What Is the Abnormal Involuntary Movement Scale (AIMS)?

The Abnormal Involuntary Movement Scale (AIMS) is a clinical outcome checklist completed by a healthcare provider to assess the presence and severity of abnormal movements of the face, limbs, and body in patients with tardive dyskinesia.

Outcome measurement tools help healthcare providers evaluate a person's overall function. The AIMS can help determine if someone is having side effects from medication and track symptoms over time to establish if adjustments to treatment are needed.

This article will explain what the AIMS is, how it works, and its uses.

What It Is

The AIMS is a clinical outcome scale used to assess abnormal movements in people with tardive dyskinesia.

Tardive dyskinesia is a movement disorder characterized by irregular, involuntary movements most commonly in areas of the face, around the eyes, and of the mouth, including the jaw, tongue, and lips.

These involuntary movements can present as abnormal tongue movements, lip smacking or puckering, grimacing, and excessive blinking.

While irregular movements occur most frequently in the face, tardive dyskinesia can also cause irregular and involuntary movements of the arms, legs, and body.

How It Works

The AIMS is an examination assessment form with 12 questions regarding the presence and severity of abnormal movements in people with tardive dyskinesia. The questions are divided into the following sections:

• Facial and oral movements (including the muscles of facial expression, lips, jaw, and tongue)
• Extremity movements (including the arms, wrists, hands, fingers, legs, knees, ankles, and toes)
• Trunk movements (including the neck, shoulders, and hips)
• Overall severity
• Dental status

Before healthcare professionals fill out the questionnaire, they will ask you some questions and instruct you to perform certain movements as they make observations.

Questions the assessor will ask include:

• Is there anything like gum or candy in your mouth?
• What's the condition of your teeth?
• Do you wear dentures?
• Have you noticed any involuntary movements in your mouth, face, hands, or feet?
• If yes, do these movements interfere with daily activities?

The assessor will then instruct you to perform the following movements:

• Sitting in a chair with hands unsupported
• Opening your mouth
• Sticking out your tongue
• Tapping your thumb, alternating with each finger
• Bending and extending each arm, one at a time
• Standing up from a chair
• Extending both arms, with palms facing down while standing
• Walking a few steps, turning around, and walking back to the starting position

Questions 1 through 9 cover the presence of abnormal movements in the face, mouth, arms, legs, and body, and the overall severity of symptoms.

Question 10 relates to your awareness of your symptoms and how distressing these symptoms are, along with the following scale:

• 0: No awareness 
• 1: Aware, no distress
• 2: Aware, mild distress
• 3: Aware, moderate distress
• 4: Aware, severe distress

For questions 11 and 12 that pertain to dental status, the assessor will answer yes or no to the following two questions:

• Current problems with teeth and/or dentures?
• Does the person usually wear dentures?

While the AIMS has 12 questions, the total score is based on the sum of questions one through seven and scored along with the following guidelines:

• 0–1: Low risk of movement disorder
• 2 for only one of seven body areas: Borderline movement disorder, requiring close monitoring
• 2 for two or more of seven body areas: Movement disorder likely, requiring referral for a complete neurological examination
• 3–4 for only one body area: Movement disorder likely, requiring referral for a complete neurological examination

Uses

The AIMS isn't used to diagnose a person with tardive dyskinesia. Rather, it's used to track the severity of symptoms and any improvement or worsening of symptoms over time. 

Tardive dyskinesia occurs as a side effect of taking certain medications, like antipsychotics to treat psychiatric disorders or dopamine agonists, which act like the neurotransmitter dopamine that sends messages between nerve cells, to treat the nervous system disorder Parkinson’s disease.

The score on the AIMS is currently used as the standard for evaluating the efficacy of treatment for tardive dyskinesia. A 2- to 3-point decrease in the total score on the AIMS can be considered clinically meaningful when evaluating whether current treatment is successful in reducing symptoms.

The Tardive Dyskinesia Assessment Working Group devised guidelines that suggest the AIMS should be administered to people treated with antipsychotic medication at regular intervals (every three to 12 months) to track symptoms of tardive dyskinesia over time.

It's also recommended to perform regular self-examinations and check in with your healthcare provider about any abnormal movements during every follow-up visit.

Summary

The AIMS is a clinical outcome measure used to assess abnormal movements in people with tardive dyskinesia. These involuntary movements primarily present as abnormal tongue movements, lip smacking or puckering, grimacing, and excessive blinking.

The AIMS is an examination assessment form with 12 questions regarding the presence and severity of these abnormal movements. The total score is based on the sum of questions 1–7 and scored along with additional guidelines. The questionnaire is completed by a healthcare provider.

The AIMS is currently used as the standard for evaluating the efficacy of treatment for tardive dyskinesia.

A Word From Verywell

The AIMS can be a useful tool for tracking tardive dyskinesia in people when first diagnosed, as symptoms progress, and as they worsen. The test doesn't diagnose tardive dyskinesia, but it's often used to track the effectiveness of treatment for reducing symptoms. 

Prevention is key for managing tardive dyskinesia. Because taking antipsychotic medication poses the risk of developing tardive dyskinesia, it should only be prescribed if absolutely necessary and at the lowest effective dose. If symptoms of tardive dyskinesia become present, the dose should be lowered or discontinued.

In other cases, Ingrezza (valbenazine) or Austedo (deutetrabenazine) can be prescribed to help reduce abnormal movements.