Biomechanics Blog Post #6: Transfers

Before joining the MOT24 class, I had very minimal knowledge regarding different kinds of mobility skills. I have worked at rehabilitation clinics, and I have seen the typical mat, wheelchair, and car transfer. However, I had no idea that there was a legitimate hierarchy and specific order, in which a therapist must guide their client in.

The following order is described as 'easiest' to more challenging: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. Truthfully, I have never heard of functional ambulation for ADL, functional ambulation for community mobility, and community mobility. Everything else does not necessarily surprise me, but I technically did not know those were a part of the sequence. 

Typically, bed mobility is considered the 'easiest' due to its vast Base of Support (BOS), considering the entire body is in full contact with the supported mattress and bed. As one goes up the hierarchy, the BOS is decreased and it involved altering one's Center of Gravity (COG), which requires muscular strength and cognitive thinking. Also, it requires the client to be able to process sensory input and produce motor output. Going up the hierarchy it requires the client to use their eyes, ears, and muscle and joints to understand where they are in space and where their body is specifically located. Thus, this allows the body to either produce compensatory or anticipatory adjustments, depending on which mobility task they're attempting to achieve. Therefore, the sequence of mobility makes sense as one goes upward. I have seen this at my old clinic, in lecture and lab, and in multiple educational videos.

After consideration, I have decided that I agree with the hierarchy of mobility skills. This system is to start the client with overcoming stability, and as you upwards, you decrease stability and increase mobility. There are many factors that go into the thought process of challenging a client. A client can be challenged by many factors, such as: footwear, cluttered ares by objects, slippery surfaces, and physical and cognitive functionality. As a client goes up the hierarchy, mobility is increased, thus creating instability. Sometimes a client does not start all the way at the bottom, depending on their injury and their personal conditions. There are client factors such as muscular strength, executive functionality, and endurance. Some clients only need to increase muscular strength to move up the latter. Others may need to work on endurance to prepare them for movement during transfers. It is important for a therapist to understand the basis of the client, because it could easily lead to overestimating the client. This could lead to liability issues, if the client falls or hits an object, due to being thrown in a simulation they are not capable of completing yet. Or, it can lead the client to getting frustrated by not able to complete certain transfers or mobility skills, which would drastically decreases their motivation. This is why it is important for a therapist to understand the client in every aspect, and to properly assess them. It is always better safe than sorry to properly assess, and start at the bottom, or the beginning in this case. This may seem discouraging to the client at times. As a recommendation, you could show them the hierarchy, and then continue to show them how much they have progressed!