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Motor Functions and Mobility Considerations for Function Based Rehabilitation

Original Editor - Ewa Jaraczewska based on the course by Tarina van der Stockt

Top Contributors - Ewa Jaraczewska and Jess Bell  

Introduction

"Motor function is the ability to learn or to demonstrate the skilful and efficient assumption, maintenance, modification, and control of voluntary postures and movement patterns." The American Physical Therapy Association[1]

Mobility interventions are interventions that focus on enhancing functional mobility and preventing functional decline in an individual. They may include positioning, transfer, balance and walking activities.[2]

Motor function and mobility are foundations for independent living for all people across the lifespan. Restoring and maintaining motor function and mobility for people with acute injuries, or chronic / progressive conditions requires a multifaceted approach to rehabilitation.

This article explores general rehabilitation principles related to motor function and mobility interventions. It introduces the Physical Activity Pyramid as a framework for physical activity before exploring specific motor function components of therapeutic exercise. It then examines mobility interventions, such as therapeutic positioning, transfers, walking and balance training, before highlighting the role of assistive technology in supporting long-term functional outcomes.

Physical Activity Pyramid

The Physical Activity Pyramid (see Figure 1) highlights activities that are necessary to achieve a balanced and active lifestyle. It can be used to guide exercise training as it illustrates the recommended amounts of physical activity across various categories.[3]

Level 1 (the foundation and largest part of the pyramid): includes everyday low-to-moderate intensity activities, such as standing or brief walks, taking the stairs or performing household chores. These activities, which accumulate over the day, play an important role in overall energy expenditure and can significantly impact health over time.

Level 2: aerobic exercise and recreational sports are activities that elevate heart rate and improve cardiovascular fitness, like running, swimming, cycling, dancing, or hiking. These activities are important for maintaining cardiovascular health, managing weight, and improving mood.

Level 3: strength and flexibility exercises help to maintain muscle mass, bone density, and joint health. Strength training should include all major muscle groups. Flexibility exercises, such as stretching and yoga, improve range of motion and help prevent injuries.

Level 4 (apex of the pyramid): sedentary behaviours should only occupy a small portion of a person's day. While some sedentary time is unavoidable, limiting these behaviours and breaking them up with movement throughout the day is important for overall health.[4]

Figure 1. Physical Activity Pyramid


Key components of motor function from the Physical Activity Pyramid will be discussed in the following sections.

Motor Function Components

Components of motor function include, but are not limited to, physical exercise training, therapeutic exercises, strength training, stretching, balance training, and aerobic exercises.

Physical Exercise Training

Different frameworks, such as the SAID and FITT frameworks, can be used to structure or design physical exercise programmes.

The SAID (Specific Adaptation to Imposed Demands) framework, shown in Figure 2, is based on the principle that biological tissue adapts to the demands, or the lack of demand, imposed on it—tissue adapts to the trained activity (specificity) and is challenged with increased intensity and/or duration of training (overload).[5] Adaptive responses to acute and chronic exercise can vary, but the benefits of regular exercise include improved cardiorespiratory fitness, physical function and glycaemic control.[6]

Figure 2. SAID Principle


Please see Principles of Exercise Physiology and Adaptation if you would like to learn more about how our bodies respond during the acute and chronic phases of exercise.

The FITT (Frequency, Intensity, Time, Type)[7] principle can be used to guide physical activity prescription for beginners, people already exercising and patients with or recovering from specific health conditions.[8] Frequency (F) defines how often the exercise should be carried out. Intensity (I) describes how hard the person should exercise (e.g. light, moderate or vigorous). Time (T) determines the duration of training. The duration of training also depends on the intensity of a training session. Finally, the type of exercise (T) refers to the type of activity undertaken, such as aerobic activities or strengthening exercises.

If you would like to read an in-depth description of each component of the FITT framework and examples of outcome measures, please see: FITT Principle.

When designing a physical exercise training programme, it is important to develop a process for increasing physical activity in appropriate increments. This process can be broken down into six steps:[9]

  • Step 1: start at the right level
  • Step 2: progress exercises appropriately
  • Step 3: incorporate exercise training into a person's daily routine
  • Step 4: build a patient's confidence through success
  • Step 5: fit the training into a person's lifestyle
  • Step 6: provide education about the body's expected response to exercise training

Strength Training

Muscle strengthening refers to "physical activity and exercise that increase skeletal muscle strength, power, endurance, and mass (e.g. strength training, resistance training, or muscular strength and endurance exercises)".[10]

When muscles work against a weight or force, it is considered strength training, or resistance training. This type of training improves muscle mass, neural function, and strength, and consequently, leads to increased physical ability, power, and overall quality of life for people of all ages.[11] According to the World Health Organization, for additional health benefits, adults should participate in muscle-strengthening activities at moderate or greater intensity on two or more days per week. These activities should involve all major muscle groups.[12]

When designing and implementing a strength programme, it's essential to: (1) establish a patient's baseline strength, (2) assess for safety, (3) screen for medical concerns, (4) set goals together, and (5) provide appropriate progressions to achieve optimal outcomes.

If you would like more information on assessing strength and designing a strength programme, please see: Strength Training.

To learn more about muscle strength testing techniques used by rehabilitation practitioners, please see this optional article: Muscle Strength Testing.

Joint Mobility and Flexibility

Flexibility is a health- and performance-related component of physical fitness.[10]

Joint mobility is the ability of a joint to move through its full range of motion. Flexibility refers to the ability of muscles, tendons and surrounding tissues to passively stretch through the available range. It is specific to each joint. Joint mobility and flexibility are considered important elements of motor function.[9] If you would like to learn more about assessing joint range of motion and muscle length, please see: Assessing Range of Motion and Assessing Muscle Length.

Stretching and flexibility exercises are commonly incorporated into rehabilitation and exercise programmes to maintain or enhance a joint's ability to move through its full range of motion.[9] While stretching primarily aims to increase the length of the musculotendinous unit, it also affects other tissues, such as the joint capsule and fascia.[13]

Recommendations for stretching are less clearly defined than strengthening and aerobic training,[9] but the American College of Sports Medicine recommends static stretching after a warm-up, 2-3 days per week. It recommends that each stretch is held for 15-30 seconds and repeated 2-4 times, though older adults may need longer hold times.[13]

The next sections of this article review mobility interventions that can be used to enhance function.

Mobility Interventions

Functional mobility is essential for independent living, social engagement, well-being, and preventing physical decline. There are various rehabilitation interventions to improve mobility, but successful implementation requires sufficient resources and knowledge, and a thorough assessment of individual and caregiver needs.[14]

Positioning

"Therapeutic positioning is believed to enable the achievement of a good postural alignment, optimise rehabilitation and prevent the complications of immobility."[15]

Maintaining a patient's neutral body alignment through proper positioning is an essential aspect of rehabilitation patient care. Proper positioning is crucial for patient comfort. It plays an important role in contracture prevention and postural alignment and aids activities of daily living. It reduces the risk of pressure injuries and improves circulation, respiration, sensory input and mental health. In addition, it helps to maintain patient dignity and respect.[16][17]

Suboptimal or incorrect positioning in a bed, chair, wheelchair, or during static standing can impact posture and lead to pressure injuries, reduced balance, and difficulty with transfers. For wheelchair users, it can affect their ability to propel their wheelchair.

If you would like to read about the indications, contradictions, precautions, and clinical considerations for therapeutic positioning, please see: Positioning and Wheelchair Fitting. Additionally, you might be interested in reading Assistive Technology for Positioning for information on postural and limb alignment devices, offloading devices, and bed mobility and bed positioning devices.

Transfers

A transfer is "the safe movement of a person from one place or surface to another."[18]

Healthcare providers and caregivers must have a strong understanding of safe and effective transfer techniques. Before performing or assisting with a transfer, rehabilitation professionals need to assess a patient's medical status, mobility restrictions, physical abilities, strength, balance, and coordination.[9]

Transfer methods differ based on the care setting (e.g., hospital, long-term care, home), the person's functional needs, and their capabilities. Rehabilitation professionals evaluate environmental factors, including bed height, the presence of bed rails or grab bars, available space, equipment, lighting, and floor surface.[9]

Family caregivers must be supported to understand the challenges associated with different transfer techniques. Physiotherapists and occupational therapists play a vital role in helping family caregivers address these challenges and recommend suitable equipment based on the caregiver's capabilities and the patient's functional level and physical limitations. Consulting a physiotherapist or occupational therapist for tailored advice on technique and creating a safe environment during transfer is always recommended.

You can read about different types of transfers and learn about assistive technology for transfers in these two optional articles: Transfers and Assistive Devices for Transfers.

Walking and Balance

"Walking is the most common form of human gait."[19]

Balance refers to a person's ability to maintain their line of gravity within their base of support. It is defined as "a state of equilibrium, an ability to move or maintain a position without falling."[20]

Balance enables us to maintain and transition between postures, and resist external disturbances or perturbations. Maintaining balance is complex, and requires coordination between sensory, motor, and biomechanical systems.[21] Impaired balance can be caused by various intrinsic and extrinsic factors, including health conditions, medication, muscle weakness, gait instability, dizziness, and cognitive decline.[22] Changes in a person's walking and balance ability can impact independence, increase a person's risk of falling and affect quality of life.[23][9]

Interdisciplinary rehabilitation programmes can lead to functional improvements in individuals with gait and balance disorders, including enhanced gait parameters and improved ability to perform activities of daily living. Therapeutic interventions, such as compensatory strategies, individualised home exercises (including strength and static and dynamic balance-challenging exercise), and biofeedback therapy during gait and treadmill training can be beneficial.[24][25][26]

If you would like to learn more about the rehabilitation management of balance and gait impairments, please read the following optional articles: Gait Deviations, Balance and Falls.

Assistive Products Supporting Motor Function and Mobility

Assistive products can help to maintain or improve an individual’s functioning and independence, facilitate participation and enhance overall well-being. Examples of assistive devices and technologies that help support an individual's motor function and mobility include wheelchairs, scooters, prosthetic devices, orthotic devices and walking aids.

Prescribing assistive products is a complex process that requires careful clinical reasoning and collaborative interdisciplinary care plans. Healthcare professionals must conduct a thorough assessment to understand a person's functional abilities, living environment and personal goals to accurately identify the most appropriate assistive product for each person.

The duration and intensity of assistive technology support varies among individuals. Some individuals, such as those recovering from an injury or surgery, may only require temporary assistance while others with chronic or progressive conditions might need long-term support. Because a person's level of assistive technology support can change with time, regular reassessment of assistive solutions is necessary.

If you would like to learn more about mobility products, please take a look at: Assistive Technology: Mobility Products.

Conclusion

Rehabilitation for motor function and mobility is multifaceted. Many interventions, from therapeutic exercise to positioning, transfers, balance and gait training, must be incorporated into individualised treatment plans. Success depends on careful attention to safety, ongoing assessment, progressive loading, and collaboration between patients, families, and interdisciplinary teams.

Resources

References

  1. ↑ Motor Function-Guide to Physical Therapist Practice APTA 2020.
  2. ↑ Quasdorf T, Manietta C, Rommerskirch-Manietta M, Braunwarth JI, Roßmann C, Roes M. Implementation of interventions to maintain and promote the functional mobility of nursing home residents - a scoping review. BMC Geriatr. 2023 Sep 26;23(1):600.
  3. ↑ Faigenbaum AD, MacDonald JP, Stracciolini A, Rebullido TR. From Hierarchy to Harmony: Transforming the Activity Pyramid into My Physical Activity Plate. Curr Sports Med Rep. 2025 Jun 1;24(6):137-139.
  4. ↑ Dean E. Physical therapy in the 21st century (Part II): evidence-based practice within the context of evidence-informed practice. Physiother Theory Pract. 2009 Jul;25(5-6):354-68.
  5. ↑ Johnson AM, Sandage MJ. Exercise science and the vocalist. Journal of Voice. 2021 Jul 1;35(4):668-77.
  6. ↑ Ashcroft SP, Stocks B, Egan B, Zierath JR. Exercise induces tissue-specific adaptations to enhance cardiometabolic health. Cell Metab. 2024 Feb 6;36(2):278-300.
  7. ↑ Katsukawa F. [FITT principle of exercise in the management of lifestyle-related diseases]. Clin Calcium. 2016 Mar;26(3):447-51. Japanese.
  8. ↑ Burnet K, Kelsch E, Zieff G, Moore JB, Stoner L. How fitting is F.I.T.T.?: A perspective on a transition from the sole use of frequency, intensity, time, and type in exercise prescription. Physiol Behav. 2019 Feb 1;199:33-34.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 Van der Stockt, T. Motor Functions and Mobility Considerations for Function-Based Rehabilitation Course. Plus, 2025.
  10. ↑ 10.0 10.1 WHO Guidelines on Physical Activity and Sedentary Behaviour. Geneva: World Health Organization; 2020. GLOSSARY OF TERMS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK566047/
  11. ↑ Hughes DC, Ellefsen S, Baar K. Adaptations to Endurance and Strength Training. Cold Spring Harb Perspect Med. 2018 Jun 1;8(6):a029769.
  12. ↑ WHO guidelines on physical activity and sedentary behaviour. World Health Organization, Geneva 2020. Available from https://www.who.int/multi-media/details/who-guidelines-on-physical-activity-and-sedentary-behaviour [last access 16.6.2025]
  13. ↑ 13.0 13.1 Page P. Current concepts in muscle stretching for exercise and rehabilitation. Int J Sports Phys Ther. 2012 Feb;7(1):109-19.
  14. ↑ Quasdorf T, Manietta C, Rommerskirch-Manietta M, Braunwarth JI, Roßmann C, Roes M. Implementation of interventions to maintain and promote the functional mobility of nursing home residents - a scoping review. BMC Geriatr. 2023 Sep 26;23(1):600.
  15. ↑ Gooch HJ, Jones SP, Stockley RC. Evaluating the current practice of therapeutic positioning in neurological rehabilitation: a qualitative interview study. International Journal of Therapy and Rehabilitation 2023, 30(8).
  16. ↑ Physiopedia, Positioning.
  17. ↑ Vera M. Patient Positioning: Complete Guide and Cheat Sheet for Nurses. 2024. Available from https://nurseslabs.com/patient-positioning/ [last access 17.06.2025]
  18. ↑ Potter PA, Laplante N, Perry AG, Ostendorf WR. Clinical nursing skills and techniques. 11th Edition, 20204. St Louis, MO: Mosby Elsevier.
  19. ↑ Domínguez-Morales M, Luna-Perejón F. Introductory Chapter: Understanding Human Gait [Internet]. Biomedical Engineering. IntechOpen; 2024.
  20. ↑ Nazrien N, Prabowo T, Arisanti F. The Role of Cognition in Balance Control. OBM Neurobiology. 2024 Feb;8(1):1-2.
  21. ↑ Ozcan EB, Saglam M, Vardar-Yagli N, Calik-Kutukcu E, Inal-Ince D, Altinsoy M, Kaya EB. Impaired balance and gait characteristics in patients with chronic heart failure. Heart, Lung and Circulation. 2022 Jun 1;31(6):832-40.
  22. ↑ Physiopedia, Falls.
  23. ↑ Diego P, Herrero S, Macho E, Corral J, Diez M, Campa FJ, Pinto C. Devices for Gait and Balance Rehabilitation: General Classification and a Narrative Review of End Effector-Based Manipulators. Applied Sciences. 2024; 14(10):4147.
  24. ↑ Sherrington C, Whitney J, Lord S, Herbert R, Cumming R, Close J. Effective exercise for the prevention of falls: A systematic review and meta-analysis. J Am Geriatr Soc. 2008; 56 (12): 2234 - 43.
  25. ↑ Peterko Y. Fall Prevention Strategies and Home Modification Course. Physiopedia Plus, 2025.
  26. ↑ Winser S, Chan HK, Chen WK, Hau CY, Leung SH, Leung YH, Bello UM. Effects of therapeutic exercise on disease severity, balance, and functional Independence among individuals with cerebellar ataxia: A systematic review with meta-analysis. Physiotherapy theory and practice. 2023 Jul 3;39(7):1355-75.
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