OT Functional Mobility Interventions and Goals

OT Functional Mobility Interventions and Goals

As occupational therapy practitioners and students, we know that functional mobility is an essential part of completing ADLs and IADLs. We all need to move in order to function in our daily lives (when able), so targeting your patients’ impaired mobility is crucial to also improving their ADL performance.

Addressing functional mobility is in our Occupational Therapy Scope of Practice, and therefore it is not something we should shy away from even if other disciplines also address mobility and transfers.

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).

This is important to say up front because I have known (a small number of) PTs that have deterred new grad OT colleagues from working on functional transfers and mobility in rehab settings because it is “their” domain. In reality, both disciplines can and should be addressing functional mobility impairments to improve our patients’ independence and maximize outcomes.

However, it is important to note that OTs and PTs should not be doing the exact same treatments for a single patient. Using an OT lens with functional mobility treatments will look different than what PT is doing. PT will be working on gait training or lower body therapeutic exercises, and OT will be addressing mobility during ADLs (for example).

If you encounter any pushback from other colleagues when you address functional mobility, you can share with them the OT Framework and OT Scope of Practice definitions that I’ve included here. These are both directly from the AOTA so you can feel fully confident when educating anyone about OT’s role with functional mobility. 

Now that I’ve said that piece, let’s talk about what functional mobility is, what interventions you can try, and what goals you can use/tailor. With any intervention, be sure to follow any necessary precautions, use assistive devices when needed, and make sure your treatments are meaningful to your patient.

What is Functional Mobility in Occupational Therapy?

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). 

To put it simply, it is moving from one place to another during ADLs. Most ADLs need movement to be completed, so functional mobility retraining and ADL retraining really go hand in hand.

Occupational therapy’s role in functional mobility is to help our patients improve their mobility through intervention. This could be achieved by practicing ADL transfers, targeted exercises to improve strength, trialing and educating on adaptive equipment, etc.

Like all of our treatments, we will be focusing on the “function” part of functional mobility. We’ll go into some specific functional mobility interventions below.

occupational therapy functional mobility

OT Functional Mobility Goals

Here are a few very simple functional mobility goals that you can certainly add to depending on your patient’s individual needs as well as their specific goals. These can be modified to be short term or long term goals. You can also add in aspects that might include safety awareness, specific assistive devices, cues, balance, etc.

These goals are based on the SMART style of goal writing (specific, measurable, achievable, relevant, and time-bound). I used two weeks for each goal but of course you can modify this for your needs as well.

  • 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].

For more tips and examples of goal writing, be sure to check out our more detailed article, OT Goal Writing Tips for Adults & Older Adults.

OT Functional Mobility Interventions

You may have gotten a few functional mobility treatment ideas already from the above goals, but I wanted to include a few more of my favorite occupation-based interventions here. As I mentioned above, the key is to keep these interventions functional as well as client-centered. Ask what activities and goals are most meaningful to your patient and go from there.

Addressing functional mobility will not only help increase independence with ADL transfers, but will also improve your patients’ balance, strength, activity tolerance, and safety awareness. Here are just a few examples:

  • Bed Mobility. If your patient is an acute care or inpatient setting and cannot yet tolerate higher level mobility, work on (1) rolling bed-level as well as (2) completing supine to side lying to sitting edge of bed for ADLs. These are a great way to work up to more advanced functional mobility.
  • Bathroom transfer training. These may be obvious functional mobility interventions for seasoned OTs, but for students and new grads functional mobility related to bathroom ADLs is one of the best ways to address mobility in a meaningful way. Along with working on ambulating from the bed to the bathroom (if you’re in acute care, for example), you can also work on toilet/shower/tub transfers with AE/DME education.
  • Wheelchair mobility into the community (outside or to the gift shop if you have one), or to/from the therapy gym, is a great way to improve their independence with mobility, versus just wheeling them if they are going home wheelchair-level. If PT is addressing this in their goals, you can document this as community re-entry wheelchair-level to [place you are going] to improve independence with community mobility. 
  • Item retrieval. Have your patient walk or propel around their room to retrieve self-care related objects from a cabinet or closet (with high and low reaching). Have them use any new assistive devices with cueing and education provided as needed.
  • Household mobility. Walking or propelling through the house (for ex. from bedroom to kitchen and back) with any new AD or even a laundry basket. Provide cues for safety with obstacles. 
  • Floor recovery/transfers. Practice getting up and down from the floor for fall recovery/prevention. This is an aspect of functional mobility that may not be your first thought, but this is such a great activity for improving confidence and increasing your patients’ overall strength and stability. Here’s how you can do this safely.
  • Higher level community mobility tasks, depending on the setting, can include grocery store/gift shop functional mobility, getting to/from the mailbox, stepping up and down from curbs, taking out the trash, with their new DME/AE when needed.

OT functional mobility in community

 

Keeping your functional mobility interventions tied to ADLs/IADLs will not only help your patients reach their goals but will also help you differentiate from the gait training that your physical therapist counterpart will be doing. 

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I hope this article gave you a good starting point to address functional mobility with your patients! If you have any additional functional mobility treatment ideas, thoughts, or questions let me know in the comments. And if you found this article helpful, please pass it along to anyone else that you think would benefit from it 🙂 

References

American Occupational Therapy Association. (2021). Occupational therapy scope of practice. American Journal of Occupational Therapy, 75(Suppl. 3), 7513410030. https://doi.org/10.5014/ajot.2021.75S3005

The American Journal of Occupational Therapy. (2016). Occupational therapy practice framework. https://www.aota.org/~/media/Corporate/Files/Advocacy/Federal/coding/OT-Practice-Framework-Table-1-Occupations.pdf

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