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.