Purpose To describe the functional activity and the communication-social ability levels of youths with developmental disabilities and to determine whether demographic factors predict these levels. ...Participants and Methods A mixed, observational and qualitative, study in which parents of students with developmental disabilities were interviewed based on the WeeFIM questions. Both quantitative and qualitative data were analysed. Results Data were collected for 30 youths with mild to severe developmental disabilities with mean age 18.5 ± 2.7 years (19 males). Mean WeeFIM total score was 106.2 ± 10.9, indicating relatively high functional and communication-social ability. No significant difference was observed for the total WeeFIM score between males and females and between adolescents and young adults with developmental disabilities. Main themes emerged from the interviews were: Difficulties with smooth and stable walking, transfers to/from bathtub and stairs. Also, youths are expressing a need for independence in self-care, while relationships with their peers are difficult and problems are primarily solved with help from their parents. Conclusion Despite the high functional and communication-social ability levels of a group of youths with developmental disabilities, parents revealed that youths had certain difficulties. Therapy should address such difficulties to promote independence and participation of these young people in the community.
Background:
Acute flaccid myelitis has emerged as the leading cause of acute flaccid paralysis in children. Acute flaccid myelitis leads to significant physical disability; hence, objective outcome ...measures to study disease severity and progression are desirable. In addition, nerve transfer to improve motor function in affected children needs further study.
Methods:
Retrospective study of acute flaccid myelitis subjects managed at Children’s Healthcare of Atlanta from August 2014 to December 2019. Clinical, electromyography and nerve conduction study, neuropsychological functional independence (WeeFIM), and nerve transfer data were reviewed.
Results:
Fifteen children (11 boys and 4 girls) mean age 5.1±3.2 years (range 14 months to 12 years) were included. All subjects (n = 15) presented with severe asymmetric motor weakness and absent tendon reflexes. Motor nerve conduction study of the affected limbs in 93% (n = 14) showed absent or markedly reduced amplitude. Ten patients received comprehensive inpatient rehabilitation and neuropsychological evaluation. Admission and discharge WeeFIM scores showed deficits most consistent and pronounced in the domains of self-care and mobility. Multiple nerve transfer surgery was performed on 13 limbs (9 upper and 4 lower extremities) in 6 children. Postsurgery (mean duration of 10.4 ± 5.7 months) follow-up demonstrated improvement on active movement scale (AMS) in 4 subjects.
Conclusion:
Acute flaccid myelitis affects school-age children with asymmetric motor weakness, absent tendon reflexes, and reduced or absent motor amplitude on nerve conduction study. Comprehensive rehabilitation and nerve transfer led to improvement in motor function on neuropsychology WeeFIM and AMS scores.
Abstract
This is an observational cross-sectional study design aimed to assess the feasibility and reliability of the Arabic version of WeeFIM in Egyptian children with healed burns with two ...measurements within a 2-week time period in a sample of 53 patients with healed burns who were aged 3 to 16 years and treated in the outpatient burn clinic, Faculty of Physical Therapy, Cairo University, and Om Elmisryeen Hospital. All patients who met the inclusive criteria were enrolled in the study. The adaptation of the Arabic WeeFIM instrument to an interview format suitable for burned children with communicative and/or cognitive problems and evaluation of its feasibility and reliability. The reliability was assessed by a test-retest procedure. Feasibility was evaluated by the assessment of the frequency of missing answers per item and administration time. The Arabic Index of Content Validity (was used for content validity assessment. The Arabic version of WeeFIM has borderline reliability (Cronbach’s Alpha = 0.619 and Pearson correlation coefficient: r = 0.986). There was an acceptable percent to have a feasible test as 83.963% of the filled questionnaires had no missing answers and the mean of administration time was 7.4 and 5.5 for first and second assessments, respectively. The Index of Content Validity of adapted WeeFIM items showed that all the questions were relevant except for two questions only. The Arabic version of WeeFIM has high test-retest reliability, moderate internal consistency, and excellent feasibility in measuring and reporting the functional independence and burden of care for children with healed burns.
Acute flaccid myelitis (AFM) is a childhood illness characterized by sudden-onset weakness impairing function. The primary goal was to compare the motor recovery patterns of patients with AFM who ...were discharged home or to inpatient rehabilitation. Secondary analyses focused on recovery of respiratory status, nutritional status, and neurogenic bowel and bladder in both cohorts.
Eleven tertiary care centers in the United States performed a retrospective chart review of children with AFM between January 1, 2014, and October 1, 2019. Data included demographics, treatments, and outcomes on admission, discharge, and follow-up visits.
Medical records of 109 children met inclusion criteria; 67 children required inpatient rehabilitation, whereas 42 children were discharged directly home. The median age was 5 years (range 4 months to 17 years), and the median time observed was 417 days (interquartile range = 645 days). Distal upper extremities recovered better than the proximal upper extremities. At acute presentation, children who needed inpatient rehabilitation had significantly higher rates of respiratory support (P < 0.001), nutritional support (P < 0.001), and neurogenic bowel (P = 0.004) and bladder (P = 0.002). At follow-up, those who attended inpatient rehabilitation continued to have higher rates of respiratory support (28% vs 12%, P = 0.043); however, the nutritional status and bowel/bladder function were no longer statistically different.
All children made improvements in strength. Proximal muscles remained weaker than distal muscles in the upper extremities. Children who qualified for inpatient rehabilitation had ongoing respiratory needs at follow-up; however, recovery of nutritional status and bowel/bladder were similar.
To compare functional and seizure outcomes in children with vascular and dysplastic etiologies of cerebral palsy and medically intractable epilepsy following functional hemispherotomy or anatomic ...hemispherectomy.
Consecutive patients satisfying inclusion criteria from 07/01/2015 to 12/01/2019 were reviewed for demographic data and seizure (Engel classification) and functional (Functional Independence Measure for Children) outcomes.
After a mean follow-up of 2 years 8 months (1 year 2 months), 11 of 18 patients achieved post-operative seizure freedom without significant difference between vascular (5/7) and dysplastic (6/11) etiologies (P = 0.64). Functional assessments were completed for 15 of 18 of subjects, split comparably between groups. Mean change in the Functional Independence Measure for Children from pre-operative baseline to inpatient rehabilitation admission (vascular, −35.3 13.2; malformation of cortical development{MCD}, −34.5 25.0; P = 0.69), inpatient rehabilitation admission to discharge (vascular, 18.7 9.0; MCD, 20.8 11.4; P = 0.60), and pre-operative evaluation to clinic follow-up (vascular, −7.6 9.7; MCD, −3.6 19.3; P = 0.61) did not differ between groups.
Quantitative functional and seizure outcomes following functional hemispherotomy or anatomic hemispherectomy did not differ significantly between vascular and dysplastic etiologies of cerebral palsy and medically intractable epilepsy in this study. Hemispheric surgery resulted in minor functional declines from baseline following comprehensive multidisciplinary therapy.
The purpose of this study was to examine the relationship between early mobility (EM) of pediatric patients mechanically ventilated and functional outcomes in rehabilitation using WeeFIM scores, as ...well as hospital length of stay (LOS), ICU LOS, and rehabilitation LOS.
A retrospective chart review of 189 patients was completed to compare those who received EM interventions to those who did not in the ICU. Data extracted from the years 2015-2019 included: all patients who were between zero and 21 years, were mechanically ventilated via endotracheal tube (ETT) for > 48 hours, and then transferred to the comprehensive inpatient rehabilitation unit (IRU).
For respiratory patients, the EM group had higher WeeFIM scores in all categories at admission to IRU compared to the comparison group. Neurosurgery patients had higher cognition and total WeeFIM scores in the EM group at admission to IRU. All diagnoses demonstrated shorter hospital, ICU, and IRU LOS for the comparison group versus the EM group.
EM of mechanically ventilated pediatric patients with a primary respiratory diagnosis demonstrated improved function at admission to IRU compared to those who did not participate in EM. Prospective research needs to be done to examine this relationship further.
PURPOSE: The WeeFIM is a tool commonly used in pediatric rehabilitation settings to measure objective patient progress while receiving comprehensive therapy services on inpatient rehabilitation ...units. This Quality Improvement (QI) project aimed for 95% of inpatients to have complete, on-time documented and displayed WeeFIM scores upon admission and discharge by 12/2017. METHODS: An interdisciplinary team examined historic WeeFIM completion rates. Using Plan-Do-Study-Act cycles, a unified flowsheet was developed in the electronic health record (EHR) to revamp workflow and identify opportunities for improvement, data accuracy, and finally sustainability. Progress was monitored in real time via an automated data visualization tool which monitored score timeliness and completeness. RESULTS: On-time admission completion rates increased from 0% to 95% during the intervention period. On-time discharge completion rates increased from 0% to 89% during the intervention period. This change has been sustained over two years with on-time admission and discharge scores averaging 79.4% and 77.9% respectively, and 96.4% of scores completed. CONCLUSION: Changes in the completion rate of WeeFIMs are sustainable, evidenced by ongoing maintenance of our initial gains over the course of multiple months. The incorporation of WeeFIM documentation into the workflow increased on-time and overall completion rates. The success of this project shows that integrating new tasks into provider workflows helps drive completion.
To examine functional independence at admission as a predictor of outcomes during an initial inpatient hospitalization for a pediatric brain injury.
A total of 531 pediatric inpatients with traumatic ...(n = 298) or nontraumatic (n = 233) brain injuries.
Retrospective analysis of data extracted from the Uniform Data System for Medical Rehabilitation.
The Functional Independence Measure for Children, a measure of self-care, mobility, and cognitive independence.
Logistic regression analyses indicated that children with traumatic brain injury showed greater odds of making large functional gains in comparison with children with nontraumatic brain injury. For both groups, children entering rehabilitation with a moderate level of functional independence had the highest probability of making large gains. Children with a nontraumatic brain injury entering treatment with a high level of functioning made greater gains than those entering with low functioning. The opposite trend emerged for children with traumatic injuries.
Level of functioning at admission may be a useful predictor of progress during an inpatient stay for youth with brain injuries. Children with nontraumatic brain injury entering treatment with low functioning are expected to make slower progress during hospitalization.
Traumatic brain injury (TBI) is a major cause of morbidity and mortality in children; survivors experience long-term cognitive and motor deficits. To date, studies predicting outcome following ...pediatric TBI have primarily focused on acute behavioral responses and proxy measures of injury severity; unsurprisingly, these measures explain very little of the variance following heterogenous injury. In adults, certain acute imaging biomarkers help predict cognitive and motor recovery following moderate to severe TBI. This multi-center, retrospective study, characterizes the day-of-injury computed tomographic (CT) reports of pediatric, adolescent, and young adult patients (2 months to 21 years old) who received inpatient rehabilitation services for TBI (
= 247). The study also determines the prognostic utility of CT findings for cognitive and motor outcomes assessed by the Pediatric Functional Independence Measure, converted to age-appropriate developmental functional quotient (DFQ), at discharge from rehabilitation. Subdural hematomas (66%), contusions (63%), and subarachnoid hemorrhages (59%) were the most common lesions; the majority of subjects had less severe Rotterdam CT scores (88%, ≤ 3). After controlling for age, gender, mechanism of injury, length of acute hospital stay, and admission DFQ in multivariate regression analyses, the highest Rotterdam score (β = -25.2,
< 0.01) and complete cisternal effacement (β = -19.4,
< 0.05) were associated with lower motor DFQ, and intraventricular hemorrhage was associated with lower motor (β = -3.7,
< 0.05) and cognitive DFQ (β = -4.9,
< 0.05). These results suggest that direct detection of intracranial injury provides valuable information to aid in prediction of recovery after pediatric TBI, and needs to be accounted for in future studies of prognosis and intervention.
Purpose: This study was conducted to verify the validity and reliability of the Functional Independence Measure for Children (WeeFIM) for children with cerebral palsy by verifying the construct ...validity, difficulty, suitability, and cultural differences using Rasch analysis. Methods: From May 1, 2015, to February 27, 2020, 105 children with cerebral palsy aged 6 months–95 months (7 years and 11 months old) from Hospital Y located in Korea were included. In WeeFIM, 18 items were divided into 3 areas: Self-care 8 items, Motor 5 items, and Cognition 5 items. Analysis and separation reliability were analyzed. Results: In the Self-care area, the Grooming item and in the Motor area, the Transfer (Tub, Shower) item were judged as inappropriate items, and the order of difficulty was arranged without excluding the unsuitable items. In Self-acre, the most difficult item was Bathing, the easiest items were Eating and Bladder management, and the separation reliability was .87, the most difficult item in Motor was Stair, and the easiest item was Locomotion, and the separation reliability was .99. In Cognition, the most difficult item was Problem Solving, the easiest item was Communication, and the separation reliability was .95. Conclusion: The reliability and validity of WeeFIM was verified for children with cerebral palsy by applying Rasch Analysis. In future research, it is thought that additional research should be conducted by dividing the children by age and type so that they can be generalized.
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