Restoring confidence in mobility

To restore a client's confidence in mobility it is important to educate the client on the steps it takes to reach that goal. As a therapist it is also important to talk with the client about their values, goals, and needs to adequately help the client. The hierarchy of mobility skills is 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. This order is what I expected because it begins with the most basic one to accomplish and understand and then it works it's way up. For example, the milestones for an infant isn't to walk right away instead it would be to grasp. 

As a therapist it is important to keep in mind that a body is easier to move when: the center of gravity is moving and the base of support is small. You can think of the hierarchy of mobility as a pyramid with bed mobility being at the bottom and community mobility and driving at the top. It is in this particular sequence for the safety of the client. During my internship in undergrad I was in acute care with an occupational therapist. We had a client that we worked with who was considered obese and when we first met with her the goal was just bed mobility. It was important that she was able to move her body in bed in various positions (supine, sitting, side lying) and perform ADL's. By meeting these goals we knew she was ready for the next step: transfers. 

I agree with this approach because it is safe for the client but provides a lot of improvement and progress to be made by the client as well. It's important to remember that every client is different and will progress differently. One may be more independent starting off than others but this hierarchy provides a good base of knowledge and starting point for the therapist.