Hierarchy of mobility
A hierarchy of mobility is a set order that guides an occupational therapist in addressing a client's needs. This hierarchy is as follows: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for activities of daily living, toilet/tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. I think there are many reasons that therapist work in this order.
The first reason is because it is all about mobility versus stability. The bottom of the hierarchy is more stable and less mobile. This could be because, for example, with bed mobility, the client's base of support is much larger, so they are more stable but the client is less mobile in this position. I think another factor that plays a role in the hierarchy being arranged in this order is based on factors like surfaces (slippery vs. rough), the size of the space, and the physical demands on the client.
I worked two years in acute care and acute inpatient rehabilitation, and the therapist always addressed their clients in this order. After seeing this in the clinic, it makes sense why they start in this order. Anyone could see how a client's confidence built with each item they checked off. A therapist wouldn't want to start with driving in the community, if the client wasn't able to transfer into the car properly first. If a therapist didn't follow this order, they could misjudge a clients abilities and eventually put them in harms way.
I agree with this approach. Especially in he field of occupational therapy, we will slowly get to know quirks, interests, and habits better about the client. We also build a better relationship with the client because they see we care about the "small things" first and knowing how to approach things like bathing and dressing. I can't wait how to see labs and simulations build my confidence in transfers and mobility.
The first reason is because it is all about mobility versus stability. The bottom of the hierarchy is more stable and less mobile. This could be because, for example, with bed mobility, the client's base of support is much larger, so they are more stable but the client is less mobile in this position. I think another factor that plays a role in the hierarchy being arranged in this order is based on factors like surfaces (slippery vs. rough), the size of the space, and the physical demands on the client.
I worked two years in acute care and acute inpatient rehabilitation, and the therapist always addressed their clients in this order. After seeing this in the clinic, it makes sense why they start in this order. Anyone could see how a client's confidence built with each item they checked off. A therapist wouldn't want to start with driving in the community, if the client wasn't able to transfer into the car properly first. If a therapist didn't follow this order, they could misjudge a clients abilities and eventually put them in harms way.
I agree with this approach. Especially in he field of occupational therapy, we will slowly get to know quirks, interests, and habits better about the client. We also build a better relationship with the client because they see we care about the "small things" first and knowing how to approach things like bathing and dressing. I can't wait how to see labs and simulations build my confidence in transfers and mobility.
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