Although physical therapists historically specialize in mobility, occupational therapists can offer a valuable perspective on community mobility in the inpatient rehabilitation setting.
Although physical therapists historically specialize in mobility, occupational therapists can offer a valuable perspective to the topic of community mobility.
Our consistent evaluation of the functionality of tasks places us in a perfect position to assess, advise, educate and intervene on the topic of community mobility.
The American Occupational Therapy Association defines community mobility as “moving around in the community and using public or private transportation, such as driving, walking, bicycling or accessing and riding in buses, taxi cabs or other transportation systems.”
Ensuring successful community mobility
There are many factors occupational therapy professionals should consider when ensuring successful community mobility.
Cognitive factors such as attention, planning, problem solving and sequencing are important for safe navigation. Physical factors such as balance, strength and activity tolerance are also important for mobility, whether it’s for using a wheelchair or walking with or without a device. Sensory factors such as vision and hearing come into play as well. In addition, psychological factors such as social skills and behavior modulation should not be overlooked.
If a person lacks some of the skills necessary for successful community mobility, an occupational therapy professional should consider structuring the environment through the use of durable medical equipment or having a capable caregiver willing to accompany the individual.
Case study
Bob is 91 years old and has a history of coronary artery and vascular disease, tremors, intracerebral hemorrhage and suspected vascular dementia. He fell at home, sustaining a brain and back injury.
After a month of being in and out of the hospital, he entered inpatient rehabilitation, where in addition to working with physical therapists, he was also able to benefit from occupational therapy. His occupational therapists focused on helping Bob and his wife adapt to his condition, so he could get back into his community.
Initially, Bob was dependent for all activities of daily living. As his therapy progressed, he improved; he could feed himself and sit on the edge of the bed. His occupational therapists taught him and his wife how to use sliding boards for transfers and soon he was able to begin sit-to-stand exercises. He eventually progressed to performing stand pivot transfers using a rolling walker with contact guard.
Bob’s occupational therapists also worked with him and his wife to learn how to complete a safe shower transfer. . Bob used a vertical grab bar placed just outside the shower to side step over a 4-inch lip, and he used a chair in the shower to sit on for bathing.
Preparing to reenter the community
After a home evaluation, his occupational therapists determined his safest access point at his home was through his garage. The home has five steps in the garage with wide wooden railings. The railings were difficult to grasp, so his OTs placed a long bar along the top of the wooden railing, and a vertical grab bar was placed at the doorway.
His OTs then had Bob practice side stepping up the stairs while holding onto the bar. Initially he did one step at a time. Then he progresssed to two steps a day. His care team placed a chair at the top and bottom of the steps for resting and were able to adjust the legs of a shower chair to sit securely halfway up the stairs in case he needed to sit before reaching the bottom or top of the stairs.
Bob’s wife’s car was positioned to allow for easy access from the stairs. His occupational therapists also introduced medical equipment to help safely transfer in and out of the car, including a car handle assist attached to the latch system in the door and a step cane to improve Bob’s ability to push himself back into the seat.
Initially their community outings consisted of just going for a drive, but they eventually progressed to going to a diner for their 57th wedding anniversary, going to Dunkin Donuts and even attending their 9-year-old granddaughter’s school concert.
Occupational therapists strive for freedom through function and helping people live a fulfilling life despite their limitations. Life is meant to be lived even if that life looks different than it did before an injury or illness.
