mobility hierarchy

As an occupational therapist restoring confidence in your patient is critical. The actual order for restoring confidence in mobility for your patient is as follows: bed mobility, mat transfers, wheelchair transfer, bed transfer, functional ambulation for ADLs, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. This order was not exactly what I expected at first, but then as it was explained it makes perfect sense. The hierarchy was explained as the bottom being the most simple or the easiest task and then as the patient becomes more confident they can move farther to the top of the hierarchy to the more complicated tasks. When working with bed mobility the client will have a larger base of support and as they move their way up the pyramid their base of support becomes smaller and there are a few obstacles or barriers for the client to overcome. For example, the client could work their way from just working on sitting up in bed to eventually transferring to the tub where there are risks for falls due to the environment. Finally, the client will end up being able to transfer to a car and drive in the community where there are many different things to be aware of and be actively engaged to ensure safety for the client as well as others. I feel like I did see this hierarchy being followed while doing my internship, and being able to see the confidence grow in a patient that mastered a new step was a great experience to get to be a part of. I definitely agree with the hierarchy because if a patient is given a task that they may not be ready for, and they can not do it successfully, not only does it hurt their confidence but it also leaves  potential for their safety to be jeopardized. Being a patient in the lab, I am made more aware of how a client feels when they change from being helped to sit up in a bed with more support and less fear of falling to being transferred to different surfaces and having to trust that their therapist is there to help them if they need them. The lab experience has given me more of a realization of how the patient feels if they do not feel supported or confident in a transfer.