The Power of Mobility

Mobility is an essential component that allows us the ability to perform many of our activities of daily living. Having full mobility allows us to live independent lives, and without mobility we have to rely on help or assistive devices. The hierarchy of mobility skills starting from least mobile to most mobile is as follows:

            1. Bed Mobility

            2. Mat Transfer

            3. Wheelchair Transfer

            4. Bed Transfer

            5. Functional Ambulation for ADL

            6. Toilet and Tub Transfer

            7. Car Transfer

            8. Functional Ambulation for Community Mobility

            9. Community Mobility and Driving 

The hierarchy of mobility skills is a system that helps therapists figure out which aspects of mobility needs to be addressed. It begins with a decrease in mobility, followed by an increased in stability and power. Within the lower levels of hierarchy, such as bed mobility and mat transfer, the client has a greater base of support which increases the stability of the client; meanwhile in the higher levels of hierarchy, such as toilet and bed transfers, the client has a smaller base of support which results in increased mobility. This order of mobility also allows for the therapist to not overestimate the client's ability which could result in injury. If the therapist were to start with a bed transfer, without observing/testing the clients bed mobility first it could greatly impact the client. It could greatly decrease the clients confidence of completing their desired occupations, because it could decrease motivation and interest of progressing in the therapy session. 

Thinking back on my own experience, this order is exactly what I would have expected. My time observing in several inpatient facilities the therapist definitely took into consideration the amount of mobility their client had and wanted to accomplish. Depending on the level of difficulty, the therapist would work their way up from easy mobility and transfers that fit their ability to the more difficult ones once they have master the previous. Therefore, I definitely agree with this approach. In our Biomechanics transfer lab, we started off by learning the basics and general rules for bed mobility. I learned that this is the stepping stone to be able to successfully perform a bed transfer. It is important for the client to be able to either get in the right position themselves or with the help of a caregiver in order to get in or out of the bed with ease and without risk of harm.