Hierarchy of Mobility Skills

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

This is similar to what I had expected. All of these are arranged in a logical sense, in that you need to accomplish one in order to successfully move onto the next. For example, if you have your client practice ambulation for ADLs after a toilet and tub transfer, it would be very unsafe. Each step needs to be taught and mastered before moving on in order to maximize client safety. I also think that is in this particular sequence because you have to be able to get out of the bed in order to go use the bathroom and so on. Every step is essential for performance in the next step. In the past, I never got to see the full hierarchy of mobility skills. When I was shadowing, it was normally for a day or a couple of days and rarely would I get to see the client progress unless I came back months later. However, I was always informed by the OTs at the centers of the mobility skills and how they typically went about them. Mainly what I saw was that we would do some in bed activity and then try to get them to walk to the bathroom (with a gait belt) or sit in the wheelchair and go to the bathroom. Then we would transfer them to a shower chair or the toilet. This was how I typically saw an initial evaluation performed. Most of the clients that I observed were still able to ambulate but since it was right after a surgery, it became more difficult. I agree with this approach in the sense that is in a logical order that will help promote client safety overall. During our simulations and labs, we always talk about how the main goal is client safety. As a therapist, you never want your client to be at risk for a fall or injury. By teaching and following the hierarchy of mobility skills, you are minimizing the risk of a fall or injury tremendously. The client will also have more confidence in each of the following steps as they are able to successfully perform them in a safe manner. Overall, the hierarchy of mobility skills is a great tool to have to ensure that you are doing everything you can to keep your client's safe and progressing further.