You Have To Roll Before You Run
The hierarchy of mobility skills in order from least to most confidence is: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADLs, toilet and tub transfer, car transfer, functional ambulation for community mobility, and the top is community mobility and driving. After seeing the hierarchy pyramid for the first time, it did make sense to me why it is in that particular order. The bottom levels have a larger base of support which helps the client stay safe while they build their confidence, strength, and balance. As they go up the skill levels, progressively smaller bases of support are introduced along with other challenges such as slick surfaces in the tub/bathroom. These added challenges require more balance and mobility skills. Driving is at the top of the pyramid because it requires a lot of both physical and cognitive skill to safely maneuver a car. For example, if a client is recovering from back surgery, bed mobility is the very first