The Abnormal Involuntary Movement Scale (AIMS) is a clinical tool specifically designed to evaluate involuntary movements, particularly those linked to neurological and psychiatric conditions. It is most commonly used to screen for and monitor tardive dyskinesia, a condition characterized by repetitive, jerky movements often resulting from long-term use of antipsychotic medications. Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening reaction to antipsychotic medications, characterized by muscle rigidity, fever, altered mental status, and autonomic dysfunction. While the AIMS test is not directly used to diagnose NMS, it plays a role in identifying residual movement abnormalities in recovering patients, such as drug-induced dyskinesias. By documenting these movements, the AIMS test helps differentiate NMS-related symptoms from those of other conditions. Although specific PPV and NPV values for NMS-related assessments are not well-documented, the AIMS test remains a valuable tool in post-recovery evaluations.
By evaluating the severity and frequency of involuntary movements, the AIMS test helps rule out conditions that mimic Parkinson’s. With a negative predictive value (NPV) of 88% in differentiating Parkinson’s from other movement disorders, it provides clinicians with greater diagnostic precision. The Tardive Dyskinesia Assessment Working Group suggests that the AIMS is a valid assessment tool for TD both for research and clinical practice but does not report data on improvement in screening rates. A 2019 study reported an increase in AIMS implementation from 0% to 80% in 12 weeks in an outpatient private practice when the scale was administered by a Doctor of Nursing Practice (DNP) student during each patient visit . However, the goal of the study was to identify TD and involved a single researcher administering AIMS to each patient to study improvement in patient outcomes and used the Plan-Do-Study-Act QI model. A 2021 QI study suggested an 85.1% increase in TD screening for high-risk patients.
Address Movement Concerns
Another hypothesis was that completing the AIMS screening is too time-consuming. The mode response (10 of 17 residents and 4 of 5 attendings) when surveyed “How long does it take to complete an AIMS screening” was “1-3 minutes” (Figure 6). The goal of this project is to increase compliance with AIMS screening of patients seen in the outpatient psychiatry clinic who are prescribed an antipsychotic medication. Through the Lean Six Sigma process, the team identified several possible causes for this problem. Providers may be conducting the AIMS screening, but it is not being documented in a manner that is easy to access such as, in the free text section of the patient’s chart (Figure 1).
Drug-Induced Movement Disorders
The AIMS test is widely utilized in this population to screen for and monitor tardive dyskinesia symptoms, ensuring early detection and effective management. Loyola’s compassionate team understands that movement diseases can be life-changing for the patient and their family. As an academic medical center, Loyola provides exceptional care and support services to patients and trains future leaders in neurology and neurosurgery. There are many types of movement disorders, each with their own symptoms, causes, risk factors and treatment options.
The AIMS test helps identify dystonic movements, particularly in cases where symptoms overlap with other involuntary movement disorders. Although not specific to dystonia, the AIMS test documents the frequency and severity of abnormal movements, offering critical insights for diagnosis and treatment planning. With an NPV of approximately 85% in ruling out dystonia, it supports clinicians in making differential diagnoses. The Abnormal Involuntary Movement Scale (AIMS) test is a widely recognized and invaluable tool for assessing and monitoring involuntary movement disorders. It plays a crucial role in diagnosing conditions such as tardive dyskinesia, Parkinson’s disease, and other neurological movement disorders.
Drug-induced movement disorders are conditions https://chickenroadapp.net/en-in/ caused by medications such as antipsychotics, antiemetics, and antidepressants. The AIMS test is a critical tool for identifying and monitoring these side effects, allowing healthcare providers to make timely adjustments to medication regimens. With a PPV of 88% and an NPV of 90%, the AIMS test is highly effective in detecting drug-induced movement abnormalities, ensuring better patient outcomes through early intervention. Dystonia is a neurological movement disorder characterized by sustained or intermittent muscle contractions, resulting in abnormal postures or repetitive movements. It can be focal, affecting specific body parts, or generalized, involving multiple regions.
- Like other neurological movement diseases, symptoms of dystonia can appear differently in different people.
- Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening reaction to antipsychotic medications, characterized by muscle rigidity, fever, altered mental status, and autonomic dysfunction.
- With a PPV of approximately 78% for identifying tremor-related movement disorders, it serves as a helpful adjunct in clinical assessments.
- Follow-up data review was planned at three months and six months post-intervention.
There was a consideration that this was potentially being documented as free text. This may have been related to recent changes in EHR, clinic location, and personnel changes. Items 1-7 assess involuntary movements across body regions, with a score ranging from zero (no dyskinesia) to four (severe, maximal amplitude, and persistence during observation of abnormal movements).
- Parkinsonism causes slowness of movement with stiffness, tremors or loss of balance.
- It can easily be incorporated into a routine office visit, making it a convenient option for both patients and providers.
- The symptoms can even change throughout the course of the disease, having a greater effect when first appearing and diminishing over time or vice versa.
- “Parkinson’s disease comprises about 80% of cases of Parkinsonism and is the disorder I deal with the most when speaking with patients.”
Non-invasive, straightforward, and highly effective, the AIMS test measures the severity of abnormal movements across various parts of the body, including the face, limbs, and trunk. By providing a structured framework for observation and scoring, it equips healthcare professionals with the information needed to make well-informed decisions about treatment plans and medication adjustments. Like other neurological movement diseases, symptoms of dystonia can appear differently in different people.
Symptoms
Drinking large amount of alcohol, doing illegal drugs such as cocaine or not having enough of certain vitamins in the body also can increase risk. The study shows that changes in electronic health records, time constraints, and limited exposure to TD screening education can be overcome with continuing education efforts. The results of increased AIMS screening show the value of near-peer teaching and learning and it has implications for resident teaching and education.
Understanding Abnormal Involuntary Movement Scale (AIMS) Results
The AIMS is administered every three to six months to monitor the patient for the development of TD. For most patients, TD develops three months after the initiation of neuroleptic therapy. Pharmacological treatment options were recently approved by the FDA for the treatment of tardive dyskinesia 3-5. Multiple system atrophy (MSA) is a rare neurodegenerative disorder that affects the autonomic nervous system and motor function. The AIMS test is used to assess involuntary movements in MSA patients, aiding in the differentiation of MSA from conditions such as Parkinson’s disease or drug-induced movement disorders.
Sometimes, RLS can run in families, especially if the patient started experiencing the condition before turning 40. Pregnant women also sometimes experience RLS signs and symptoms, although they usually go away after delivery. Some patients describe the urges as pulling, throbbing, aching, itching, and electric. Self-care steps, lifestyle changes, and medications can help people who suffer from RLS.
In summary, the Abnormal Involuntary Movement Scale (AIMS) test is a versatile and reliable tool for diagnosing and monitoring a wide range of movement disorders. Antipsychotic medications are a central part of the treatment process for those with schizophrenia and other mental health conditions, including depression and bipolar disorder. As a result, the potential for an antipsychotic to contribute to the development of a drug induced movement disorder continues to be a clinical concern. Adverse events such as drug induced movement disorders play an important role in treatment considerations when quality of life and medication adherence must be considered. One part of offering quality care is being able to assess the effectiveness and tolerability of medication using movement disorder assessment tools to help identify both the presence and severity of movements. Drug induced movement disorder assessment tools are not diagnostic and should not substitute for other differential assessments; however, they can serve as a tool to more effectively use medications.
Medical Professionals
Incorporating the AIMS test into routine care empowers primary care providers to play a critical role in the early detection and management of movement disorders. Conditions like tardive dyskinesia and other neurological movement disorders often go unnoticed in their early stages, as symptoms may be subtle or mistaken for unrelated issues. The AIMS test provides a systematic approach to identifying these movements, ensuring they are not overlooked during routine evaluations.
This proactive approach reduces the risk of long-term complications and enhances patient safety. For example, dystonia causes muscle contractions that lead to twisting of the body. Another movement disorder called chorea causes brief periods of quick involuntary movements that happen over and over. Parkinsonism causes slowness of movement with stiffness, tremors or loss of balance. At our online urgent care and primary care practice, your well-being is our top priority. If you have concerns about involuntary movements or neurological symptoms, we encourage you to reach out.
Potential Limitations of the AIMS Assessment
“These diseases can cause excessive movement, lack of movement, neurological cell death, and much more. There is a wide variety of symptoms and diseases that can be classified as neurological movement disorders.” A neurological movement disorder is any nervous system condition that changes how the body moves, whether voluntary or involuntary. Unfortunately, many of these conditions can make simple tasks difficult for patients who are diagnosed.
In the current EHR, it is difficult to find and compare previous AIMS scores to facilitate clinical intervention (Figure 2). Further, providers may not know how to use the tool or even be aware that the tool exists. One potential explanation is the switch to a new EHR that does not include automated alerts to physicians to conduct and document an AIMS result.
X18 – Nurse gives a paper copy of the AIMS tool to a physician for every encounter on individual on antipsychotic medications A third of the residents surveyed reported that they had screened patients on antipsychotic medication with AIMS. One of the five attendings surveyed indicated they screen every patient on an antipsychotic with AIMS (Figure 4). The Lean Six Sigma quality improvement (QI) model, utilizing DMAIC steps of define, measure, analyze, improve, control, was followed. Psychiatry attendings and residents were surveyed to assess reasons for AIMS non-documentation, and they ranked their preferred solutions to increase compliance. A random sample of patient charts for individuals on antipsychotic medications was obtained to determine AIMS documentation compliance prior to and following the implementation of improvements.
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Dystonia is a muscle disease that causes involuntary contraction, including repetitive or twisting motions. It can affect one, two or more, or all parts of your body, and the spasms can be mild or severe. Other psychiatric conditions can also occur, such as obsessive-compulsive disorder (OCD), mania and bipolar disorder. Like Parkinson’s, Huntington’s disease can appear as many symptoms, some of which will vary greatly from person to person. The symptoms can even change throughout the course of the disease, having a greater effect when first appearing and diminishing over time or vice versa. We spoke with Behzad Elahi, MD, PhD, a movement disorder specialist at Loyola Medicine, about the different types of disorders and their causes.
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