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Journal of Human Growth and Development

versión impresa ISSN 0104-1282versión On-line ISSN 2175-3598

J. Hum. Growth Dev. vol.31 no.1 Marília ene./abr. 2021 



Opportunities in child motor development at home: bibliometric and scientometric review



Tamiris FerreiraI; Thomaz da Cunha FigueiredoII; Marília Alessandra BickIII; Tassiane Ferreira LangendorfIV; Stela Maris de Mello PadoinV; Cristiane Cardoso de PaulaVI

IPrograma de Pós-Graduação em Enfermagem, Universidade Federal de Santa Maria Santa Maria, Rio Grande do Sul, Brasil
IICurso de medicina, Universidade Federal de Santa Maria Santa Maria, Rio Grande do Sul, Brasil
IIIPrograma de Pós-Graduação em Enfermagem, Universidade Federal de Santa Maria Santa Maria, Rio Grande do Sul, Brasil
IVPrograma de Pós-Graduação em Enfermagem, Universidade Federal de Santa Maria Santa Maria, Rio Grande do Sul, Brasil
VPrograma de Pós-Graduação em Enfermagem, Universidade Federal de Santa Maria Santa Maria, Rio Grande do Sul, Brasil
VIPrograma de Pós-Graduação em Enfermagem, Universidade Federal de Santa Maria Santa Maria, Rio Grande do Sul, Brasil





INTRODUCTION: Child development comprises a complex and dynamic transformation process due to continuous and progressive interactions, which begins at conception. It involves aspects that permeate the child's physical growth, neurological, behavioral, cognitive, social, and affective maturation.
OBJECTIVE: Analyze the characteristics of scientific literature about the use of the instrument Affordances in the home environment for motor development (AHEMD).
METHODS: It is a bibliometric and scientometric review performed in January 2018, including primary studies in English, Portuguese, and Spanish. By searching the electronic databases Publisher Medline (PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), Elsevier SciVerse Scopus (SCOPUS), Web of Science Main Collection, Clarivate Analytics (WoS), and at Scientific Electronic Library Online (SciELO)
RESULTS: 38 studies applied AHEMD to assess opportunities for motor development at home, of them 39.5% (n=15) with children aged 3 to 18 months and 60.5% (n = 23) with children aged 18 to 42 months. The majority (76.4%- n=29) of them from Brazil, 47.4% (n = 18) were cross-sectional studies, 50% in the period between 2014 and 2017 and 50% (n = 19) with multi-professional authorship. The evaluation was done with children of different characteristics, scenarios, and social contexts with scores of dimensions and overall classified from very weak to sufficient.
CONCLUSION: The analysis of the studies concerning the application of AHEMD instrument shows a gap in longitudinal research in populations with clinical conditions, consistent with the notification issues of the information systems that indicate public health problems in the child population.

Keywords: child development, environment, play and playthings, family, evaluation.



Authors summary

Why was this study done?

This study was developed considering the history of a decade of application of the instruments Affordances in the Home Enviroment for Motor Development - Self-Report (AHEMD-SR) and Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS) in health research. The results produced from the creation and validation of the scale to the application in different contexts indicate that the trend of the use of AHEMD in the national and international context makes it possible to point out the evolution of knowledge in the thematic field of child motor development. This mapping was motivated by the relevance of organizing information, in an objective and quantitative manner, of the use of this self-applicable questionnaire both in research and in care practice, so that professionals can access clinical decision-making subsidies consistent with the opportunities available at home.

What did the researchers do and find?

This is a bibiliometric and scientometric review to answer the question: "What are the characteristics of the production of scientific production on the use of the AHEMD instrument?". The mapped terms were combined as search strategies and appropriate to the fields and filters available in electronic databases in the health area. Identification, selection, eligibility and inclusion followed the PRISMA check list for quality and transparency. The methodological development of this review resulted in the inclusion of 38 articles, of a cross-sectional design followed by validation studies, with chronology of the use from 2005 to 2017, most authors physical educators or physiotherapists, published in international journals and with impact factor, among the controlled descriptors, the most frequent were environment and infant. The population was mainly of healthy children.

What do these findings mean?

In the period of 12 years of production of the use of AHEMD there was a 100% increase in production in the last four years (2014-2017). This, added to the authors' profile, indicates that theme of child motor development is multifaceted and that it arouses the interest of researchers from different areas of knowledge. The validation of the instrument in six countries indicates its application in different cultural and social contexts. It was evidenced in most articles evaluating the correlation of the dimensions of AHEMD-IS and AHEMD-SR with the sociodemographic variables of the families investigated, in which the income and socioeconomic conditions better and the higher schooling of parents have a significant positive correlation for the development of children.



Child development comprises a complex and dynamic transformation process due to continuous and progressive interactions, which begins at conception. It involves aspects that permeate the child's physical growth, neurological, behavioral, cognitive, social, and affective maturation1. It also includes motor development resulting from a succession of events influenced by the environment, the task required, and the biology of the individual2,3.

The relationship between the environment and the individual is present in the ecological theory that highlights the relationship between perception and action4. In this theory, the affordances concept describes the opportunities offered by the environment to a particular agent that influences the child's motor development according to their quality and quantity. They can be toys, materials, appliances, space availability, and stimulation provided by parents and family members present in the environment where the child lives in5.

The family environment is the first context where the child is inserted, and the home configures the space where he can explore and obtain opportunities for stimuli. There are two instruments to measure the quantity and quality of these opportunities in the home environment and their influence on motor stimulation: Affordances in the Home Environment for Motor Development - Self-Report (AHEMD-SR) and Affordances in the Home Environment for Motor Development - Infant Scale (AHEMD-IS). The first was developed and validated for children aged 18 to 42 months6, and the second, for infants aged 3 to 18 months7,8.

The AHEMD-SR, created by a partnership between the Polytechnic Institute Vianna do Castelo and Texas A&M University, it exposes features of the child and the family's character and 67 questions that address opportunities in the home environment, physical space, daily activities, and toys. It comprises five subscales: outdoor space, indoor space, variety of stimulation, fine motor material, and gross motor material, with their results classified as very weak, weak, good, or very good6,9.

The AHEMD-IS was developed by the University of Texas and the Universidade Metodista de Piracicaba (Methodist University of Piracicaba/UNIMEP), which characterizes the family and the child, in addition to analyzing the opportunities for stimulation in the infant's motor development. Initially built with 56 items6, after review and validation, it was reduced, with its new version consisting of 35 items, which contemplate the dimensions of the physical space of the house, variety of stimulation, and toys in the home. According to the score, there are four classifications for affordances in the domestic environment: less than adequate, moderately adequate, adequate, or excellent7.

After a decade of application of these instruments in health research, it is more than justified the trend of using them. Thus, the objectives of this review are: a) to show the chronology of the use of Affordances in the home environment for motor development (AHEMD); b) identify the journals, descriptors, authors, and countries of scientific production; c) characterize the origin, design, promotion and impact factor of the research instrument Affordances in the Home Environment for Motor Development (AHEMD) in the national and international context. The results achieved from its creation and validation of the scale to the application in different contexts makes it possible to point out the evolution of knowledge in the field of child motor development.

This study intends to contribute to the organization of information, objectively and quantitatively, from the use of this self-administered questionnaire both in research and healthcare practice, so that professionals access accurate data for clinical decision making consistent with the opportunities available at home. Thus, the objectives of this study are: a) to show the chronology of the use of Affordances in the home environment for motor development (AHEMD); b) identify the journals, descriptors, authors, and countries of scientific production; c) characterize the origin, design, promotion and impact factor of the research.



It is a Bibliometric and Scientometry review. Bibliometrics allows us to plan and find several journals to answer the research question and critically analyze the available studies in the databases10. Scientometry analyzes the production, consumption, and circulation of scientific publications. By using both technics, it is possible to qualify, verify, and give meaning to the data and a broad study about the productions of the subject in question10.

The review question was: "What are the characteristics of scientific production about the use of the AHEMD instrument?". Primary research articles that applied the AHEMD, available in full and in English, Portuguese or Spanish, were included without a time frame for selecting studies.

The bibliographic search was developed in the electronic databases Publisher Medline (PubMed), Latin American and Caribbean Literature in Health Sciences (LILACS), Elsevier SciVerse Scopus (SCOPUS), Web of Science Main Collection Clarivate Analytics (WoS), and at Scientific Electronic Library Online (SciELO) in January 2018. The search strategy was: AHEMD or "Affordances in the home environment for motor development" (keywords or keywords or topic or title/abstract/keyword or all indexes, according to each base or library). Another source for identification was the list of references of the articles included through the databases. Figure 1 shows the path taken for the selection of publications.

The studies duplicated were considered only once. The retrieval of not open access articles was carried out through the Portal of Journals of the Coordination for the Improvement of Higher Education Personnel (Capes), on the journal's website, or at the request of the manuscript to the primary author.

A total of 38 articles were analyzed, from them the following information was extracted: reference, year of publication, journal, journal impact factor, controlled and uncontrolled descriptors, support for promotion, area of knowledge, academic level, qualification of authors, institutions linked to authors, the origin of the study, objectives, study design and main results.

The data were analyzed according to the year of publication, respecting the highest professional degree and journal impact factor, corresponding to this period. The impact factor was taken according to the Journal Citation Reports, provided by Clarivate Analytics. The authors' formation and qualification were collected from the articles and on the online page of their institution. For articles with authors from different professional backgrounds (example: medicine, physiotherapy, physical education, among others), it was adopted as a multi-professional knowledge area. For those authors present in more than one publication with different degrees, the highest academic degree was considered.

The extraction of information was according to ethical principles, presented faithfully, and cited and described the ideas, definitions, and concepts used by the authors of the articles.



Of the articles selected (n = 38), the year of publication was distributed every four years, with significant growth in recent years, 50% (n = 19) between 2014 and 2017. Regarding the origin of the studies, 76.4% (n = 29) were from Brazil. Concerning the knowledge area, 50% (n = 19) of the productions was multi-professional (table 1).

As for the academic degree of the authors, 34.3% (n = 44) are physical educators and 26.5% (n = 34) physiotherapists. For 28.1% (n = 36) the professional qualification prevailed, followed by a doctorate 27.3% (n = 35). There were 19 authors in more than one publication when the professional qualification attributed to it was different; only the highest level was counted (table 1).

The 128 authors are linked to 44 institutions: Universidade Federal do Rio Grande do Sul/Federal University of Rio Grande do Sul 12.7% (n = 15), Fundação Universidade do Estado de Santa Catarina/Santa Catarina State University Foundation 10.2% (n = 12), Universidade Estadual de Maringá/State University of Maringá 9.3 % (n = 11), University of Texas 8.5% (n = 10), Texas A&M University 6.8% (n = 8), Universidade Federal de Santa Maria/Federal University of Santa Maria 5.1% (n = 6), Universidade Metodista de Piracicaba/Methodist University Piracicaba 4.2% (n = 5). With 2.5% (n = 3) participation, there is the Universidade do Vale do Rio dos Sinos/University of Vale do Rio dos Sinos, Universidade Federal do Amazonas/Federal University of Amazonas, Universidade Federal de Juiz de Fora/Federal University of Juiz de Fora, National Institute of Fitness and Sports in Kanoya, Azad University of Ahvaz and Islamic Azad University. And, with 1.7% (n = 2) of participation: Universidade Federal do Ceará/Federal University of Ceará, Universidade Federal do Pampa/Federal University of Pampa, Pontifícia Universidade Católica/Pontifical Catholic University, University of Nebraska. Other institutions were present only once each.

The articles were published in 27 journals, 59.3% (n = 16) Brazilian and 40.7% (n = 11) foreign. Among the Brazilian ones: Revista Fisioterapia e Pesquisa, Brazilian Magazine of Human Growth and Development, Magazine of Physical Education, Magazine of Public Health, Thinking Practice, Revista Paulista de Pediatria, Brazilian Magazine of Physical Education and Sport, Brazilian Journal of Physical Therapy, Neuroscience Magazine, Brazilian Journal of Ophthalmology, Physiotherapy and Movement, Brazilian Journal of Health Sciences, Physical Education and Sports Notebook, Themes on Human Development, Health and Journal of Physical Education.

The foreign journals were: Pediatrics International, Disability and Rehabilitation, International Journal of Mental Health and Addiction, Physical Therapy, Infant Behavior & Development, Research Quarterly for Exercise and Sport, Early Child Development and Care, Child Development Research, Journal of Social Sciences, Motricity and The first six international journals cited had an impact factor; however, only the Brazilian Journal of Physical Therapy had an impact factor among the Brazilian journals.

Of the 38 articles, 26.3% (n = 10) received funding for the research from: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Coordination for the Improvement of Higher Education Personnel/Capes) 60% (n = 6) and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (National Council for Scientific Development and Technological/CNPq) 50% (n = 5). The publications were supported by The National Science Council of Taiwan ROC 10% (n = 1) and National Institute of General Medical Sciences of the National Institutes of Health 10% (n = 10).

Figure 2 presents the 66 controlled and uncontrolled descriptors found in the publications.

Most of the studies were cross-sectional 47.4% (n = 18), followed by 26.3% (n = 10), concerning the creation, validation, or analysis of the instrument's properties AHEMD, longitudinal 10.5% (n = 4) of longitudinal design, 7.9% (n = 3) quantitative descriptive and other four studies.

The AHEMD-IS instrument was analyzed in 39.5% of the productions (n = 15) and the AHEMD-SR in 60.5% (n = 23) of them. Sometimes, these instruments were associated with the use of other tools , the most frequent being: Alberta Infant Motor Scale (AIMS) 23.5% (n = 8), the Questionnaire of the Brazilian Association of Research Companies (ABEP) 17.6% (n = 6), Test of Gross Motor Development 2 (TGM-2) 8.8% (n = 3), Pediatric Dysfunction Assessment Inventory (PEDI) 8.8% (n = 3), Movement Assessment Battery for Children - 2 (MABC-2) 5.9% (n = 2), Bayley Scales of Infant Development - Second edition (BSDI-II) 5.9% (n = 2), Daily Activities Scale of Infants (DAIS) 5 , 9% (n = 2), Knowledge of Infant Development Inventory (KIDI) 5.9% (n = 2). The others only once.

Figure 3 shows the dimensions of the instruments, AHEMD-IS, or AHEMD-SR of the studies selected, except for those studies related to translation, adaptation, or validation.

Most of the children studied had a good health condition. Those with some clinical involvement, situations of prematurity are mentioned16,23,39, low birth weight23, developmental delay11, and impaired visual acuity28,41 (board 1).



When analyzing the characteristics of the productions that used the instruments AHEMD-SR and AHEMD-IS, an increase in publications was noticed as of 2010, which can be related to the studies on creation, validation, and adaptation of instruments6-8,11,29-34 which instigate the scientific community interest to apply them and publish the results.

The studies were linked to high education institutions and those who created the instruments. In the majority with studies developed in Brazil, however, those in other countries, Portugal13,30, USA6, Japan11,29, Iran27,31,32 and Spain34, signal the use and dissemination of these tools for evaluation, enabling the assessment of opportunities in the home environment of children from different cultural and social contexts.

The authors were physical educators, physiotherapists, or professions focused on motor development. On the other hand, the multi-professional knowledge area was predominant, pointing out the interest and involvement of other professionals in child development assessment research. Other health professionals such as nurses, nutritionists, and speech therapists were not found as authors, which suggests the need for inclusion according to their professional expertise in child health. For nursing, their role in monitoring child growth and development in different healthcare settings is pointed out, including home visits. Nutrition due to the influence of adequate and safe dietary conditions consistent with the child's clinical condition and caloric expenditure to explore the home environment. Speech therapy due to the need for speech for verbal communication and success in a variety of stimulation.

The meaningful participation of authors with master's and doctoral degrees highlights the implication in answering questions related to the theme, pointing out the reference names, both of those validated the instruments and are consolidating their use. The lack of information regarding graduation and qualification in the articles, due to incompleteness or lack of standardized curriculum vitae, represented an obstacle to bibliometrics. It is estimated that a lack of authors' data of 20%, it reinforces the importance and needs to include complete information in journals indexed in the databases.

The articles are linked to journals that were meticulously evaluated by Thomson Reuters Journal Citation Reports (JCR) through the average number of times that the journal's articles were cited by others in subsequent publications during a period of two years46, configuring a higher probability of reading the findings of these studies internationally.

The fact of having the support of funding agencies to promote this theme reinforces the relevance of it. It raises the need for investment of public resources of further studies that address the opportunities of the home environment for motor development. It also converges with the Sustainable Development Goals47, which guides national and international policies on different topics, including child health.

The studies were characterized according to a variety of controlled and uncontrolled descriptors; such heterogeneity can be related to the publication rules of each journal. Some journals allow us to insert keywords; that is, they are not yet indexed. It is suggested to standardize the use of controlled descriptors, enhancing the evidence-based practice to optimize the recovery of the documents from the database48. The standardization of controlled descriptors increases the potential of evidence-based practices.

The use of AHEMD to assess the opportunities of the environment for motor development obtained different ratings: low14,21,26,38,42,44,45, averages21-23,26,28 and sufficient13,43. These results suggest that the evaluated children present opportunities in the domestic environment; however, in quantity and variability below what is considered excellent. On the other hand, the assessment of opportunities in the school setting showed excellent ratings for stimulating child motor development13, possibly because it is a safe place where the child can play, eat and interact with other children49.

The dimension physical indoor environment obtained a very good classification in several studies21-23,25,26,36,39,40,43,44. It is the most punctuated dimension in a study that evaluated the opportunities present at home and daycare centers13. In the outdoor environment dimension, regardless of gender21 and economic level26, the classification was weak and very weak. Another study evaluated the opportunities for stimulation in children of adolescent mothers who lives or not with their grandmother. The physical space was also classified as very weak14. Another research considered considering income; the better the financial condition, the better the classification for internal and external physical space36.

Concerning the variety of stimulation, research that compared the relationships between motor performance and the characteristics of the family environment of infants in two regions of Brazil did not identify significant differences for the dimension of daily activities12. A study in Brazil, which evaluated the domestic environment opportunities of different socioeconomic levels, obtained 65.9% of households with good and very good ratings for the dimension26. The result converges with the findings of other studies36,40, which found a "very good" classification for the variety of stimulation.

In contrast, other studies14,21,40 reported weak and very weak results for this dimension, revealing low opportunities, which can be improved by adding to the routine of the child, putting him to play in the supine position or games that stimulate parts of the body, for example50. According to the findings of a study conducted at the home of 88 Brazilian families, the existence of a higher number of children at home was associated with a better result in the variety of stimulation36.

The dimensions of toys for both fine motor skills and gross motor skills also varied as the results with very weak ratings14,16,21-23,26,38,40, weak23,26,38, and good13,43 for children of different groups, age groups, and scenarios. Thus, for those with a classification "very weak," regardless of the group, both infants who lived with their grandmothers and those who lived with their parents, the classification was the same14. An assessment of preschoolers in Rio Grande do Sul, Brazil, 91.7% of homes showed unsatisfactory values for fine motor skills development and 83.3% with impairments for the development of gross motor skills21. When comparing infants living in municipalities in two regions of Brazil, children in the North region had lower scores in toys for fine and gross motor skills than children living in the Southeast region12. In the comparison between scenarios, both in daycare centers and in residences, the toys for motor skills showed the lowest average score in the study, even so, included in the classification of good opportunities13.

Certain variables can influence the results obtained through AHEMD, especially socioeconomic level and income15,17,18,20,22,24,26,36,39,43, maternal education15,17,18,22,26 and paternal12,15,18,20,22,36. A study with infants in a city in Minas Gerais State, Brazil, revealed that the parents' stable union, maternal and paternal with high educational level, and high economic income were the factors associated with the best opportunities for motor stimulation at home18.

Another study also pointed out that families from higher social classes provided more significant physical space and availability of toys, and those where both parents had an undergraduate course provided significantly more toys than families with high school education15; such findings corroborate the results of a research carried out with children from the northern region of Brazil, with significant differences in the dimensions of indoor space and fine motor skills, indicating that upper-middle-class children have more motor opportunities at home, in addition to having more toys related to fine motor skills24.

The use of these instruments proved to be valid, with perspectives of dimensions that promote child motor development, signaling that opportunities in the home environment are as significant as biological factors17 and can even generate a positive impact on children's motor and cognitive behavior in short and long term19.

The limitation of this study was concerning the reading and interpretation of the results when described by the instrument's dimension and the total score. The studies used different terms in some of them; the score was described as weak and very weak, good and very good, in others dichotomized as good or bad, inadequate or adequate, or even low, medium, or high. This implies a difficulty in comparing the results. Furthermore, the lack of information regarding the formation and qualification of the authors represent a barrier for bibliometrics.

It should be highlighted that in the analyzed period (12 years), there was an increase of 100% of the scientific publications during the last four years (2014-2017). This fact added to the authors' profile indicates that the theme of child motor development is multifaceted and arouses the interest of researchers in different areas of knowledge. The validation of the instruments in 6 countries indicates that this has been applied in different cultural and social contexts. The evidence found in most articles that evaluated the correlation of the dimensions of the AHEMD-IS and AHEMD-SR with the socio-demographic variables of the investigated families showed that the income and better socioeconomic conditions and the higher education of the parents have a significant positive correlation for children's development.


Universal Notice of the National Council for Scientific and Technological Development (CNPq), Brazil, No. 01/2016 (track A). Case number: 408710 / 2016-0.

Research for SUS Program: shared health management - PPSUS of the Rio Grande do Sul Research Support Foundation (FAPERGS), Brazil, No. 03/2017 (Track 02). Process no .: 17 / 25510001452-9.

Conflicts of interest:

Nothing to declare.



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Manuscript received: July 2020
Manuscript accepted: November 2020
Version of record online: March 2021

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