Rehabilitation subdirector Clínica Universidad de La Sabana
Objectives Children with neurodevelopmental and neurological disorders often present with motor, cognitive, and behavioral limitations that restrict independence and participation in age-appropriate activities. Early and structured rehabilitation is essential to harness neuroplasticity and improve functional outcomes. Interdisciplinary, goal-oriented programs such as the Process of Interdisciplinary Rehabilitation (PIR®) provide comprehensive care by integrating multiple specialties to address the complex needs of this population. Our objective is to evaluate the impact of a multidisciplinary and goal-oriented rehabilitation program (PIR®) on functional independence in children with neurodevelopmental and neurological disorders. Design We conducted a retrospective cohort study of children enrolled at the PIR® between january 2021 and august 2025. Functional outcomes were measured at baseline and completion of the program using the Functional Independence Measure for Children (WeeFIM™). Non-parametric data were summarized as medians (IQR), and differences were analyzed using the Mann-Whitney U test. Statistical analyses were performed in RStudio (Version 2024.09.1+394).
Results A total of 539 children participated in the PIR® program during the study period, with a median age of 5 years (IQR 3–8), of whom 343 (63%) were male. The most frequent diagnoses were neurodevelopmental disorders (285, 52%), attention deficit hyperactivity disorder (ADHD) (74, 14%), and epilepsy (29, 6%), with less frequent diagnoses including brain tumors, traumatic brain injury, and Down syndrome. The median duration of participation was 3 months (IQR 3–5). Initial WeeFIM™ scores were 73 (IQR 49–94), increasing significantly to 83 (IQR 54–100) after completion of the program (p < 0.001), with a median functional gain of 5 points (IQR 2–9).
Conclusions Participation in the PIR® rehabilitation program was associated with significant functional improvements in children with neurodevelopmental disorders, ADHD, epilepsy, and other neurological conditions. These results underscore the effectiveness of specialized, interdisciplinary, and goal-oriented rehabilitation in enhancing independence and functional outcomes within pediatric populations. Led by physiatrists and supported by a coordinated team, PIR® integrates medical, therapeutic, and psychosocial interventions that not only promote gains in self-care, mobility, and cognitive-social skills, but also support families as key facilitators of progress. The structured use of validated tools such as the WeeFIM enables objective monitoring of change and provides evidence of sustained benefits over time. These findings reinforce the importance of early, comprehensive rehabilitation as a cornerstone for optimizing development and long-term participation in children with complex needs.
Introduction Neurodevelopmental and neurological disorders in childhood are among the leading causes of disability worldwide. They frequently result in significant motor, cognitive, language and social limitations, affecting their ability to achieve independence in daily activities and to participate fully in age-appropriate roles. Early and comprehensive rehabilitation interventions are critical to maximize neuroplasticity, optimize developmental trajectories, and reduce the long-term impact of these conditions.
The Process of Interdisciplinary Rehabilitation (PIR®) was designed to provide a structured, coordinated, and patient-centered framework led by physical medicine and rehabilitation, that integrates multiple specialties—including pediatric neurology, physical therapy, occupational therapy, speech and language therapy, psychopedagogy, psychology, social work and nurses. This program focuses on individualized, goal-oriented rehabilitation, emphasizing both the patient and their family as active participants in the process.
While there is increasing recognition of the importance of interdisciplinary approaches, evidence on the measurable functional outcomes of such programs in large pediatric cohorts remains limited. To address this gap, we conducted a retrospective cohort study of children enrolled in the PIR® program between January-2021 and March-2025, using the Functional Independence Measure for Children (WeeFIM™) as the main outcome to evaluate changes in functional independence over time.
Methods
We performed a retrospective cohort analysis including all pediatric patients enrolled in the PIR® at Clínica Universidad de La Sabana, Colombia, from January-2021 to March-2025.
Participants
Eligible participants were children aged 1–13 years old referred for rehabilitation with a confirmed diagnosis of a neurodevelopmental or neurological disorder and who were enrolled in the rehabilitation program PIR®. Inclusion criteria required baseline and follow-up WeeFIM™ assessments. Children with incomplete data or who discontinued the program before completing at least 3 months of rehabilitation were excluded.
Intervention
The PIR® program applies an interdisciplinary approach to rehabilitation. Patients are first assessed by a physiatrist, who coordinates individualized interventions with other team members, including physical therapy, occupational therapy, speech and language therapy, psychopedagogy, psychology, social work, nurses and, when indicated, pediatric neurology, genetics or another medical specialists. Families are actively engaged through training, counseling, and home-based strategies to reinforce therapeutic goals.
Outcomes and measures
The primary outcome was functional independence measured by the WeeFIM™, a validated tool with 18 items across three domains, total scores range from 18 to 126, with higher scores indicating greater independence.
WeeFIM™ was administered by trained rehabilitation professionals using an standardized procedure at program entry and upon completion.
Statistical analysis
Non-parametric statistics were applied due to skewed data distribution. Medians and interquartile ranges (IQR) were used to describe continuous variables, and proportions were used for categorical variables. Differences in WeeFIM™ scores between baseline and follow-up were analyzed using the Mann-Whitney U test. Statistical analyses were performed using RStudio (Version 2024.09.1+394). Significance was set at p< 0.05.
Results
Cohort characteristics: A total of 539 children were included in the analysis. Median age was 5 years(IQR 3–8), with 343(63%) males. The most frequent diagnoses were:
Neurodevelopmental disorders: 285(52%) Attention deficit hyperactivity disorder(ADHD): 74(14%) Epilepsy: 29(6%) Other less common diagnoses included brain tumors, traumatic brain injury (TBI), and Down syndrome. Program duration: Median length of participation was 3 months(IQR 3–5).
Functional outcomes: At baseline, the median WeeFIM™ score was 73(IQR 49–94). After completing the PIR® program, the median WeeFIM™ increased significantly to 83(IQR 54–100) (p < 0.001). The median functional gain was 5 points(IQR 2–9). Improvements were observed across all three domains (self-care, mobility, cognition), though the greatest changes were recorded in mobility and self-care.
Subgroup trends: Children with neurodevelopmental disorders demonstrated steady improvement, with a median gain of 6 points. Patients with ADHD showed smaller but still significant gains, primarily in cognitive and social domains. Children with epilepsy and other neurological conditions (e.g., TBI, tumors, Down syndrome) exhibited heterogeneous but overall positive outcomes.
Discussion
Our findings demonstrate that participation in the PIR® program is associated with significant functional improvements in a large and heterogeneous pediatric population. The observed median increase of 5 WeeFIM™ points, though modest in absolute terms, is clinically relevant when considering the chronic and complex nature of the included conditions. Even small functional gains can translate into meaningful improvements in independence, quality of life, and caregiver burden.
Several aspects of the PIR® program likely contributed to these outcomes:
Interdisciplinary approach: Coordinated input from multiple specialties ensured a comprehensive evaluation and intervention strategy, addressing motor, cognitive, and psychosocial needs simultaneously. Family-centered model: Training and empowerment of caregivers allowed reinforcement of therapeutic activities at home, sustaining gains beyond therapy sessions. Goal-oriented interventions: Individualized rehabilitation goals aligned with the child’s developmental stage and functional priorities maximized relevance and engagement. Early intervention and neuroplasticity: Many participants were enrolled before age 6, a critical window for brain plasticity and functional adaptation, which may have enhanced responsiveness to therapy. Comparison with literature
Previous studies have shown the WeeFIM™ to be sensitive in detecting functional gains in children with cerebral palsy, TBI, and developmental disorders. Our results align with international evidence that structured, multidisciplinary rehabilitation produces measurable functional benefits in pediatric populations. However, our study adds value by including a broad spectrum of diagnoses and by documenting outcomes in a Latin American cohort, where published data are scarce.
Limitations
This study has several limitations. First, its retrospective design limits control over confounding factors such as baseline severity, comorbidities, and variations in therapy intensity. Second, follow-up was limited to program completion; long-term sustainability of functional gains was not assessed. Third, diagnostic subgroups were uneven in size, which may limit the generalizability of subgroup analyses. Nonetheless, the large overall sample, standardized outcome measure, and significant improvements observed strengthen the validity of our findings.
Conclusion
Participation in the PIR® was associated with significant improvements in functional independence in children with neurodevelopmental and neurological disorders, including ADHD, epilepsy, brain tumors, TBI, and Down syndrome.
These findings reinforce the importance of early, comprehensive rehabilitation as a cornerstone for optimizing development and long-term participation in children with complex needs.
Future research should explore long-term outcomes, cost-effectiveness, and the impact of integrating technological innovations such as digital data capture, tele-rehabilitation, and predictive analytics to further enhance the PIR® model.
