Diagnosis Specific Information Flashcards
Key information regarding visual search for people with ASD
-more attention to the distant road ahead than close up
- Less time focused on sides of roads
– Last time on pedestrians, signs, red lights
– No differences and UFOV scores observed
Key factors for drivers education for individuals with ASD
– Teach to the learning preferences of individuals with ASD
– Minimize anxiety provoking situations
– Provide longer driver training period
Suggested IQ per AMA
70+
Behavior patterns that may occur with stress
– Indifference and an attention due to absorption in problems
– Despondency, depression and psycho motor retardation, which slows the reflexes
– Antagonism and impulsiveness or open aggressiveness with loss of judgment and caution
For personality characteristics with an increased risk of accidents
– Paranoid thinking
– Suicidal tendencies
– Impulsiveness
– Violent or aggressive behavior against others
Psychiatric reasons to deny driving privilege per paper from the VA
– Intellectual impairment
– Impaired reality testing
– Suicidal or homicidel inclinations
– Alcohol and drug abuses
Recommendations for persons with suicidal or homicidal inclinations
– Hospitalized for self-inflicted injury or involved in three accidents in one year or multiple tickets within a given. Should under go re-examination and file a medical report
– Anyone proven to have used vehicle to perpetrate consciously intended destructive or self-destructive act should be barred from driving permanently or at least five years
Difference in driving habits of older adults
- more hesitant and drive slower
- drive less frequently, especially for night and winter
- accident rates are higher based on miles driven
Worst problems older drivers face
Headlight glare
Night time driving
Being tired/upset
Rain/ fog
Rush hour driving
Long distance driving
Snow, sleet, or slush
Most frequent causes of accidents for older adults
Left turns
Merging with traffic
Intersections
Most frequent violations for older adults
Failure to yield left turn
Failure to yield to approaching vehicle
Improper vehicle following
Failure to stop for school bus
Failure to stop for stop sign and red lights
Strategies to improve vehicle safety for older adults
Improve mirrors-larger and location
Blind spot mirrors
Collision avoidance warning system
Rear view cameras
Tips for vehicle selection for older adults
Mid size, suv or crossover
Four doors
Full power for all systems
Education options for older adults
Carfit
AAA
AARP
VA
national safety counsel
Senescence
Normal aging of cells and body structures
Common syndromes in older adults
Acute delirium
Malnutrition
Dementia
Depression
Falls
Polypharmacy
Urinary incontinence
Frailty
Constipation
Sensory problems
Common diseases/disorders in older adults
Cancer
Parkinson’s
Heart disease
Hypertension
Osteoarthritis
Prostate disease
Osteoporosis
DM
Hip fracture
Infection
Thyroid disease
Pressure sores
Dental/oral disease
Sleep problems
Definition of forgetfulness
Diff recalling recent events if not regularly rehearsed
Normal aging. Memory loss (info that can’t be stored or recalled) not normal.
Visuospatial abilities on older adults
Some impairments with age and possibly sense of direction
Greater risk of getting lost, usually not severe enough to impact driving in familiar areas
Reaction time changes in older adults
10-30% longer for 70 years+ compared to young adults
May over compensate by using excessive caution
Most frequent Errors for older adults
Failure to yield right of way
Turning
Running lights
Improperly changing lanes
Improper passing
Improper highway driving – proper speed/slowing unexpectedly/demonstrating uncertainty and unfamiliar areas
Situations when older drivers demonstrate slowed reaction time
When required to initiate movement in which there is no opportunity to prepare a response
When faced with two or more choices of action
When anticipated driving actions must be rapidly altered
When the complexity of the driving situation increases
People with dementia are more likely to crash then healthy older adults due to deficits in which three areas
Attentional skills
Divided attentional skills
Selective attention
Evidence-based consensus statements regarding dementia
-An individual with moderate to severe dementia should not drive
-Those with very mild or mild dementia may be appropriately referred for further testing when risk factors for unsafe driving are present
– If the patient has a ner degenerative dementia mobility counseling should start immediately, anticipating driver sensation
- regardless of driving assessment outcome diagnosis of dementia should include planning exploration of alternative transportation options and begin using them to increase familiarity
– Regardless of diagnosis assessment and recommendations for optimal And safest community mobility should be provided
-self reporting driving capability may be in accurate; observe occupational performance
-call piloting is an indication that patient should stop active driving. Navigational assistance is OK
-Oh tees need to know legal and ethical obligations related to driving and community mobility
Community mobility education for people with dementia should include:
Resources For community mobility
Senior driving friendly places
Valet parking
Full service gas stations and grocery stores
Application for disabled parking permit
Involve family as much as possible
10 warning signs of Alzheimer’s disease
Recent memory loss
Difficulty performing familiar tasks
Problems with language
Disorientation of time and place
Poor or decreased judgment
Problems with abstract thinking
Misplacing things
Changes in personality
Changes in mood or behavior
Lots of initiative
Definition of dementia
Significant decline in at least 3/5 areas
-Memory
– Language
– Reasoning
– Visual spatial ability
– Personality traits
Driving implications for people with dementia/Alzheimer’s disease
-Lost in a car, especially not their own – confusion with primary controls seem uncoordinated with gas/brake pedals
– Forget directions
– Assess in unfamiliar areas and a typical paths they would normally take. May become confused in unfamiliar surroundings
– Conversation may distract them
– Very early stages, restrict to certain streets or routes or times of day. Prepare client and family for driving cessation within 3 to 8 months
– If has already gotten lost, should stop driving immediately. At risk for being lost with subsequent injuries or death
Motor problems with Alzheimer’s disease
Loss of gross motor skills and coordination
Loss of balance
Loss of fine motor skills
Problems with walking, stumbling or shuffling the feet
May have lost a range of motion
Sensory problems for people with Alzheimer’s disease
Loss of sensory awareness, sensory processing, spatial relations
May lose binocular vision
Stages of cognitive decline
-Normal
-Forgetfulness: no objective evidence of impairment, reports for getting simple things, no problems with ADLs
-Borderline Alzheimer’s disease: objective evidence hard to obtain, family confirms problems. May get lost, job performance declines, difficulty with conversation. No problems with ADLs
-Mild Alzheimer’s disease: objective evidence of cognitive deficit, difficulty with finances/shopping, difficulty with concentrating. No consistent problems with ADLs
-moderate Alzheimer’s disease: objective evidence of dementia, inability to recall address/phone number/names of family members. ADLs beginning to be affected
-Moderately severe Alzheimer’s: difficulty in remembering name of primary caregiver, not oriented to time and place, semi-dependent on most ADLs may eat if food is placed on plate.
-Severe Alzheimer’s no longer completing voluntary activities. Verbal/psycho motor skills severely limited or lost. Stupor or coma possible. Totally dependent in all ADLs.
Michon’s’s model of driving, area most affected with dementia
Strategic
Tests and “cut off’s “for dementia
Clock drug test, freund clock scoring: any incorrect or missing elements
Snellgrove maze test: >60 seconds or any errors
Trail making test part B: >180 seconds
Brief cognitive assessment tool: 34-43 =MCI; 25 -33 = mild dementia; 0 -24 = moderate to severe dementia
MMSE: score of < 24
Short blessed test: 10+
Moca: <26 = MCI; 18/30 or less = potential driving retirement
Consider red flags in driving history
Consensus statements on Parkinson’s
-Mild motor disability and no or few risk factors may be fit to drive
-Newly diagnosed recommended to plan baseline comprehensive evaluation, consider annual evaluation’s, plan for driving cessation, develop a plan for alternative transportation, start conversations with family about retiring from driving
-Severe motor impairment and multiple risk factors should cease driving , be report to licensing agency as allowed, address alternative transportation
-Mild to moderate motor disability and few risk factors strongly recommend driving evaluation, begin conversations regarding driving retirement, develop mobility plan for driving cessation
Risk factors for driving with Parkinson’s
Decreased processing speed
High risk score on UFOV
Scoring 180+ seconds on trails B
Impaired contrast sensitivity
Scoring more than seven seconds on rapid pace walk
Over 70 years old
Tendency to fall
Reaction time greater than the norm
On multiple medication’s for Parkinson’s
Considering Michon’s’s model which skills are best to look at for those with Parkinson’s
Operational and tactical combat changes here indicate need for concern
Tools to assess processing speed for Parkinson’s disease
MVPT
Task shifting on BCAT
Trails making a and B
Assessment tools for reaction time for Parkinson’s disease
Brake reaction time test
Alternating foot tap test
Timed up and go
Rapid pace walk
Chair rise
Considerations for cognition and Parkinson’s disease
Impaired cognition is red flag for continued driving. Can be referred to DRS with moderately intact cognition, ability to self correct and utilize compensatory techniques, absence of dementia
Visual skills to pay particular attention to with Parkinson’s
Succades and pursuits
Contrast sensitivity
Confrontational field of view
Are intact cognition and ability to use compensatory techniques
Symptoms of Parkinson’s
– Tremor or shaking, pill rolling
– Small hand writing, words crowded together
– Loss of smell
– Trouble sleeping; thrashing, kicking, or punching while in deep sleep
-Trouble moving or walking; arms don’t swing when walking, shuffling gait, rigidity, pain in shoulders or hips, Brady kinesia
– Constipation
– A soft or a low voice
– Masked face
– Dizziness and fainting
-impaired posture and balance; stooping, leaning, or slouching
– Cognitive impairment(Including spatial awareness/proprioception)
– Changes an ocular motor movements impacting vision processing

Implications for driving with Parkinson’s
– Medications may have adverse side effects
– Visual scanning, awareness of blind spots, moving into lanes
– Coordination for turns, parking, lane changes or pedal management; sustained breaking, smooth acceleration
– Processing, decision-making, reaction, timing
– Large portion of people with Parkinson’s stop driving by five years of the disease
-Impaired contrast sensitivity; has been shown to be a good predictor of crash risk for people with Parkinson’s
– Falling asleep is a common risk
– Noticing differences in contrast
– Difficulty with depth perception
Examples of driver training or evaluation for adaptive devices, compensatory strategies, or restrictions For Parkinson’s
– Resistive steering to diminish effects of tremors
– Special rearview and outside mirrors to enhance vision due to limited trunk rotation, rigidity, or tremors
– Develop habit of relaxation time prior to driving to reduce stress
– Use a longer than normal following distances
– Refrain from driving an inclement weather or at night
– Plan driving trips to give plenty of time to get to destinations without being a hurry
– Plan to adjust for good and bad days
Motor assessments to pay particular attention to with Parkinson’s
Coordination for timing, fluidity, and planning: rapid pace walk and chair rise test
How often to reevaluate Parkinson’s
Every six months or sooner based on decline
How many people who drive prior to CVA cease driving after CVA
58%
 Cognitive difficulties with right CVA
– Poor planning due to inadequate scanning
– Inability to shift according to changing demands of driving task
– Distractibility
– Poor judgment And insight
– Confusion
– Reduced awareness of traffic conditions
– Impaired left right discrimination
– Inadequate use of space
– Poor time and space management
– Decreased flexibility in thinking

Differences/recommendations in driver training with right sided CVA compared to left CVA
-decreased performance and complex visual searching tasks
-Less likely to pass driver training program
– Required twice as many sessions for successful training
-Instruct by showing not just telling
– Remove excess of stimuli at first
- schedule short training sessions
Went to refer to DRS regarding pain
When pain is limiting performance. DRS can consider a specialty adaptations, such as mirrors, adaptive equipment, etc. could improve performance
How many TBIs involve visual disturbances
65%
Visual disturbances caused by TBI
– Impaired accommodation
– Change in visual field
– Binocular dysfunction
– Visual information processing disorder
Symptoms of a right CVA other than cognition
– Left hemi with possible sensory deficits
– Vision: visual acuity, homonymous hemianopsia, left visual field neglect
– Unilateral neglect of affected side
– Difficulty in scanning visual space; visual perceptual deficits
– Apraxia
– Difficulty crossing midline of body
Implications for driving with right CVA
– Deviates to left of Lane
– May not look to left at stop, yield, right on red
– Does not always get into left turn lane for a left turn
– May do lane changes without checking left mirror or head check
– Denies errors
– Is overconfident and impulsive
– Has unrealistic goals
– Typically cannot be trusted to do something that they shouldn’t
- high frustration due to performance not improving despite repetition
Symptoms of left CVA
– Right hemi with possible sensory deficits
-Right homonymous hemianopsia or field cuts
– Aphasia
– Apraxia
– Compulsive or slowness
– Poor left/right discrimination
– Impaired thought processes
– Emotional lability
– Risk for depression
– Intact visual perceptual skills allow learning when communication is impaired
– Memory impairment
Deficits with attention in brain injury
– Cannot process information to make decisions or judgments with impaired attention to environment
– Distractibility
– Impaired attention and concentration impacts learning
Common possible symptoms with brain injury
– Attention and concentration
– Memory and orientation
– Slowed information processing
-problems with judgment
– Problem-solving difficulties
– Loss of initiative
– Emotional problems
– Loss of capacity for social perceptiveness
How impaired memory and orientation impact driving with brain injury
Short term memory is most affected, affects where a person is going and why
Negatively impacts learning and assimilation of new information, difficult for teaching new drivers

How slowed information processing affects driving with brain injury
Delayed response time and slowed visual motor coordination

How problems with Judgement impact driving with brain injury
Poor safety awareness
Impulsiveness
Impaired insight
