Hierarchy of Mobility Skills

The hierarchy of mobility skills is the order that guides the therapist in knowing what area of mobility needs to be addressed in therapy. It starts out with decreased mobility with increased stability and works its way up to increased mobility with decreased stability. One of the reasons why stability is increased in the lower levels of this chart is because the client has a larger base of support; mobility is increased when the client has a smaller base of support. However, I believe that stability vs. mobility isn’t the only reason for the placement of this order. The order 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, and community mobility and driving. 

While the order of mobility skills wouldn’t have made sense to me prior to the Biomechanics lectures and practicing transfers in lab, it is now clear to me why this order is important to follow. Not only is stability decreased as you work your way up the hierarchy, but other factors, such as slippery surfaces, small spaces, and/or items that are easier to trip on, makes it vital that the client is mentally and physically ready for the higher levels of mobility.  Without this order, it would be very easy for a therapist to overestimate the client’s ability and possibly increase the risk of a patient getting hurt. It would also pose as a frustrating task for the client since she hasn’t worked her way up to such a higher level task. This could decrease her confidence and motivation and serve as a barrier to completing her occupational goals.  

While we didn’t touch on every level of the hierarchy of mobility in our Biomechanics lab, such as toilet and tub transfers, car transfers, etc., learning how to help a client with bed mobility, wheelchair transfers, and bed transfers helped me understand the level of skill needed for the client in order to be successful in completing these tasks. When helping a client with bed mobility, there was a large base of support and a decreased risk of the client falling or getting injured. In the lab, this put me more at ease because there weren't as many barriers. it became very clear that this was a task that was important for the client to achieve in order to be able to do something like a mat or wheelchair transfer due to stability, posture, physical strength, endurance, cognitive function, etc. It also made me even more aware of the fact that each client has different needs. Some just need to build their strength and endurance in order to do higher level mobility skills, some may need multiple assistive devices, and some people may not have goals that go to the top of the hierarchy of mobility skills chart.

When I worked as a rehab tech, I would assist in bed mobility and transfers. However, I had not learned about the hierarchy of mobility before my Biomechanics class and therefore didn’t think too much about the kind of mobility that was appropriate for the client. It seemed as if it was more common sense and instinctive to the therapist who had been practicing for several years. When I reflect back, the therapists I worked with did follow this model; however, it was not always clear how much the client could achieve due to their condition or motivation. It was always interesting to observe how the therapist would know when to encourage the client to increase the level of their mobility further and when to stay at the same level of mobility. I’m excited to learn more about how to help my future clients in their occupational tasks!