Ranking of Mobility Skills

Although we are not physical therapists, occupational therapists view mobility as a key component to help our clients function in their occupations successfully. In order to for us to know which mobility skills to address with our clients we can reference the mobility skill hierarchy to use as a guide. The order is as follows, from #1 being the most stable, to #10 being the least.

 Mobility Skill Hierarchy:

1. Bed mobility (moving within the bed; can be to prepare for transfer) 
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 

    As you can see all of these mobility skills are important and maybe more important than others according to the individual, but none the less our body's were made for some sort of mobility to support our overall health, wellbeing, and occupation. It would seem while simply looking at this list that it would make perfect sense to why moving within the bed would be on the opposite spectrum of operating a vehicle. Just imagine the amount of effort it requires to scoot your head up to the pillow versus the amount of effort/muscle force/movement required to operate a vehicle. 

    When comparing the in-between #2-#8, it may be easy to get them mis-matched. I, myself, would have had a hard time deciphering the order before taking gross anatomy and biomechanics to help facilitate knowledge of movement. In general, it helps to take into account the different context of each mobility skill. For instance, the surface being hard/soft, the additional obstacles like stepping up/over/down, or the presence of things that may require safety precautions for the mobility, like water for tub transfer, or other vehicles on the road for driving mobility. Once you go through the list while viewing these aspects it begins to click!

    Through my experience of living with my grandmother who has limited mobility, this list makes perfect sense. She has a very difficult time/needs assistance or cannot perform the mobility actions of #6-9. She requires assistance to step over her bathtub to take a shower because the mobility within her legs cannot assist this motion. Along with observing my grandmothers mobility skills, I also did my internship within a geriatrics skilled nursing facility. I was not introduced to this hierarchy then, but reflecting back to experiences of my time there I can see the connection. The rehabilitation gym there had a stationary car in which the OT's would assist car transfers with clients, but it was one of the last steps of their OT process before going home, because the earlier steps needed to be addressed first. 

Photo retrieved from: https://www.mindful.org/getting-started-with-mindful-movement/