The most frequent early observable delays in high-risk infants occur in the gross motor development. Early identification of gross motor delays is, therefore, essential to maximize the child's potential for positive developmental and functional outcomes.[10
] In recent years, some reports which indicate the positive impacts of early physiotherapy on the neuromotor development of high-risk infants were published and various tests were used to distinguish the infants who are at risk for permanent motor deficits and to start early physiotherapy and to determine the effects of the physiotherapy.[4
] Early identification takes advantage of this critical developmental period and provides a window of opportunity to maximize the benefits of early intervention programs.[10
] In Turkey, because of the high birth rates and the busy outpatient clinics, it is necessary to choose a practical test to be used with the routine neurological examination. To our knowledge, this is the first study in Turkey assessing the feasibility and validity of different tests, which can be practiced together in a routine neurological examination.
Among the tests that assess neuromotor development of infants, BSID-II, validity and reliability of which were accomplished, has a wide range of use including mental, motor, and behavioral situations of the infants in a wide spectrum in terms of their ages. Benefits of choosing the BSID-II include compatibility with the BSID-II Mental Scale, little need for equipment, and a combined score for both fine and gross motor areas.[10
] It is recommended to complete the motor and mental scales of BSID-II together in the test book. Mental scale is necessary for assessment of child's cognitive, language, motor, and social fields separately. Therefore, we used mental scale of BSID-II together with motor scale. However, we had no chance to compare the mental scale with AIMS and MCMDST as these tests lack of their own mental scales. BSID-II is recognized as gold standard because of these properties. Another important property of BSID-II is that it has a high stability. The most crucial disadvantage of BSID-II is long length of its practice.[5
MCMDST is based on observation. It is practiced in a short time and it assesses the spontaneous movements and postural reactions that are practiced during the neurological examination.[8
] It can assess the infants that are 1 month old or older as chronological age. We chose this test as it is mostly observational, requires short time, and contains similar items with AIMS. Five items were the same in MCMDST and AIMS for 0-6 month babies so that we were able to administer these tests together. Normally, when administered alone MCMDST takes 10–15 minutes, but after AIMS, it took average 5 minutes. We did not face any problem. The infants who have distinctive motor retardation are classified as abnormal by the test.[9
] However, the test does not classify infants as suspicious, so it is not useful for early physiotherapy programs. We believe that its correlation with other tests is weak because of the fact that it classifies the cases as only normal and abnormal.
We have detected a high correlation between AIMS and BSID-II. In the similar studies conducted in Brazil and Taiwan by Almeida KM et al
] and Jeng SF et al
] they also reported correlation for the entire population of infants, with higher values at 12 months. However, it seems to be inferior to BSID-II in picking up suspicious cases, so that close follow-up schedule for these children must be instituted. AIMS involves observation of the infant's movement repertoire with minimal or no handling that can be accomplished before the scheduled neurological examination.[3
] Its standardization has been accomplished in Canada and Greece. There is no standardization study for Turkey, but because the infants between 0 and 6 months of ages show unique neuromotor patterns, we do not expect local factors to affect the results.[16
We think that an important limitation of our study is the lack of prospective follow-up, which limits evaluation of continuity of the correlation at advanced ages and predictive power of the tests.
Although BSID-II is a superior test with detailed motor and mental evaluations, we concluded that AIMS, which has a high correlation and consistency with BSID-II, can be used with routine neurological examination as it is based on observations, has few items, and can be performed in a shorter duration.