Hierarchy of Mobility Skills

     The hierarchy of mobility skills, in regard to someone who is in the hospital is as follows: starting off with bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. When I first read this, I was having a hard time with wrapping my head around from the bed transfer to mat transfer. After some clarification, from bed to mat really has to deal with similar bases of support, so for example possibly bed to gurney, or bed to ex-ray table, both are mat type bases allowing for a great amount of support to the body. This makes more sense than what I was imagining. I was thinking in terms of therapeutic mat but usually those are in a different room. In the many times I was in the hospital with my Mother for hip replacement issues, I never witnessed her, or any other patient being wheeled down in their bed then transferred from bed to therapy mat. I did however see her movement/mobility increase from bed to a chair, just practicing sitting up and then on to wheelchair and how to safely maneuver it, from there eventually to the bathroom and how to safely move on to the toilet. I think it would have been helpful if the occupational therapists who were helping her maybe had shared the order thought process to both my mom, my brother, and myself. I think this would have helped us understand certain processed progressions better. My Mom was always in a bit of a hurry to get back to her so called normal, which was not always good for her healing and rehabilitation.

     With that clarification made the hierarchy of mobility skills reminds me of the developmental patterns a child goes through in progressing from being an infant who cannot roll over to eventually learning to roll over, sit up, rock back and forth on all fours, to learning to crawl, to standing with support, to learning to step by holding on to something also called (cruising), and finally to walking without any extra supports. In looking at it from a building block point of view it makes sense, the need to build upon and be comfortable and confident in one skill before progressing on to the next. It is always important to lay a good foundation down in whatever one is learning or relearning to do. I also believe that there is no one size fits all application of any system. It is very important to take into consideration the immediate needs of each individual client/patient receiving therapeutic services for determining just exactly what comes next in the order of treatment.