Occupational Therapy and Mobility

In the occupational therapy world, each client has a different level of mobility based on individual injury/diagnosis. As clients get more stable and stronger, they slowly climb the hierarchy of mobility skills until they meet their individualized goals. The hierarchy of mobility skills from least mobility to greatest mobility is as follows:

          1. Bed Mobility

          2. Mat Transfer

          3. Wheelchair Transfer

          4. Bed Transfer

          5. Functional Ambulation for Activities of Daily Living (ADL)

          6. Toilet and Tub Transfer

          7. Car Transfer

          8. Functional Ambulation for Community Mobility

          9. Community Mobility and Driving

After studying the hierarchy of mobility skills, I think it makes sense because the lowest level requires the least amount of participation from the client, and the highest level indicates independence. The hierarchy of mobility skills is set up this way in order to progress to more independence by building upon each level. Bed mobility consists of moving in the bed, but not transferring to other surfaces. A bed transfer is harder than a wheelchair transfer because a bed mattress is not as sturdy as a wheelchair. Also, a wheelchair has chair arms that are easier to push off of compared to pushing off a bed mattress. Once a client shows the stability and strength to perform a certain level of mobility, the client can then start working on the next level of mobility.

From my experience, I have seen this system used, and I think it is a successful system. Rather than overloading the client, this hierarchy of mobility helps clients slowly progress without getting furthered injured and without feeling intimidated or getting discouraged. While observing occupational therapists, there were a couple of times when a client was not able to perform a mat or wheelchair transfer. So, the occupational therapists would work on bed mobility to get the client moving and using muscles. Eventually, the clients were strong enough to stand and transfer to a wheelchair. 

By slowly progressing to more and more mobility, it helps the clients not be as scared and develop a trusting relationship with their therapists. For example, if a client is extremely weak after having pneumonia for several weeks, he/she is going to be really hesitant to perform a toilet and tub transfer on the first day of therapy. However, if the therapist starts with bed mobility and works up the ladder showing the client that he/she is capable of performing those skills without injury, then the client will likely be more willing to trust the therapist and hopefully be more willing to participate in therapy treatment.