Driver Rehabilitation

Question 1

Why is driving an issue?

Answer 1

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

Question 2

Why OT & Driver Rehab

Answer 2

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

Question 3

Community Mobility Definition

Answer 3

Moving self in the community & using public or private transportation, such as driving, or accessing buses, taxi cabs, or other public transportation systems

Question 4

During ADL Eval the OT Should

Answer 4

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

Question 5

OT Responsibility is to

Answer 5

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

Question 6

What to do if they should retire driving

Answer 6

Counsel & listen
Look at transportation alternatives in client’s community
Eval their ability to use transport options
Doccument all actions & recomendations

Question 7

Driver Rehab Specialist Overview

Answer 7

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

Question 8

Role of Driver Rehab Specialist

Answer 8

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

Question 9

Driver Rehab Clientele

Answer 9

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

Question 10

Medical conditions that may impair driving

Answer 10

Vision, CVA, CardioVA, Metabolic, Musculoskeletal

Neuro, peripheral, vascular, psychiatric, respiratory

Question 11

Older driver concerns

Answer 11

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

Question 12

Referral Pathways

Answer 12

Phsyicians, families, Ckients
Consumer support groups. Area agencies on aging
Schools, Vocational Rehab
Department of Motor vehicles, Judicial system

Question 13

When to Evaluate

Answer 13

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

Question 14

Reimbursement

Answer 14

Private Pay, Medical
Department of vocational rehab 
Department of veterans affairs 
Local organizations & charities 
Manufactures rebate (equipment only)

Question 15

Overview of the Eval Process

Answer 15

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

Question 16

Functional Deficits & the Implications for Driving : Lack of ROM in the neck

Answer 16

• limited ability to see the full field of traffic

- difficulty checking “blind” spots or backing up

Question 17

Functional Deficits & the Implications for Driving : Both legs missing/non functional for driving

Answer 17

Inability to use brake & accelerator
Inability to use foot operated parking break
Possible interferance of legs w/ driving controls
Possible balance issues

Question 18

Functional Deficits & the Implications for Driving : Partial loss of Strength for 1 side of the Body

Answer 18

Difficulty steering
Inability to operate secondary controls on effected side
Inability to operate gas & break if right side is involved

Question 19

Limited Figure Ground Skills

Answer 19

Difficulty finding signs among other visual stim

Increasing difficulty as traffic increase and/or road scene increases in complexity

Question 20

Perception : Visual Closer

Answer 20

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)

Question 21

Perception : Position in Space

Answer 21

Unsure of portion as related to another object (i.e. cars)

Trouble orienting vehicle when in curves or coming out of turns

Question 22

Perception : Spatial Relationships

Answer 22

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

Question 23

Perception : Spatial Neglect

Answer 23

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

Question 24

Functional (on-road) assessment: Parking Lot

Answer 24

Entry/exit skills 
Mobility aid management 
Seating & positioning behind the wheel 
Operates controls 
Backing & Parking

Question 25

Functional (on-road) assessment: Residential Area

Answer 25

Acceleration/Breaking 
Steering Control 
Lane position, turning position 
maneuvers turn 
complete stops 
appropriate stopping distance 
checks traffic

Question 26

Functional (on-road) assessment: Rural & City Areas

Answer 26

Appropriate speed control 
Proper following distance 
Signals & positions for turns 
Check traffic 
Appropriate speed & gap for turns 
Yeilds right of way 
Obeys traffic signs & signals 
Lane changes

Question 27

Functional (on-road) assessment: Expressways/highways

Answer 27

Appropriate use of acceleration & deceleration ramps
Merges safely
Appropriate speed

Question 28

Observed Driving Behaviors

Answer 28

Handles distractions
Adjust speed and position for potential hazards
Responds quickly to changing conditions & unexpected events
Plans ahead for maneuvers
Maintains a safe space cushion
Communicated & interacts w/ other drivers safely

Question 29

Possible outcomes for recommendations

Answer 29

Demos safe driving w/ no restrictions
Demos safe driving in a restricted area (no highways, unfamiliar areas, busy traffic, or @ night)
Demos safe driving w/ adaptive driving equipment

Question 30

DMV : NYS Re-Exam Process

Answer 30

NYS does not have a mandatory reporting law.
DMV acts when it has info that a driver has a possible condition that can affect driving skills.
-Drivers license application or renewal form
-police or physician report
-Report from a family/concerned citizen
-Unfavorable physicians reports will result in a suspended license until a favorable report is received
Other reports will trigger the re-exam process (eval interview, vision/written test, physician report, road test)

Question 31

Resources : We need to Talk

Answer 31

Preparing having a convo
Warning signs
Tranport cost & getting there worksheet

Question 32

Resources : Dementia

Answer 32

Having a + attitude & productive convos 
Tips for balancing I & safety 
Waarning signs 
Agreement w/ my family about driving 
Easing the transition from driver to passenger

Question 33

Resources : Drivewell ToolKit

Answer 33

Comprehensive info & resources for professionals to provide conversations, seminars, & presentation to community groups

Question 34

Resources : Driving Transitions & education

Answer 34

steb-by-step procedures for responding to inquires about older driver safety
Tools & scripts to use in preparing the older adult & his or her family for the decisions they need to make when transitioning from driving
Resources for the professional & public

Question 35

Resources : CarFit

Answer 35

Public ed event for older adults to check how well their vehicles “fit” them

Question 36

Resources : NHTSA

Answer 36

Driving w/ conditions and aging…

Honestly to long to type and no time to care