Posted on: March 4, 2017 | By: mcraig3 | Filed under: Functional Independence Measure for Children (WEEFIM), T&M Tools

The data reported here for the Functional Independence Measure for Children (WeeFIM) has been reviewed and was found to be up-to-date, besides cost of subscription. The yearly subscription to the WeeFIM assessment is $4,200 (no discrepancy in cost between in-pt. vs. out-pt).

Below is a summary of an article in which the Functional Independence Measure for Children (WeeFIM) was used as the primary objective assessment for progress throughout rehabilitation:

Maria Tozzi & R. Scott Van Zant (2017) Rehabilitation of Conjoined Twins Pre and

Postsurgical Separation, Physical & Occupational Therapy In Pediatrics, 37:2, 139-154, DOI:

10.3109/01942638.2016.1150382. Accessed March 3, 2017.

This article describes the rehabilitation of conjoined twins throughout two episodes of inpatient rehabilitation, early intervention, and outpatient services. The patients were 14-mo. old ischiopagus tripus (fused from umbilicus to a large joined pelvis and share a lower extremity) twins. More specifically, these twins were joined just below the diaphragm at the level of the xiphoid. Prior to surgical separation, the twins received 3 months of rehabilitation which included mobility, feeding, communication, developmental skill training, development of adaptive equipment, education to caregivers. At 24 mos., the twins underwent separation surgery, and at 27 mos., participated in rehabilitation promoting strength, endurance, gait training, feeding, communication, developmental skill training, orthotics, adaptive equipment, and caregiver education. Pre-surgical WeeFIM scores were 18/126 (Twin A) and 19/126 (Twin B). Prior to surgery, the twins performed supine to sit transfers with supervision. Following pre-surgical rehab, WeeFIM scores were recorded to be 28/126 for both twins A and B. Following surgery, each twin sat and performed bed mobility independently. Discharge WeeFIM scores were 42/126 (Twin A) and 45/126 (Twin B). By discharge, the twins performed floor mobility by scooting, were able to stand at an anterior surface with assistance (MaxA for Twin A, MinA for Twin B), and propelled a manual wheelchair indoors (MinA for both Twins A and B).

Prior to surgical separation, rehabilitation was important in order to maximize the twins’ functional capacity, as well as to assess the necessary equipment that would be essential for their continued growth and development. Pre-surgical and post-surgical physical therapy rehabilitation consisted of bed mobility, developmental positioning, and pre-gait activities. Bed mobility focused on scooting up in bed while supine using LEs to assist with pushing. Supine to sit transfers were practiced with one twin able to sit in an upright position while the second twin remained supine. In order to allow for the twins to practice weight bearing through all extremities, as well as to promote trunk and cervical strength, various developmental positions were explored. Sitting activities were performed by supporting the trunk of both twins as they sat in upright positions on benches, floor mats, and in bed. Tall-kneeling was performed at an anterior surface with assistance required to assume the position and maintain trunk and hip position. Supported standing also took place at an anterior surface with assistance from the therapist. Twin A’s pre-surgical WeeFIM score increased from 18/126 to 22/126 during pre-surgical rehabilitation.  During this time, she had increased her ability to maintain head control in supported sitting from 3 mins. with MaxA initially, to 20 mins. with complete independence at discharge (prior to surgery). She also demonstrated increased tolerance for kneeling and sitting postures with reduced need for assistance. Twin B increased her ability to independently maintain seated head control from 30-60 secs initially, to >20 minutes (while simultaneously performing dynamic sitting activities). She also demonstrated enhanced postural endurance with reduced support in kneeling and sitting activities during pre-surgical rehabilitation. Her WeeFIM score increased from 19/126 to 22/126.

Post-surgical physical rehabilitation for Twin A focused on transitions to different developmental positions such as prone, quadruped, and tall-kneeling. Bed mobility focused on rolling and sit to/from supine transfers. Floor mobility included scooting and commando crawling. She also participated in strength and endurance training for the LE, performing kicking activities, tall-kneeling, standing, and movements against manual resistance. Endurance activities included propelling a scooter from a seated position using the LE, propelling a manual wheelchair, and using an arm cycle. Pre-gait activities including standing at an anterior surface and pull to stand tasks. Wheelchair skills included propelling on level surfaces indoors and outdoors, negotiating turns and doorways, ascending/descending graded surfaces, and negotiating wheelchair management within tight spaces to mimic a home environment.

Post-surgical physical rehabilitation for Twin B was similar to that of Twin A. At discharge, the twins received AFOs, manual wheelchairs, recommendations for standers, and bath equipment. The twins were discharged home with their mother, who was encouraged to pursue outpatient rehabilitative services.

A strength of this case study was that the twins participated in physical rehabilitation prior to surgery, maximizing their physical abilities and health prior to surgical separation. This is believed to have played an important role in their successful surgical outcome. One weakness of this case study was that there was no opportunity to gather follow-up information for long-term outcomes of the twins following discharge from the in-patient rehabilitation setting, as they did not live nearby to the rehabilitation facility. In conclusion, this case study provides unique documentation of both pre- and post-surgical rehabilitation treatment and outcomes of conjoined twins.


2 responses to “WeeFIM”

  1. jfleming5 says:

    This is a very interesting case of conjoined twins. I love the fact that this study followed their journey through inpatient rehab stays, early intervention, and outpatient rehabilitation services. It is also particularly interesting that the study chose to enroll the twins in pre-surgical rehabilitation to maximize their abilities and how it was apparent through the WeeFIM that functional improvements were possible even prior to surgery. This study further encourages the idea that rehab prior to surgery can be beneficial and effective to decrease functional mobility loss after surgery. Thanks for sharing!

  2. mcole12 says:

    Below is a summary of an article that utilized the Functional Independence Measure for Children (WEEFIM):

    Kramer ME, Suskauer SJ, Christensen JR, et al. Examining acute rehabilitation outcomes for children with total functional dependence after traumatic brain injury: a pilot study. J Head Trauma Rehabil. 2013; 28(5):361-370.

    The purpose of the study was to examine patient outcomes and functional independence in children with severe traumatic brain injury (TBI) who demonstrated the lowest level of functional skills upon admission into inpatient rehabilitation. The retrospective study assessed 39 children and adolescents (ages 3-18) who sustained a severe TBI and scored the lowest (18) on the Functional Independence Measure for Children (WeeFIM) upon admission. Functional outcomes were quantified using the WeeFIM among a multitude of other outcome measures. The WeeFIM specifically evaluates mobility, self-care, and cognitive abilities in the following pediatric patient populations: normal developing children, adolescents with cerebral palsy, and older children with TBI. The WeeFIM ratings were obtained from the children’s primary therapist and administered at admission, at two-week intervals, and at discharge. A 3-month follow up interview performed by a trained interviewer was obtained after the patient’s discharge from the inpatient facility to evaluate continued patient progress and functional status. The results revealed that a majority of the children made gains in functional status as seen in 16/39 (40%) children scoring below 30 demonstrating the Dependence group and 23/39 (59%) of children scored above 30 demonstrating Partial Dependence group. The results of the study suggest that children with even the most severe of TBI who enter inpatient rehabilitation completely dependent can make significant gains in functional skills. The earlier a child demonstrated improvements in their WeeFIM scores, the likelihood of accomplishing partial dependence by discharge increased. The strengths of the article include the use of high validity outcome measures demonstrating a representation of a child’s functional mobility and independence. The main limitation of the study was the lack of interventions and specificity of each patient’s treatment protocol while in the inpatient rehabilitation facility. Overall, the study demonstrated the efficacy of the WeeFIM in assessing functional status of children; however, the lack of information and evidence regarding the children’s physical therapy program and its impacts on the scores remains.

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