Restoring Confidence in Mobility

The hierarchy of mobility skills, increasing in independence, are 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, and community mobility and driving. 

    After initially reading the hierarchy, I did not expect there to be this many skills. The list is much longer than I expected. I believe the hierarchy is in this particular order because it builds upon the skills of the level below. Once the patient can successfully complete one level of the hierarchy then they will move on to the next level. For example, after successfully completing a toilet or tub transfer the patient would then move onto a car transfer. Each skill is more complex than the preceding one. After rereading the skills, I believe I have observed this in some of my shadowing prior to OT school. I do agree with this methodology for moving onto more complex tasks and skills. If a patient can complete a toilet or tub transfer they should move on to a car transfer to increase their independence and active participation in their ADLs. I believe this hierarchy is formatted in such a way that the patient will increase their independence and promote self sufficiency.

    After reflecting on what we have learned in labs and simulations, I believe we have been taught the most efficient ways to perform transfers and mobility. We will use these skills everyday at our jobs and I look forward to putting them to work. I am thankful for our simulation experiences and the resources UTHSC provides to enhance our education. We have used wheelchairs, hospital beds, Hoyer lifts, and many more tools to hone in our skills as future therapists. 

Assistive Devices

The proper fitting of assistive devices for clients is crucial for their safety. Safety is the first reason you want to properly fit a person for an assistive device. If their device is not fit according to their specific height, weight, etc. then they will more than likely compensate with poor body mechanics and posture to use the device. For example, if you incorrectly fit a client with a walker and the individual is very tall then they will be bent over for the majority of the time they are using the walker. This compensatory method would create more problems for the individual and we would be at fault for the incorrect fitting. The second reason proper fitting of assistive devices is crucial is to ensure their insurance will pay for the device they NEED. If we improperly fit a child/client for a wheelchair they will outgrow in the next year or two then insurance may not cover the cost of their next wheelchair. This is incredibly valuable for the client and the insurance companies so that they will get the most of their device the maximum amount of time. We, as healthcare professionals, also do not need to be advocating for our clients for additional devices when we were the ones who improperly fitted the client in the first place. This will ensure the client gets the most for their dollar!

The correct fitting for a cane is the handle should be at the same level of the ulnar styloid, the wrist crease, or the greater trochanter. The elbows should be relaxed and flexed at 20-30 degrees. (Also, we must ensure the client places the cane on the opposite side of the injured limb.) The same fitting will apply to a rolling walker. The hand grips will be at the same level as stated above. To properly fit axillary crutches the axillary rest must be 2 and 1/2 inches below the floor of the axilla. The hand grips should also be at the same level of the greater trochanter. For Loftstrand crutches, the arm band should be 2/3 of the way up the client's forearm. This provides the greatest stability for the client when using their crutches. Lastly, for the platform walker, the client should be standing upright with their scapula relaxed. The client should place their elbow at a 90 degree angle and their weight should be applied through their forearm and not their wrist. Also, the platform should be placed 1 to 2 inches away from the elbow to prevent ulnar nerve compression. The handle attached to the platform should be placed medially to allow the client to have a comforting grip when using the platform walker. All of these should be taken into consideration when fitting an individual with a walker, cane, or crutches. We must take extra precautions to ensure the client is receiving properly fitted equipment and by doing this it will prevent further injuries.