Hierarchy of Mobility Skills

The order for restoring confidence in mobility based on increasing activity demands (easiest to hardest) is as follows: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet & tub transfer, car transfer, functional ambulation for community mobility, and community mobility & driving. 

Based on my past observation experiences and information learned in this class, this is what I expected. Skills in each step build upon each other and independence is increased. In acute care settings many of the mobility skills used on are towards the bottom of the pyramid. In contrast, in an outpatient clinic a client who is independent with self-care activities at home may have the goal of becoming more active in the community, which is towards the top of the pyramid. 

As one moves through the hierarchy, increased effort from the client is needed. This sequence follows physical ability and corresponds with cognitive function needed for task completion. I agree with the hierarchy of mobility skills approach. A client can progress though the hierarchy to meet activity demands. I believe the hierarchy is a useful guide; however, all people are different, so it is okay if someone naturally progresses in a different sequence.