Transfers & Mobility Skills

It is very important for our clients to feel confident in their mobility skills, and there is a certain hierarchy of mobility skills that restore confidence based on increasing activity demands. The hierarchy is as follows: it begins with bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet & tub transfer, car transfer, function ambulation for community mobility, and finally community mobility and driving. I think that the hierarchy is in this particular sequence so that the client can make slow transitions into being more active in their ADL's and iADLs. If a client was to go from bed mobility straight to toilet & tub transfer without first mastering the levels below, their risk of injury and falling jumps exponentially. I did an internship at my local VA hospital where I witnessed some of this firsthand. If a patient had just started therapy, the therapist would work first on their bed mobility to teach them how to safely and comfortably move around in their bed to gain confidence in their skills. From there the therapist worked with the patient for a few weeks building their confidence but also making sure the patient slowly mastered each transfer before moving on. Finally, when the patient was well enough they left the hospital more mobile than they were before. I agree with this hierarchy of mobility skills because we want our client to be as confident as possible with the very basic mobility skills before allowing them to fully immerse themselves back into the community. By following this hierarchy we can ensure safety and confidence in our clients.