The Hierarchy of Mobility Skills

The hierarchy of mobility skills is how mobility skills should be addressed. The order is from the least mobile and most stable to the least stable and most mobile and is listed as follows: 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. 

I completely understand why this would be the order of mobility skills. As you get further down the list, the stability is decreased for each of the skills listed, requiring more from the client in terms of strength, control, and balance. The reduced base of support allows for more movement, which is why the actions are more extensive, like transferring in and out of a car or throughout the community, but it also requires more effort from the client. 

I have limited experience working with clients in a clinic, so I have not had the opportunity to see the full range of this hierarchy in action. Before starting graduate school, my old roommate in California had to have back surgery and was starting the process of moving through this hierarchy of mobility. Now she is completely healed and is moving at the same level as before the surgery, so I can only assume it was a successful intervention. At times, she expressed some frustrations with the pace at which she was moving through these skills and tried to rush the process. This usually results in a lot of pain and discomfort. 

I agree with this approach because it allows for the just-right challenge as a client continues to heal. Adjusting skills and expectations based on the current needs and abilities of the client is needed when creating client-based interventions. These stages allow for small increments of growth and reachable goals as a client improves. The flow from skill to skill is sequential; the success in one skill will facilitate further success in the skills to follow.