Objective To study the correlation between caries experience in individuals with cerebral palsy (CP) and the quality of life of their primary caregivers.
Materials and methods Sixty‐five ...non‐institutionalized individuals, presenting CP, aged 2–21 years old, were evaluated for caries experience. Their respective caregivers aged 20–74 years old answered the Short Form 36 (SF‐36) health survey and Independence Measure for Children. Fifty‐eight non‐disabled individuals (ND group), aged 2–21 years old, and their respective caregivers, aged 25–56 years old, were submitted to the same evaluation process as the CP group.
Results Primary caregivers of CP individuals exhibited significantly lower scores than the ND group in all subscales of the SF‐36 health survey questionnaire: physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role and mental health. The CP group presented significantly higher values for the Decayed, Missed and Filled (DMF‐T) index than the ND group and a significant negative correlation was obtained between the SF‐36 and DMF‐T index.
Conclusion The results suggest that caregivers of CP individuals exhibited worse quality of life than those of the non‐disabled. A negative correlation exists between caries experience of CP individuals and their caregivers' quality of life.
Objetivo: Describir los cambios en la independencia y la movilidad funcional en una muestra de niños y niñas con secuelas neurológicas secundarias a accidente cerebrovascular subagudo.
Materiales y ...Métodos: Estudio observacional, descriptivo, retrospectivo y longitudinal. Se incluyeron aquellos pacientes de 4 a 18 años, con diagnóstico de ACV subagudo, internados en un Centro de Rehabilitación, entre el 1/02/2005 y el 28/02/2023. Los datos de funcionalidad fueron evaluados al ingreso y egreso con la Escala de Independencia Funcional en Niños (WeeFIM) y la Escala de Movilidad Funcional (FMS).
Resultados: Se analizaron 37 pacientes de los cuales 17 (45,9%) presentaban ACV secundario a malformación arteriovenosa. Al comparar el puntaje del FMS entre el ingreso y egreso las diferencias resultaron estadísticamente significativas en las 3 distancias evaluadas (p<0,001). La mediana del puntaje de la escala WeeFIM fue de 46 (RIQ 36 - 55) al ingreso y de 86 (RIQ 74 - 95) al egreso mediana de cambio 32,5 (RIQ 19 - 46) puntos; p<0,001.
Conclusión: En esta muestra de niños con ACV subagudo se observaron cambios favorables en el porcentaje de independencia funcional y en la adquisición de la marcha independiente en distancias cortas, medias y largas.
BACKGROUNDPatients with arthrogryposis often report decreased ambulation and physical activity. Given that skeletal mineralisation is responsive to force, we identified the need to characterize bone ...mineral density and functional measures in this population, and conducted a cross-sectional study to establish a reference for future investigations.
METHODSThirty consecutive patients aged 5 to 18 years with either the diagnosis of amyoplasia or nonsyndromic arthrogryposis with predominantly lower extremity involvement underwent bone densitometry testing, and lumbar spine Z-scores were calculated against an age and sex-matched control population as is customary in children. Pediatric outcomes data collection instrument (PODCI) and functional independence measure for Children (WeeFIM) assessment forms were completed. Mean Z-scores, PODCI, and WeeFIM scores were calculated. Statistical analysis was performed to compare lumbar spine Z-scores between patients divided by ambulatory status and to correlate WeeFIM and PODCI scores.
RESULTSMean lumbar spine Z-score was −0.47, with 73% of Z-scores being <0. Mean Z-score among nonambulators or home ambulators was −1.05, as compared to a mean Z-score among limited and unlimited community ambulators of −0.14 with a trend toward significance (P=0.10), and a dose-response relationship between higher bone density and increasing ambulatory function. Mean WeeFIM self-care and mobility quotient scores were 67.5/100 and 70.9/100, respectively. PODCI normative scores were decreased for upper extremity (10/50), transfer/basic mobility (−17/50), and sports/physical function (4/50), but normal in pain/comfort (45/50) and happiness (49/50). A linear relationship was noted between functional ambulation level and WeeFIM quotient and PODCI normative scores. There was good correlation between WeeFIM mobility and PODCI transfers and basic mobility standardised scores (R=0.86).
CONCLUSIONSThis is the first study to measure bone mineral density in children with arthrogryposis, and shows it to be lower than age-matched means, especially in patients with limited ambulation. Objective measures of functional ability (WeeFIM and PODCI) are decreased and demonstrate a linear relationship with ambulatory level. Further investigation is needed to quantify long-term effects of entering adulthood with below average bone mineral density in patients with arthrogryposis.
LEVEL OF EVIDENCELevel II.
To evaluate the WeeFIM instrument's reliability and internal construct validity for the Turkish child population.
License was taken from UDSmr to use the WeeFIM instrument. For the reliability and ...validity studies of the Turkish translation of the WeeFIM instrument, 573 Turkish nondisabled children were included in the study. The reliability of the instrument was assessed by Cronbach's alpha coefficient, intraclass correlation coefficient (ICC), and test-retest reliability. Internal construct validity was assessed by both using Rasch unidimensional measurement model and testing for differential item functioning for age and gender.
Cronbach alpha value was 0.99 for motor WeeFIM rating and 0.99 for cognitive WeeFIM rating. ICC was 0.81 for motor WeeFIM rating and 0.92 for cognitive WeeFIM rating. The internal construct validity of the Turkish translation of the WeeFIM instrument was confirmed by excellent fit to the Rasch measurement model. Two subscales were found from the principal component analysis of standardized residual correlation for items. Among the items, bowel management, bladder management, eating, and comprehension showed considerable levels of misfit.
The Turkish translation of the WeeFIM instrument is valid, reliable, and practical for the Turkish child population. Further studies are required to determine the cross-cultural validity of the instrument.
A depth of lesion (DOL) model using brain imaging has been proposed to aid in medical decision-making and planning for rehabilitation resource needs. The purpose of this study was to determine the ...early prognostic value of a DOL classification system for children and young adults following severe traumatic brain injury.
CT/MRI brain imaging studies on 92 patients, aged 3 to 21, admitted to the Kluge Children's Rehabilitation Center, University of Virginia, were evaluated to determine DOL. Images were classified according to 5 DOL levels (cortical to brainstem). Functional outcomes in mobility, self-care, and cognition, as rated on the WeeFIM instrument, were compared by DOL levels.
Admission WeeFIM scores were significantly different for the DOL levels with the highest score for frontal and/or temporal lesions and the lowest for lesions including the brainstem or cerebellum (P<.001). However, the deeper the lesion, the greater the functional gains (P=.05), resulting in discharge WeeFIM scores that were not significantly different across DOL levels. Patients with deeper lesions tended to have longer lengths of stay in rehabilitation but were able to "catch up" with patients who had more superficial lesions.
While relatively simple and convenient, the DOL classification system is limited in its usefulness as an early prognostic tool. It may not be possible to predict outcome in the early acute phase in the intensive care unit on the basis of standard brain imaging alone. Patients with deeper lesions may enter rehabilitation at a more impaired level but can make remarkable progress, though it may take longer than for less severely injured individuals.
The Functional Independence Measure for Children (WeeFIM) is a simple-to-administer scale for assessing functional independence across 3 domains (self-care, mobility, cognition) in children. There ...are normative data from America and Japan. In 2001 to 2002, the authors created a normative Chinese WeeFIM profile and compared this with the American one. In this study, they aimed to compare their Chinese normative data with the Japanese one. Methods. A random sampling of 445 normal Chinese children from different social classes in Hong Kong was conducted in the community. It was conducted via face-to-face interviews with the mother, and a normative database was created. Results. Similar to the Japanese children, the WeeFIM total score and 3 main domain subscores (self-care, mobility, and cognition) increased progressively with age. In the self-care domain, Chinese children achieved modified independence or level 6 earlier in all items except toileting. For the mobility domain, the item chair transfer was achieved earlier in the Chinese children, whereas toilet transfer, stair, tub transfer, and locomotion were achieved later in Chinese children. As for cognition domain, the item problem solving was achieved earlier but comprehension, social interaction, and memory were achieved later in the Chinese children. The authors’ results showed the same pattern of increasing WeeFIM score with increasing chronological age, which is similar to the Japanese children. There are 3 patterns of WeeFIM score achievement in this Chinese cohort. As for the Japanese children, the 3 patterns of WeeFIM score achievement from independent to dependent are 1) rapid change, 2) gradual change, and 3) linear change. Conclusions. WeeFIM is a validated standardized tool for assessing the outcome of rehabilitation programs. It should be widely used to assess rehabilitative achievement in children from different ethnic origins. The authors’ previous study and this current study demonstrated that the authors’ normative WeeFIM profile showed similar results to the American and Japanese children. However, there are minor differences in the WeeFIM scoring in the 3 main domains, which might be due to cultural differences between ethnic groups. Thus, usage of the WeeFIM with a different age criteria in achieving independence according to local culture should be adopted.
Introduction: Burns create a myriad of complications that affect the child's developmental, functional and aesthetic status. The WeeFIM is a standardized measure of functional performance developed ...for use in children 6-months to 8-years of age but with application through adolescence. It includes 18 domains of performance which are scored on a 7-point scale from 'total assistance' to 'complete independence'. In this study, the WeeFIM was used to evaluate the influence of burn size on functional independence and on time to recovery.
Methods: Children, 6 months to 16 years of age, with total body surface area (TBSA) burns of 10-100% burn injury were recruited for a 2-year longitudinal study. Due to unstable WeeFIM measurements on children 6 months to 6 years, analyses on normalized WeeFIM scores among subjects 6-16 years are presented. Children were evaluated at discharge from acute care, 6 months, 1 year and 2 years after burn injury.
Findings: In this analysis, 454 WeeFIM evaluations from 249 patients, 6-16 years of age, were reviewed. While mean WeeFIM scores varied significantly at discharge based on the size of burn, there were no significant differences in any of the WeeFIM scales at 24 months post-burn. At 24 months, the mean WeeFIM score for all children, independent of size of their burn, indicated full independence. Hands-on assistance was not required for performing activities of daily living (ADLs). The rates of improvement differed statistically by size of burn. Maximum improvement was attained by 6 months for 10-15% TBSA burns, 12 months for 16-30% burns, 12 months for 31-50% burns and 24 months for 51-100% TBSA.
Conclusion: The WeeFIM can be utilized by burn centres to describe diminished functional capacity at discharge from acute care for severely burnt children. The tool can be used to track return to baseline independence after a major burn injury in a paediatric population.
Introducción: Las quemaduras crean una serie de complicaciones que afectan al niño en su desarrollo, en su función y en su apariencia. La WeeFIM es una medición estandarizada del desempeño funcional, desarrollada para ser usada en niños con edades de 6 meses a 8 años, pero que también puede aplicarse a lo largo de la adolescencia. Incluye 18 dominios de desempeño que son calificados en una escala de 7 puntos que abarca desde una "asistencia total" hasta una "independencia completa". En este estudio, la WeeFIM fue usada para evaluar la influencia del tamaño de la quemadura sobre la independencia funcional y sobre el tiempo de recuperación. Métodos: Se incluyeron a niños con edades en el rango de los seis meses a los 16 años, con una lesión por quemadura del 10 al 100% de quemaduras de área de superficie corporal total (TBSA), en un estudio longitudinal de dos años. Debido a las mediciones de WeeFIM inestables en los niños de 6 meses a 6 años de edad, se presenta el análisis de las calificaciones WeeFIM normales entre sujetos de 6 años a 16 años. Los niños fueron evaluados a su egreso del manejo agudo, a los seis meses, al año y a los dos años después de la lesión por quemaduras. Resultados: En este análisis, se revisaron 454 evaluaciones WeeFIM de 249 pacientes, con edades de 6 a 16 años. Las calificaciones promedio WeeFIM variaron significativamente al egreso en base al tamaño de la quemadura y no hubo diferencias significativas en ninguna de las escalas WeeFIM a los 24 meses después de la quemdura. A los 24 meses la calificación promedio WeeFIM para todos los niños, independientemente del tamaño de su quemadura, indicó una completa independencia. No fue requerida asistencia alguna para desarrollar las actividades de la vida diaria (ADL's). Las tazas de mejoría difirieron estadísticamente de acuerdo al tamaño de la quemadura. Se obtuvo una mejoría máxima a los 6 meses para quemaduras con una TBSA de 10-15%, a los 12 meses para quemaduras con un 16 a 30%, a los 12 meses para quemaduras con un 31 a 50%, y a los 24 meses para quemaduras con una TBSA de 51 a 100%. Concluiones: La WeeFIM puede utilizarse en los centros para el manejo de quemaduras con el propósito de describir la disminución en la capacidad funcional al egreso del manejo agudo en niños con quemaduras severas. El instrumento puede ser usado para realizar el seguimiento del paciente hacia su independencia, después de una lesión mayor por quemadura en la población pediátrica. Palabras clave: WeeFIM, quemaduras pediátricas, independancia, resultados, QOL, actividades de la vida diaria
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
Objective: To field test, in questionnaire format, the Functional Independence Measure for Children (WeeFIM, a schedule usually administered by interview) on parents of a cohort of school‐aged ...children with Down syndrome.
Methods: The parents of 211 Western Australian children with Down syndrome participated in the present study, representing 79.9% of all children with Down syndrome in the State. Subjects were identified using two sources: (i) the Birth Defects Registry; and (ii) the Disability Services Commission.
Results: The total WeeFIM score was 106.2 ± 17.0 (mean ±
SD) out of a possible 126. Girls scored higher than boys (108.6 vs 103.6;
P = 0.05). Scores increased across all age groups (P < 0.0001), even relative to normative data. Performance was strongest in the transfer and locomotion domains and weakest in social cognition.
Conclusion: We found that severe functional limitations are rare in school‐aged children with Down syndrome. Some support and supervision are required for complex self‐care, communication and social skill tasks. This study demonstrates the feasibility of using the WeeFIM for collecting population survey data in children with developmental disability. This may be useful for the longitudinal tracking of such populations, as well as the monitoring of response to interventions.
PURPOSE:Although frequently used in pediatric rehabilitation settings, the WeeFIM has not been tested in surgical pediatric orthopaedic patients.
METHODS:The WeeFIM was administered to patients with ...surgical cerebral palsy at defined intervals preoperatively and at both 6 and 12 months postoperatively. The age-adjusted change scores from baseline to follow-up were tested both parametrically and nonparametrically.
RESULTS:Four hundred sixty-eight patients had baseline evaluations. There were 161 six-month follow-up assessments and 108 twelve-month follow-up assessments. The baseline WeeFIM was able to separate children with different patterns of cerebral palsy. Hemiplegic patients had higher scores than diplegic and tetraplegic patients. Overall age-adjusted scores were improved at both 6 (mean increase 2.0) and 12 months (mean increase 2.2). The instrument showed significant ceiling effects for diplegic and hemiplegic patients with lower or upper extremity surgery and limited responsiveness for lower extremity surgery in tetraplegic patients. Parametrically, it showed improvements in mobility for both rhizotomy and tetraplegic upper extremity surgery. Nonparametric tests were not significant for rhizotomy mobility improvement.
CONCLUSIONS:Although the WeeFIM adequately reflects the severity of neurological involvement in pediatric orthopaedic patients with cerebral palsy, it has a significant ceiling effect in diplegic and hemiplegic patients limiting responsiveness and lacks content validity for tetraplegic patients. The instrument may have some use in tetraplegic patients with upper extremity surgery and in rhizotomy patients. We recommend against its general use for orthopaedic surgery in patients with cerebral palsy lower extremity or spine surgery and in hemiplegic patients with upper extremity surgery.
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