Hierarchy of Mobility

In order to restore confidence in mobility within a client, one must first achieve bed mobility. From then, the client must master a mat transfer, wheelchair transfer, and bed transfer. Next, a client will master functional ambulation to participate in activities of daily living and then toilet and tub transfers. Then, a client must perform car transfer to move onto functional ambulation for community mobility. Finally, to reach the highest level of mobility, one must master community mobility and driving. This hierarchy makes a lot of sense to me. I think it is sequenced in this particular order because it takes you from the least mobile position in bed to the most independence in mobility through driving and community mobility. In my experience as an intern and oberver, I have noticed many practitioners use this sequence when helping a client with independence. I saw a lot of practitioners work on bed mobility first and work a client’s way up to working on transfers and finally to community re-integration. When I interned at Memphis Jewish Home and Rehab, I saw therapists work with clients towards a goal of attending the bi-weekly community re-integration outings to Kroger and Walgreens. Once a client worked their way up the hierarchy of mobility and were close to a discharge date, they were able to go out to local grocery and drugstores to practice community mobility through shopping. Some clients shopped using a car with a therapist nearby, and other clients learned how to shop using a wheelchair. I agree with this approach because it really moves from least mobile to most mobile. Through my time as an OT student, I have learned that this hierarchy may not be exactly the same for everyone. There are going to be clients who may not reach the highest level of mobility, however, it is our job as future practitioners to find the “just right challenge” with each level in order to help the client reach their goals. Community mobility may look different among clients, but the goal is the same. As an OT, you may have to teach one client how to navigate public transportation while helping another client get back to driving again. Despite the differences in how the client commutes, the overall goal of mobility is the same.