WeeFIM score sheet

Name:

Date of birth:

Age:
months
Date of assessment:
children 3 to 8 yrs.
Hospital/unit:
Method

of

administration:

* Injury:
TBI
SCI or blindness)
Area

Age
norm

*Use norms overleaf for

Direct

Multiple amputations
Score

observation

Interview

with:

Burns (Note WeeFIM is not required for

Explain reasons for giving this score

*Due to
injury?

SELF CARE
1.Eating

Yes
No

2.Grooming

Yes
No

3.Bathing

Yes
No

4.Dressing
Upper

Yes
No

5.Dressing
Lower

Yes
No

6.Toileting

Yes
No

7.Bladder
management

Yes
No

8.Bowel
management

Yes
No

Self care total

MOBILITY
9.Transfers:
Chair/Wheelch
air

Yes
No

WeeFIM score sheet

Area

Score

Age
norm

Explain reasons for giving this score

*Due to
injury?

10.Transfers:
Toilet

Yes
No

11.Transfers:
Tub/Shower

Yes
No

12.Locomotion
:
Walk/
Wheelchair/Cr
awl
13.Locomotion
: Stairs

Yes
No

Yes
No

Mobility total
COMMUNICATION
14.Comprehen
sion

Yes
No

15.Expression

Yes
No

SOCIAL COGNITION
16.Social
interaction

Yes
No

17.Problem
solving

Yes
No

18.Memory

Yes
No

Cognition
total
WeeFIM
total

WeeFIM score sheet

Administered by:
No
Signature:

WeeFIM credentialed:

Yes

Date of assessment:

WeeFIM LEVELS
NO HELPER
7 Complete Independence (Timely, Safely)
6 Modified Independence (Device)
HELPER Modified Dependence
5 Supervision
4 Minimal assistance (subject = 75% or more)
3 Moderate assistance (subject = 50% or more)
Helper Complete Dependence
2 Maximal assistance (subject = 25% - 49%)
1 Total assistance (subject = 0% - 24%)
Contact details for queries about eligibility to the Lifetime Care and Support
Scheme:
Lifetime Care and Support Authority: http://www.lifetimecare.nsw.gov.au
Phone: 1300 738 586
Fax: 1300 738 583 Email: enquiries@lifetimecare.nsw.gov.au

WeeFIM norms for children 3 to 8 years

Apply to ages
(months)
Norm for age
(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

78>81

81>84

84>87

87>90

90>93

93>96

36

39

42

45

48

51

54

57

60

63

66

69

72

75

78

81

84

87

90

93

5
3
3
4
4
4
5
6
34

5
4
3
4
4
5
5
6
36

6
4
4
4
4
5
5
6
38

6
4
4
5
4
5
5
6
39

6
5
4
5
5
5
5
6
41

6
5
4
5
5
5
6
6
42

6
5
5
5
5
5
6
6
43

6
5
5
5
5
6
6
7
45

6
5
5
6
5
6
6
7
46

6
5
5
6
6
6
6
7
47

6
6
6
6
6
6
6
7
49

7
6
6
6
6
6
6
7
50

7
6
6
6
6
6
7
7
51

7
6
6
6
6
7
7
7
52

7
6
6
7
7
7
7
7
54

7
7
6
7
7
7
7
7
55

7
7
7
7
7
7
7
7
56

7
7
7
7
7
7
7
7
56

7
7
7
7
7
7
7
7
56

7
7
7
7
7
7
7
7
56

7
6
5

7
6
5

7
6
5

7
6
6

7
6
6

7
6
6

7
7
6

7
7
6

7
7
6

7
7
6

7
7
6

7
7
7

7
7
7

7
7
7

7
7
7

7
7
7

7
7
7

7
7
7

7
7
7

7
7
7

6
5
29

6
6
30

6
6
30

6
6
31

6
6
31

7
6
32

7
6
33

7
6
33

7
7
34

7
7
34

7
7
34

7
7
35

7
7
35

7
7
35

7
7
35

7
7
35

7
7
35

7
7
35

7
7
35

7
7
35

5
6

5
7

5
7

5
7

5
7

6
7

6
7

6
7

6
7

6
7

7
7

7
7

7
7

7
7

7
7

7
7

7
7

7
7

7
7

3
5
5

3
5
5

4
5
5

4
5
5

4
6
5

4
6
5

4
6
6

5
6
6

5
6
6

5
7
6

5
7
6

5
7
6

5
7
7

5
7
7

6
7
7

6
7
7

7
7
7

7
7
7

7
7
7

7
7
7

Cognition Total

24

25

26

26

27

28

29

30

30

31

32

32

33

33

34

34

35

35

35

35

Motor Total
Cognitive Total
Total

63
24
87

66
25
91

68
26
94

70
26
96

72
27
99

74
28
102

76
29
105

78
30
108

80
30
110

81
31
112

83
32
115

85
32
117

86
33
119

87
33
120

89
34
123

90
34
124

91
35
126

91
35
126

91
35
126

91
35
126

1 Eating
2 Grooming
3 Bathing
4 Dressing Upper
5 Dressing Lower
6 Toileting
7 Bladder
8 Bowel
Self Care Total
9 Bed, Chair,
Wheelchair
10 Toilet
11 Tub, Shower
12
Walk/Wheelchair
13 Stairs
Mobility Total
14 Comprehension
15 Expression
16 Social
Interaction
17 Problem Solving
18 Memory

Source: Uniform Data System for Medical Rehabilitation. 1998, 2000. The WeeFIM Clinical System Guide, Version 5.01. Buffalo: UDS MR.