Hierarchy of Mobility

In order to restore a client’s confidence in mobility, we have the hierarchy of mobility skills that guides the process of restoring mobility. The order is as follows:

1. Bed mobility
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

This order is definitely what I expected even without the experience of this biomechanics class, but it is interesting to think that something we do so often like getting in a car is so far down the list. However, the order makes sense because each item on the list requires more effort on the client’s part—it requires more control. As you climb the list, the base of support for the client gets smaller and requires more distance to travel (i.e. the distance between the bed and tub is farther than the distance between the bed and the wheelchair). Additionally, I think this list is in this order because each step requires more active participation by the client, and mastery of these steps indicates more independence with each step. After my experience in lab, I support this hierarchy. When we practiced bed mobility, the client wasn’t moving as much as when we did bed transfers, so it required less effort and control for both the practitioner and the client. Since most bed mobility is done in multiple, short steps, it is easier to control than a bed transfer like the lateral swing transfer.

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