Occupational Therapy's Role in Functional Mobility

As occupational therapists and assistants working for LifeCare, we know that the majority of our patients, irrespective of their diagnoses, can present to occupational therapy with functional mobility impairments and at risk for falls. Often, we tend to shy away from the treatment of these impairments because "physical therapy is taking care of it". Yet, doing so does a disservice to our patients and to our practice as our approach and interventions can and should differ significantly from physical therapy.

Our OT scope of practice states that…

“The practice of occupational therapy includes the following components: Assessment, recommendation, and training in techniques to enhance functional mobility, including fitting and management of wheelchairs and other mobility devices” (AOTA, 2021).

What is Functional Mobility?

Functional mobility is defined as “Moving from one position to another during performance of everyday activities.” This includes bed mobility, wheelchair mobility, transfers, as well as functional ambulation and transportation of objects (Occupational Therapy Practice Framework). 

Task	OT Focus
Transfers Assess not only level of assistance, but also evaluate patient safety. Do they need their arms to transfer? Are they steady at immediate stand? What impairments prevent the patient from performing safely and how can we adjust the task/person/environment to improve their independence?	On/off toilet, in/out of favorite living room chair, dining room chair, shower and car transfers. Community mobility is an important skill and part of our domain.
Ambulation You do not need to "assess" the patient's gait, but OT can and should assess safety and mobility. Are the paths clear for mobility equipment and safe for the patient? Does the patient "furniture walk?"	Assess in-home functional mobility and patient's ability to move from room to room. Also, assess outdoor ambulation. Can the patient reach the car? The mailbox? Take out the trash?

Assessment Tools:

These are functionally based tools that correlate with occupational therapy's domain of practice.

Lower Extremity Functional Scale: 20 questions for lower body impairments that focus on a person's ability to perform everyday tasks.

Fall Efficacy Scale: Measures a patient's fear of falling during various tasks.

Functional Mobility Goals

(credit to an awesome OT Sarah Stromsdorfer, well worthy of following! www.myotspot.com

• In two weeks, patient will transfer to toilet with [level of assist] using DME as needed for safety.

• In two weeks, patient will complete tub transfer with [level of assist] and DME as needed.

• In two weeks, patient will ambulate 100 ft to ADL kitchen with [level of assist] and DME as needed, in order to resume meal preparation tasks and improve activity tolerance.

• In two weeks, patient will retrieve 4 clothing items from high and low surface with [level of assist] with AE as needed [to increase overall independence with dressing].

• In two weeks, patient will propel 50 ft in gift shop [around obstacles] with [level of assist] and rest breaks as needed [to increase strength and activity tolerance for ADLs and community re-entry].

Treatment Ideas

Truly, anything with a functional endpoint can be done. Always assess the task and the environment so that we can optimize safety and function. Here are some creative ideas:

• Sort and carry a load of laundry to the washing machine;

• Write a letter and bring it to the mailbox to send to a loved one;

• Make a simple meal in the kitchen;

• Take out the trash;

• Carry a glass of water from the kitchen to the bedroom;

• Organize cabinets and drawers;

• Use tape to create obstacles and pathways to walk;

• Visit a neighbor;

• Dance, dance and more dance!
  

Share your ideas with the team on HUCU in the OT Group and keep being awesome.

Connie, OT