Abnormal Involuntary Movement Scale (AIMS Score)

Assesses level of dyskinesias in patients taking neuroleptic medications.

Refer to the text below the calculator for more information about the AIMS score.


The Abnormal Involuntary Movement Scale (AIMS) was originally published by the Psychopharmacology Research Branch of the National Institute of Mental Health in 1976.

It was aimed at recording occurrence of tardive dyskinesia (TD), detecting TD, and at allowing the follow-up on the severity of a patient's TD over time in patients receiving neuroleptic medications.


The AIMS consists in 12 items that are clinician rated. The first 7 items assess the severity of dyskinesias in oro-facial, extremity and trunk movements. Additional items assess the over-all severity, incapacitation, and the patient’s level of awareness of the movements, and distress associated with them.

The scale provides a total score (items 1 through 7) or item 8 can be used in isolation as an indication of overall severity of symptoms.


Facial & Oral Movements

1

Muscles of facial expression

e.g. movements of forehead, eyebrows, periorbital area, cheeks. Include frowning, blinking, grimacing of upper face
2

Lips and perioral area

e.g. puckering, pouting, smacking
3

Jaw

e.g. biting, clenching, chewing, mouth opening, lateral movement
4

Tongue

Rate only increase in movement both in and out of mouth, not inability to sustain movement

Extremity Movements

5

Upper (arms, wrists, hands, fingers)

Include movements that are choreic (rapid, objectively purposeless, irregular, spontaneous) or athetoid (slow, irregular, complex, serpentine). Do not include tremor (repetitive, regular, rhythmic movements)
6

Lower (legs, knees, ankles, toes)

e.g. lateral knee movement, foot tapping, heel dropping, foot squirming, inversion and eversion of foot

Trunk Movements

7

Neck, shoulders, hips

e.g. rocking, twisting, squirming, pelvic gyrations. Include diaphragmatic movements

Global Movements

8

Severity of abnormal movements

Based on the highest single score on the above items.
9

Incapacitation due to abnormal movements

10

Patient's awareness of abnormal movements

Dental Status

11

Current problems with teeth and/or denture

12

Does patient usually wear dentures?

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About the AIMS

The Abnormal Involuntary Movement Scale (AIMS) was originally published by the Psychopharmacology Research Branch of the National Institute of Mental Health in 1976. It was aimed at recording occurrence of tardive dyskinesia (TD), detecting TD, and at allowing the follow-up on the severity of a patient's TD over time in patients receiving neuroleptic medications.

The scale is one of the most widely used questionnaires for dyskinesias and can be readily administered in a few minutes by an experienced clinician. It is indicated in the assessment of movement disorders, schizophrenia and dyskinesias.

In clinical settings, the AIMS is regularly assessed after administration of medication, the time course of abnormal movements being regularly recorded and plotted.

The AIMS consists in 12 items that are clinician rated. The first 7 items assess the severity of dyskinesias in oro-facial, extremity and trunk movements. Additional items assess the over-all severity, incapacitation, and the patient’s level of awareness of the movements, and distress associated with them.

The scale provides a total score (items 1 through 7) or item 8 can be used in isolation as an indication of overall severity of symptoms.

Items 1-9 are scored based on:
None (0); Minimal (1); Mild (2); Moderate (3); Severe (4)
Facial and Oral Movements
1. Muscles of facial expression
e.g. movements of forehead, eyebrows, periorbital area, cheeks. Include frowning, blinking, grimacing of upper face
0 1 2 3 4
2. Lips and perioral area
e.g. puckering, pouting, smacking
0 1 2 3 4
3. Jaw
e.g. biting, clenching, chewing, mouth opening, lateral movement
0 1 2 3 4
4. Tongue
Rate only increase in movement both in and out of mouth, not inability to sustain movement
0 1 2 3 4
Extremity Movements
5. Upper (arms, wrists, hands, fingers)
Include movements that are choreic (rapid, objectively purposeless, irregular, spontaneous) or athetoid (slow, irregular, complex, serpentine). Do not include tremor (repetitive, regular, rhythmic movements)
0 1 2 3 4
6. Lower (legs, knees, ankles, toes)
e.g. lateral knee movement, foot tapping, heel dropping, foot squirming, inversion and eversion of foot
0 1 2 3 4
Trunk Movements
7. Neck, shoulders, hips
e.g. rocking, twisting, squirming, pelvic gyrations. Include diaphragmatic movements
0 1 2 3 4
Global Judgements
8. Severity of abnormal movements.
Based on the highest single score on the above items.
0 1 2 3 4
9. Incapacitation due to abnormal movements. 0 1 2 3 4
10. Patient's awareness of abnormal movements.
No awareness (0); Aware, no distress (1); Aware, mild distress (2); Aware, moderate distress (3); Aware, severe distress (4)
0 1 2 3 4
Dental Status
Current problems with teeth and/or denture Yes (1); No (0)
Does patient usually wear dentures? Yes (1); No (0)
 

Instructions to accompany AIMS

Part of the AIMS assessment includes observation of the patient under specific examination procedures. Because in some cases patients may suppress movements while concentrating intensely it is advisable that the administration of the AIMS be supplemented by requesting that the patient perform additional tasks during the assessment, where necessary.

Either before or after completing the Examination Procedure, observe the patient unobtrusively, at rest (e.g., in the waiting room). The chair to be used in this examination should be a hard, firm one without arms.

  1. Ask the patient whether there is anything in his/her mouth (i.e. gum, candy etc.) And if there is, remove it.
  2. Ask patient about the current condition of his/her teeth. Do teeth bother patient now?
  3. Ask the patient whether he/she notices any movements in mouth, face, hands, or feet. If yes, ask to describe and to what extent they currently bother patient or interfere with his/her activities.
  4. Have patient sit in chair with hands on knees, legs slightly apart, and feet flat on floor. (Look at entire body for movements while in this position).
  5. Ask patient to sit with hands hanging unsupported. If male, between legs; if female and wearing a dress, hanging over knees. (Observe hands or other body areas).
  6. Ask patient to open mouth. (Observe tongue at rest within mouth). Do this twice.
  7. Ask patient to protrude tongue. (Observe abnormalities of tongue movement). Do this twice.
  8. Ask patient to tap thumb, with each finger as rapidly as possible for 10 to 15 seconds; first with right hand, then with left hand. (Observe facial and leg movements).
  9. Flex and extend patient's left and right arms (one at a time).
  10. Ask patient to stand up. (Observe in profile. Observe all body areas again, hips included).
  11. Ask patient to extend both arms outstretched in front with palms down. (Observe trunk, legs, and mouth).
  12. Have patient walk a few paces, turn, and walk back to chair. (Observe hands and gait). Do this twice.

According to the original AIMS instructions, one point is subtracted if movements are seen only on activation, but not all investigators follow this convention.

 

References

Original reference

Guy W. ECDEU Assessment Manual for Psychopharmacology: Revised (DHEW publication number ADM 76-338). Rockville, MD, US Department of Health, Education and Welfare, Public Health Service, Alcohol, Drug Abuse and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs; 1976: 534–7.

Other references

Lane RD, Glazer WM, Hansen TE, Berman WH, Kramer SI. Assessment of Tardive Dyskinesia Using the Abnormal Involuntary Movement Scale. J Nerv Ment Dis. 1985;173(6):353-7.

Munetz MR, Benjamin S. How to Examine Patients Using the Abnormal Involuntary Movement Scale. Hosp Community Psychiatry, 1988;39(11):1172-7.

Stacy M, Sajatovic M, Kane JM, et al. Abnormal involuntary movement scale in tardive dyskinesia: Minimal clinically important difference. Mov Disord. 2019.


Specialty: Neurology

System: Musculoskeletal

Year Of Study: 1976

Abbreviation: AIMS

Article By: Denise Nedea

Published On: May 28, 2020

Last Checked: May 28, 2020

Next Review: May 28, 2025