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WeeFIM Score Sheet

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Ghea Mae Villas
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255 views3 pages

WeeFIM Score Sheet

Uploaded by

Ghea Mae Villas
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Name: Date of birth: / / Age: months

Date of assessment: *Use norms overleaf for children 3 to 8 yrs.

Method of administration: Direct observation Interview with:

Area Score Age Explain reasons for giving this score


norm

1.Eating

2.Grooming

3.Bathing

4.Dressing– Upper
Body

5.Dressing– Lower
Body

6.Toileting

7.Bladder
management

8.Bowel management

Self-care subtotal
9.Transfers: Mode: W– Walk C- Wheelchair B- Both
Chair/Wheelchair

10.Transfers:
Toilet

11.Transfers:
Tub/Shower

12. Locomotion: Mode: W – Walk C-


Walk/ Wheelchair L- Crawl
Wheelchair/Crawl B- Both
13.Locomotion: Stairs

Mobility subtotal
Area Score Age Explain reasons for giving this score
norm

14.Comprehension Mode: A – Auditory V - Visual C - Both

15.Expression Mode: V – Vocal N - Non-vocal B - Both

16.Social interaction

17.Problem solving

18.Memory

Cognition subtotal
WeeFIM® TOTAL

Administered by: WeeFIM® credentialed: Yes No


Signature: Date of assessment:
WeeFIM® norms for children 3 to 8 years

Apply to ages
(months) 36>39 39>42 42>45 45>48 48>51 51>54 54>57 57>60 60>63 63>66 66>69 69>72 72>75 75>78
Norm for age
(months) 36 39 42 45 48 51 54 57 60 63 66 69 72 75

1 Eating 5 5 6 6 6 6 6 6 6 6 6 7 7 7
2 Grooming 3 4 4 4 5 5 5 5 5 5 6 6 6 6
3 Bathing 3 3 4 4 4 4 5 5 5 5 6 6 6 6
4 Dressing Upper 4 4 4 5 5 5 5 5 6 6 6 6 6 6
5 Dressing Lower 4 4 4 4 5 5 5 5 5 6 6 6 6 6
6 Toileting 4 5 5 5 5 5 5 6 6 6 6 6 6 7
7 Bladder 5 5 5 5 5 6 6 6 6 6 6 6 7 7
8 Bowel 6 6 6 6 6 6 6 7 7 7 7 7 7 7
Self Care Total 34 36 38 39 41 42 43 45 46 47 49 50 51 52

9 Bed, Chair,
Wheelchair 7 7 7 7 7 7 7 7 7 7 7 7 7 7
10 Toilet 6 6 6 6 6 6 7 7 7 7 7 7 7 7
11 Tub, Shower 5 5 5 6 6 6 6 6 6 6 6 7 7 7
12
Walk/Wheelchair 6 6 6 6 6 7 7 7 7 7 7 7 7 7
13 Stairs 5 6 6 6 6 6 6 6 7 7 7 7 7 7
Mobility Total 29 30 30 31 31 32 33 33 34 34 34 35 35 35

14 Comprehension 5 5 5 5 5 6 6 6 6 6 7 7 7 7
15 Expression 6 7 7 7 7 7 7 7 7 7 7 7 7 7
16 Social
Interaction 3 3 4 4 4 4 4 5 5 5 5 5 5 5
17 Problem Solving 5 5 5 5 6 6 6 6 6 7 7 7 7 7
18 Memory 5 5 5 5 5 5 6 6 6 6 6 6 7 7

Cognition Total 24 25 26 26 27 28 29 30 30 31 32 32 33 33

Motor Total 63 66 68 70 72 74 76 78 80 81 83 85 86 87
Cognitive Total 24 25 26 26 27 28 29 30 30 31 32 32 33 33
Total 87 91 94 96 99 102 105 108 110 112 115 117 119 120

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