Alyssa Sherd & Rachel Elery WeeFIM Alyssa Sherd & Rachel Elery

History Created in 1987 Adaptation of the Functional Independence Measure (FIM) for adults Criterion and norm-referenced

WeeFIM Purpose & Philosophy Intended to provide an overview of child’s functional status Should be used in conjunction with other assessments of daily living skills Measures burden of care and disability Assists in setting treatment goals Tracks child’s outcomes and monitors changes Burden of care: how much assistance is required from the caregiver for the child to perform basic life activities effectively Assessment measures “what the child actually does, not what he or she is capable of doing”; how they consistently perform, not if they have successfully completed occasionally

Who can administer? Not domain-specific, so used by multiple health professionals Administrators must be trained and pass exam Re-certification every 2 years

Cost & Availability $4,100 for inpatient & outpatient training programs Includes: WeeFIM instrument & Data set WeeFIMware software National Database & Benchmark Reports Education, training, credentialing, & consulting Research & Development

Who does it measure? No disability: children 6 months to 7 years Initial normative sampling of 400 children Disability: children 6 months to 18 or 21 years Congenital, developmental, or acquired disabilities Functioning at or below 7 years

Assessment Direct observation, interview, or both 15-30 minute administration time Inpatient, outpatient, & community-based settings Follow-up data can be retrieved by phone if necessary

Measurement 18 items measured within 3 domains: All 18 must be rated Self-care Mobility Cognition All 18 must be rated Self-care: eating, grooming, bathing, dressing (upper body), dressing (lower body), toileting, bladder management, bowel management Mobility: transfers (chair, wheelchair), transfers (toilet), transfers (tub, shower), locomotion (walk, wheelchair, crawl), locomotion (stairs) Cognition: comprehension, expression, social interaction, problem solving, memory

Scoring 7-level ordinal scale 1= Total assistance (child performs >25% of task) 2=Maximal assistance (25-49%) 3=Moderate assistance (50-74%) 4=Minimal assistance (<75%) 5=Supervision/setup 6=Modified independence 7=Complete independence Scores 1-5 require a helper, scores 6-7 do not Total assistance (1)= this score is given to children who either do not perform the task, helper performed the task for the child, or child needs assistance from two or more helpers Possible reasons for nonperformance: clinician determines it unsafe to perform, child cannot perform due to current medical status, child refuses, or child is physically unable to do task Supervision/setup (5) = cueing, coaxing, and providing setup for activity; otherwise the child can complete it Modified independence (6)= assistive device, extra time, safety concerns

Rating & Interpretation Calculate WeeFIM items (self-care, moblility, cognition) & total raw score Convert raw scores to functional quotients (raw score ÷ age-based norm score) x 100 Refer to norm table and graphs for data

Psychometric Properties Normative sampling of over 400 children without disabilities ages 6 months to 8 years Statistically significant correlation between WeeFIM ratings and chronological age Studies of children with disability Test/retest & inter/intrarater reliability Equivalence reliability Normative sampling of over 400 children ages 6 months-8 years without disabilities demonstrated statistically significant correlation between total WeeFIM instrument ratings and child’s chronological maturity, meaning that as children got progressively older, their independence in performing daily tasks increased Cerebral palsy, spina bifida, motor, communicative, and neurodevelopmental delays, extreme prematurity, down syndrome, congenital limb disorders, TBI, pediatric brain tumors, congenital heart disease,

Research: Cerebral Palsy in Turkey 134 children ages 6 months to 16 years Varying degrees of CP WeeFIM has strong: Test-retest reliability Internal consistency Interrater reliability

Research: Norms for Children in China 445 typically developing children Ages 6 month to 7 years As age progresses, so does independence Concluded environmental and cultural differences in level of independence by age

Research: Equivalence Reliability 30 children with developmental disabilities Ages 19-71 months Assessed with direct observation and parental interview Agreement between the two methods was found Established usefulness of interviewing

0-3 Module Measures the precursors to functioning Contains 36 items in 3 domains (motor, cognitive, behavioral) Used when child is rating is less than 30 on WeeFIM Uses a four-level rating system: 3=Usually 2=Sometimes 1=Rarely 0=Never

Group Activity Case studies EDIT THIS TO INCLUDE THE 3 ITEMS WE WANT THEM TO SCORE

Strengths & Weaknesses Abundance of research across ethnicities and diagnoses in support of the reliability and validity Can be administered by a variety of healthcare professionals   Can be administered in a variety of healthcare settings Helps determine goals for client and monitor gains in functioning Short administration time Weaknesses: Still could be some room for subjectivity in scoring Parents may not give true/accurate depiction of their child’s abilities Training program for facilities is very expensive Scoring sheet is confusing and difficult to navigate Information and norms may need to be updated since this evaluation tool was established almost thirty years ago

References Niemeijer, A.S., Reinders-Messelink, H.A., Disseldorp, L.M., & Nieuwenhuis, M.K. (2012). Feasibility, reliability, and agreement of the WeeFIM instrument in Dutch children with burns. Physical Therapy. 93(7), 958-966. Occupational Therapy for Children Assessment Portfolio. (2013). Pediatric functional independence measure (WeeFIM). Retrieved from http://otforchildrenassessmentportfolio.blogspot.com/2013/04/pediatric-functional- independence.html Sperle, P.A., Ottenbacher, K.J., Braun, S.L., Lane, S.J., & Nochajski, S. (1997). Equivalence reliability of the Functional Independence Measure for Children (WeeFIM) administration methods. The American Journal of Occupational Therapy. 51(1), 35-41. Tur, B.S., Kucukdeveci, A.A., Kutlay, S., Yavuzer, G., Elhan, A.H., & Tennant, A. (2009). Psychometric properties of the WeeFIM in children with cerebral palsy in Turkey. Developmental Medicine and Child Neurology, 51(9), pp. 732-738. DOI: 10.1111/j.1469-8749.2008.03255.x Uniform Data System for Medical Rehabilitation. (2009). The WeeFIM II teaching guide, version 1.0. Buffalo, NY: UDSMR. WeeFIM System Clinical Guide: Version 5. (1998). Buffalo, NY: University at Buffalo Wong, V., Wong, S., Chan, K., & Wong, W. (2002). Functional Independence Measure (WeeFIM) for Chinese children: Hong Kong Cohort (Abstract). Pediatrics (Evanston). 109(2), pp. 309-310.