Mobility Skills

After an individual has sustained an injury, surgery, or any other various factor that may influence mobility, a hierarchy has been developed for mobility skills. This allows for therapists to have a consistent and useful tool to help patients back to a more individualized lifestyle. The mobility skills hierarchy starts with bed mobility, to mat transfers, to wheelchair transfers, to bed transfers, to functional ambulation for ADLs, to toilet/tub transfers, to car transfers, to functional ambulation for community mobility, to community mobility and driving.  

After thinking about the reasoning and various factors behind each mobility skill, this hierarchy is what I would expect. Each level increases the amount of skill, balance, and stability an individual must have to complete a transfer and that would begin with the simplest task of bed mobility. This includes rolling, bridging, and going from supine to sit. This is an important base to begin with because it ensures the development of trunk stability and movement and will relieve the chance of developing a pressure ulcer. With each level, the stability and base of support decreases which is why trunk stability, being able to push off with UE and reach for objects, etc. is important. Additionally, the tub/bath transfer is an important transfer but is located farther to top of this hierarchy because there are many factors to consider when completing this. This environment can include smaller spaces, client may be in little or no clothing, or slippery surfaces that would allow for less stability. Other higher levels, such as a car transfer, offer less flexible movement options such as the distance between the assistive device and the seat of the car and the fact that the car seat is immoveable/not adjustable. These are all factors to consider when working from one level to the next.  

In past experiences, I have observed this technique for mobility skills. For example, I have seen a therapist work with a client post-surgery who is experiencing weakness on the affected side and the therapist worked with them from the ground up (starting with bed mobility and so on). Although this is true, just recently I was in the hospital with a family member who had surgery, and I observed as the therapist worked with them and immediately began with bathroom transfers. I do think that this specific level of the hierarchy is important to an individual but definitely needs to be considered before moving up to it. This may depend based off the specific patient and their needs.  

After practicing many of these transfers on classmates in lab, I can see the many factors that are involved with each level and the reasoning behind the hierarchy. I definitely agree with this approach because I can see the skills and progression needed for each type of mobility. Obviously these techniques will vary from client to client because of different levels of capabilities which is why the balance assessments are so important. Mobility skills are an important aspect for therapists to consider in order to ensure safety and stability in all settings.