Hierarchy of Mobility Skills

Restoring mobility skills goes in the order of bed mobility, mat transfer, wheelchair transfer, bed transfer, functional ambulation for ADL, toilet and tub transfer, car transfer, functional ambulation for community mobility, to lastly community mobility and driving.  This hierarchy is what I expected.  I think it is in this particular sequence because it seems to flow in order of a person needing the most help and being most dependent to having the least help and being more independent.  In this sequence the steps build on one another. For example, it would be hard to have a toilet transfer without being able to do a wheelchair transfer first.  In the past I did an internship at a retirement community and looking back now I did see this order of skills.  Each resident would have to have one of these mobility skills before they could move safely to the next mobility skill.  However, with the use of assistive devices not every step was followed in this order.  For example, one time the residents went on a scenic drive and then went to Baskin Robbins.  They took the accessible van that allows for the person in a wheelchair to be put on a platform, raised up, and secured safely in the van while never leaving the wheelchair.  This way residents could partake in community mobility/outings.  With the use of assistive devices the order might change but without assistive devices it would stay very close to this order.  I agree with the order of this hierarchy of mobility skills because it does make the most sense to go from activities without independence to activities with independence.  I do think though that some steps may be in different orders for some clients because not every person is the same and will function in the same way.  From my experiences I have learned that we as future OTs need to know the foundation of mobility but also understand that not every client will be the same so we must be aware of this order for the safety of our clients and also be adaptable.