Hierarchy of Mobility Skills

The order for restoring confidence in mobility starts at the most basic level and gradually increases difficulty based on increasing activity demands until you reach the most complex level. A client will start with bed mobility, then progress through mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADLs, toilet and tub transfer, car transfer, functional ambulation for community mobility, community mobility, and finally, driving. For safety reasons, it makes sense to gradually build confidence in this way. The skills learned and mastered in the early stages will prepare the client for the progression of transfers. For example, the muscles engaged in bridging, scooting, rolling, and sitting for bed mobility are the same muscles that are going to be engaged in the future transfers, but with added challenges like dynamic balance and stability. It is important to build confidence in oneself's ability to move and control their body in bed before in more potentially dangerous environment's like the bathroom or in the community. I did my practicum at a regional center that housed several clients with Cerebral Palsy. The transfers I observed varied from client to client, and because the goal of intervention for most clients was to maintain their current functional ability, I never got to see a progression of transfer. I am eager to learn more about helping clients climb up the hierarchy of mobility skills towards independence.