Confidence is Key

What is the order for restoring confidence in mobility based on increasing activity demands? Is this what you expected? Why do you think the hierarchy is in this particular sequence? Is this what you have observed in the past? Do you agree or disagree with this approach? Why? Reflect on what you have learnt in labs and your simulation experiences.

    As learned in class, the hierarchy of mobility skills proceeds as follows: bed mobility--mat transfer--wheelchair transfer--bed transfer--functional ambulation for ADL-- toilet and tub transfer--car transfer--functional ambulation for community mobility--community mobility and driving. Each level that the client increases, they decrease in their base of support (bos). Decreasing one's base of support is imperative to mobility due to the fact that the more bos a person has the more stable they are; and if that client is stable that means that their line of gravity (log) is going to be inside the bos. After reviewing this chart, it sort of surprised me that one would need a larger bos for a wheelchair transfer and less for bed transfer. I thought that bed transfer would be right after bed mobility or mat transfer, however after discussing it in class and learning about the different techniques clinicians use in order to help their client with their mobility, I can see why the chart is categorized the way that it is. 

       The reason that the hierarchy, in my opinion, is portrayed in this manner is because it literally increases the client's movement abilities. The chart takes into consideration surfaces that may be more slippery or less sturdier than others. For example, the wheelchair transfer is below the bed transfer because it is sturdier or more stable than the bed. Wheelchairs have armrests that the client can push off of in order to maintain their balance, a bed does not. One would have to use majority of their own strength and mobility to push off of a bed. Another example would be how bed transfers are below toilet and tub transfers. This would be an example of surfaces being wet; it would also require a more mobile person and them being able to maintain balance with such a limited base of support because of the confined space. 

   The idea behind this chart is definitely information I have seen implemented during my observations and is something I totally agree with. When doing observations at a SNF, I would see OT's use a chart similar to this to track their client's level of mobility. They would try to increase their mobility by doing small exercises and increase their repetition to facilitate their endurance. This approach, to me, is something I would do in a real clinical setting because it helps and increases the client's independence and mobility. I also feel as if this approach helps build confidence within the the client. In my pediatric observation, the clinicians had a chart similar to this one and the clients got to put a decorative pin or magnet by the level they had completed. This type of visual representation lets them know that they are doing better and regaining their independence in their own way, it gives them the courage and will-power to keep going forward. It also makes them feel more self assured; knowing that they completed a task that they could not do before.

    As this term comes to an end, I learned a lot about transfers and body biomechanics due to the sim labs and the regular labs we had. I learned that no matter what level your client is on when doing mobility exercises or if a clinician is doing regular transfers, always put a gait belt around your client. I also learned about the different ways a person can/could be transferred and what movements are needed from the client's/clinician's body in order to make the transfer run smoothly. The labs also taught me how to use AE and the proper biomechanics when using an assistive device. I also learned how to effectively communicate different positions and movements that I would be doing on the client.