Restoring Confidence in Mobility

The definition of mobility is controlled instability. Mobility is a very important step to the restoration process of an OT client, but the word instability in and of itself lets us know that it will come with a set of guidelines that will create a safe and beneficial environment for our clients. One thing that mobility does is not just allow a client to move, but also increases their confidence in their restored ability to move, getting closer to the set of goals they would like to achieve in their OT sessions.

When trying to restore confidence in a client, it is important that the hiearchy of mobility skills is implemented. The hierarchy of mobility skills goes in order as follows:

1. Bed Mobility (Start) -The ability to move the body in bed to perform activities in various positions of supine, prone, side lying, or sitting. Basic functional skills, that provide the basis to allow the individual to engage in ADL's, to provide presure relief, and positioning for sleeping.
2. Mat transfer
3. Wheelchair transfer
4. Bed transfer
5. Functional ambulation for ADL
6. Toilet and tub transfer
7. Car transfer
8. Functional ambulation for community mobility
9. Community mobility and driving (Highest Point)

By going in this order confidence is restored in your client by them accomplishing the activity demands of say a toilet/tub transfer or a car transfer, both ADLs that are important to the majority of the population, essentially improving QOL. The order of the hierarchy of mobility skills is important here and makes sense if you look deeply at what is being done at each point. Bed mobility and mat transfers are easier and safer to complete than a car transfer or an ambulation. Therefore, we must start at the bed mobility for several reasons. One, we need to take every safety precaution there is and be positive that our client's can complete these tasks in a safe way. Starting at an easier point allows us to get a read on what our client can do while not putting them in harms way. In addition to this, the earlier levels in the hierarchy of bed mobility provides the framework for later levels. As mentioned above, bed mobility allows the client to safely do basic functional skills that provide the basis to allow the individual to engage in ADL'S, provide pressure relief, and positioning for sleeping. Starting at an easier level also helps the client not get as frustrated. If we for example started our client out doing a toilet/tub transfer and they had an extremely hard time completing that task they one could fall and suffer a debilitating injury or become extremely unmotivated to put in full effort in therapy sessions because they did not have that basis established in earlier bed mobility tasks. Due to this reasoning, I fully back the hierarchy of mobility skills and all they represent.