► A prospective cohort study describing functional independence in children with burns. ► 119 Dutch patients (0.5–16 years) were assessed using the WeeFIM® instrument. ► Burns impact children's ...functional independence. ► Six months after injury functional independence is adequate for age in the majority (>90%) of children with burns.
Although the attention for functional outcomes after burn injury has grown over the past decades, little is known about functional independence in performing activities of daily living in children after burn injury. Therefore, in this prospective cohort study functional independence was measured by burn care professionals with the WeeFIM® instrument in 119 pediatric patients with burns (age: 6 months–16 years; 58.8% boys) in the Netherlands. In order to identify whether functional independence was affected, participants’ total scores on the WeeFIM® instrument were compared to American norm values. Of the participants assessed at 2 weeks post burn (n=117), 3 months post burn (n=68) and/or 6 months post burn (n=38), 22, 9 and 9 participants showed affected performance, respectively. Improvements in WeeFIM® total scores for the total study population between 2 weeks and 6 months post burn were significant (Wilcoxon T=2.5; p<.001, effect size=−0.59). Individual improvements were found to be significant for 30.3% of the assessed participants between 2 weeks and 3 months post burn, and for 12.1% between 3 and 6 months post burn. This study is unique in providing data on functional independence for this large and special population. However, a proportion of participants were lost to follow-up and the use of the WeeFIM® instrument in this specific population and setting has its limitations. To conclude, burn injury impacts functional independence in children, yet the vast majority of Dutch pediatric patients with burns returns to functional independence typical for age within 6 months post burn.
In pediatric acquired brain injury, heterogeneity of functional response to specific rehabilitation treatments is a key confound to medical decisions and outcome prediction. We aimed to identify ...patient subgroups sharing comparable trajectories, and to implement a method for the early prediction of the long-term recovery course from clinical condition at first discharge. 600 consecutive patients with acquired brain injury (7.4 years ± 5.2; 367 males; median GCS = 6) entered a standardized rehabilitation program. Functional Independent Measure scores were measured yearly, until year 7. We classified the functional trajectories in clusters, through a latent class model. We performed single-subject prediction of trajectory membership in cases unseen during model fitting. Four trajectory types were identified (post.prob. > 0.95): high-start fast (N = 92), low-start fast (N = 168), slow (N = 130) and non-responders (N = 210). Fast responders were older (chigh = 1.8; clow = 1.1) than non-responders and suffered shorter coma (chigh = −14.7; clow = −4.3). High-start fast-responders had shorter length of stay (c = −1.6), and slow responders had lower incidence of epilepsy (c = −1.4), than non-responders (p < 0.001). Single-subject trajectory could be predicted with high accuracy at first discharge (accuracy = 0.80). In conclusion, we stratified patients based on the evolution of their response to a specific treatment program. Data at first discharge predicted the response over 7 years. This method enables early detection of the slow responders, who show poor post-acute functional gains, but achieve recovery comparable to fast responders by year 7. Further external validation in other rehabilitation programs is warranted.
Osteogenesis imperfecta (OI) is a group of rare genetic disorders that affect bone formation. Patients with OI present mainly with increased bone fragility and bone deformities. Twenty-seven ...Taiwanese children between 2 and 21 years of age with OI and their parents were recruited at MacKay Memorial Hospital from January 2013 to December 2019. We used the Functional Independence Measure for Children (WeeFIM) questionnaire to assess the functional independence of the children and describe any functional limitations or additional burden of daily care. Out of a potential score of 126, the mean total WeeFIM score was 113.7. There was a statistically significant difference between the scores of type I, type III and type IV OI (121.88 SD 7.01 vs. 80.8 SD 26.25 vs. 119.17 SD 10.89; p < 0.001). There were no statistically significant differences between the scores in different age groups, the male and female participants, and patients with pathogenic variants in COL1A1 and COL1A2. The mean scores for the self-care, mobility, and cognition domains were 48.78 (maximum 56, mean quotient 91.14%), 30.44 (maximum 35, mean quotient 87.12%), and 34.44 (maximum 35, mean quotient 99.05%), respectively. The best performance was in the cognition domain (mean quotient 99.05%), and the worst was in the mobility domain (mean quotient 87.12%). There were no statistically significant correlations between WeeFIM scores and age, or age when symptoms began. The total WeeFIM score and 13 subscores for the self-care and mobility domains were all positively correlated with body height (p < 0.01). The correlation was lowest for bowel and walking/wheelchair tasks, and the highest for bathing and dressing-upper tasks. For tasks in bathing, over 40% of the patients needed help. For tasks in the cognition domain, most patients required no help. For the Taiwanese children with OI, some support and supervision were required for self-care and mobility tasks, and the functional independence in these two domains was correlated with body height and disease types. The WeeFIM questionnaire may be a useful tool to assess the functional strengths and weaknesses of children with OI.
To describe the medical complexity of traumatic spinal cord injury (TSCI) in paediatric patients in Western Australia (WA). Secondly, to determine if Princess Margaret Hospital (PMH) for Children ...(the tertiary paediatric centre in WA where all TSCI patients are managed) is meeting the requirements of the Australasian Rehabilitation Outcomes Centre (AROC) paediatric rehabilitation minimum data set gathered on each patient.
Retrospective cohort study of patients seen at PMH between 1996-2016. The AROC minimum dataset information data were gathered on each patient. Functional status and rehabilitation outcomes were assessed using Functional Independence Measure for Children (weeFIM), Canadian Occupational Performance Measure (COPM), and Goal Attainment Scaling (GAS). Patient complexity was captured by documenting the specialty teams involved, the number of readmissions, and the International Statistical Classification of Disease and Related Health Problems Z codes.
Data from 19 patients (13 males, age range 6 months-15 years; 6 females, age range 4 years-13 years) were available. There were 10 cervical TSCIs with a median length of stay of 213 days and 9 thoracic TSCIs with a median length of stay of 49 days. Patients had between zero and six comorbidities prior to their TSCI.
Children with medical complexity are responsive to rehabilitation but have a high burden of care, requiring multiple-specialty care and hospital re-admissions. AROC has set a minimum data set recommendation for the collection and examination of patient data. PMH meets the AROC guidelines for patient data collection and descriptive analyses.
Primary objective and hypothesis: To test the hypothesis that there is a significant relationship between WeeFIM ratings of cognitive functioning and performance on neuropsychological tests of ...children with traumatic brain injury (TBI).
Design: Retrospective analysis of archival data.
Participants: Data from 52 children with severe TBI collected during inpatient rehabilitation.
Main outcome measures: Multiple regression analysis with Neuropsychological test scores from Wechsler Abbreviated Scale of Intelligence (WASI) and Children's Memory Scale (CMS) entered as predictor variables and WeeFIM cognitive ratings as criteria variables.
Results: Analyses revealed significant relationships between WeeFIM cognitive rating and neuropsychological test scores. Delayed verbal memory was most highly associated with WeeFIM cognitive ratings.
Conclusions: Results support the hypothesis of significant relationships between neuropsychological performance and WeeFIM ratings of children with TBI and support generalizability of neuropsychological performance to daily cognitive functioning.
Purpose: Determining the psychometric properties such as reliability and validity of Functional Independence Measure for Children (WeeFIM) instrument would help health professionals to understand the ...comprehensive assessment of children with spastic cerebral palsy (CP). The purpose of this study was to investigate the factor structure of the WeeFIM in children with spastic CP. Methods: Two hundred seven children (138 boys, 69 girls) with spastic CP were recruited in this cross-sectional study; their mean age (SD) was 9.10 (2.7) years. Data were collected through a questionnaire that included the WeeFIM. Of the 207 children, 57 (27%), 105 (51%), and 45 (22%) were quadriplegic, diplegic, and hemiplegic, respectively. In each of these groups, 49 (24%), 32 (15%), 31 (15%), 19 (9%), and 76 (37%) children were classified as Gross Motor Function Classification System (GMFCS) levels I-V, respectively. The factor structure of the WeeFIM was analyzed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) by using AMOS 20.0. The reliability of WeeFIM was assessed by calculating the internal consistency of Cronbach's α. Results: The internal consistency of Cronbach's α was 0.98. The 1- and 2-factor models did not demonstrate adequate fit indices according to CFA. However, the 3-factor structure (i.e. self-care, motor, and cognitive factors) was supported by EFA and CFA, which explained 87.12% of the variance. The self-care factor included 6 items (eating, grooming, dressing upper, dressing lower, bathing, and toileting), the motor factor included 7 items (bladder and bowel management, bed/chair/wheelchair, toilet, tub/shower, walk/wheelchair, and stairs), and the cognitive factor included the same 5 items as the original cognitive domain. Conclusion: In children with spastic CP, 3 factors of the WeeFIM were determined by factor analysis. Therefore, self-care, motor, and cognitive domains should be treated as separate scales in children with spastic CP.
Implications for Rehabilitation
The reliability and validity of the 3-factor WeeFIM were confirmed with spastic CP.
Findings suggest that the WeeFIM should not be used as an overall summary score of activity daily living in children with spastic CP.
It is recommended that those working in the field of rehabilitation assess self-care, motor, and cognitive domains separately and develop an appropriate intervention programs for each domain.
Background: Rehabilitation in children with acquired brain injury is a challenging endeavour. There is a large variability in motor recovery between patients, and a need to optimize therapies by ...exploiting cerebral plasticity and recovery mechanisms. This retrospective study aims to identify tract-based markers that could serve as predictors of functional outcome following rehabilitation. Methods: Twenty-nine children with traumatic brain injury (
n
= 14) or stroke (
n
= 15) underwent a 3 T Magnetic Resonance Imaging (MRI) measurement, including Diffusion Tensor Imaging (DTI) between admission to the Hospital and onset of rehabilitation therapy at the Rehabilitation Centre. The Functional Independence Measure for Children (WeeFIM) was routinely applied at admission and discharge from the Rehabilitation Centre. Distinguishing between children with good versus poor functional independence was performed using ROC-analysis. A non-parametric partial correlation analysis between the DTI and WeeFIM motor scores was performed with age, time in rehabilitation, and time of MRI scan after injury as covariates. Results: Mean fractional anisotropy (FA) from the DTI in the ipsilesional corticospinal-tract provided the highest predictive accuracy (sensitivity = 95 %, specificity = 78 %, Youden Index = 0.73, Area under the curve = 0.9), in comparison to the lesion volume or other clinical variables. Mean FA of the ipsilesional corticospinal-tract correlated positively with the WeeFIM discharge motor scores (ρ = 0.547,
p
= 0.004). Prediction was poorer for the lesion volume or Glasgow Coma Scale. Conclusion: The results suggest that DTI data could improve the prediction of functional outcome after rehabilitation in children and adolescents with stroke or traumatic brain injury. Specifically, mean FA shows the highest predictive accuracy in comparison to lesion volume or clinical scales.
The WeeFIM is an outcome measure used worldwide to evaluate the functional abilities of children. The aim of this study was to evaluate the psychometric properties of WeeFIM in Korean children with ...cerebral palsy (CP) using the Rasch model. The mean age of the participants (92 boys and 53 girls) was 10.6 years (SD=2.3, range 5~15 years). The Winsteps software was used for analyzing the internal constrict validity and reliability of WeeFIM. For analyzing the internal validity the motor and cognitive area items of the WeeFIM were analyzed both together and separately. When all 18 items were analyzed, 4 were considered to be misfits; upper extremity dressing, lower extremity dressing, toileting, and comprehension. When only the 13 motor items were analyzed, toileting, bladder management, and bowel management were considered misfits. In addition, only comprehension was considered as a misfit among the 5 cognitive items. The most difficult motor items were stair climbing, and bathing. The simple ones were eating, bowel management, and bladder management. The most difficult cognitive item was problem solving, and the simplest one was comprehension. The person separation indexes and reliability for combined and divided instruments were reported as excellent. These results demonstrated the applicability of WeeFIM to Korean CP children with satisfactory reliability and validity. Further studies should include young children with CP and compare item difficulty among the different types of CP. In addition, the Korean normative data of nondisabled children should be used to compare the cultural differences between Korea and other countries.
Background
Information on functional strengths and weaknesses of mucopolysaccharidosis (MPS) patients is important for early intervention programs and enzyme replacement therapy (ERT).
Methods
We ...used the Functional Independence Measure for Children (WeeFIM) questionnaire to assess the functional skills of 63 Taiwanese MPS patients (median age, 13 years 3 months; range, 3–20 years) from January 2012 to December 2018.
Results
Mean total WeeFIM score was 75.4 of a potential score of 126. Mean total WeeFIM scores of each type (MPS I, MPS II, MPS IIIB, MPS IVA, and MPS VI) were 103.8, 76.2, 41.6, 92.2, and 113.6, respectively. Mean scores for self‐care, mobility, and cognition domains were 30 (maximum 56), 23 (maximum 35), and 22 (maximum 35), respectively. MPS type IIIB patients had the lowest scores in self‐care, mobility, cognition, and total domains compared to other types of MPS. All patients with ERT in MPS I, II, and IVA had higher scores in self‐care and mobility domains than patients without ERT. Most patients required assistance for self‐care skills, especially in grooming and bathing.
Conclusion
MPS patients require support and supervision in self‐care tasks. For cognition tasks, MPS IIIB patients also require help. This questionnaire is useful to identify the strengths and limitations of MPS patients.
Mucopolysaccharidosis (MPS) patients require support and supervision in self‐care tasks. For cognition tasks, MPS IIIB patients also require help. WeeFIM questionnaire is useful to identify the strengths and limitations of MPS patients.
Objective
To study preschool functional status in children following fetal myelomeningocele (fMMC) surgery.
Material and methods
Prior to the NICHD-MOMS trial, 30 fMMC underwent standardized ...neurodevelopmental examination at 5 years of age. Functional status was determined with the Functional Independence Measure (WeeFIM), which assesses self-care, mobility, and cognitive independence.
Results
Evaluations were completed in 26 (87%). Mean cognitive (93.0 ± 21.9), self-care (66.5 ± 23.9), mobility (82.3 ± 19.5), and total (77.9 ± 20.3) functional quotient of fMMC children were significantly lower than age-matched population norms (
P
< 0.01). Complete caregiver independence was achieved by 22 (84%), 10 (38%), 16 (62%), and 15 (58%) fMMC children for cognition, self-care, mobility, and total functional outcome, respectively. Cognitive, mobility, and total independence were higher in non-shunted than shunted fMMC children (
P
= 0.02,
P
= 0.02, and
P
< 0.01, respectively) and in fMMC children with average neurodevelopmental scores (
P
< 0.001,
P
= 0.01, and
P
< 0.01, respectively). Self-care independence tended to be higher in the non-shunted group and in fMMC children with normal neurodevelopmental outcome (
P
= 0.07 and
P
= 0.09, respectively).
Conclusion
The majority of fMMC children achieved cognitive and mobility independence, but continue to require significant assistance in self-care. Non-shunted and fMMC children with normal neurodevelopmental outcome were more likely to be independent in daily living activities. Better understanding of the extent of functional limitations following fMMC surgery will allow for more effective early interventions geared toward maximizing independence in everyday tasks in all environments.
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