Hierarchy of Mobility

It is important as future healthcare providers that we know the hierarchy of mobility skills and educate our patients on this hierarchy. Knowing this will help us to know which transfer might be most acceptable to practice with our client based on their functional level. The hierarchy of mobility skills is as follows: bed mobility-mat transfer-wheelchair transfer-bed transfer-functional ambulation for ADL-toilet and tub transfer-car transfer-functional ambulation for community mobility-community mobility and driving. We would begin with bed mobility and work up towards community mobility and driving. I would expect this sequence because as the client advances the environments become less stable and we must ensure the client is adequately prepared to maneuver and stay safe in each transfer.

I believe the hierarchy is in the particular sequence for a number of reasons. I believe as the hierarchy progresses the transfers get progressively harder. A toilet and tub transfer for example, may be completed in wet or slippery conditions and require greater stability and balance than a wheelchair or mat transfer. Further a car transfer may need to be completed in a small space, or require great push off to gap the distance between the wheelchair and the car. 

In my time as an occupational therapy technician I felt as though this hierarchy was generally followed. I would never see an occupational therapist trying to master a car or tub transfer before they mastered bed mobility. Often times, they would work on bed mobility at the beginning of the patients stay when they were weak. Once the patient was stronger they would work on wheelchair transfers and bed transfers to be set up to work on ADL’s. Toilet and tub transfers generally came next to master bathroom ADL’s with car transfers coming right before discharge to ensure that the client could successfully get in and out of their mode of transportation. While I worked in an acute care/skilled nursing facility, I feel as though this hierarchy may be followed less in an outpatient clinic or pediatric clinic as needs are different for different groups. 

Based on the labs and simulation experience, I can say that I believe the hierarchy of mobility skills is an important resource and piece of information to base our treatment and teaching off of. However, every client will have differing capabilities, whether in balance, cognition, strength, endurance, etc. It is important that we take that into consideration and focus on the needs of the client, to create a safe and meaningful treatment plan when addressing transfers and mobility.