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Form Structure: Functional Independence Measure for Children (WeeFIM)

This form structure is an organized set of data definitions for a copyrighted form
Title:
Functional Independence Measure for Children (WeeFIM)
Short Name:
WeeFIM
Description:
The Functional Independence Measure for Children (WeeFIM) is an 18-item, seven-level ordinal scale instrument used to assess a child's typical and consistent performance.Children 0 to <3 years no WeeFIM (or FIM) is required. Children 3 to <12 years WeeFIM must be used because age norms apply. Children 12 to 18 years as no age norms apply, either the WeeFIM or FIM can be used. Copyright 2003 Uniform Data System for Medical Rehabilitation; Msall, M. E., DiGaudio, K., Duffy, L. C., LaForest, S., Braun, S., & Granger, C. V. (1994). WeeFIM. Normative sample of an instrument for tracking functional independence in children. Clin Pediatr (Phila), 33(7), 431-438. http://cpj.sagepub.com/content/33/7/431.full.pdf
Disease:
Traumatic Brain Injury General (For all diseases)
Organization:
NIH/CIT/BRICS
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Version:
1.0
Date Created:
2016-10-17
Owner:
Number of Data Elements:
62
eForms:
N
Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study. CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

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Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Language form administration ISO code  Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration LangCRFAdministratISOCode Recommended CDE
2 Language form administration ISO code other text  The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text. LangCRFAdministratISOCodeOTH Recommended CDE
3 Context type  The context to which the questions were answered ContextType Recommended CDE
4 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
5 Data source  Source of the data provided on the case report form DataSource Recommended CDE
6 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

WeeFIM Instrument Motor Self Care Assesstment (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wee FIM instrument for children Self-care subscale of Motor domain-Eating scale  Scaled ability of a subject to eat independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfCareEatingScl Recommended CDE
2 Wee FIM instrument for children Self-care subscale of Motor domain-Grooming scale  Scaled ability of a subject to groom independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfCareGroomingScl Recommended CDE
3 Wee FIM instrument for children Self-care subscale of Motor domain-Bathing scale  Scaled ability of a subject to bath independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfCareBathingScl Recommended CDE
4 Wee FIM instrument for children Self-care subscale of Motor domain-Dressing lower body scale  Scaled ability of a subject to dress lower body independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSlfCaDresLowBodScl Recommended CDE
5 Wee FIM instrument for children Self-care subscale of Motor domain-Dressing upper body scale  Scaled ability of a subject to dress upper body independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSlfCaDresUppBodyScl Recommended CDE
6 Wee FIM instrument for children Self-care subscale of Motor domain-Toileting scale  Scaled ability of a subject to toilet independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSlfCaToiletingScl Recommended CDE
7 Wee FIM instrument for children Self-care subscale of Motor domain-Bladder management scale  Scaled ability of a subject control/manage their bladder, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfBladderScl Recommended CDE
8 Wee FIM instrument for children Self-care subscale of Motor domain-Bowel management scale  Scaled ability of a subject control/manage their bowel, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfCareBowelScl Recommended CDE
9 Wee FIM instrument for children Self- care subscale of Motor domain-Total score  Self-care subscore of Motor domain, as part of the WeeFIM instrument for children WeeFIMMotorSelfCareScore Recommended CDE

WeeFIM Instrument Motor Self Care Goal (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wee FIM instrument for children Self-care subscale of Motor domain-Eating scale  Scaled ability of a subject to eat independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfCareEatingScl Recommended CDE
2 Wee FIM instrument for children Self-care subscale of Motor domain-Grooming scale  Scaled ability of a subject to groom independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfCareGroomingScl Recommended CDE
3 Wee FIM instrument for children Self-care subscale of Motor domain-Bathing scale  Scaled ability of a subject to bath independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfCareBathingScl Recommended CDE
4 Wee FIM instrument for children Self-care subscale of Motor domain-Dressing lower body scale  Scaled ability of a subject to dress lower body independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSlfCaDresLowBodScl Recommended CDE
5 Wee FIM instrument for children Self-care subscale of Motor domain-Dressing upper body scale  Scaled ability of a subject to dress upper body independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSlfCaDresUppBodyScl Recommended CDE
6 Wee FIM instrument for children Self-care subscale of Motor domain-Toileting scale  Scaled ability of a subject to toilet independently, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSlfCaToiletingScl Recommended CDE
7 Wee FIM instrument for children Self-care subscale of Motor domain-Bladder management scale  Scaled ability of a subject control/manage their bladder, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfBladderScl Recommended CDE
8 Wee FIM instrument for children Self-care subscale of Motor domain-Bowel management scale  Scaled ability of a subject control/manage their bowel, as part of the self-care subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorSelfCareBowelScl Recommended CDE

WeeFIM Instrument Motor Mobility Assessment (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wee FIM instrument for children Mobility subscale of Motor domain-Chair wheelchair scale  Scaled ability of a subject control/manage their chair/wheelchair, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityChWCScl Recommended CDE
2 Wee FIM instrument for children Mobility subscale of Motor domain-Toilet scale  Scaled ability of a subject to transfer themselves to/from a toilet, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityToiletScl Recommended CDE
3 Wee FIM instrument for children Mobility subscale of Motor domain-Tub shower scale  Scaled ability of a subject to transfer themselves to/from a tub or shower, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityTubShowScl Recommended CDE
4 Wee FIM instrument for children Mobility subscale of Motor domain-Walk wheelchair scale  Scaled ability of a subject to walk or use a wheelchair, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityWlkWCScl Recommended CDE
5 Wee FIM instrument for children Mobility subcale of Motor domain-Walk wheelchair catergory  Category of mobility used by the subject (walk/wheelchair/crawl/combination), as part of the Motor subscale of the WeeFIM instrument for children WeeFIMMotorMobilityWlkWCCat Recommended CDE
6 Wee FIM instrument for children Mobility subscale of Motor domain-Stairs scale  Scaled ability of a subject to use stairs, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityStairsScl Recommended CDE
7 Wee FIM instrument for children Mobility subscale-Score  Mobility subscore of Motor domain, as part of the WeeFIM instrument for children WeeFIMMotorMobilityScore Recommended CDE

WeeFIM Instrument Motor Mobility Goal (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wee FIM instrument for children Mobility subscale of Motor domain-Chair wheelchair scale  Scaled ability of a subject control/manage their chair/wheelchair, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityChWCScl Recommended CDE
2 Wee FIM instrument for children Mobility subscale of Motor domain-Toilet scale  Scaled ability of a subject to transfer themselves to/from a toilet, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityToiletScl Recommended CDE
3 Wee FIM instrument for children Mobility subscale of Motor domain-Tub shower scale  Scaled ability of a subject to transfer themselves to/from a tub or shower, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityTubShowScl Recommended CDE
4 Wee FIM instrument for children Mobility subscale of Motor domain-Walk wheelchair scale  Scaled ability of a subject to walk or use a wheelchair, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityWlkWCScl Recommended CDE
5 Wee FIM instrument for children Mobility subcale of Motor domain-Walk wheelchair catergory  Category of mobility used by the subject (walk/wheelchair/crawl/combination), as part of the Motor subscale of the WeeFIM instrument for children WeeFIMMotorMobilityWlkWCCat Recommended CDE
6 Wee FIM instrument for children Mobility subscale of Motor domain-Stairs scale  Scaled ability of a subject to use stairs, as part of the mobility subscale of Motor domain of the WeeFIM instrument for children WeeFIMMotorMobilityStairsScl Recommended CDE

WeeFIM Instrument Cognition Assessment (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 WeeFIM instrument for children Cognition subscale-Comprehension scale  Scaled ability of a subject to comprehend (auditory/visual/both), as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognCompehensScl Recommended CDE
2 WeeFIM instrument for children Cognition subscale-Comprehension category  Category of usual mode of comprehension (auditory/visual/both), as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognCompehensCat Recommended CDE
3 WeeFIM instrument Cognition subscale-Expression scale  Scaled ability of a subject to comprehend (vocal/nonvocal/both), as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognExpressionScl Recommended CDE
4 WeeFIM instrument for children Cognition subscale-Expression category  Category of usual mode of comprehension (vocal/nonvocal/both), as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognExpressionCat Recommended CDE
5 Wee FIM instrument for children Cognition subscale-Social interaction scale  Scaled ability of a subject to handle social interactions, as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognSocialInterScl Recommended CDE
6 Wee FIM instrument for children Cognition subscale-Problem solving scale  Scaled ability of a subject to handle problem solving, as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognProSolvScl Recommended CDE
7 WeeFIM instrument for children Cognition subscale-Memory scale  Scaled ability of a subject to memorize, as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognMemoryScl Recommended CDE

WeeFIM Instrument Cognition Goal (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 WeeFIM instrument for children Cognition subscale-Comprehension scale  Scaled ability of a subject to comprehend (auditory/visual/both), as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognCompehensScl Recommended CDE
2 WeeFIM instrument for children Cognition subscale-Comprehension category  Category of usual mode of comprehension (auditory/visual/both), as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognCompehensCat Recommended CDE
3 WeeFIM instrument Cognition subscale-Expression scale  Scaled ability of a subject to comprehend (vocal/nonvocal/both), as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognExpressionScl Recommended CDE
4 WeeFIM instrument for children Cognition subscale-Expression category  Category of usual mode of comprehension (vocal/nonvocal/both), as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognExpressionCat Recommended CDE
5 Wee FIM instrument for children Cognition subscale-Social interaction scale  Scaled ability of a subject to handle social interactions, as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognSocialInterScl Recommended CDE
6 Wee FIM instrument for children Cognition subscale-Problem solving scale  Scaled ability of a subject to handle problem solving, as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognProSolvScl Recommended CDE
7 WeeFIM instrument for children Cognition subscale-Memory scale  Scaled ability of a subject to memorize, as part of Cognition subscale of the WeeFIM instrument for children WeeFIMCognMemoryScl Recommended CDE

WeeFIM Instrument Score (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Wee FIM instrument for children-Wee FIM Total Rating Score  Total score for the WeeFIM instrument for children WeeFIMTotalScore Recommended CDE
2 Wee FIM instrument for children-Motor subscore  Motor functions subscore, as part of the Motor subscale of the WeeFIM instrument for children WeeFIMMotorSubScore Recommended CDE
3 Wee FIM instrument for children-Cognition functions score  Cognition functions subscore, as part of the Cognition subscale of the WeeFIM instrument for children WeeFIMCognFunctScore Recommended CDE
Keywords

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