Driver Rehabilitation Flashcards
Why is driving an issue?
It is a transportation method that is considered a right vs a privilege
It is associated w/ autonomy & identity
Changes in health can affect driving skills
Loss of driving privileges can have a - effect on social connectedness, psychological, & physical health.
Driver safety is a public health issue
Why OT & Driver Rehab
Community mobility and driving is an IADL
Only transportation option in rural areas
OT’s have a professional & ethical obligation to identify performance deficits that may affect safety in driving & community mobility w/ all of their clients
Community Mobility Definition
Moving self in the community & using public or private transportation, such as driving, or accessing buses, taxi cabs, or other public transportation systems
During ADL Eval the OT Should
Develop and occupational profile regarding the importance of community mobility & driving
- identify need, problems, & concerns about driving
- identify roles& priorities
- ask if individual is a licensed driver/wants an eval
- discuss process for addressing driving issues
- inform of resources/specialist
- communicate w/ other disciplines
- determine readiness/appropriateness for a referral to a specialist
OT Responsibility is to
know when and how to refer
to understand your limitations but to act when you should
do not recommend adaptive equipment or where they can get it
What to do if they should retire driving
Counsel & listen
Look at transportation alternatives in client’s community
Eval their ability to use transport options
Doccument all actions & recomendations
Driver Rehab Specialist Overview
Provide targeted clinical assessment & objective data regarding abilities required for driving
Perform functional on-road assessment & relate clinical finding s and abilities to the actual driving task
Prescribe & train clients in the use of adaptive equipment
Assure that abilities are w/in state regulation
Role of Driver Rehab Specialist
A client & family w/ driving safety for the present & future
Counsel & advise on driving concerns and mobility alternatives
Provide recommendations for passenger transportation & vehicle mods
Community awareness & programs
Driver Rehab Clientele
The call for a driving eval would imply that there is a concern regarding increased risk when an individual is operating or ridding in a motor vehicle
- licensed drivers w/ a medical condition or change in fx’l status
- new drivers w/ a physical or learning disability
- older drivers w/ safety concerns
- Individuals in need of passenger vehicle mods
Medical conditions that may impair driving
Vision, CVA, CardioVA, Metabolic, Musculoskeletal
Neuro, peripheral, vascular, psychiatric, respiratory
Older driver concerns
The # of older licensed drivers in the US is expected to increase from ~~20 mill today to ~40 mill in 2020.
Driving will remain the primary mode of transport for older adults
New cohorts of older adults are increasing their millage per year
Anticipate an increase in the # of absolute crashes over time
Referral Pathways
Phsyicians, families, Ckients
Consumer support groups. Area agencies on aging
Schools, Vocational Rehab
Department of Motor vehicles, Judicial system
When to Evaluate
Before a person who may be at increased risk for driving wants or needs to drive
When an individual w/ a disability reaches the state age required to pursue driving
When an individual w/ a physical disability is purchasing a new vehicle
When vehicle modification recommendations are needed to facilitate passenger transport
Reimbursement
Private Pay, Medical Department of vocational rehab Department of veterans affairs Local organizations & charities Manufactures rebate (equipment only)
Overview of the Eval Process
Client history: medical & driving Clinical Assessment: physical, vision/perception, cognition & behavior Functions (on the road) assessment Vehicle & Equipment Recommendations Driving recommendations Final fitting Licensing Documentation
Functional Deficits & the Implications for Driving : Lack of ROM in the neck
- limited ability to see the full field of traffic
- difficulty checking “blind” spots or backing up
Functional Deficits & the Implications for Driving : Both legs missing/non functional for driving
Inability to use brake & accelerator
Inability to use foot operated parking break
Possible interferance of legs w/ driving controls
Possible balance issues
Functional Deficits & the Implications for Driving : Partial loss of Strength for 1 side of the Body
Difficulty steering
Inability to operate secondary controls on effected side
Inability to operate gas & break if right side is involved
Limited Figure Ground Skills
Difficulty finding signs among other visual stim
Increasing difficulty as traffic increase and/or road scene increases in complexity
Perception : Visual Closer
Trouble recognizing signs or other traffic control devices that are partially covered by trees or other objects
May not be able to look ahead & see what is happening w/ in the whole environment (i.e. see a pedestrian/vehicle)
Perception : Position in Space
Unsure of portion as related to another object (i.e. cars)
Trouble orienting vehicle when in curves or coming out of turns
Perception : Spatial Relationships
Unable to determine position in relationship to two or more objects in the road scene or their relation to each other
Likely to have difficulties at complex and/or angled intersections
Trouble backing up
Perception : Spatial Neglect
Does not acknowledge one side of the environment
Misses vehicles or other objects to one side
Drifts in lance to one side w/ little or no improvement when cued
Often unsafe in lance changes
Functional (on-road) assessment: Parking Lot
Entry/exit skills Mobility aid management Seating & positioning behind the wheel Operates controls Backing & Parking
