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assessing driving

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assessing driving

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    1. M-CASTL Conference 2009 Paula Kartje, OTR, DRS UMHS Drive-Ability Program

    3. Who’s Appropriate? Typical Ages: 14.5 years old (pre-driver’s ed eval) up to 95+ years old Anyone with whom driving concerns have been identified Most Common Medical Diagnoses: -Neurological (TBI, CVA, SCI, MS, PD, ALS) -Orthopedic & Amputee populations -Older Drivers (Dementia, Alzheimers, Memory Impairment, Arthritis, Debilitation) -Teens with Disabilities (CP, ADHD, TBI, Autism)

    4. Standard Practices in Driver Rehab Provision of Clinical Assessment & On Road Evaluation Followed by Post Evaluation Recommendations Performed by: OT, DRS, Driving Instructor, other Healthcare or Teaching Professionals with Driver Rehab Training May be one Evaluator for both portions or a Team Physician & DMV may also be involved

    5. Purpose of Clinical Assessment Pinpoint Client’s Strengths and Weaknesses Determine Appropriateness for On Road Evaluation Establish if Client Meets State Licensing Requirements Identify Education and Training Needs Identify Adaptive Equipment Required

    6. Medical & Driving History Vision Visual Perception Cognitive Skills Motor & Sensory Functions Driving Knowledge Attitude / Behavior

    7. Medical History Significant Past Medical History Medical Diagnoses Acute vs Chronic Health Issues Medications & Potential Side Effects

    8. Driving History License Status Tickets/Moving Violations Driving Experience Driving Frequency, Habits/Routines Family Concerns Client Driving needs Self Restrictions Type of Vehicle to be driven

    9. Vision Assessment Vision History Far/Near Acuity with correction Peripheral Fields Depth Perception Color Vision/Contrast Sensitivity Night Vision/Glare Visual Scanning

    10. Vision Assessment Tools OPTEC Machines Snellen Eye Chart Porto Clinic Keystone Vision Tester AAA Night Vision/Glare Tester Most states require minimum 20/40 in one eye

    11. Visual Perception Visual Discrimination Figure Ground Visual Memory Visual Closure Spatial Reasoning

    12. Common VP Assessment Tools Motor Free Visual Perception Test–Revised Test of Visual Perceptual Skills Clock Drawing Block Design Perceptual Worksheets: -directional concepts -design copy tasks Topographical orientation

    13. Cognitive Evaluation Orientation Attention/Concentration Processing Speed Memory Problem Solving/Decision Making Judgment / Insight Driving Knowledge

    14. Cognitive Assessment Tools UFOV (Useful Field of View) Trails A & B Comprehensive Trail-Making Test Mini Mental Status Exam Memory Tests- Contextual, Short Blessed, Rivermead Traffic Sign Recognition & Driving Situations Observation

    15. UFOV Testing

    16. Motor & Sensory Evaluation Range of motion, strength, coordination Sensation & Proprioception Transfers, balance and mobility Endurance Foot placement, coordination and reaction time

    17. Physical Assessment Tools Functional Range of Motion Manual Muscle Test Dynamometer & Pinch Meter BTE Steering Wheel Foot Reaction Timer

    18. Attitude / Behavior Impulsiveness Distractibility Anger Control Risk Taking Anxiousness Depression

    19. Summarize Concerns Suggest Treatment &/or Compensatory Strategies Provide Education Adaptive Equipment Recommendations Determine Best Type of Road Test

    20. Potential outcomes: No Return to Driving at this time—Client is not an appropriate candidate for road testing. On Road Evaluation with either a CDRS or referral to the DMV The O.T.’s role at this point in the evaluation process is to support the recommendations of the CDRS and counsel the family/client regarding driving concerns and mobility options. The O.T. is the one who obtains and submits all the required documentation from the physician to the DMV for cessation of driving. OTR also counsels family/client regarding driving concerns and mobility options if driving cessation is the goal.The O.T.’s role at this point in the evaluation process is to support the recommendations of the CDRS and counsel the family/client regarding driving concerns and mobility options. The O.T. is the one who obtains and submits all the required documentation from the physician to the DMV for cessation of driving. OTR also counsels family/client regarding driving concerns and mobility options if driving cessation is the goal.

    21. On Road Evaluation Considerations Type of Road Test Client’s Needs Where Available? Cost Time Frame Whose Car?

    22. On Road Evaluation Types Fixed Route-Unrestricted driver, All traffic situations Limited/Restricted Route-Restricted driver, May limit types of roads, routes, etc. Individualized- Specific Destinations from home, can evaluate wayfinding

    23. On Road Assessment Areas Assessed Visual Components Maneuvers Vehicle Controls Cognitive/Behavioral

    24. Road Test- Visual Components Awareness & Scanning the Environment Use of Mirrors Recognizing & Obeying signs and signals Checking Blind Spots Lane Placement Preplanning Stop Lines

    25. Road Test- Maneuvers Entering/Exiting Roads, Expressways, Lots Right & Left Turns Handling Different Intersections Lane Changes Parking

    26. Road Test- Vehicle Controls Pre-Ignition Skills Pedal Use-Foot Coordination Steering Controls Following/Stopping Distance Speed Control Use of Equipment

    27. Road Test- Cognitive/Behavioral Attitude Attention / Concentration Processing Speed Handling Multiple Directions Distractibility Decision Making Impulsivity

    28. Potential Outcomes Unrestricted, Independent Driving Independent Driving with Self Restrictions Driving with Equipment Restrictions Driving with Other Restrictions Recommend Formal Training Sessions and Reassessment No Independent Driving

    29. How Bad is Too Bad?

    30. How Bad is Too Bad?? Many Factors Influence This Decision…….. Severity of Deficits Impairments across many Performance Areas Level of Insight Ability to Remediate/Compensate for Deficits Prior Driving History Medical History: Acute vs Chronic/Deteriorating Decision primarily comes down to Therapist/DRS’s Clinical Judgment based on Experience

    31. Opportunities for Education/Training Education: To Identify Specific Difficulties-Relate to Driving To Increase Self Awareness To Improve Driving Habits / Knowledge To Teach Compensatory Strategies Training: To Improve Component Skills To Teach Use of Adaptive Equipment

    32. Thank You ! Paula Kartje, OTR, DRS Manager, MedRehab OT/PT Drive-Ability Program kartje@umich.edu 734-998-7898

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