Transfers

There is a hierarchy of mobility skills that orders the transfers a therapist can perform with their client to increase mobility. The hierarchy order goes; 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 for driving. When I think about this order I think the sequencing makes sense. If a person were to begin in bed with little mobility, this chart slowly works up from beginner skill to more advanced in that the first level is the biggest base of support (being the most stable) to the smallest base of support (the least stable). The hierarchy also moves from an order of least adherent to ADL performance to most. Also, it moves from larger room for moving to more confined increasing the difficulty of the transfer. I have had much experience performing and even teaching others transfers from working at a camp for people with disabilities. At camp I have worked with several people who require different levels of transfers. I have learned that patient comfort and trust is at the forefront of the decision of which transfer to perform. Transfers can be a very vulnerable experience as they are placing their safety in the hands of those transferring them, this is why we must be confident and gain as much practice as possible. I would say overall the hierarchy makes sense with my experience as a general rule but I have also seen instances that do not follow this hierarchy. The one instance I have noticed that does not follow this hierarchy is the lumping of toilet and tub transfers in to the same category. I would say tub transfers, depending on the level of equipment, are much more complex, dangerous, and often require more help. I say this because the spacing is different and the slipperiness and accessibility of tubs varies widely whereas toilets, while there is some variation, can often be predicted ahead of time the difficulty of the transfer.