Alberta infant motor scale in Brazilian research: a bibliometric study

Abstract

The Alberta infant motor scale (AIMS) is an instrument for assessing the gross motor development of newborns, aged 0-18 months. This study aimed to summarize the Brazilian studies that used the AIMS and identify their objectives to know the main uses of the scale for professionals interested in child motor development. This is a bibliometric study on SciELO, PubMed, Scopus, and Web of Science databases. The searched keywords were “Alberta infant motor scale” and “Brazil,” with their equivalents in Portuguese and united by “AND.” Inclusion criteria were: use of AIMS with children aged 0-18 months carried out in Brazil. The variables database, journal, year of publication, language, region of the institution linked to the authors, and type of study were analyzed in a descriptive quantitative manner. Content analysis was performed on the objectives described in the articles. In total, 79 articles were included and most of them had a cross-sectional design and were linked to institutions in the South and Southeast regions. Furthermore, most studies were from the last 10 years and in English. The journal Fisioterapia e Pesquisa was the Brazilian journal that most published studies of the sample. The analyzed objectives were distributed into six word classes, with two large groups: psychometric validity (19.1%) and evaluative studies (80.9%). The latter considered the various child populations analyzed. We presented studies that used the AIMS to evaluate the motor development of Brazilian children, reinforcing the importance of this instrument in the national context and also encouraging its use.
Keywords:
Developmental Disabilities; Child Development; Scientific Research and Technological Development; Review

Full text

1
ORIGINAL RESEARCH
DOI: 10.1590/1809-2950/e22021823en
Fisioter Pesqui. 2023;30:e22021823en
Study developed by the Laboratory of Motor Assessment and Intervention (LAVIM) of the Institute of Physical Education and Sports,
Universidade Federal do Ceará (UFC), Fortaleza (CE), Brazil.
This study was extracted from the Final Course Paper entitled Alberta Infant Motor Scale in Brazilian research: a bibliometric study,
authored by Carla Thais de Sousa, presented for the completion of the Physical Education course at UFC in 2022.
1Universidade Federal do Ceará (UFC) – Fortaleza (CE), Brazil. E-mail: thaiscarlasousa@gmail.com. ORCID-0000-0002-5455-9980
2Universidade Federal do Ceará (UFC) – Fortaleza (CE), Brazil. E-mail: taynaalbuquerquet@gmail.com. ORCID-0000-0002-3964-081X
3Universidade Federal do Ceará (UFC) – Fortaleza (CE), Brazil. E-mail: marcelaferracioli@ufc.br. ORCID-0000-0003-1782-691X
1
Corresponding address: Marcela de Castro Ferracioli Gama – Av. Mister Hull, s/n, Parque Esportivo, Bloco 320 – Fortaleza (CE), Brazil – ZIP Code: 60455-760 – E-mail:
marcelaferracioli@ufc.br – Financing source: nothing to declare – Conflict of interest: nothing to declare – Presentation: Dec. 2nd, 2022 – Accepted for publication: Apr 26th, 2023.
Alberta infant motor scale in Brazilian research:
abibliometric study
Alberta infant motor scale em pesquisas brasileiras: estudo bibliométrico
Escala Motora Infantil de Alberta en la investigación brasileña: un estudio bibliométrico
Carla Thais de Sousa1, Tayná Albuquerque Tabosa2, Marcela de Castro Ferracioli-Gama3
ABSTRACT | The Alberta infant motor scale (AIMS) is an
instrument for assessing the gross motor development
of newborns, aged 0–18 months. This study aimed to
summarize the Brazilian studies that used the AIMS
and identify their objectives to know the main uses
of the scale for professionals interested in child motor
development. This is a bibliometric study on SciELO,
PubMed, Scopus, and Web of Science databases.
Thesearched keywords were “Alberta infant motor
scale” and “Brazil,” withtheir equivalents in Portuguese
and united by “AND.” Inclusion criteria were: use of
AIMS with children aged 0–18 months carried out
in Brazil. Thevariables database, journal, yearof
publication, language, region of the institution linked
to the authors, and type of study were analyzed in a
descriptive quantitative manner. Content analysis was
performed on the objectives described in the articles.
In total, 79 articles were included and most of them had
a cross-sectional design and were linked to institutions
in the South and Southeast regions. Furthermore,
moststudies were from the last 10 years and in English.
The journal Fisioterapia e Pesquisa was the Brazilian
journal that most published studies of the sample.
Theanalyzed objectives were distributed into six word
classes, with two large groups: psychometric validity
(19.1%) and evaluative studies (80.9%). Thelatter
considered the various child populations analyzed.
Wepresented studies that used the AIMS to evaluate
the motor development of Brazilian children, reinforcing
the importance of this instrument in the national
context and also encouraging its use.
Keywords | Developmental Disabilities; Child Development;
Scientific Research and Technological Development; Review.
RESUMO | A Alberta infant motor scale (AIMS) é um
instrumento de avaliação do desenvolvimento motor
grosso dos recém-nascidos entre 0 e 18 meses de
idade. Este estudo buscou sumarizar as pesquisas
brasileiras que utilizaram a AIMS e identificar seus
objetivos, a fim de fornecer um quadro das principais
utilizações da escala aos profissionais interessados no
desenvolvimento motor infantil. Trata-se de um estudo
bibliométrico realizado por meio de buscas nas bases
de dados SciELO, PubMed, Scopus, e Web of Science.
Os descritores foram “escala motora infantil de Alberta”
e “Brasil”, com seus equivalentes em inglês, unidos
pelo termo booleano “AND”. O critério de inclusão
foi a utilização da AIMS no Brasil, com crianças de 0
a 18 meses. As variáveis base de dados, revista, ano
de publicação, idioma, região da instituição vinculada
aos autores e tipo de estudo foram analisadas de
forma quantitativa descritiva. Foi realizada análise
de conteúdo dos objetivos descritos nas pesquisas,
e foram incluídos 79 estudos, a maioria dos quais
apresentou delineamento transversal e estava vinculada
a instituições das regiões Sul e Sudeste. Boa parte das
publicações era dos últimos 10 anos, em inglês, e a
revista Fisioterapia e Pesquisa foi o periódico nacional

Fisioter Pesqui. 2023;30(2):e22021823en
2
que mais publicou estudos referentes à amostra. Os objetivos
analisados foram distribuídos em seis classes de palavras,
contidas em dois grandes grupos: validades psicométricas
(19,1%) e estudos avaliativos (80,9%). Este último considerou
as várias populações infantis analisadas. O estudo
apresentou as pesquisas que utilizaram a AIMS para avaliar o
desenvolvimento motor de crianças brasileiras. Isso reforça a
importância deste instrumento no contexto nacional, além de
estimular sua utilização.
Descritores | Deficiências do Desenvolvimento; Desenvolvimento
Infantil; Pesquisa Científica e Desenvolvimento Tecnológico;
Revisão.
RESUMEN | La Escala Motora Infantil de Alberta (AIMS) es
un instrumento que evalúa el desarrollo motor grueso de los
recién nacidos de entre 0 y 18 meses de edad. Esteestudio
pretendió hacer una síntesis de estudios brasileños que
utilizaron la AIMS, así como identificar sus objetivos, conel
fin de proporcionar una tabla de los principales usos de
la escala a los profesionales interesados en el desarrollo
motor infantil. Se trata de un estudio bibliométrico, en el
que se realizaron búsquedas en las bases de datos SciELO,
PubMed, Scopus y Web of Science. Los descriptores utilizados
fueron “escala motora infantil de Alberta” y “Brasil”, con sus
equivalentes en inglés, unidos por el término booleano “AND”.
El criterio de inclusión fue la aplicación de la AIMS en Brasil,
con niños de entre 0 y 18 meses. Las variables base de datos,
revista, año de publicación, idioma, región de la institución
vinculada a los autores y tipo de estudio se analizaron de
manera cuantitativa y descriptiva. Se realizó un análisis de
contenido de los objetivos descritos en los estudios, y se
incluyeron 79 estudios, de los cuales la mayoría presentó
un diseño transversal y estaba vinculado a instituciones
de las regiones Sur y Sudeste de Brasil. La mayoría de las
publicaciones son de los últimos 10 años, en inglés, y la
revista Fisioterapia e Pesquisa fue la revista nacional que más
publicó estudios. Losobjetivos analizados se dividieron en
seis clases de palabras, que contienen dos grupos principales:
validez psicométrica (19,1%) y estudios evaluativos (80,9%).
Este último tuvo en cuenta las diversas poblaciones infantiles
analizadas. Este estudio presentó las investigaciones que
evaluaron la AIMS respecto al desarrollo motor de los niños
brasileños. Estodestaca la importancia del citado instrumento
en el contexto nacional, además estimula su uso.
Palabras clave | Discapacidades del Desarrollo; Desarrollo Infantil;
Investigación Científica y Desarrollo Tecnológico; Revisión.
INTRODUCTION
e rst months of the child’s life are characterized
by sensorimotor development. us, the lack of stimuli
in this phase may delay the acquisition of essential
motor skills and, consequently, in child development
1
.
erefore, standardized and validated tools for the
assessment of these skills are widely used by health
professionals for the surveillance of child development,
as they provide the quantication of children’s motor
performance, which is compared with pre-established
norms regarding their peers2.
The Alberta infant motor scale (AIMS) is an
instrument for assessing the gross motor development of
full-term and preterm newborns aged from 0 to 18 months
(38 weeks of gestational age to 18 months of corrected
age or independent gait). Professional’s observation
provides information about the spontaneous repertoire
of children’s motor skills
3
. e AIMS has 58items,
divided into the following subscales: prone (21 items),
supine (9 items), sitting (12 items), andstanding
(16 items). Each item from the subscales must be
recorded based on the observation of the spontaneous
description of the child’s movements. e scale presents
crude scores, percentiles, and categorization of motor
performance as: normal (>25%), suspicious (25–5%),
and atypical (<5%)4.
Even 25 years after its publication, AIMS is still
widely tested5. In Brazil, AIMS proved to be an ecient,
reliable, and consistent tool to assess children’s motor
development, with predictive and discriminating power
of signicant delays
6
. Among the many facilities of
access and use, the reasons that justify its wide use are
little time needed for the application (10–30 minutes),
it does not require specific materials, it is cheap,
andlittle handling required from the child1,7.
Motor assessment based on AIMS has guided
several types of studies, especially in Brazil, whether
to formulate situational diagnoses or to evaluate
intervention strategies6,8. Although AIMS stands out

Sousa et al. Alberta infant motor scale bibliometrics
3
among the most used protocols for the evaluation
of Brazilian children, the literature does not show
quantitative surveys of the studies that used the
scale. is analysis may provide essential data on
the applicability and reliability of AIMS in many
research centers and in dierent Brazilian regions.
us, this bibliometric study aimed to summarize the
Brazilian studies that used AIMS and its ndings in
important databases, contributing to future studies
on motor development and the performance of the
professional, who may use this scale to intervene in
child development.
METHODOLOGY
This is a bibliometric study, with quantitative
(descriptive) and qualitative (content analysis) survey,
on the scope of Brazilian studies that used the Alberta
infant motor scale (AIMS). e searches were performed
by two reviewers, at dierent and independent times,
in March and April 2022, in the databases SciELO,
PubMed, Scopus, and Web of Science. e searched
keywords were: “Alberta infant motor scale,” “Brazil,”
“escala motora infantil de Alberta,” and “Brasil.” e Boolean
term “AND” was used in all searches, both in English
and in Portuguese.
e investigation focused on original studies with
cross-sectional, longitudinal, and methodological
design, which used the scale and were published from
1994 (publication year of the scale) onward, in any
language. e inclusion criteria were using AIMS as
an instrument to assess motor development; inclusion
of children aged from 0 to 18 months; and studies
carried out in Brazil. e last criterion was chosen
due to the need to know the evaluation of the motor
development of Brazilian children to come up with
plans to cope with motor delays that specically aect
this population. Systematic reviews were excluded
from the study.
Research and initial screening were carried out based
on the reading of title and abstract of the studies that
were found by the keywords in the dierent databases,
excluding the duplicates and applying the proposed
inclusion and exclusion criteria. en, thefull texts were
obtained to be read in full. Studies in which inclusion
criteria were not explicit were also fully examined.
An electronic spreadsheet was prepared to catalog
the studies data, with the following information:
database; title; journal; year of publication; language;
Brazilian region; authors; institution; objective;
design; results; and conclusions. e study design was
subdivided into longitudinal (longitudinal, clinical,
experimental, and/or quasi-experimental trials) and
cross-sectional (cross-sectional, methodological,
reports, case, and exploratory studies)
9
. Studies on
the development, validation, and evaluation of research
tools and methods were considered methodological
research10. e language identied in the spreadsheet
refers to the one found in the databases, not excluding
publications in another language. Regarding the related
institutions and their respective Brazilian regions,
therst Brazilian institution linked to the authors
was considered, in the sequence of authorship.
Descriptive analysis was used to present absolute
and relative frequencies of the variables “design,”
“database,” “journal,” “year of publication,” “language,”
and “region.” Data related to the objectives were
examined by content analysis11. In the creation of the
textual corpus, the terms “motor development” and
“newborns” were grouped into a single term, respectively
as follows: desenvolvimento_motor and recém_nascidos.
For the grouping, the Interface de R pour les Analyses
Multidimensionnelles de Textes et de Questionnaires
program (IRaMuTeQ) was used12.
en, two specic types of analyses were performed:
analysis of specicities, aiming to verify the dierences
in evocations (considering the incidence of words
frequency and their hypergeometric indexes) between
the objectives of the studies in variable function to
the region of Brazil; and descending hierarchical
classication (DCH), to recognize the dendrogram with
emerging classes, in which, the higher the χ², themore
associated the word is with the class, disregarding the
words with χ²<3.80 (p<0.05).
RESULTS
In total, 181 studies were found; however, after
the reading stage, only 79 studies constituted the nal
sample. Figure1 shows the owchart of screening and
selection of articles.

Fisioter Pesqui. 2023;30(2):e22021823en
4
Studies found in the
databases:
PubMed (n=41)
Scopus (n=26)
Web of Science (n=58)
SciELO (n=56)
Studies analyzed
(n=97)
Excluded studies
(n=18)
Systematic
review studies
Eligible studies
(n=79)
Excluded studies
(n=0)
Removal of
duplicates
(n=84)
Studies included in the
bibliometric review
(n=79)
IdentificationScreening
Included
Figure 1. Flowchart of identification and selection of studies from
the literature review
Source: Adapted from Page et al.13.
In total, 45 (57%) studies were published in English
and 34 (43%) in Portuguese, which were published
in 37 journals. Of these, 18 (48.6%) are Brazilian
journals, in which 50 (63.3%) studies were published,
and 19 (36.7%) international journals, in which
29 (36.7%) studies were published. The Brazilian
journals with the highest number of publications
were Fisioterapia e Pesquisa (n=14) and Fisioterapia
em Movimento (n=7), and the international ones
were Pediatrics International (n=4) and Research in
Developmental Disabilities (n=3). The selected studies
were published from 2006 onward (Figure2).
Figure3 shows the frequencies of studies linked to
the regions where the authors’ institutions are located.
Furthermore, the evocations in the objectives of the
studies were compared and described by the analysis
of specicities, considering the frequency of incidence
of words and their hypergeometric indexes, among the
regions of Brazil.
Regarding the studies design, the following
were recorded: 27 (34.2%) longitudinal, 25 (31.7%)
cross-sectional, 16 (20.2%) methodological, 4 (5%)
clinical trials, 3 (3.8%) experimental and/or quasi-
experimental, 2 (2.5%) reports, 1 (1.3%) case study,
and 1 (1.3%) exploratory study. Longitudinal studies
had the highest frequency in the sample, of which
15 (55.6%) are from institutions in the Southeast,
8 (29.6%) from the South, 2 (7.4%) from the Midwest,
and 2 (7.4%) from the Northeast. Regarding the clinical
trials (n=4), 3 (75%) were from institutions in the South
and 1 (25%) from the Southeast. Of the experimental
and quasi-experimental studies (n=3), 2 (66.6%) were
from the South and 1 (33.3%) from the Southeast
(Supplementary Chart1).
Publication year
Number of studies (N)
2006 2008 2010 2012 2014 2016 2018 2020 2022
10
9
8
7
6
5
4
3
2
1
0
Figure 2. Number of studies published per year

Sousa et al. Alberta infant motor scale bibliometrics
5
Distribution of studies by region of Brazil
7,6 %
5,1%
43%
44,3%
North Region
Midwest Region
Northeast Region
Southeast Region
South Region
Southeast
Infant
To compare
To check
To evaluate
Brazilian
Northeast
AIMS
Child
To check
Motor
Premature
Midwest
Weight
Premature
Infant
To check
Motor
South
To investigate
Baby
Motor
Brazilian
Child
Evocations of the objectives of the
studies by region of Brazil
Figure 3. Distribution of studies according to the region of Brazil and the main evocations present in the objectives of the studies,
classified by region
Among the 25 studies with a cross-sectional design,
15 are from institutions in the South (60%), 8 (32%)
Southeast, 1 (4%) Northeast, and 1 (4%) Midwest.
Among the methodological studies found (n=16),
all investigated the reliability of the scale and its
respective validations in the Brazilian public, inwhich
7 (43.7%) were from institutions in the South,
7 (43.7%) from the Southeast, and 2 (12.5%) from
the Northeast. Two reports were found, 1 (50%) linked
to an institution in the South and 1 (50%) in the
Southeast. Moreover, a case study from an institution
in the Southeast region and an exploratory study from
an institution in the Northeast region (Supplementary
Chart2) were found.
e corpus was composed of 68 textual segments
(86.0%). In total, 1,932 occurrences (words and forms)
were found, of which 462 were distinct words and
284had a single occurrence. e analyzed content was
categorized into six classes (Figure4).
The segments of Class 1 refer to the evaluation
of the motor development of infants participating in
interventions: aquatic intervention, cognitive-motor
intervention, guidance for maternal practices, parental
intervention, and telehealth. is class of words was
prevalent in the South region (χ²=4.85).
Class 2 refers to terms related to the evaluation
of motor development of premature children with
low weight, verifying the inuence of adequate sleep,
length of hospital stay, and quality of the environment.
This class of words was prevalent in the Midwest
region (χ²=16.26).
Class 3 is related to terms referring to the evaluation
of motor development of children exposed to Zika
virus and human immunodeciency virus (HIV) and
their possible consequences, such as cerebral palsy in
children with congenital Zika virus syndrome.
Class 4 is composed of terms referring to the
comparison between the development of preterm and
full-term infants regarding segmental trunk control,
postural control, and gait. This class of words was
prevalent in the Southeast region (χ²=3.9).
Class 5 includes terms related to the characterization
of the development of children with Down syndrome
and the verication of their diculties in the acquisition
of motor skills.
Finally, Class 6 presents terms referring to the
validity and reliability of AIMS. e instruments used
for comparison were the third edition of the Bayley Scales
of Infant and Toddler Development (Bayley III) and
the gross motor function measure (GMFM). Groups
of children exposed to HIV and premature infants were
also included. ese studies contributed to the aspects
of the Brazilian version of the scale, which also served
as a comparator regarding the test of infant motor
performance (TIMP). is class was prevalent in the
Northeast region (χ²=5.83).

Fisioter Pesqui. 2023;30(2):e22021823en
6
Class 6 – Validity and
reliability of AIMS
Class 1 – Evaluation of
intervention results
Class 4 – To compare the
motor development of preterm
and full-term newborns
Class 3 – Development of
newborns exposed to viruses
Class 2 – Characterization of the
development of premature
children with low birth weight
Class 5 – To verify motor
acquisition in newborns
with Down syndrome
19,1%
16,2%
16,2%
14,7%
16,2%
17,6%
Class 1
newborn
cognitive
intervention
eect
program
risk
early
χ
42,65
34,1
34,1
22,2
12,26
12,37
10,85
χ
40,45
40,44
25,05
16,21
5,09
4,96
χ
24,65
18,02
12,32
7,6 6
χ
22,2
9,66
8,3
5,9
χ
30,71
25,81
20,52
14,59
14,44
9,62
5,19
χ
55,68
33,1
23,8
22,83
17,98
13,28
13,28
Class 2
weight
low
premature
influence
birth
child
Class 3
zika
virus
to expose
to evaluate
Class 5
Down
acquisition
syndrome
infant
relationship
skill
to identify
Class 6
AIMS
validity
Brazilian
version
reliability
value
competitor
Class 4
term
development
to check
preterm
Figure 4. Dendrogram of the descending hierarchical classification of the study objectives of the sample and its percentage and the
most prevalent words in each class, with the value of χ²
AIMS: Alberta infant motor scale.
DISCUSSION
By bibliometric search, this study aimed to answer
the following question: what is the scope of the studies
that used AIMS to evaluate the motor development of
children aged from 0 to 18 months in Brazil? Moststudies
had a cross-sectional design, aiming to delimit values and
characteristics of motor development and reference curves
of AIMS for premature and full-term Brazilian children.
e longitudinal design studies reinforce AIMS
robustness and its consolidation in clinical practice.
However, methodological studies contribute mainly to
the safety in the choice of AIMS, since it is necessary that
the screening and developmental assessment instruments
have psychometric validation. Eorts in this direction
are very necessary in Brazil14.
e methodological studies showed the ecacy,
validity, and reliability of AIMS, by establishing curves
and norms for Brazilian children. In clinical practice,
professionals should choose motor development
assessments based on psychometric properties aimed at
the context of the child in evaluation. us, studies on the
predictive validity, reliability, and responsiveness of gross
motor assessment tools are highly important. e AIMS
proved to be a valid, reliable, and eective instrument
for the evaluation of motor development in Brazilian
children, including contemporary samples5.
e South and Southeast regions had the largest
number of institutions linked to the selected studies.
e survey of articles by region is essential to trace
the development trajectory of each one since regional
dierences, considering the culture and social context,

Sousa et al. Alberta infant motor scale bibliometrics
7
can influence motor development
15
. Furthermore,
wefound no studies on this topic in the North region,
and few studies were linked to the Midwest and the
Northeast Brazil, showing regional asymmetries in the
national scientic production on the subject. e higher
concentration of graduate programs, considering area21
(Physical Education, Physical erapy, Occupational
Therapy, and Speech-Language Pathology and
Audiology) of the Coordination for the Improvement
of Higher Education Personnel (CAPES), may increase
the incidence of published studies on the subject in
certain Brazilian regions. In 2021, the Southeast and
South regions covered about 71% of the graduate
programs in this area, while only 8.2% of these were
in the North region. It is possible that there are, in the
nal sample, studies with authors linked to institutions
from all regions of Brazil. However, since these regions
are not those of the rst authors or of the institutions
highlighted as the place where the study was developed,
they were disregarded.
Notably, the great concentration of recent studies
may indicate that this is a subject that aroused greater
interest recently, with great potential for expansion and
innovation. Furthermore, most studies in the sample
were published in English, even though most of them
are present in Brazilian journals.
Regarding the distribution of word classes in the
dendrogram, we observed a first division between
psychometric validity studies and evaluative studies.
is second category encompasses most of the studies,
considering the various child populations analyzed.
ese studies are essential since they meet a great need
of our country: the monitoring of the development
of our children16.
erefore, our ndings can contribute to obtain a
broader view of the evaluation of motor outcomes in
children and highlight its importance for the promotion
of good strategies for early motor intervention in
Brazilian children. One of the study limitations isthe
disproportion of the studies regarding the types of
design and the subjects studied, which promotes a
signicant number of studies for some themes and
scarcity of others.
CONCLUSION
Most studies using AIMS with Brazilian children
are cross-sectional, followed by longitudinal and
methodological studies. Furthermore, most studies
provided values, developmental trajectories, and reference
curves of the scale for premature and full-term children,
as well as good criteria for the scale.
e thematic categories of the objectives of the studies
present classes regarding validation and evaluation studies
of the development of premature children, exposed to
viruses, with low birth weight, and Down syndrome.
This reveals the growing use of AIMS to monitor
the development of Brazilian children by broad and
reliable instruments.
Considering these ndings, future studies on these
topics, covering Brazilian children, should be conducted.
ese future studies face a great challenge: the training
and improvement of health professionals (physical
therapists, physical education professionals, pediatricians,
among others) for a detailed evaluation of aspects
suspected of causing the delay in motor development of
Brazilian children.
Supplementary material
The supplementary material can be found at
https://osf.io/xdcjn.
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