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Using AIMS Assessment Effectively In Your Practice

The Abnormal Involuntary Movement Scale (AIMS) was developed in the 1970s to help clinicians assess involuntary movements, specifically Tardive Dyskinesia. The APA 2020 guidelines for the treatment of patients with schizophrenia discuss that all patients on neuroleptic/antipsychotic medications should be screened for Tardive Dyskinesia, which can occur after several months of being on these medications. Other movement disorders can occur that are not screened for in the AIMS, such as Parkinsonism, dystonia, and akathisia. 

This clinical assessment overview offers a brief summary of the evidence-based, best practice assessment tool for monitoring involuntary muscle movements. 

Contents of the AIMS Assessment 

The AIMS assessment consists of 12 questions that are clinician-rated to determine the presence of dyskinesias a patient may be experiencing, scored on a scale of 0-4, with 4 indicating the most severe level. 

  1. Facial/Oral movements
    • Muscles and facial expressions
      • Movements of the forehead, eyebrows, periorbital area, and cheeks include frowning, blinking, smiling, and grimacing
    • Lips and periorbital area
      • Puckering, pouting, smacking
    • Jaw
      • Biting, clenching, chewing, mouth opening, and lateral movement
    • Tongue
      • Rate only increases in movement, both in and out of the mouth, NOT inability to sustain movement
  2. Extremity Movements
    • Upper extremities (arms, wrists, hands, fingers)
      • Include choreic movements (ie, rapid, objectively purposeless, irregular, spontaneous), athetoid movements (ie, slow, irregular, complex, serpentine). DO NOT include tremor (ie, repetitive, regular, rhythmic)
    • Lower extremities (legs, knees, ankles, toes)
      • Lateral knee movement, foot tapping, heel dropping, foot squirming, inversion, and eversion of the foot
  3. Trunk Movements
    • Shoulders, hips, neck
      • Rocking, twisting, squirming, pelvic gyrations
  4. Global Judgments
    • Severity of abnormal movements
    • Incapacitation due to abnormal movements
    • Patient awareness of abnormal movements - (rate only Patient’s report) 0=No awareness; 1=Aware, no distress; 2=Aware, mild distress; 3=Aware, moderate distress; 4=Aware, severe distress
  5. Dental Status
    • Does the patient wear dentures?
    • Current dentures/problems with teeth?

Conducting an AIMS assessment 

For patients who are taking antipsychotic medications, symptoms of tardive dyskinesia should be assessed. The AIMS assessment is the most widely used screening tool that should be conducted at least every 3 or 6 months for higher-risk individuals. 2 The test can be completed in approximately 10 minutes by a person who has been trained to conduct this assessment. 

Please observe for unusual movements with each prompt for at least 15 seconds. 

Before the Exam observations

  • Observe the patient at rest while sitting
    • Have the patient remove their shoes and socks
    • While sitting, ask the patient to rest their hands on their knees with legs apart and feet flat on the floor
      • Watch for unusual movements in the trunk and extremities
    • Next, have the patient rest their arms hanging unsupported
      • Watch for unusual movements in the trunk and extremities 

Questions to ask before the Exam

  1. What is the current condition of the patient's teeth?

      2.   Is the patient wearing dentures? 

  • If yes, do they fit appropriately?

      3.   Has the patient noticed any unusual movements of hands, face, mouth, or feet?

  • If yes, is it interfering with daily activities?

During the Exam 

  • Have the patient open their mouth
    • Watch the tongue at rest, do this twice
    • Ask the patient to protrude their tongue, do this twice
      • Watch for unusual movements with the tongue
  • After, have the patient tap their finger to their thumb rapidly
    • Watch for unusual movements in the face and legs
  • Ask the patient to stand up
    • Observe the body for unusual movements
  • Ask the patient to extend their arms with palms down
    • Observe face, body, and legs for unusual movements
  • Have the patient walk a few paces
    • Observe the gait of the patient for unusual movements 

Conducting AIMS via video/telehealth

The AIMS assessment can be conducted virtually without compromising the results, provided the camera placement is ideal to observe all aspects of the body. In fact, telehealth video visits have some benefits when conducted through AIMS because the patient is in their own environment, is less likely to miss the appointment, and involves family/caregivers. 4 

              Telehealth considerations for the AIMS 

  • If a caregiver or friend/family is around, ask if they can assist so that they can point the camera to where the provider can see a full view of movements
  • If no one is available to assist the patient, ask the patient to move the camera around so that the provider can see all movements
  • If a patient is parked in their car, the AIMS assessment will have to wait until they have access to the below
  • Ask patient to be in a room where they have room to walk
  • Ask the patient to be in a room where the lighting is good
  • Ask the patient if they have a firm chair to sit in vs. their bed

Scoring/Interpretation of an AIMS assessment  

  • The first 7 questions are rated using the scale below, looking at facial/oral movements, extremity movements, and trunk movements:
    • 0: No unusual movements detected
    • 1: Minimal (difficult to detect) unusual movements
    • 2: Mild (infrequent/easy to detect) unusual movements
    • 3: Moderate (frequent/easy to detect) unusual movements
    • 4: Severe (continuous/extreme intensity) unusual movements
  • Moving to question 8, which asks about the severity of the movements from 0-4
    • This score is based on the highest single score in questions 1-7 in one domain
  • Ex., patient scores a 3 in facial oral movements while scoring a 1 or 2 in other domains→ severity scale would be a 3 on question 8
  • Moving to questions 9-10 assesses the overall impact on the patient as well as their awareness of unusual movements
  • Lastly, questions 11-12 assess dental issues with a ‘yes’ or ‘no’ answer that could impact clinical decision-making
  • After assessing and choosing the correct severity level in questions 1-12, the administrator can determine whether the AIMS assessment is positive or negative
    • A score of 2 in two or more movements is a positive assessment, indicating that tardive dyskinesia is present 

OR

  • A score of 3 or 4 in a single movement is a positive assessment, indicating that tardive dyskinesia is present

AIMS is a quick, reliable assessment to determine the presence of tardive dyskinesia may be present

  • If your patient is positive for the AIMS assessment, they may be a candidate for tardive dyskinesia medications
  • There are only two FDA-approved medications for tardive dyskinesia
    • Ingrezza
    • Austedo 

Resources:

References

  1. Psychiatry and Behavioral Health Learning Network. https://www.hmpgloballearningnetwork.com/site/pcn/multimedia/aims-exam-instructional-video
  2. American Psychiatric Association. https://psychiatryonline.org/doi/epub/10.1176/appi.books.9780890424841
  3. Mind-TD.  https://www.mind-td.com/aims-the-abnormal-involuntary-movements-scale-aims-understanding-the-what-why-when-and-how
  4. Mind-TD. https://www.mind-td.com/aims-reel-insight-into-the-aims-aims-assessment-in-a-telehealth-setting 

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