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Abnormal Involuntary Movement Scale (AIMS)(301894-DT)

Abnormal Involuntary Movement Scale (AIMS)(301894-DT) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



Patient Name

DOB:

MR #

Index to Questionnaire-Health\Encounter

301894-DT (Rev. 12/23/16) Abnormal Involuntary Movement Scale (AIMS)
Page 1 of 2
UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
ABNORMAL INVOLUNTARY MOVEMENT
SCALE (AIMS)






Date: ______________________
Examiner’s Name _________________________
CURRENT MEDICATIONS AND TOTAL mg/Day
Medication #1 ___________________ Total mg/Day ________ Medication #2 __________________ Total mg/Day_______



INSTRUCTIONS: COMPLETE THE EXAMINATION PROCEDURE BEFORE ENTERING THESE RATINGS.

N
o
n
e
.

N
o
r
m
a
l

M
i
n
i
m
a
l

(
m
a
y

b
e

e
x
t
r
e
m
e

n
o
r
m
a
l
)

M
i
l
d



M
o
d
e
r
a
t
e

S
e
v
e
r
e

Facial and Oral Movements

1. Muscles of Facial Expression eg. movements of forehead, eyebrows, □
0

1

2

3

4

periorbital area, cheeks: include frowning, blinking, smiling, grimacing

2. Lips and Perioral Area □
0

1

2

3

4

Eg. puckering, pouting, smacking

3. Jaws eg, biting clenching, chewing, mouth opening, lateral movement □
0

1

2

3

4


4. Tongue □
0

1

2

3

4

Rate only increases in movement both in and out of mouth,
NOT inability to sustain movement


Extremity Movements

5. Upper (arms, wrists, hands, fingers) □
0

1

2

3

4

Include choreic movements (ie, rapid, objectively, purposeless,
Irregular, spontaneous): athetoid movements (ie, slow, irregular, complex,
Serpentine). DO NOT include tremor (ie, repetitive, regular rhythmic).

6. Lower (legs, knees, ankles, toes) □
0

1

2

3

4

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


Trunk Movements

7. Neck, shoulders, hips □
0

1

2

3

4

Eg, rocking, twisting, squirming, pelvic gyrations









Patient Name

DOB:

MR #

Index to Questionnaire-Health\Encounter

301894-DT (Rev. 12/23/16) Abnormal Involuntary Movement Scale (AIMS)
Page 2 of 2
UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
ABNORMAL INVOLUNTARY MOVEMENT
SCALE (AIMS)







SCORING:
• Score the highest amplitude or frequency in a movement on the 0-4 scale, not the average;
• Score the Activated Movements the same way; do not lower those numbers as was proposed at one time;
• A POSTIVE AIMS EXAMINATION IS A SCORE OF 2 IN TWO OR MORE MOVEMENTS or a SCORE OF 3 OR 4 IN A SINGLE MOVEMENT
• Do not sum the scores: e.g. a patient who has scores 1 in four movements DOES NOT have a positive AIMS score of 4.


Overall Severity
8. Severity of abnormal movements □
0

1

2

3

4


9. Incapacitation due to abnormal movements □
0

1

2

3

4

N
o

a
w
a
r
e
n
e
s
s

A
w
a
r
e
,

n
o

d
i
s
t
r
e
s
s

A
w
a
r
e
,

m
i
l
d

d
i
s
t
r
e
s
s

A
w
a
r
e
,

m
o
d
e
r
a
t
e

d
i
s
t
r
e
s
s

A
w
a
r
e
,

s
e
v
e
r
e

d
i
s
t
r
e
s
s

10. Patient’s awareness of abnormal movements (rate only patient’s report) □
0

1

2

3

4



Dental Status Yes No
11. Current problems with teeth and/or dentures? □ □
12. Does patient usually wear dentures? □ □




























Guy W: ECDEU Assessment Manual for Psychopharmacology – Revised (DHEW Publ No ADM 76-338), US Department of Health, Education, and Welfare; 1976


Signature of Patient/Representative ____________________________________Date: _________ Time: ________AM/PM

If signed by person other than the patient, print name and state relationship and authority to do so.

Print Name: _____________________________________Relationship: __________________________________

Patient is:  Minor  Incompetent / Incapacitated
Legal Authority:  Legal Guardian  Parent of Minor
 Health Care Agent  Other _____________________

Reviewed by: ______________________________________________ Date: ________________ Time: _________AM/PM