Hierarchy of Mobility

The hierarchy for restoring confidence in mobility is as follows: bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL’s, toilet and tub transfer, car transfer, functional ambulation for community mobility, and community mobility and driving. As you move up the heirarchy, the size of the base of support gets smaller and the level of stability decreases, but the level of mobility increases. 

To be totally honest, before this course, I had not given much thought as to what order mobility skills would be addressed in. After my experiences in this course, the hierarchy of mobility makes perfect sense. I believe the hierarchy is in this particular order because it builds from one step to the next. This order ensures that a client has mastered one set of activity demands and prepares them to move forward to the next set.

For example, the hierarchy begins with bed mobility. Bed mobility is the ability to move the body in bed to perform activities in various positions. These are basic functional skills that provide the basis to allow the client to participate in ADL’s. Bed mobility is also the basic skill in preparation for transfers. So, it makes sense that bed mobility would come before any type of transfer.

During my observations, I was able to spend time in an assisted living facility. The therapist I observed would ensure that a client displayed appropriate bed mobility before moving on to another task, such as a transfer. At the time, I was unsure as to why the therapist did this, but after taking this course, I now realize that the therapist was using the hierarchy of mobility.

I agree with this approach because I believe it gives your client the best chance in reaching their individual level of independence, while ensuring the safety of theclient. Each level builds off of the next, making sure that the client is never unprepared for the next set of activity demands.

The Perfect Fit.

Assistive devices, put simply, are things that help people do things that they may not be able to do otherwise. Some of the commonly used assistive devices include a cane, axillary crutches, lofland crutches, a platform walker and a rolling walker. These devices can be instrumental in helping a client regain independance. Fitting your client’s assistive device appropriately is extremely important. If an assistive device is ill-fitting, it can negatively affect a client’s gait, cause instability, and even cause pain.

To properly fit a cane, the hand grip should be at the level of the greater trochanter, the ulnar styloid process, or the wrist crease. The elbow should be relaxed and flexed between 20-30 degrees. The shoulders should also be relaxed and not elevated. For crutches, the hand grip should be at the level of the greater trochanter, the elbows should be relaxed and flexed between 20-30 degrees, and the shoulders shoulb be relaxed and not eleveate. The axillary rest should be 5 centimeters below the axilla with the shoulders relaxed. For Lofstrand crutches, the arm band should be placed about 2/3 up the forearm.

In addition to crutches, it is important to properly fit walkers as well. When fitting a platform walker, the platform surface should be placed so that weightbearing is allowed through the forearm when the elbow is bent to 90 degrees. The client should be standing with the scapula relaxed. The proximal ulna should be placed 1-2 inches off the platform surface and the handle should be place towards the middle to allow for a comfortable grip. For a rolling walker, the height should be adjusted to that of the client and the hand grips should be inline with the greater trochanter or wrist crease when the hands are at the clients sides. The client’s elbows should be flexed between 20-30 degrees.

Regardless of the type assistive devices being used, to maximize the benefit of the device and minimize further damage or pain, it is of the utmost importance that they be properly fit for patient usage, comfort, and mobility.

Body Mechanics and Posture

Body mechanics is referred to as the way we move our bodies and body parts during everyday life in order to protect our bodies from pain and injury. To have good body mechanics means to have good posture and good body alignment when lifting or moving. Posture is defined as the relationship of our body parts to each other and to our base of support. It is important to teach good body mechanics and posture to clients because it minimizes the risk of injury, helps prevent pain, allows internal organs to function properly, and helps promote overall long term health.

 In clients who work in manual labor or lift heavy objects, I would teach proper lifting technique. Using proper lifting techniques would help prevent injury and avoid pain. In order to properly lift a heavy object, the client should get as close as possible to the object he or she intends to lift. They should get a firm grip on the object using their hands and fingers. The client should keep their back as straight as possible and keep their feet flat on the ground, shoulders length apart. This provides a stable base of support. The client should then bend at the hips and knees, keeping the load as close to the trunk as possible. I would also encourage the client to ask for help when needed and to lift smaller loads when possible.

 In clients who work in an office or sit for long periods of time, I would explain the benefits of posterior sitting. In posterior sitting, the pelvis is in neutral and there is an open angle between the torso and the thighs. In other words, the bottom is situated at the back of the seat with the back against the backrest. In this position, the center of gravity is behind the ischial tuberosities and lumbar lordosis is reduced. I would also encourage the client to change positions often and to turn their body by moving their feet instead of twisting at the waist. I may also suggest using a cushion or adapted chair to help relieve pressure on the lower back.

A "Little" Problem.

In Roald Dahl’s story “Man from the South”, a soldier makes a bet involving his little finger. If the soldier lost the bet, he would have lost his little finger. While the little finger may not seem like it serves much of a purpose, it is very important for grip strength and power. The little finger works with the ring finger in order to grip every day items and carry out every day activities. Without his little finger, the soldier would have trouble holding anything weighted, big or small. This would affect many of the soldiers occupations, specifically grooming and personal care. 

 One of the first things that comes to mind when I think of individuals in the armed forces is the serious dress code they abide by and the pride they take in their appearance. I mean, who does notWithout his little finger, the soldier may have trouble gripping and using a hair brush and tooth brush. In order to help facilitate the soldiers ability to carry out his grooming and personal care, a universal grip cuff could be used. 

love a man in uniform?

The universal grip cuff is a peice of adaptive equipment designed with those who have grip strength deficites in mind. These grip cuffs can be attached to just about anything with a handle and allow you to hold and “grip” everyday items without having to use much grip strength. This universal grip cuff would allow the soldier to continue to keep up his appearance in and out of uniform independently.  

Healthy People 2020 defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make the appropriate health decisions. The field of Occupational therapy uses a client-centered approach and an essential part of this is health literacy. As an Occupational therapist, it is a practitioner's job to make sure that clients know and understand what is going on at all times during therapy. This means explaining everything from the diagnoses to the treatment while using plain, easy to understand language. This is important in Occupational therapy because if a client does not understand what is going on, then they are not able to be an active contributor in their recovery.

The Scapulohumeral Rhythm

The scapulohumeral rhythm is the ratio of movements between the scapula and humerus, it is very important for full range of motion at the shoulder.  Full range of motion at the shoulder is 180 degrees, that is 120 degrees at the glenohumeral joint and 60 degrees at the scapulothoracic joint.  The scapulohumeral rhythm is necessary for congruency between the scapulothoracic joint and the glenohumeral joint, that is, it makes sure everything is lined up and working way it is supposed to. When these to joints are synchronized and working together, it allows for good length tension relationships, it maintians the subacromial space to avoid impingements, it prevents active insufficiency, and decreases shear forces. If there is an issue with the scapulohumeral rhythm, there will likely be a decrease in range of motion and this can negativley affect the client's ability to perform everyday tasks. 

Just keep Swimming!

For this Knowledge check, I chose to listen to the podcast about swimming lessons for kids on the autism spectrum. Autism is something that is near and dear to my heart and I love that more experiences are being adapted to fit the needs of the ASD community. Not only are they providing swimming lessons for kids with ASD, they are advocating for and teaching people about Autism Spectrum Disorders. Programs like this are very important in promoting support and acceptance for the ASD community.
One thing in particular that I learned from this podcast is that children with autism are at a particularly high risk for drowning. So not only are these swimming lessons great therapy tools for kids on the autism spectrum (specifically the sequence and sensory components), but they also teach a survival skill and help reduce the risk of drowning.