Hierarchy of Mobility

Mobility is defined as the ability or capacity to move. It seems so simple, but for some, it is difficult to achieve after an accident, injury, or disability that limits their abilities to move. As OTs, we want to help those who have lost function in mobility, gain as much as they can back to become as independent as they can be. We can do this by following the guideline of the hierarchy of mobility. The order of the hierarchy starts with bed mobility, goes to mat transfers, to wheelchair transfers, to bed transfers, to functional ambulation for ADL, to toilet and tub transfer, to car transfer, to functional ambulation for community mobility, and lastly, to community mobility and driving. 

This order of mobility makes sense to me and is expected because the order starts from the least amount of function and effort given from a client to the most difficult and functional. The order also increases with the amount of independence someone has. The pyramid goes up from someone needing almost 100% assistance to full independence at the top of the pyramid. I think the hierarchy is in this particular sequence because it gives the client step-by-step goals in a simplified and achievable way. When they reach another step of difficulty, they can gain confidence by seeing the progress that they are making.

During observations, I have seen these steps being taken to a help client who had a stroke and a client who had a LE amputation gain back function and independence in their everyday lives. When I observed these clients at the beginning of their sessions with an OT, they seemed down and discouraged, but the more they climbed up that pyramid, the more confident and excited they were to keep working hard to continue reaching their goals. Because of the effects I have seen through the hierarchy, I do agree with its approach in the clinical setting.

By working in the SIM labs, I have been able to be hands on and learn for myself the steps to the hierarchy of mobility. While learning about bed mobility and transfers, I've seen how important it is to learn them in order from lowest level of difficulty to the highest level because they can be complicated to learn and perform. Knowing this, I have a better understanding of how hard it must be for the client to remain patient while they gain back strength, stability, and function step-by-step. It has been a huge help to me to work in the SIM labs to see the pyramid in action and its importance in occupational therapy.