Test of Infant Motor Performance (TIMP)

Posted on: March 6, 2016 | By: mperry10 | Filed under: Uncategorized

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. Am J Occup Ther. 2005;59:446-56.

The purpose of the above study was to analyze collected data from an individual Infant Motor Performance test (TIMP) in a sample of infants to determine which individual items were the best indicators for cerebral palsy. The TIMP has 28 observed items such as head centering and individual finger movements, while 31 items examine motor responses in various positions & visual/auditory stimulation. Each infant was assessed using the TIMP repeatedly from birth to approximately 4 months corrected age. Follow-up information was later collected after the study to see if any of the infants were diagnosed with Cerebral palsy at 1 to 11/2 years of age.

The study originally included 96 infants that were born from 1996-1998 that were at risk for poor developmental outcomes in Chicago. Once the study was complete, the 96 infants were then put into one of three groups at the 1.5 year old mark as: 1) typically developing (TD) 2) motor delayed (MD) and 3) having cerebral palsy (CP). The diagnosis was made based on a pediatrician’s clinical judgment and independent assessment of AIMS at 12 months of age for each infant. Scores below the 16th percentile rank on AIMS without diagnosis of CP was used to define DD. Since 11 infants were unavailable for a follow-up diagnosis, there were excluded from the study. During the study, eleven testers participated in the weekly TIMP assessment of the infants.

To analyze the data, a graphical and Rasch analysis were used. In the graphical exploratory analysis, the CP group compared to the TD and MD group had a better performance than average in items involving neck extension (E23) and lateral head righting in vertical suspension (E30/31). However, staring at 2 weeks post term, children with CP showed decreased ability to hold head in line with midline (E9) of the body in supine and continued to remain delayed compared to typical developing and those with delays and without CP despite improvements. Arm movements against gravity were also poor in the CP from 2-10 weeks (E14), but only reached average performance level of delayed infants at 12 weeks. The CP group also were less likely to inhibit trunk rotation to the side when head is passively rotated (E7/8), have poor anterior-posterior head control (E4/5) in supported sitting, and lateral hip abduction reactions (E22) and unable to mature. The CP group showed signs of difficulty at the 90-day mark with postural control compared to the TD and DD. The CP group also regressed in developmental skills such as antigravity hip flexion and kicking during the study, which was not present in the TD and DD groups.

The Rasch Analysis grouped infants by age of each development group and compared line items. The Rasch analysis showed the CP group having overall difficulty of 11 observed and 19 elicited items. Some key items include: head in midline, hand to mouth & trunk control in supported sitting. TD children compared to CP group had difficulty with head turning to the side in prone/supine, turning to sound in prone and arm movement in prone. Overall, the Rasch analysis identified the same 17 of the 30 items the CP group behaved differently in compared to the TD group in the graphical analysis group. The WINSTEPS statistical program used to analyze the DIF data.

Overall the study revealed that the TIMP did well in quantifying improvements in movement patters but there is still no proof of neurological impairments presenting the same at every age. However, most early atypical motor behaviors of children with CP presented the most at 90 days of age. One item of the TIMP that was highly significant in determining children with CP compared to DD without CP was decreased neck flexion when pulled to sit at 90 days. CP group also had consistent difficulty with movements against gravity compared to the other groups and supported other literature for preterm infants and infants who were later diagnosed with CP.

 

Leave a Reply