Mobility

Mobility is a person's ability to move around, and it occurs in levels or stages. Even babies follow stages: holding their head up, holding themselves up, rolling over, crawling, standing, walking, and running. Not everything occurs all at once, and the same principle can apply when people are working to gain or re-gain their mobility. The order for restoring confidence in mobility is listed in a hierarchy shown by a pyramid. From the bottom to the top, the order is 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 have never really stopped to think specifically about the steps a person has to take to become more mobile, but learning about and looking at the hierarchy of mobility, the steps make logical sense. The first level of mobility is bed mobility. If a person is unable to move themselves on a level surface with a large base of support, they cannot be expected to move themselves up at higher levels. Bed mobility can include tasks such as scooting and rolling to help with repositioning as well as bridging which can help increase the strength in the abdomen, glutes, and legs to help with higher levels of mobility. As the pyramid gets a little higher, people can complete movements that require a little more strength, coordination, and cognition. For example, when transferring to a wheelchair, the first step could include using a slide board. This allows the individual to use their upper body to move from one surface to another. If the client has even more upper body strength, they can do a lateral swing transfer which does not require standing but does require the person to lift themselves with their arms. If the individual is able to stand, then they can do the stand-pivot transfer which would require them to have lower body strength. Once the person becomes more mobile, then they may have more movement that is required to complete ADLs which can help support their independence. The highest levels of the pyramid have some of the lowest bases of support and thus require the most balance, coordination, strength, and cognition. At this level, a person could most likely be fully independent as they are able to drive and be mobile in the community. 

These concepts are similar to what I have observed in the past. With one particular client, I was able to watch him go from sling transfers, to squat pivot transfers, to standing pivot transfers, to walking with assistance. As he became stronger and more competent, the level of difficulty of his tasks increased. I have also observed with a few therapists that until a person can successfully complete a wheelchair transfer and some ambulation, they do not try to teach the bathroom transfers. I agree with this approach because, first, if a person does not have the abilities to do a lower level of mobility, the chances of them completing one that is higher is unlikely. This could be disheartening and result in them losing drive and motivation to get better. Secondly, it makes logical sense to complete the lower level of skills first from a safety standpoint. If you can teach a person how to do certain movements properly, they can help at higher levels of mobility. The person slowly increases their strength and their knowledge of proper body mechanics which can reduce injuries later on.

From my experience in lab, I have learned the importance of being able to help people move through the various levels to protect the individual as well as myself. It was much easier to move a person on a bed and across a sliding board than it was to move them in a pivot transfer. It was also interesting to experience hands on how, as a therapist, we are able to help encourage movements that aid in effective mobility and can also help conserve the energy of future clients.