The Hierarchy of Mobility

The Hierarchy of Mobility Skills is a conceptual model that shows the gradual path a client will take in order to increase their mobility skills. The order of skills begins with bed mobility, and continues to mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and then it ends with community mobility and driving. For the most part, this is what I would expect in terms of how to grade mobility activities for a client. I did not perceive that these skills have a natural grading to them, but it makes sense when presented in this manner. I think it is in this sequence because a client needs to learn how to do the most basic tasks like bed mobility and mat transfer in order to build upon these activities to achieve other skills such as wheelchair transfer and bed transfer. A client needs to be able to do gain confidence in certain skills before others. I have observed this method in adult settings and geriatric settings. I remember watching patients work on bridging and I can remember watching OTs teach their clients how to properly sit up in bed and to bring themselves to a walker and how to properly achieve that posture. I think it is important to follow this hierarchy because many clients will struggle with balance and mobility and will lack confidence when doing the most basic of tasks. It is part of therapist's job to help their client rebuild their confidence.