Restoring Confidence in Mobility

September 2013. My grandfather was showing some impressive bed mobility while recovering from a stroke and I was heading to my senior homecoming dance!

       Mobility is defined as controlled instability. Occupational therapists play a large role in  promoting mobility in individual's that have faced setbacks or weakness. A body is more mobile when the center of gravity is moving, the base of support is smaller, and inappropriate joint motion is controlled.  The Hierarchy of Mobility Skills outlines the order in which you should direct a client to master movement. With each level, the demands of the activity increase and the base of support gets smaller.
          The first phase of mobility is bed mobility. This includes moving up and down the bed, rolling, or sitting up. It is important for the therapist to practice good body mechanics and move the bed to waist level in helping a client in this step. The client will not move independently from the bed until they are able to move within the bed. The client will then continue to transfer to the mat, wheelchair and bed. These become increasingly more difficult because a mat is harder material that provides more stability. A wheelchair has arm rests to and a back rest push off from. A bed is less stable and does not have a hard back. The next step after, bed transfer, is functional ambulation for ADL. This requires the client to be out of bed and on their feet. Their base of support has becomes dramatically smaller in this step. After a client can safely ambulate, they can begin transferring to the tub and toilet. This step requires control of several joints and visual perception. The final three steps support a patient becoming safe in the community. A car transfer might involve transferring from different levels and using a sliding board. Ambulation in the community will present new hazards and control. The final step in the hierarchy of mobility is community driving and mobility. A client that is able to dwell among the community can regain a sense of safety and independence.
        The order of these steps were initially surprising but after spending time in the simulation lab, the steps became more practical to me. These steps not only involve mobility but strength, coordination, and planning. Following these steps to promote mobility can help a client to regain confidence. I believe that fear of transfers to different surfaces ambulation can hinder a patient's recovery. That fear can be diminished by encouraging and teaching clients to move safely. The simulation lab gave me a new perspective to these steps of mobility. I am just a student that has not experienced an injury or weakness and I still felt a sense of uneasiness in the steps when first beginning this lesson. I can now better imagine how it would feel to conquer these steps for an individual that has had had a stroke, a surgery, or spent many days in the hospital. I am grateful for the opportunity to spend time in the simulation center to gain a  hands-on experience in such a valuable lesson.