The physiological change measured during the current study was the pulse change.

The
change in pulse at rest and pulse during effort was measured as an indicator of the degree
of change in physical fitness as pulse is greatly dependent on aerobic fitness[20] and also
since fitness examinations validated for people with ID[10,21] were not applicable for the
current research population due to their limited physical abilities. Pulse during effort and at
rest improved significantly. It must be stated that the improvements in pulse at rest and
during effort occurred despite the short duration of the intervention period. The research
results indicated a correlation between increased functional ability and improved
cardiovascular fitness. Such findings might suggest that one of the elements responsible for
low functional performance common among individuals with developmental disabilities is due
to the sedentary lifestyle leading to poor physical fitness. Due to the small number of
participants, the findings call for further investigation, but should alert professionals to the
urgent need for physical intervention programs for this population.

The WeeFIM® is a measure of functional ability that can be used for typically developing
children, aged 6 months through 7 years, as well as children over 7 years with disabilities
and delays in functional development. It is an 18-item performance measurement system
that documents self-care, functional mobility, and cognitive abilities. The self-care domain
includes 8 items (eating, grooming, bathing, lower and upper body dressing, toileting, as well
as bowel and bladder control). The mobility domain includes 5 items (chair, toilet, and tub
transfers, walking or wheelchair management, and stairs). The cognitive domain includes 5
items (language comprehension and expression, social interaction, problem solving, and
memory). The WeeFIM® was designed to measure outcome and change in functional status
over time. Based on direct observation or caregiver report obtained by a trained examiner,
WeeFIM® items are rated on a 7-level ordinal scale, where a 1 represents the need for total
assistance and a 7 represents complete independence. Scores are derived for the three
domains as well as a total score; the latter ranges from 18 to 126. Given that independence
increases with age, a total functional quotient for each domain as well as the total score can
be calculated based on normative data for children of different ages. Specific criteria for
rating each item are provided in the clinical guide (Uniform Data Systems for Medical
Rehabilitation, 2005). A description of the general criteria for rating items is provided in Table
1:

Given the solid reliability and validity in both of these early studies, the WeeFIM® was
thought to be a useful instrument for measuring functional disability in children. The
WeeFIM® was based on the format of the Functional Independence Measure (FIMTM), a
measure of functioning in adults medical rehabilitation inpatients with acquired disabilities
(Granger, Hamilton, Keith, Zielenzy, & Sherwin, 1986). While having items similar to those
on the FIMTM, the WeeFIM® contains a limited set of essential items to measure consistent
and actual performance through discipline-free observations in order to track outcome
across settings.

Clinical Uses
The Functional Independence Measure for Children (WeeFIM®) is frequently used as a
quantitative tool in pediatric rehabilitation facilities to measure level of independence in
personal care, mobility, and psychosocial competence in many groups of children, including
those with developmental disabilities or acquired neurological injury. Facilities subscribing to
the WeeFIM® system choose indicators from this instrument along with other relevant
markers of performance (i.e., length of stay) to be used for performance evaluation and
hospital accreditation purposes. Over 1200 adult and pediatric facilities subscribe to UDSMR
across the USA and around the world (Uniform Data System for Medical Rehabilitation,
2004–2006). Each quarter, facilities subscribing to UDSMR receive a report with the number
of cases, mean, median, standard deviation, minimum, and maximum values for selected
indicators of interest of their facility. Several clinical research studies have also used the
WeeFIM® to measure outcome in children with a variety of disabilities (see Uniform Data
System for Medical Rehabilitation, 2005 for review). In clinical settings, because the
WeeFIM® has a minimal data set, it is often used in conjunction with other measures to
obtain more precise measurement of motor, self-care, and cognitive functioning

The WeeFIM instrument can be easily administered in 20 minutes or less through direct
observation and/or interview, and does not require special equipment19, 21) . The English
version of the WeeFIM, used in the current study, has demonstrated a sufficient amount of
validity, reliability, and responsiveness in assessing the functional activities of children with
developmental disabilities1

The aim of this tool is to measure changes in function and assess the burden of care over
time. The WeeFIM test tool has excellent consistency and the scores provided are stable.

American normative data, based on a sample of more than 500 children in good health and
without disability, are available for the total score, as well as scores on the different
domains.23 The WeeFIM instrument is reliable in both children with disabilities and those
without disabilities.22,24,25 In children with developmental disabilities in the United States,
the intraclass correlation coefficients (ICCs) for different subscales were greater than .90.25
Indexes of responsiveness in children with disabilities indicated reliable and statistically
significant changes over time.26 Further testing of psychometric properties also has been
done, suggesting distinct motor and cognitive scales and an age-specific item hierarchy.2

Therefore, this study aims to determine the construct validity of the Korean version of
WeeFIM in children with cerebral palsy, measure the difficulty of Self-care, Motor, and
Cognition items, change the ordinal scale to an interval scale, to examine the fitness of the
use of WeeFIM in children with cerebral palsy and the cultural differences and validity of
WeeFIM, and determine the internal reliability through individual reliability of the participants
and items

Separation reliability of the participants and items for Selfcare, Motor, and Cognition was
analyzed. When separation index is within 0.7 and separation reliability is 1.5, it was
interpreted as Acceptable. If separation index is within 0.8 and separation reliability is 2.0, it
was interpreted as Good. If separation index is within 0.90 and separation reliability is 3.0, it
was interpreted as Excellent.9,19,20 Separation index of the participants for Self-care was
2.64, .87 for separation index, item separation index was 5.42, and separation reliability was
.97 as shown in Table 9. As for Motor domain, participant separation index was 2.57 and
separation reliability was. 87. Item separation index was resulted in 8.12 and .99 for
separation reliability as shown in Table 10. Cognition domain resulted in participant
separation index of 3.78 and .93 for separation reliability, and 4.43 for item separation index
and .95 for item separation reliability
7 Complete independence The child performs all tasks without assistance from a helper or
device in a safe manner and reasonable amount of time.
6 Modified independence The child performs all tasks without assistance from a helper, and
one or more of the following are true: The child requires an assistive device to perform
tasks. The child requires a prosthesis or orthosis that is necessary for performing tasks.
The child takes extra time to perform tasks. There is a concern for the child’s safety when
performing tasks.
5 Supervision or setup The child performs all tasks but requires supervision (typically
standing by, cuing, and coaxing) or setup (e.g., setting out necessary items and helping to
apply a prosthesis or orthosis.
4 Minimal assistance The child performs 75% or more of tasks, requiring no more help than
touching.
3 Moderate assistance The child performs 50–74% of tasks, requiring physical assistance
beyond touching.
2 Maximal assistance The child performs 25–49% of tasks.
1 Total assistance One or both of the following are true: The child performs less than 25% of
tasks. The child requires assistance from two helpers to perform tasks

berkembang dan juga gagal mencapai kompetensi keterampilan motorik dasar, (Chang,
Tsai, Lee, & Liang, 2020). Faktor biologis dan lingkungan akan membentuk karakteristik
anak dengan interaksi berupa aktivitas, bermain hal baru, beradaptasi dengan teman baru,
dan kekuatan mental, (Angelka & Goran, 2018). Kompleksitas kepribadian anak tunagrahita
terlihat dari berbagai cara yang berkaitan dengan tutur kata, tingkah laku, ciri-ciri sosial, dan
fungsi keseluruhan dalam aktivitas sehari-hari. Bermain mempunyai ciri-ciri seperti motivasi
intrinsik dengan dorongan yang berkaitan dengan keinginan untuk melakukan aktivitas
bermain yang bersifat aktif dan dapat dilakukan oleh siapa saja sehingga menuntut setiap
orang untuk aktif dalam bermain, sehingga timbul perasaan menyenangkan dalam
melakukan kegiatan bermain yang berkaitan dengan motorik kasar anak. Perlu adanya
bentuk permainan olah raga yang atraktif dan menarik secara bertahap berdasarkan
karakteristik anak, (Ma, Wang, Li, & Wang, 2020). Ciri-ciri motorik kasar yang berhubungan
dengan otot besar dalam perkembangan motorik kasar anak stimulasi motorik dengan
lingkungan yang aman dan dukungan orang tua, bermain merupakan hal penting yang dapat
memberikan partisipasi sosial dan juga mempengaruhi kognitif, fisik dan emosional anak,
(Kennedy-Behr, Rodger, & Mickan, 2013). Dalam melakukan kegiatan yang dapat
mempengaruhi perkembangan emosi, fisik, kognitif, dan sosial anak melalui bermain, maka
bermain dapat dikatakan kegiatan bermain merupakan kegiatan yang menyenangkan bagi
anak, bermain merupakan suatu keharusan karena memberikan kesempatan pada anak
untuk beradaptasi dengan teman dan lingkungannya. lingkungan sehingga akan berdampak
pada keterampilan motorik