Mobility is the constant state of instability. Therefore restoring confidence in mobility to perform occupations is an important factor in life. For an individual to be moved safely and with confidence, involves being comfortable with a small base of support, the line of gravity is outside of the base of support near the limit of stability, and the center of gravity is moving. The hierarchy of mobility skills is a great way to restore a clients confidence, no matter the level of independence they have. Based on this hierarchy the client can start at a level of functioning that is best for them, then as a therapist we can help that client build up from there to reach a state of stability and independence. The hierarchy of mobility starts with bed mobility and increases with --> mat transfers--> wheelchair transfers--> bed transfers--> functional ambulation for ADLs--> toilet and tub transfers--> car transfer--> functional ambulation for community mobility--> community mobility and driving.
I agree with this hierarchy of mobility. My previous job in an inpatient rehab allowed me this opportunity. I have seen this hierarchy applied to many different clients, not only in occupational therapy, but physical therapy too. This approach to mobility is great for increasing trunk control as their stability becomes more unstable. It is also a great approach for a client that may have problems with orthostatic blood pressure and increase their ability to regulate BP as they increase in mobility. This hierarchy is not only helpful for the client, but also the therapist. It helps reduce fall risk, injury, and help to build confidence.
I think this approach is very helpful because after SIM labs, it showed that transferring from the bed to the wheelchair vice versa can be very tiring and if the client is not strong enough they may need more help to transfer. Bed mobility allows them the chance to control how they move and increase strength. Even moving from the bed the a mat will allow them the ability to still build strength and confidence that they can transfer safely. Each level will get more challenging, and at each level you can strengthen the client to prepare for transfers. Even if they are not completely independent they can be safe and feel confident in whichever transfer they are performing.
I personally never knew there was a hierarchy explaining this, I thought it was just what the therapist thought was best. I really love the fact that there is a specific chart to increase a clients stability and strength to reach a state of independence with mobility.
