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Research on the Test of Infant Motor Performance
Peer-reviewed Publications and Book Chapters


Campbell SK. Test-retest reliability of the Test of Infant Motor Performance. Pediatr Phys Ther. 1999;11:60-66: Documents test-retest reliability for 116 pairs of tests of r = .89 over 3 days; no significant difference between testers. http://journals.lww.com/pedpt/Abstract/1999/01120/Test_Retest_Reliability_of_the_Test_of_Infant.2.aspx

Campbell SK, Hedeker D. Validity of the Test of Infant Motor Performance for discriminating among infants with varying risk for poor motor outcome. J Pediatr. 2001;139:546-551: Documents ability of the TIMP to discriminate among infants with varying risk for poor motor performance in early infancy. http://dx.doi.org/10.1067/mpd.2001.117581

Campbell SK, Kolobe THA, Osten ET, Lenke M, Girolami GL. Construct validity of the Test of Infant Motor Performance. Phys Ther. 1995;75:585-596: Documents relationship between age and TIMP test scores for infants from 32 weeks postconceptional age through 3.5 months AA with r = .83.  https://academic.oup.com/ptj/article-abstract/75/7/585/2632886/Construct-Validity-of-the-Test-of-Infant-Motor?redirectedFrom=fulltext

Campbell SK, Levy P, Zawacki L, Liao P-j. Population-based age standards for interpreting results on the Test of Infant Motor Performance.  Pediatr Phys Ther. 2006;18:119-125.  Provides age standards for performance on the TIMP based on testing of 990 U.S. infants.  High risk infants and Latino/a infants performed less well than infants of other races/ethnicities and infants with lower risk for poor outcome based on perinatal medical complications. http://journals.lww.com/pedpt/pages/articleviewer.aspx?year=2006&issue=01820&article=00002&type=abstract

Campbell SK, Swanlund A, Smith E, Liao P-j, Zawacki L.  Validity of the TIMPSI for estimating concurrent performance on the Test of Infant Motor Performance.  Pediatr Phys Ther 2008;20:3-10. Performance on the TIMP and the TIMPSI were compared at the same age in 990 U.S. infants.  A cutscore of -.5 SD on the TIMPSI correctly classified 83.7% of the infants on the TIMP as delayed/not delayed, but the cutscore of -.25 SD produced the best combination of false negatives (5.8%) and false positives (12.5%) and is recommended for use in clinical practice. http://journals.lww.com/pedpt/Fulltext/2008/01910/Validity_of_the_TIMPSI_for_Estimating_Concurrent.2.aspx  http://dx.doi.org/10.1097/PEP.0b013e31815f66a6

Campbell SK, Wright BD, Linacre JM. Development of a functional movement scale for infants.  J Applied Meas. 2002;3(2):191-204.  Description of use of Rasch analysis to develop Version 4 of the TIMP used in a population-based study of 990 infants in 10 U.S. cities. http://jampress.org/abst2002.pdf

Ustad T, Helbostad JL, Campbell SK, Girolami GL, Jorgensen L, Oberg GK, Evensen KAI. Test-retest reliability of the Test of Infant Motor Performance Screening Items in infants at risk for impaired functional motor performance. Early Human Development 2016;93:43-46. Test-retest reliability of the TIMPSI was .99. http://dx.doi.org/10.1016/j.earlhumdev.2015.12.007


Byrne EM, Campbell SK. Physical therapy observation and assessment in the neonatal intensive care unit. Phys Occup Ther in Pediatr 2013;33(1):39-74. Review of appropriate tests and measures for use in NICU physical therapy practice.  http://dx.doi.org/10.3109/01942638.2012.754827

Byrne R, Noritz G, Maitre NL. Implementation of early diagnosis and intervention guidelines for cerebral palsy in a high-risk infant follow-up clinic. Pediatr Neurol 2017. To implement international guidelines for early recognition of CP, a NICU follow-up clinic added the GMA and HINE to the TIMP at 3-4 months, and the HINE plus developmental assessments at later visits. Diagnosis of CP was decreased from 18 months to age 13 months by application of the guidelines.  https://doi.org/10.1016/j.pediatrneurol.2017.08.002

Cahill SM, Bowye P (eds). Cases in Pediatric Occupational Therapy; Assessment and Intervention. Slack Incorporated, Thorofare NJ. 2015.  TIMP developer Maureen Lenke is a contributing author to chapter 1, The Neonatal Intensive Care Unit, pp 9-16. There are 40 case studies ( 5 from NICU), from all areas of Pediatric OT.

Campbell SK. The infant at risk for developmental disability. In: Campbell SK, ed. Decision Making in Pediatric Neurologic Physical Therapy. Philadelphia, PA: Churchill Livingstone; 1999:260-332: Provides case examples of clinical use of the TIMP to document need for intervention and outcomes of treatment.

Campbell SK. The quest for measurement of infant motor performance.  In Refshauge K, Ada L, Ellis E (eds).  Science-based Rehabilitation: Theories into Practice.  Philadelphia, PA: Butterworth Heinemann; 2005:49-65.

Chiquetti EMS, Carvalho ACF, Zanella AK, Vaentin NC. Risk factors and motor development of infants born small for gestational age (SGA) term and preterm (Portuguese with English abstract). Resista Varia Scientia, Ciencias da Saude 2018;4(1). Among 41 Brazilian infants born SGA, 54% showed delay on the TIMP; delay was present in 70% of those born preterm. Correlation between motor development and gestational age was .327, p = 0.013. Motor development was not affected by SES.

da Silva AJ, Neves LAT, Fronio JdS, Ribeiro LC. Factors related to motor developmental delay of newborns. J Hum Growth Develop 2014;24(3):320-327. In a Brazilian sample of 178 newborns, TIMP scores at hospital discharge were significantly associated with presence of prematurity, presence of seizures, and being female. 35.8% had scores below -1 SD from the mean.  http://dx.doi.org/10.7322/jhdg.88970

Duff SV, DeMatteo C. Clinical assessment of the infant and child following perinatal brachial plexus injury. J Hand Ther 2015;28(2):126-134. Recommends use of the TIMP for functional assessment in infants with brachial plexus injury. http://dx.doi.org/10.1016/j.jht.2015.01.001

Dusing SC, Izzo T,Thacker LR, Galloway JC. Postural complexity influences development in infants born preterm with brain injury: Relating perception-action theory to 3 cases. Phys Ther 2014;94(10). Presents 3 cases of infants with PVL for whom postural complexity was used to quantify action and perception during development of early motor behaviors. http://dx.doi.org/10.2522/ptj.20140023

Dusing SC, Lobo MA, Lee H-M, Galloway JC. Intervention in the first weeks of life for infants born late preterm: A case series. Pediatr Phys Ther 2013;25:194-203. The TIMP was used as an outcome assessment in two cases of late preterm infants receiving intervention from .5 to 2 months corrected age.  http://journals.lww.com/pedpt/Fulltext/2013/25020/Intervention_in_the_First_Weeks_of_Life_for.16.aspx

Dusing SC, Murray T, Stern M.  Parent preferences for motor development education in the neonatal intensive care unit.  Pediatr Phys Ther 2008;20:363-368.  Demonstrates through use of parent focus groups that observing the Test of Infant Motor Performance is a preferred mode of parent education on infant motor development.  Parents who viewed a videotaped TIMP followed by explanation of infant performance and ideas for play had improved knowledge of motor development and were able to describe ways that they would play with their infant. http://journals.lww.com/pedpt/Fulltext/2008/02040/Parent_Preferences_for_Motor_Development_Education.9.aspx

Dusing SC, Van Drew CM, Brown SE. Instituting parent education practices in the neonatal intensive care unit: An administrative case report of practice evaluation and statewide action. Phys Ther. 2012;92;2-9. Case report describes the process of implementing a new education program for parents in the NICU. http://dx.doi.org/10.2522/ptj.20110360

Echevarria Ulloa M. Adaptacion Transcultural y Version Espanola de la Prueba de Rendimiento Motor Infantil (TIMP). Unpublished Doctoral Thesis, Universidad Complutense de Madrid, 2015. Translation of the TIMP to Castillian Spanish authorized for research by Echevarria Ulloa M, Lavin Lopez J.L, Ubeda Tikkanen A, Maroto M, Alvarez Vadillo A, Arroyo Riano MO.

Giachetta L, Nicolau CM, Juliani RCTP, de Carvalho WB, Krebs VLJ. Characterization of the motor performance of newborns in a neonatal unit of tertiary level. Rev Assoc Med Bras 2016;62:553-560.  The TIMP was used to assess infants between 34 and 41 weeks CA. Early age groups showed average TIMP scores compared to U.S. TIMP norms, but infants between 38-41 weeks were statistically lower performers than the reference values. Mothers of infants in the latter group were found to have higher rates of smoking, infection, and diabetes. No subject in this group of relatively low risk infants (no chronic lung disease or brain insult) scored in the below average or lower range. Authors concluded that the TIMP is useful clinically and can be used safely in tertiary care units. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-42302016000600553&lng=en&tlng=en

Gasparin M, Silveira JL, Garcez LW, Levy BS. Oral and general motor behavior of newborns from crack and/or cocaine using mothers. Rev Soc Bras Fonoaudiol 2012:17(4):459-463 (Portuguese). No differences in TIMP scores were found between offspring of cocaine using mothers and those of non-users from a public hospital in Porto Alegre, Brazil. Differences were found in oral motor behavior.  Delay on the TIMP was reported as follows: 62.5% of preterm infants of cocaine using mothers, 50% of preterm infants of nonuser mothers, 82.4% of term infants of user mothers, and 76.5% of term infants of non-user mothers. http://www.scielo.br/pdf/rsbf/v17n4/16.pdf

Goldstein LA, Campbell SK.  Effectiveness of the Test of Infant Motor Performance as an educational tool for mothers.  Pediatr Phys Ther 2008;20:152-159.  Use of the TIMP in a developmental followup clinic was successful in increasing knowledge of premature infant motor development in African-American mothers.  Mothers retained information on how to facilitate their baby's development when asked later to recall what they were taught. Use of the pictorial version of the TIMP was not more effective than a text-only version. http://journals.lww.com/pedpt/Fulltext/2008/02020/Effectiveness_of_the_Test_of_Infant_Motor.5.aspx

Guimaraes CLN, Reinaux CM, Botelho ACG, Lima GMS, Cabral Filho JE. Motor development evaluated by Test of Infant Motor Performance: Comparison between preterm and full-term infants. Rev Bras Fisioter, Sao Carlos 2011;15 (5):357-362. In a group of 92 infants, half of whom were born full term, TIMP scores showed delay in 26% of the preterm infants and none of the full term infants when assessed at term-equivalent age. Mean scores showed significant differences between full- and preterm infants. http://www.scielo.br/pdf/rbfis/2011nahead/AOP020_11.pdf

He L, Shao D-D, Du H-Y, Chen Y-N. Role of Test of Infant Motor Performance in premature evaluation in corrected gestational aged 8-9 and 12-13 weeks. Chinese J Child Health Care 2014;22(3):252-254 (Chinese language with English abstract). TIMP scores were significantly correlated with concurrent Gesell Developmental Scale scores at > .5.  Raw scores of Chinese infants were on average significantly lower than those of same-age U.S. infants. www.cjchc.net
Hilderman CGE, Harris SR. Early intervention post-hospital discharge for infants born preterm. Phys Ther 2014;94:1211-1219. A Linking Evidence and Practice article with a case history of an infant born preterm for whom the TIMPSI was used in the nursery to identify risk followed by a full TIMP assessment to document delay and then progress in an early intervention program. https://academic.oup.com/ptj/article/94/9/1211/2735587/Early-Intervention-Post-Hospital-Discharge-for

Lee E-j, Han J-t, Lee J-h. Risk factors affecting Tests of Infant Motor Performance (TIMP) in pre-term infants at post-conceptional age of 40 weeks. Developmental Neurorehabilitation 2012;15(2):79-83. IVH was the clinical risk factor most strongly correlated with TIMP scores at 40 weeks; other correlates were c-section, neonatal seizures, LBW and multiple birth. Authors suggest that the TIMP be performed early in infants with multiple risk factors in order to select infants for early intervention.  http://www.tandfonline.com/doi/full/10.3109/17518423.2011.633571

Lekskulchai R, Cole J. The relationship between the scarf ratio and subsequent motor performance in infants born preterm. Pediatr Phys Ther. 2000;12:150-157: Documents predictability to TIMP scores of a measure of upper extremity muscle tone in premature infants. http://journals.lww.com/pedpt/Abstract/2000/01240/The_Relationship_Between_the_Scarf_Ratio_and.2.aspx

Liao P-j M, Campbell SK. Comparison of two methods for teaching therapists to score the test of Infant Motor Performance. Pediatr Phys Ther 2002;14:191-198. Experiment comparing training approaches to learning to score the TIMP showed that the CD learning program reduced learning time by half with similar resulting rater reliability. http://journals.lww.com/pedpt/Fulltext/2002/14040/Comparison_of_Two_Methods_for_Teaching_Therapists.4.aspx

Morgan C. Towards more accurate prognostication after preterm birth. Dev Med Child Neurol 2018 10 Mar epub commentary. Concludes that the TIMP is a robust test that can be used in the NICU and followup care to improve accuracy of early detection of developmental impairment. https://doi.org/10.1111/dmcn.13765

Murney ME, Campbell SK. The ecological relevance of the Test of Infant Motor Performance Elicited Scale items. Phys Ther. 1998;78:479-489: Describes the relationship between caregiver demands for movement placed on infants during naturalistic interactions and the items on the TIMP. https://academic.oup.com/ptj/article/78/5/479/2633279

Palisano RJ, Snider LM, Orlin MN. Recent advances in physical and occupational therapy for children with cerebral palsy. Seminars in Pediatrics 2004;11(1):66-74. http://dx.doi.org/10.1016/j.spen.2004.01.010

Raniero EP, Tudella E, Mattos RS. Pattern and rate of motor skill acquisition among preterm infants during the first four months corrected age. Rev Bras Fisioter 2010;14(5):396-403. Longitudinal development of infants born preterm (relatively low risk) and term was compared. Infants born preterm had higher scores than the full term group between 1 and 4 months of age, but there were no statistically significant differences and development was highly linear across time. Both groups performed on average below TIMP normative values between 1 and 3 months, but there were no statistically significant differences from TIMP norms. Infant born preterm showed relatively faster rate of development than those born at term from 0-1 month. http://www.scielo.br/pdf/rbfis/v14n5/en_a08v14n5.pdf

Rose RU, Westcott SL.  Responsiveness of the Test of Infant Motor Performance (TIMP) in infants born preterm.  Pediatr Phys Ther 2005;17:219-224.  Demonstrates the responsiveness of the TIMP to change in motor performance in preterm infants between 32 and 36 weeks postconceptional age.  Fourteen percent of the variance in change scores was related to receipt of therapy services (p = .06); other infant variables were not related to change scores. http://journals.lww.com/pedpt/Fulltext/2005/01730/Responsiveness_of_the_Test_of_Infant_Motor.8.aspx

Santos VM, Formiga CKMR, de Mello PRB, Leone CR. Late preterm infants' motor development until term age. Clinics 2017;72(1):17-22.  Open access. Although some late preterm infants in a sample of 29 demonstrated delay on the TIMP, average performance at term did not differ from a control group of 88 infants born at term.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5251193/?report=classic

Wang CJ, Zhao SL, Shen L, Hu B, Pu XQ, Cai YI, Xiao C, Zhang YP. Analysis of the Test of Infant Motor Performance data from 642 infants with a postconceptual age of 38-58 weeks (article in Chinese). Zhongguo Dang Dai Er Ke Za Zhi 2017 Dec;19(12):1252-1256. All age groups had significantly lower mean scores on the TIMP than the US norms. Chinese norms are needed. PMID 29237525

Zawacki L, Campbell S. From observation to rehabilitation.  In Cioni G,Mercuri E (eds), Neurological Assessment in the First Two Years of Life.  London, MacKeith Press, 2007, pp. 230-245.


Case-Smith J. Analysis of current motor development theory and recently published infant motor assessments. Infants & Young Children 1996;9(1): 29-41. http://journals.lww.com/iycjournal/toc/1996/07000

Craciunoiu O, Holsti L. A systematic review of the predictive validity of neurobehavioral assessments during the preterm period. Phys Occup Ther in Pediatr 2016;Jun 17:1-16. GMA and TIMP have the strongest evidence of predictive validity in preterm infants.  http://dx.doi.org/10.1080/01942638.2016.1185501

Heineman KR, Hadders-Algra M. Evaluation of neuromotor function in infancy--A systematic review of available methods. J Dev Behav Pediatr 2008;29:315-323. A review of available assessments concludes that only the GMA and the TIMP have good predictive validity. http://journals.lww.com/jrnldbp/toc/2008/08000

Hughes AJ, Redsell SA, Glazebrook C. Motor development interventions for preterm infants: A systematic review and meta-analysis. A large, significant effect size was found on motor development at 3 months in infants born preterm for motor-specific interventions but not generic interventions. Pediatr 2016;138(4):e20160147 http://pediatrics.aappublications.org/content/pediatrics/138/4/e20160147.full.pdf

Majnemer A, Snider L. A comparison of developmental assessments of the newborn and young infant. In Allen MC, Lipkin PH (eds). Developmental Disabilities and Mental Retardation Reviews, "Neurodevelopmental Assessment of the Fetus and Young Neonate" 2005;11:68-73. http://onlinelibrary.wiley.com/doi/10.1002/mrdd.20052/abstract

Nobel Y, Boyd R. Neonatal assessments for the preterm infant up to 4 months corrected age: A systematic review. Dev Med Child Neurol 2012;54:129-139. Reviews tests appropriate for the first few months. Compared to other tests, the TIMP has particularly strong psychometric characteristics, such as rater reliability evidence, and has the best evaluative validity which makes it an excellent choice for clinical use. http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2010.03903.x/epdf

Spittle AJ, Doyle LW, Boyd RN.  A systematic review of the clinimetric properties of neuromotor assessments for preterm infants during the first year of life.  Dev Med Child Neurol 2008;50:254-266.  A systematic review of assessments used to discriminate, predict, or evaluate motor development of preterm infants during the first year of life revealed that, of 18 identified assessments, only the TIMP has demonstrated a difference between groups in response to physical therapy in two randomized controlled clinical trials.  Along with the General Movement Assessment and the Movement Assessment of Infants, the TIMP has the best predictive validity in early infancy (at 3-4 months corrected age). http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2008.02025.x/epdf


Campbell M, Rabbidge B, Ziviani J, Sakzewski L. Clinical feasibility of pre-operative neurodevelopmental assessment of infants undergoing open heart surgery. J Paediatr Child Health 2017;53:794-799. Authors assessed the clinical feasibility of neurodevelopmental assessment with the GMA and the TIMP prior to open heart surgery. Forty percent were unable to complete assessment due to factors such as intubation or ECMO (49%), emergency surgery (1%) or too unstable for handling (5%), or environmental factors such as surgery already done (32%) or hospital transfer (3%). For every point increase in the Aristotle Patient-Adjusted Complexiy score, the infant's likelihood of being unable to undergo assessment increased by 35%. https://onlinelibrary.wiley.com/doi/pdf/10.1111/jpc.13565

Campbell MJ, Ziviani JM, Stocker CF, Khan A, Sakzewski L. Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age. Cardiol Young 2019;29:100-109. Infants were assessed pre- and post-operatively with the GMA and TIMP. Pre-operatively, 13% of infants could not be tested on the TIMP because of medical and/or physiological instability with handling.  At discharge 26% of the 60 infants presented with abnormal GMs and a median TIMP score of -0.93. Three infants could not be tested on the TIMP because they could not maintain a quiet alert state. Gross motor performance on the ASQ-3 at 6 months was significantly negatively correlated with gestational age, length of hospital stay and TIMP discharge score. Delay was found in 52.8% of infants at 6 months; two had CP as predicted by the presence of cramped synchrony on the GMA at hospital discharge. Post-operative assessment with the GMA and TIMP is useful to identify infants requiring targeted developmental follow-up. https://www.cambridge.org/core/journals/cardiology-in-the-young/article/neuromotor-performance-in-infants-before-and-after-early-openheart-surgery-and-risk-factors-for-delayed-development-at-6-months-of-age/510058C1662086EAB4890689369387A0

Cheatham SL, Carey H, Chisolm JL, Heathcock JC, Steward D. Early results of neurodevelopment following hybrid stage I for hypoplastic left heart syndrome. Pediatr Cardiology 2015;36:684-691. In 18 subjects who had undergone Hybrid Stage I palliation for hypoplastic left heart syndrome, development on the TIMP at 2 months fell on average between -1 and -2 SDs below the mean. At 4 months delay was still evident with TIMP scores averaging between -.5 and -1 SD below the mean. Development on the Bayley III motor scale was also delayed still at 6 months and attention to intervention is recommended for these infants.  http://dx.doi.org/10.1007/s00246-014-1065-5

Uzark K, Smith C, Donohue J, Yu S, Romano JC. Infant motor skills after a cardiac operation: The need for developmental monitoring and care. Annals Thoracic Surg 2017;104:681-687. Authors present preliminary data on reliability and validity of a new test, the Congenital Heart Assessment of Sensory and Motor Status (CHASMS) for infants undergoing cardiac operations. CHASMS scores were significantly correlated with TIMP (r=.70) and AIMS scores (r=.88).  http://dx.doi.org/10.1016/j.athoracsur.2016.12.032


Barbosa VM, Campbell SK, Sheftel D, Singh J, Beligere N. Longitudinal performance of infants with cerebral palsy on the Test of Infant Motor Performance and on the Alberta Infant Motor Scale. Phys Occup Ther in Pediatr. 2003;23(3):7-29.  Demonstrates ability of the TIMP to make early identification of children with CP.  http://www.tandfonline.com/doi/abs/10.1080/J006v23n03_02

Barbosa VM, Campbell SK, Berbaum M. Discriminating infants from different developmental outcome groups using the Test of Infant Motor Performance (TIMP) item responses. Pediatr Phys Ther. 2007;19:28-39.  Documents differences in rates of development of individual TIMP items in children with cerebral palsy versus groups with typical or delayed development.  Eight weeks adjusted age seems to be an important timepoint demonstrating differences in  developmental rates in children with CP. http://journals.lww.com/pedpt/Fulltext/2007/01910/Discriminating_Infants_From_Different.5.aspx

Barbosa VM, Campbell SK, Smith E, Berbaum M. Comparison of Test of Infant Motor Performance (TIMP) item responses among children with cerebral palsy, developmental delay, and typical development. Amer J Occup Ther 2005;59:446-456.  Presents a profile of item performance that discriminated 10 children with CP from children with typical or delayed development.  Children with CP may present "advanced" performance in items using extension patterns and slow development or regression in items requiring antigravity and balanced use of flexion-extension patterns of muscle activity.  https://ajot.aota.org/article.aspx?articleid=1872095

Duff SV, Morris C, Stanley CS, Adeniyi-Jones S, Gringlas M, Damle V, Desai S. Neural recovery in infants who sustained perinatal asphyxia and received head cooling.  Pediatr Phys Ther 2009;21:106 (abstract).  Mean newborn TIMP scores of full term infants with birth asphyxia treated with head cooling was 42 (12th percentile) with 13/21 scoring at <5th percentile.  At 3-4 months of age the mean TIMP score was 98 (27th percentile) with 16/21 at or above the 15th percentile.  The rate of improvement was better in infants who had 5-minute Apgar scores >4. http://journals.lww.com/pedpt/Citation/2009/02110/Abstracts_of_Poster_and_Platform_Presentations_at.15.aspx

Gullion L, Stansell J, Moss H, Jenkins D, Aljuhani T, Coker-Bolt P. The impact of early neuroimaging and developmental assessment in a preterm infant diagnosed with cerebral palsy. Case Reports in Pediatr 2019: Article ID 9612507. Authors present a case report demonstrating use of brain imaging, STEP test, and TIMP to promote early diagnosis and referral for intervention of an infant with CP. https://doi.org/10.1155/2019/9612507

National Institute of Neurologic Diseases and Stroke: Cerebral Palsy Common Data Elements--recommends GMA and TIMP as supplemental tests for research on CP in infants younger than 5 months of age. https://www.commondataelements.ninds.nih.gov/CP.aspx#tab=Data_Standards

Novak I, Morgan C, Adde L., et al. Early, accurate diagnosis and early intervention in cerebral palsy: Advances in diagnosis and treatment. JAMA Pediatr 2017;171:897-907. GMA and brain imaging are recommended to aid earlier diagnosis of CP. When imaging is not available, the TIMP is recommended. https://dx.doi.org/10.1001/jamapediatrics.2017.1689


Cardoso ACN, de Campos AC, dos Santos MM, Santos DCC, Rocha NACF. Motor performance of children with Down syndrome and typical development at 2 to 4 and 26 months. Pediatr Phys Ther 2015;27:135-141. Infants with DS performed significantly less well on the TIMP at 2-4 months of age than typically developing children. TIMP scores at 4 months predicted performance on the Bayley III at 26 months. http://journals.lww.com/pedpt/Fulltext/2015/27020/Motor_Performance_of_Children_With_Down_Syndrome.9.aspx

Kloze A, Brzuszkiewicz-Kuzmicka G, Czyzewski P. Use of the TIMP in assessment of motor development of infants with Down syndrome. Pediatr Phys Ther 2016;28:40-45.  In a large study of 64 infants with Down syndrome and 77 control infants, TIMP scores were significantly delayed in the children with Down syndrome. Of special significance for clinical practice, items related to visual tracking with head rotation, upright head control, behavioral response to a cloth placed over the face, and most items measuring anti-gravity postures and trunk control were more delayed than others, suggesting avenues for early treatment. http://journals.lww.com/pedpt/Fulltext/2016/28010/Use_of_the_TIMP_in_Assessment_of_Motor_Development.11.aspx


Finkel RS, Hynan LS, Glanzman AM, Owens H, Nelson L, Cone SR, Campbell SK, Iannaccone ST, and the AmSMART Group.  The Test of Infant Motor Performance: Reliability in spinal muscular atrophy type I. Pediatr Phys Ther 2008;20:242-246.  http://journals.lww.com/pedpt/Fulltext/2008/02030/The_Test_of_Infant_Motor_Performance__Reliability.6.aspx

Glanzman AM, Mazzone E, Main M, Pelliccioni M, Wood J, Swoboda KJ, Scott C, Pane M, MessinE, Mercuri E, Finkel RS. The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND): Test development and reliability. Neuromuscul Disord. 2010;20:155-161. A new test for infants with SMA was developed based on the TIMP and the CHOP Test of Strength in SMA.  http://dx.doi.org/10.1016/j.nmd.2009.11.014

Kolb S, Coffey C, Yankey J, et al. Baseline results of the NeuroNEXT spinal muscular atrophy infant biomarker study. Ann Clin Transl Neurol 2016;3:132-145. The TIMPSI and the CHOP-INTEND test were used to establish baseline measures of motor function in infants with SMA and controls. Both measures documented already delayed motor function compared to control subjects by the time of subject recruitment; earlier enrollment for studies is recommended. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748311/pdf/ACN3-3-132.pdf

Kolb S, Coffey C, Yankey J, Krosschell K, et al. Natural history of infantile-onset spinal muscular atrophy. Annals of Neurol 2017; Nov. TIMPSI scores were correlated with risk of endpoint of death or need for permanent invasive ventilation in infants with SMA. http://dx.doi.org/10.1002/ana.25101

Kronn DF, Day-Salvatore D, Hwu W-L, Jones SA, Nakamura K, Okuyama T, Swoboda KJ, Kishnani PS and on behalf of the Pompe Disease Newborn Screening Working Group. Management of confirmed newborn-screened patients with Pompe disease across the disease spectrum. Pediatr 2017;140;S24. Presents guidelines for management of patients with Pompe disease across the disease spectrum, including developmental assessment using the TIMP and the CHOP INTEND.  http://pediatrics.aappublications.org/content/140/Supplement_1/S24

Krosschell KJ, Bosch M, Nelson, et al. Motor function test reliability during the NeuroNEXT spinal muscular atrophy infant biomarker study. J Neuromusc Dis 2018;5:509-521. Article describes training provided to multi-site clinical evaluators in a longitudinal study of reliability of the TIMPSI, CHOP Intend, and AIMS in children with SMA I. TIMPSI inter-rater reliability was consistently higher than .92 and did not differ significantly between novice and experienced testers.  Provides guidance for investigators planning large-scale clinical trials to ensure reliability of assessment across multiple sites and raters, both experienced and novice. https://content.iospress.com/articles/journal-of-neuromuscular-diseases/jnd180327

Krosschell KJ, Maczulski JA, Scott C, King W, Hartman JT, Case LE, Viazzo-Trussell D, Wood J, Roman CA, Hecker E, Meffert M, Leveille M, Kienitz K, Swoboda KJ, on behalf of Project Cure. Reliability and validity of the TIMPSI for infants with spinal muscular atrophy type I. Pediatric Phys Ther 2013;25:140-148. Interrater reliability for scoring the TIMPSI was 0.97-0.98 and test-retest reliability 0.82-0.95 in infants with Type I SMA. TIMPSI scores were related to ability to reach. http://journals.lww.com/pedpt/Fulltext/2013/25020/Reliability_and_Validity_of_the_TIMPSI_for_Infants.4.aspx

National Institute of Neurologic Diseases and Stroke: Spinal Muscular Atrophy Common Data Elements—recommends TIMPSI for motor assessment in Types 1 and 2 SMA (see SMA Pediatric Clinical Outcomes Recommendations by Domain and Classification). National Institute of Neurologic Diseases and Stroke: Spinal Muscular Atrophy Common Data Elements—recommends TIMPSI for motor assessment in Types 1 and 2 SMA (see SMA Pediatric Clinical Outcomes Recommendations by Domain and Classification). https://commondataelements.ninds.nih.gov/SMA.aspx#tab=Data_Standards


Kaplan SL, Coulter C, Sargent B. Physical therapy management of congenital muscular torticollis: A 2018 evidence-based clinical practice guideline from the APTA Academy of Pediatric Physical Therapy. Recommendations for developmental assessment include use of the Test of Infant Motor Performance for infants up to 4 months of age.  https://pediatricapta.org/clinical-practice-guidelines/

Nuysink J, Eijsermans MJ, van Haastert IC, Koopman-Esseboom C, Helders PJ, de Vries LS, van der Net J. Clinical course of asymmetric motor performance and deformational plagiocephaly in very preterm infants. J Pediatr 2013;163:658-665. Natural course of positional preference and deformational plagiocephaly was studied in 120 infants born at < 30 weeks GA or under 1000 gms. Positional preference was present in 36.7% at 3 months corrected age (CA). Infants with low scores on the TIMP or the AIMS at 3 months CA were more likely to display persistent plagiocephaly at 6 months CA. http://dx.doi.org/10.1016/j.jpeds.2013.04.015


Bentzley JP, Coker-Bolt P, Moreau NG, Hope K, Ramakrishnan V, Brown T, Mulvihill D, Jenkins D. Kinematic measurement of 12-week head control correlates with 12-month neurodevelopment in preterm infants. Early Human Development 2015;91:159-164. Kinematic measures of head control in prone and pull-to-sit were correlated with TIMP scores at 12 weeks CA in 22 preterm infants.  http://www.sciencedirect.com/science/article/pii/S0378378215000110?via%3Dihub

Coker-Bolt P, Barbour A, Moss H, Tillman J, Humphries E, Ward E, Brown T, Jenkins D. Correlating early motor skills to white matter abnormalities in preterm infants using diffusion tensor imaging. J Pediatr Rehab Med 2016;9:185-193. Low FA measures from DTI at term can predict TIMP performance at 3 months. In particular high FA of the left anterior limb of the internal capsule predicted mean in TIMP scores on items for head lift and head turn to sound in prone. http://dx.doi.org/10.3233/PRM-160380

Coker-Bolt P, Woodbury ML, Perkel J, Moreau NG, Hope K, Brown T, Ramakrishnan V, Mulvihill D, Jenkins D. Identifying premature infants at high and low risk for motor delays using motor perforrmance testing and MRS. J Pediatric Rehab Med 2014;7:219-232. TIMP scores at term and 12 weeks corrected age (CA) in 22 infants born preterm between 24 and 35 weeks GA were used to determine a useful 10-item screening set at each age that is proposed to provide good prediction of those at high/low risk for poor developmental outcome as measured with the Bayley III at 12 months CA. TIMP scores also correlated with measures from magnetic resonance spectroscopy performed in a subset of the infants.  http://dx.doi.org/10.3233/PRM-140291

George JM, Boyd RN, Colditz PB, Rose SE, Pannek K, Fripp J, Lingwood BE, Lai MM, Kong AHT, Ware RS, Coulthard A, Finn CM, Bandaranayake SE. PPREMO: A prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome. BMC Pediatrics 2015;15:123. This article presents the protocol for a study to examine the clinical correlates of early advanced brain imaging and clinical measures at 30 weeks PMA to predict motor (including TIMP scores) and neurodevelopmental outcomes at 3 and 12 months CA.  https://bmcpediatr.biomedcentral.com/track/pdf/10.1186/s12887-015-0439-z?site=bmcpediatr.biomedcentral.com

George JM, Fiori S, Fripp J, Pannek K, Guzzetta A, David M, Ware RS, Rose SE, Colditz PB, Boyd RN. Relationship between very early brain structure and neuromotor,neuorlogical and neurobehavioral function in infants born <31 weeks gestational age. Early Hum Dev 2018;117:74-82. In 119 infants born preterm, cerebellar MRI scores at 32 weeks were correlated with HINE and General Movements scores.  Term white matter MRI and global brain abnormality scores were correlated with TIMP scores at term. http://dx.doi.org/10.1016/j.earlhumdev.2017.12.014

Linke AC, Wild C, Zubiaurre-Elorza L, Herzmann C, Duffy H, Han VK, Lee DSC, Cusack R. Disruption to functional networks in neonates with perinatal brain injury predicts motor skills at 8 months. NeuroImage: Clinical 2018;18:399-406. Functional connectivity MRI at term predicted motor development on the AIMS at 4 months and on both the AIMS and the INFANIB at 8 months. Correlation of the neonatal MRI connectivity with the TIMP at 1 month was non-significant but the 1-month TIMP scores were correlated with both AIMS and INFANIB at 8 months. Authors conclude that connectivity measures in sensorimotor as well as executive neural networks at term provide a unique prediction to motor development at 8 months. https://www.sciencedirect.com/science/article/pii/S2213158218300366

Magalhaes RC, Moreira JM, Vieira ELM, Rocha NP, Miranda DM, Simoes e Silva AC. Urinary levels of IL-1beta and GDNF in preterm neonates as potential biomarkers of motor development: A prospective study. Mediators of Inflammation 2017; Article ID 8201423. First research to examine the relationship between TIMP scores and biomarkers of inflammation and neuroprotection in preterm period. Unexpectedly higher levels of inflammatory markers and lower levels of neuroprotective factors in urine were related to higher TIMP scores at 34 weeks PMA. Authors discuss the complex relationship between reaction to injury and plasticity responses. Long term development was not measured. https://www.hindawi.com/journals/mi/2017/8201423/ 

McLean G, Hough C, Sehgal A, Ditchfield, Polglase GR, Miller SL. Three-dimensional ultrasound cranial imaging and early neurodevelopment in preterm growth-restricted infants. J Paediatr Child Health 2017;54:420-425. TIMP scores were lower in infants with fetal growth restriction and perinatal 3-D US showed correlations with development at 12 weeks; greater ventricular volume was correlated with lower TIMP scores.  https://research.monash.edu/en/publications/three-dimensional-ultrasound-cranial-imaging-and-early-neurodevel


Campbell SK, Cole W, Boynewicz K, Zawacki LA, Clark A, Gaebler-Spira D, deRegnier R-A, Kuroda MM, Kale D, Bulanda M, Madhavan S. Behavior during tethered kicking in infants with periventricular brain injury. Pediatr Phys Ther 2015;27:403-412. TIMP performance was correlated with kicking frequency at 4 months corrected age in a clinical trial of tethered kicking.  http://journals.lww.com/pedpt/Fulltext/2015/27040/Behavior_During_Tethered_Kicking_in_Infants_With.18.aspx

Dusing SC, Brown SE, Van Drew CM, Thacker LR, Hendricks-Munoz KD. Supporting play exploration and early development intervention from NICU to home: A feasibility study. Pediatr Phys Ther 2015;27:267-274. The TIMP was used as an outcome measure for a NICU- and home-based intervention for infants born at or prior to 34 weeks GA. An effect size of 1.29 in favor of the experimental group supports use of the TIMP as a sensitive outcome measure for a future clinical trial of the intervention.  http://journals.lww.com/pedpt/Fulltext/2015/27030/Supporting_Play_Exploration_and_Early_Development.14.aspx

Fucile S, Gisel EG. Sensorimotor interventions improve growth and motor function in preterm infants. Neonatal Network 2010;29(6):359-366.  Both a 10-day (15 min per day, twice a day) whole body stimulation program and a stimulation program that also included oral stimulation beginning at approximately 32 weeks PMA improved outcomes on the TIMP in comparison with a control group or an oral stimulation only group in a study of 75 preterm infants (GA between 26 and 32 wks at birth) randomly assigned to treatment groups. The groups with full body stimulation had only 10% of infants with scores below -1 SD while 40% of control infants and 37% of oral stimulation only infants scored below average. http://dx.doi.org/10.1891/0730-0832.29.6.359

Girolami G, Campbell SK. Efficacy of a Neuro-Developmental Treatment program to improve motor control of preterm infants. Pediatr Phys Ther. 1994;6:175-184.  Demonstrates responsivity of the TIMP to effects of NDT provided to high risk premature infants in a controlled clinical trial in the special care nursery.  http://journals.lww.com/pedpt/Abstract/1994/00640/Efficacy_of_a_Neuro_Developmental_Treatment.2.aspx 

Ho YB, Lee RS, Chow CB, Pang MY. Impact of massage therapy on motor outcomes in very low-birthweight infants: Randomized controlled pilot study.  Pediatr Int 2010;52:378-385. Infants in a randomized controlled study who had below average TIMP scores at study entry gained more on the TIMP and experienced earlier hospital discharge following massage therapy than a sham treated group. Because these experimental group infants also had a shorter duration of total parenteral nutrition more study is needed to verify this finding in a larger group of subjects.  http://dx.doi.org/10.1111/j.1442-200X.2009.02964.x

Lee E-J. Effect of Neuro-Development Treatment on motor development in preterm infants. J Phys Ther Sci 2017;29:1095-1097.  High risk infants born preterm who received NDT until 40 weeks PMA had higher TIMP scores than both high and low risk infants who did not receive intervention. http://dx.doi.org/10.1589/jpts.29.1095

Lee E-j, Pack S-H, Oh T-Y, Pack R-J. The effects of sensorimotor stimulation on development of infants with low birth weight premature in NICU. J Korean Soc Phys Med 2010;5(3). Sensorimotor stimulation of infants born preterm improved development on the TIMP.

Lee H-M, Galloway JC. Early intensive postural and movement training advances head control in very young infants. Phys Ther 2012;92:935-947.  A group of full-term infants provided with early training to promote head control performed better on the TIMP than a social interaction control group.  http://dx.doi.org/10.2522/ptj.20110196

Lekskulchai R, Cole J. Effect of a developmental program on motor performance in infants born preterm. Australian J Physiother 2001;47:169-176: Demonstrates responsivity of the TIMP to a home physical therapy program provided in a controlled clinical trial to high risk premature infants upon hospital discharge. The TIMP successfully discriminated a group of infants at hospital discharge who would profit from physical therapy from a group that did not need intervention. http://www.journalofphysiotherapy.com/article/S0004-9514(14)60264-6/pdf

Øberg GK, Campbell SK, Girolami GL, Ustad T, Jørgensen L, Kaaresen PI.  Study protocol. An early intervention program to improve motor outcome in preterm infants: A randomized controlled trial and a qualitative study of physiotherapy performance and parental experiences.  BMC Pediatrics. 2012;Feb 15;12(1):15. [Epub ahead of print]. Describes protocol of a NICU intervention study using the TIMPSI as a baseline measure and the TIMP as one of the outcome measures. http://www.biomedcentral.com/1471-2431/12/15

Ustad T, Evensen KAI, Campbell SK, Girolami GL, Helbostad J, Jorgensen L, Kaaresen PI, Oberg GK. Early parent-administered physical therapy for preterm infants: A randomized controlled trial. Pediatr 2016;138(August). PT administered by parents improved motor performance for preterm infants in the NICU.  http://dx.doi.org/10.1542/peds.2016-0271

Valizadeh L, Sanaeefar M, Hosseini MB, Jafarabadi MA, Shamili A. Effect of early physical activity programs on motor performance and neuromuscular development in infants born preterm: A randomized clinical trial. J Caring Sci 2017;6(1):69-81. Passive range of motion was compared with hydrotherapy or a combination of both versus control in 76 infants born preterm. These passive interventions had no significant effect on motor development but postural tone as measured by leg recoil was significantly higher in exercise groups.  http://journals.tbzmed.ac.ir/JCS/Manuscript/JCS-6-67.pdf


Amini M, Aliabadi F, Alizade M, Kalani M, Qorbani M. The relationship between motor function and behavioral function in infants with low birth weight. Iran J Child Neurol. 2016;10(4):49-55. Performance on the TIMP and the Brazelton Scale was compared in 50 infants under 2 months CA.  Statistically significant relationships were found between TIMP observed item performance and Brazelton items involving social interaction, state organization and regulation, and reflexes, and between TIMP elicited item performance and all Brazelton items except habituation. Notably each increase of 1 point in autonomic function was related to an increase of 18 points on elicited items of the TIMP. The authors conclude that Brazelton scores can be used to predict motor function.  http://dx.doi.org/10.22037/ijcn.v10i4.10965

Campbell SK, Kolobe THA. Concurrent validity of the Test of Infant Motor Performance with the Alberta Infant Motor Scale. Pediatr Phys Ther. 2000;12:1-8: Documents concurrent validity of the TIMP with the AIMS of r = .64 at 3 months adjusted age (AA).  http://journals.lww.com/pedpt/Abstract/2000/01210/Concurrent_Validity_of_the_Test_of_Infant_Motor.2.aspx

Campbell SK, Kolobe THA, Wright B, Linacre JM. Validity of the Test of Infant Motor Performance for prediction of 6-, 9-, and 12-month scores on the Alberta Infant Motor Scale. Dev Med Child Neurol. 2002;44:263-272: Documents sensitivity = .92, specificity = .76, positive predictive validity = .39, and negative predictive validity = .98 for prediction of AIMS performance at 12 months AA from TIMP testing at 3 months AA.  http://onlinelibrary.wiley.com/doi/10.1111/j.1469-8749.2002.tb00802.x/epdf

Campbell SK, Zawacki L, Rankin KM, Yoder JC, Shapiro N, Li Z, White-Traut R. Concurrent validity of the TIMP and the Bayley III Scales at 6 weeks corrected age. Pediatr Phys Ther 2013;25(4):395-401. At 6 weeks corrected age, 9% of infants (n = 145) scored more than -1 SD from the mean on the TIMP while no children performed outside the average range on the Bayley III.  http://journals.lww.com/pedpt/Fulltext/2013/25040/Concurrent_Validity_of_the_TIMP_and_the_Bayley_III.3.aspx

Flegel J, Kolobe THA. Predictive validity of the Test of Infant Motor Performance as measured by the Bruininks-Oseretsky Test of Motor Proficiency at school age. Phys Ther 2002;82:762-771. Statistically significant partial correlation between TIMP scores in early infancy and Bruininks at 5 years was .36. Diagnostic validity values were sensitivity=.50, specificity=1.00, positive predictive validity=1.00, and negative predictive validity=.87. https://academic.oup.com/ptj/article/82/8/762/2857646/Predictive-Validity-of-the-Test-of-Infant-Motor

Gower L, Jenkins D, Fraser JL, Ramakrishnan V, Coker-Bolt P. Early developmental assessment with a short screening test, the STEP, predicts one-year outcomes. J Perinatol 2018 October 9. Study examined predictive validity of the STEP, a 10-item screening test based on items from the TIMP selected via Rasch analysis (9 items), and the full TIMP with a cutoff at -1 SD (article misstates the cutoff as -2 SD; the recommended cutoff is -0.5 SD), in 19 infants born preterm (24-34 weeks GA) at term and 3 months CA with 12-month Bayley III motor and cognitive scores less than 1 SD from the mean. STEP scores were correlated with concurrent TIMP scores at 0.76 at term and at 0.82 at 3 months. STEP scores but not TIMP scores predicted Bayley III scores at 12 months CA. TIMP raw scores at 3 months <89 had sensitivity 0.33, specificity 0.91, negative predictive value of 0.67, and positive predictive value of 0.75 in predicting Bayley III motor scores at 12 months. No child had Bayley III cognitive scores < 1.0 SD. STEP scores at 3 months <23 had sensitivity 0.80, specificity 0.71, negative predictive value 0.92, and positive predictive value of 0.44 for predicting concurrent 3-month TIMP scores. Authors conclude that the STEP needs to be validated in a larger, more heterogeneous cohort.  https://www.nature.com/articles/s41372-018-0234-4

Kim SA, Lee YJ, Lee YG. Predictive value of Test of Infant Motor Performance for infants based on correlation between TIMP and Bayley Scales of Infant Development. Ann Rehabil Med; 2011 35(6):860-866. TIMP and Bayley scores were highly correlated with ROC values of .825 for PDI and .992 for MDI. http://europepmc.org/articles/PMC3309382

Kolobe THA, Bulanda M, Susman L. Predicting motor outcome at preschool age for infants tested at 7, 30, 60, and 90 days after term age using the Test of Infant Motor Performance. Phys Ther 2004;84:1144-1156.  Documents sensitivity = .72, specificity = .91, positive predictive validity = .75, and negative predictive validity = .91 for prediction of Peabody Developmental Motor Scales < -2 SD below the mean at preschool age from TIMP testing with a cutoff score of -0.5 SD at 90 days post term. https://academic.oup.com/ptj/article/84/12/1144/2805318/Predicting-Motor-Outcome-at-Preschool-Age-for

Manacero SA, Marschik PB, Nunes ML, Einspieler C. Is it possible to predict the infant's neurodevelopmental outcome at 14 months of age by means of a single preterm assessment of General Movements? Early Hum Dev 2012;88:39-43.  The TIMP and the GMA were performed at 34 weeks PMA in 37 high risk preterm infants with GA at birth 24-33 weeks and the AIMS and PEDI were used at 14 months to assess outcomes in 32 infants. Thirty-two percent of infants had poor repertoire and 19% had cramped-synchronized GMs. All of these high risk infants had delayed scores on the TIMP (one was in the low average range with normal GMs). TIMP scores were not correlated with GMs indicating that the TIMP and GMA are not assessing the same construct. TIMP results were not correlated with outcome at 14 months, confirming previous research showing that the TIMP at preterm age is not predictive of later outcome; there was only a fair to moderate correlation of GMs with outcome, thus a single GM assessment at preterm age cannot be used to predict outcome either.  http://dx.doi.org/10.1016/j.earlhumdev.2011.06.013

Nuysink J, van Haastert IC, Eijsermans MJ, Koopman-Esseboom C, Helders PJ, de Vries LS, van der Net J. Prediction of gross motor development and independent walking in infants born very preterm using the Test of Infant Motor Performance and the Alberta Infant Motor Scale. Early Hum Dev 2013;89:693-697. Study of concurrent and predictive validity of the TIMP and the AIMS in 95 infants born at < 30 weeks GA or under 1000 gms. Mean raw score on the TIMP at 3 months corrected age (CA) was 99.8 with a range of 54-127; mean Z score was -0.48. At 3 months CA the correlation between the TIMP and the AIMS raw scores was .82 and between Z scores was .71. A cutoff Z score of -1.0 on the TIMP had a diagnostic agreement of 92% with an AIMS score <10th percentile. Neither test at 3 months CA predicted AIMS performance at 15 months. The median age of independent walking was 15.7 months CA and was predicted by 6 month AIMS scores. http://dx.doi.org/10.1016/j.earlhumdev.2013.04.016

Peyton C, Schreiber MD, Msall ME. The Test of Infant Motor Performance at 3 months predicts language, cognitive, and motor outcomes in infants born preterm at 2 years of age. Dev Med Child Neurol 2018 Mar 13 epub ahead of print. TIMP scores below z = -0.5 or less at 10-15 weeks had sensitivities for predicting Bayley III cognitive, lanuage and motor development at 2 years of .41, .49, and .57, respectively; specificities were .87, .88, and .89, indicating in agreement with previous results that when infants perform well on the TIMP, later outcomes are predicted very well while failing the TIMP at 3-4 months has less predictive validity. Of 8 children with CP, 6 had TIMP scores less than -0.5 and all scored below average at 10-15 weeks.  https://doi.org/10.1111/dmcn.13736

Peyton C, Yang E, Kocherginsky M, Adde L, Fjortoft T, Stoen R, Bos AF, Einspieler C, Schreiber MD, Msall ME. Relationship between white matter pathology and performance on the General Movement Assessment and the Test of Infant Motor Performance in very preterm infants. Early Hum Dev 2016;95:23-27. This article compares GMA and TIMP performance at 10-15 weeks corrected age in infants born prior to 31 weeks who had MRI assessments at term age. Infants with abnormal white matter were more likely to have both abnormal GMA and abnormal TIMP scores. However only 3 infants were classified as abnormal on all 3 tests indicating that they are not always measuring the same thing.  http://www.sciencedirect.com/science/article/pii/S0378378215300761?via%3Dihub

Shehee L, Coker-Bolt P, Barbour A, Moss H, Brown T, Jenkins D. Predicting motor outcomes with 3 month prone hip angles in premature infants. J Pediatr Rehab Med 2016;9:231-236. Smaller angle of the hip in prone at 3 months as a proxy measure of increased postural tone was related to lower TIMP scores at the same age and white matter abnormality at term, but not to outcome on the Bayley III at 1 year. TIMP scores at 3 months were correlated with Bayley III scores at 1 year. http://dx.doi.org/10.3233/PRM-160384

Snider LM, Majnemer A, Mazer B, Campbell S, Bos AF.  A comparison of the general movements assessment with traditional approaches to newborn and infant assessment: Concurrent validity.  Early Hum Dev 2008; 84:297-303.  Research examined the relationship between the GM assessment, the TIMP, the Einstein Neonatal Neurobehavioral Assessment Scale, and the AIMS using examinations at three age points: 34 weeks postmenstrual age, term and 12 weeks corrected age.  The traditional tests were more strongly correlated with each other than with the GM assessment, documenting unique neurologic construct of the GM assessment. https://www.sciencedirect.com/science/journal/03783782/84/5?sdc=1

Snider L, Majnemer A, Mazer B, Campbell S, Bos A.  Prediction of motor and functional outcomes in infants born preterm assessed at term.  Pediatr Phys Ther 2009;21:2-11.  The TIMP at term age in infants born at less than 32 weeks GA predicted outcomes on the Alberta Infant Motor Scales and Vineland Adaptive Behavior Scales-Daily Living Skills (items measure primarily feeding skills) at 12 months adjusted age but the variance explained was very small.  Low scores at 12 months on motor and functional outcome measures were related to presence of IVH and extended time on a ventilator.  Prediction to outcomes from testing at term is not accurate enough to be useful for making a clinical prognosis about expected development, but test results can be used to make contemporary decisions regarding close followup or intervention for those with high risk for adverse outcomes.  http://journals.lww.com/pedpt/Fulltext/2009/02110/Prediction_of_Motor_and_Functional_Outcomes_in.2.aspx

Song YH, chang HJ, Shin YB, Park YS, Park YH, Cho ES. The validity of two neuromotor assessments for predicting motor performance at 12 months in preterm infants. Ann Rehabil Med 2018;42(2):296-304. Forty-four preterm infants tested with the GMA and the TIMP at 1 and 3 months CA were assessed with the AIMS at 12 months CA. TIMP score at 3 mo. and GMs at 1 and 3 mo. were significantly correlated with AIMS at 12 mo. For infants with normal GMs at 3 mo., TIMP score at 3 mo. correlated significantly with AIMS classification above the 5th percentile at 12 mo. Authors provide suggestions for how to use GMA and TIMP together in clinical practice: GMA is best for identification of CP while TIMP identifies delay regardless of medical diagnosis. https://doi.org/10.5535/arm.2018.42.2.296

Current Research on the TIMP
Current projects include:
1. Use in a clinical trial for children with SMA. https://www.neuronext.org/nn101-sma
2. Use in a clinical trial to identify very early markers of CP.  https://qcprrc.centre.uq.edu.au/prebo
3. Use in a clinical trial of the effects of parent-administered physical therapy in the NICU on infant developmental outcome. FOR INFO, CLICK HERE
4. Use in a clinical trial of early intervention for infants born preterm. https://clinicaltrials.gov/ct2/show/NCT03518736?term=dusing&rank=1
Annotated Bibliography of Research on the HINT

Cardoso MV, Maia PC, Silva LP, Silva GR, Hayes VE, Harris SR.  Infant development and parents’ perceptions associated with use of the Harris Infant Neuromotor Test. Revista da Rede de Enfermagem do Nordeste.  2010;11:124-132.  Demonstrates Brazilian caregivers’ accuracy about their infants’ development when compared to HINT total scores, as administered by pediatric nurses. http://citeseerx.ist.psu.edu/viewdoc/download?doi=
Goelman H & The CHILD Project. Three complementary community-based approaches to the early identification of young children at risk for developmental delays/disorders. Infants & Young Children. 2008;21:306-323.Describes use of the HINT for screening 141 at-risk and typically developing infants and their developmental outcomes at ages 2 and 3 years; compares this approach for identifying infants at risk for developmental delays to two other approaches used in The CHILD Project in British Columbia, Canada: a longitudinal NICU follow-up program and a community-based, universal, developmental screening project.

Harris SR. A plea for developmental motor screening in Canadian infants. Paediatrics & Child Health. 2016;21:129-30. This commentary encourages the Canadian Paediatric Society to revise its position statement on well-baby visits to include screening for motor delays during the infant’s first year, with recommendations for motor screening tests normed on Canadian infants: the HINT and the Alberta Infant Motor Scale (AIMS). Free at Pub Med Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4933070/

Harris SR.  Early identification of motor delay:  Family-centred screening tool. Canadian Family Physician. 2016;62:629-32. Review article describing the HINT and encouraging its use by family physicians. Free at Pub Med Central. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982721/
Harris SR. Congenital hypotonia: Clinical and developmental assessment. Developmental Medicine & Child Neurology. 2008; 50:889-892.A review of clinical and developmental assessment approaches for infants with congenital hypotonia with suggestions of the HINT and the Test of Infant Motor Performance (TIMP) as appropriate clinical assessment tools. https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-8749.2008.03097.x
 Harris SR. Congenital idiopathic microcephaly in an infant: Congruence of head size with developmental motor delay. Developmental Neurorehabilitation. 2013;16:129-132.Case report of a 6.5-month-old infant with idiopathic microcephaly; the degree of developmental motor delay as assessed by the HINT and Bayley-II Motor Scale was consistent with the degree of microcephaly. https://www.tandfonline.com/doi/full/10.3109/17518423.2012.737040?scroll=top&needAccess=true
Harris SR. Listening to parents’ concerns: Three case examples of infants with developmental motor delays. Pediatric Physical Therapy. 2009;21:269-274.Parent concerns about motor delays were corroborated by HINT and Bayley-II Motor Scale scores.  The two tests were concurrent in identifying significant delays.  https://insights.ovid.com/pubmed?pmid=19680069
Harris SR. Parents’ and caregivers’ perceptions of their children’s development.  Developmental Medicine & Child Neurology. 1994; 36: 918-923.  Parents’ perceptions of their infants’ motor development based on HINT questions to parents had strong sensitivity (80.0%) and specificity (90.9%) with scores on the Motor Scale of the Bayley Scales of Infant Development. https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1469-8749.1994.tb11783.x
Harris SR, Backman CL, Mayson TA. Comparative predictive validity of the Alberta Infant Motor Scale and the Harris Infant Neuromotor Test. Developmental Medicine & Child Neurology. 2010; 52:462-467.Predictive correlations of the HINT and AIMS at 4-6.5 months and 10-12.5 months to 2-year BSID-II Motor Scale scores and 3-year Bayley-III gross motor outcomes were comparable, with all predictive correlations consistently stronger for at-risk infants.  https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1469-8749.2009.03518.x
Harris SR, Daniels LE.  Content validity of the Harris Infant Neuromotor Test.  Physical Therapy. 1996;76:727-737.An interdisciplinary panel of 26 international experts in infant development examined the content of the initial research version of the HINT. Based on their feedback, additional background information items were added, a fifth question was added to the parent questionnaire portion, and 20 of the 22 infant assessment items were modified.  https://doi.org/10.1093/ptj/76.7.727
Harris SR, Daniels LE. Reliability and validity of the Harris Infant Neuromotor Test.  Journal of Pediatrics. 2001; 139: 249-253.ICCs for reliability for the Total HINT Score ranged from 0.98 to 0.99. Concurrent validity of the HINT with the BSID-II Mental Scale during the first year was r = –0.73 (P < .01), and with the BSID-II Motor Scale, r = –0.89 (P < .01). The predictive relationships between the HINT and the BSID-II at 17 to 22 months were r = –0.11 for the BSID-II Mental Scale and r = –0.49 (P < .01) for the BSID-II Motor Scale.  https://www.jpeds.com/article/S0022-3476(01)13832-1/pdf
Harris SR, Megens A, Backman CL, Hayes VE.  Development and standardization of the Harris Infant Neuromotor Test.  Infants& Young Children. 2003; 14:143-151.Review article describing the development and standardization of the HINT.
Lee LLS, Harris SR. Psychometric properties and standardization samples of four screening tests for infants and young children: A review. Pediatric Physical Therapy. 2005;17:140-147.This article compares traditional psychometric properties (interrater and test-retest reliability, concurrent and predictive validity), clinical epidemiological characteristics (sensitivity, specificity, and positive predictive values), and standardization samples of four tests used by pediatric therapists in screening infants and young children for developmental delays: ASQ, AIMS, Denver-II, and HINT. https://insights.ovid.com/pubmed?pmid=16357664

Lopes MMCO, Cardoso MVLML. Evaluation of neuromotor development by means of the Harris Infant Neuromotor Test (English and Portuguese). Rev Esc Enferm USP 2014;48(4):586-593. A longitudinal study of 78 Brazilian children using the HINT. http://www.scielo.br/pdf/reeusp/v48n4/0080-6234-reeusp-48-04-586.pdf
Mayson TA, Harris SR, Backman CL, Hayes VE. Motor development in Canadian infants of Asian and European ethnic origins. Journal of Early Intervention. 2009;31;199-214.Using a cross-sectional design, the authors analyzed HINT scores of 335 infants of Asian and European origins. Factorial ANOVA results indicated no significant differences in test scores between infants from these two groups.
McCoy SW, Bowman A, Smith-Blockley J, Sanders K, Megens AM, Harris SR. The Harris Infant Neuromotor Test (HINT): Comparison of US and Canadian normative data and examination of concurrent validity with the Ages and Stages Questionnaire. Physical Therapy. 2009;89:173-180.There were no significant differences between HINT total scores for American and Canadian infants or for US racial or ethnic groups and SES groups. There were high correlations (r -.82 to -.84) between HINT and ASQ scores. https://academic.oup.com/ptj/article/89/2/173/2737605
Megens AM, Harris SR, Backman CL, Hayes VA. Known groups validity of the Harris Infant Neuromotor Test. Physical Therapy. 2007:87:164-169.Mean HINT scores for infants at low risk were lower than mean scores for infants at high risk, as would be expected in that higher scores indicate higher risk. Significant differences were found at 4, 5, 7, and 8 months. At 6 months, there were no significant differences. There were not enough high-risk infants in other subgroups for reliable comparison.  https://doi.org/10.2522/ptj.20060096
Ravenscroft EF, Harris SR. Is maternal education related to infant motor development? Pediatric Physical Therapy. 2007;19:56-61.Secondary analysis of normative data derived through administration of the HINT to 412 Canadian infants was conducted. Our results confirmed other researchers’ findings of no association between maternal education and infant motor development.  https://insights.ovid.com/pubmed?pmid=17304098

Scher A, Tse L, Hayes VE, Tardif M. Sleep difficulties in infants at risk for developmental delay: A longitudinal study.  Journal of Pediatric Psychology. 2008;33:396-405.A convenience sample (n=142 infants) was assessed at 4–6 months and 10–12 months of age using the HINT and Morrell’s Infant Sleep Questionnaire. Based on a cumulative risk index, three groups were defined: higher risk (n=28), lower risk (n=42), and no risk (n=72). At both ages, sleep scores were similar among the groups. In the no risk and lower risk group, sleep difficulties decreased with age, while for infants in the higher risk group, more difficulties were reported over time. Overall, neuromotor attainments were not related to sleep fragmentation or settling difficulties. https://academic.oup.com/jpepsy/article/33/4/396/1746716
Tse L, Leo S, Fuchs T, Lee LLS, Harris SR, Hayes VE, Backman CL, Cameron D, Tardif M. Concurrent validity of the Harris Infant Neuromotor Test and the Alberta Infant Motor Scale. Journal of Pediatric Nursing. 2008; 23: 28-36.We examined concurrent validity of scores for the HINT and the AIMS in 121 Canadian infants. Relationships between the two tests for the overall sample were as follows: r = -.83 at 4 to 6.5 months (n = 121; p < .01) and r = -.85 at 10 to 12.5 months (n = 109; p <. 01), suggesting that the HINT, the newer of the two measures, is valid in determining motor delays. https://www.pediatricnursing.org/article/S0882-5963(07)00289-8/fulltext
Other Related References:
  • Harris SR.  Early detection of cerebral palsy: Sensitivity and specificity of two motor assessment tools. Journal of Perinatology. 1987; 7: 11-15.
  • Harris SR.  Early neuromotor predictors of cerebral palsy in low-birthweight infants. Developmental Medicine & Child Neurology.  1987; 29: 508-519.
  • Harris SR. Early motor delays as diagnostic clues in autism spectrum disorders. European Journal of Pediatrics. 2017;176:1269-72.
  • Harris SR. Early diagnosis of spastic diplegia, spastic hemiplegia, and quadriplegia. American Journal of Diseases of Children, 1989;143:1356-1360.
  • Harris SR. Movement analysis – An aid to early diagnosis of cerebral palsy.  Physical Therapy. 1991; 71: 215-221.
  • Harris SR, Langkamp DL.  The predictive value of the Bayley Mental Scale in the early detection of cognitive delays in high-risk infants.  Journal of Perinatology. 1994; 14: 275-279.
  • Harris SR, Swanson MW, Andrews MS, et al. (1984). Predictive validity of the Movement Assessment of Infants. Journal of Developmental & Behavioral Pediatrics. 1984; 5: 336-342.
  • Langkamp DL, Harris SR. Predicting preschool motor and cognitive performance in appropriate for gestational age children born at <32 weeks’ gestation. Early Development and Parenting. 1992;1:89-96.
  • Mayson TA, Harris SR, Backman CL. Similarities and differences in gross motor development in children of varied ethnic backgrounds: A literature review. Pediatric Physical Therapy. 2007;19:148-153.
  • Washington KA, Harris SR.  Mental and motor development of low birth-weight infants with normal developmental outcomes.  Pediatric Physical Therapy. 1989;1:159-165.