Leg position• Frequency and variety of movements
Testing	• Head circumference • Eye tracking	• Asymmetrical tonic neck reflex• Pull-to-sit (supine)• Passive range of motion (supine)• Head righting from prone to supine (and vice versa)• Trunk mobility from prone to supine (and vice versa)• Passive range of motion (prone)

Methods for 0–18 months

Alberta Infant Motor Scale (AIMS)

What does it assess? – 58 items assessing three motor components in at-risk infants: weight-bearing, postural control, and antigravity movement.
How is it performed? – Observation of the child in different positions (10–30 minutes).
When is it used? – From 0 to 18 months.
Main advantage: – Takes little time. Can be used for diagnosis and evaluation of effectiveness. Training is not required.
Main limitation: – Low specificity for premature infants.

Positions used for assessment with the Alberta Infant Motor Scale

Infant Motor Profile

What does it assess? – 5 subtests / 80 items: symmetry, performance, speed, skills, and the ability to choose.
How is it performed? – Analysis of a 15-minute video of the child’s spontaneous movements.
When is it used? – From 3 to 18 months.
Advantages: – Can be used to assess and predict motor development.
Limitations: Specialized training is required.

Methods for 2–24 months

Hammersmith Infant Neurological Examination (HINE)

What does it assess? – Neurological examination (positions, cranial nerve functions, reflexes, tone, movements); motor function development (head control, sitting, walking, crawling, rolling, grasping); behavioral state (alertness, social orientation, emotional state).
How is it performed? – A 10–15-minute examination.
When is it used? – From 2 to 24 months.
Advantages: – Certification is not required. Not only screening, but also prognosis of type and severity.

Part of the HINE assessment form

Wider age range methods

The Toddler and Infant Motor Evaluation (TIME)

What does it assess? – Mobility, stability, motor organization, and atypical movements.
How is it performed? – Child examination and parent interview (15–55 minutes).
When is it used? – From 4 to 42 months.
Advantages: – For diagnosis and therapy evaluation. Training is not required.
Limitations: – Developed for children with Down syndrome and Prader–Willi syndrome.

Materials set for the TIME test (Toddler and Infant Motor Evaluation)

Bayley Scales of Infant Development-II (Bayley-II)

What does it assess? – Gross motor functions (72 items) and fine motor skills (66 items).
How is it performed? – Assessment using defined items, parent interview, and analysis using normative scales (20–60 minutes).
When is it used? – From 1 to 42 months.
Advantages: – Diagnosis of delay in one component of development and therapy evaluation.
Limitations: – Special training is required. Not sensitive enough for premature infants.

Bayley Scales of Infant Development kit for infant assessment

The Neurological, Sensory, Motor, Developmental Assessment (NSMDA)

What does it assess? – Gross motor functions, fine motor skills, neurological indicators, postural control, primitive movements, and sensory processing.
How is it performed? – 10–30 minutes observation of the child performing tasks.
When is it used? – From 1 month to 6 years.
Advantages: – Tasks and norms are developed for each age category from 1 month to 6 years.
Limitations: – Not used to measure treatment effectiveness.

Example of NSMDA tasks for a 6-year-old

Peabody Developmental Motor Scales-2 (PDMS-2)

What does it assess? – Reflexes, stationary movements, locomotion, object manipulation, grasping, and visual-motor integration.
How is it performed? – 30–60 minutes assessment using defined items.
When is it used? – From 0 to 5 years.
Advantages: – Can be used for diagnosis and prognosis regarding motor development delay. Training is not required.
Limitations: – Low sensitivity for infants under 8 months.