1. Alyssa Sherd & Rachel Elery
WeeFIM
Alyssa Sherd & Rachel Elery

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

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

13. 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

16. 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,

17. 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

18. 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

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

20. 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

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

22. 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

23. 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), Occupational Therapy for Children Assessment Portfolio. (2013). Pediatric functional independence measure (WeeFIM). Retrieved from 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), 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 DOI: /j 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