Prediction of Return to Driving Post-CVA: An Evidence-Based Review. Presented by Melissa Arakelian. Introduction…. Currently CVA is the most frequently encountered diagnosis by occupational therapists in the adult setting Leading cause of disability in the U.S.
Occupational Therapy Generalist: Possess general knowledge and understanding of performance and processing skills related to driving.
Occupational Therapist with Advanced Training: Further educated to evaluate the integration of sub-skills associated with driving, and provide specific sub-skill training.
Occupational Therapist with Specialized Training:Received specialized education, examination, and/or certification.
Physical Abilities Review
Physical and Mental Endurance
Information Processing Speed
Visuomotor coordinationIn order to Drive…
Trail Making Test (Part A) Review
Visual Form Recognition Test
Single and Double-Letter Cancellation
Cognitive Behavioral Driver’s Inventory (CBDI)
Dynavision Assessment Battery (DPAB)
Motor-Free Visual Perception Test
TMT-A and TMT-B
UFOV (useful field of vision)
Complex Reaction Timer
Money Road Map of Direction Test
Charron TestAssessments Currently Employed…
Currently there are no universally accepted clinical guidelines defining what constitutes a complete assessment battery for determining the ability to return to driving
General clinical evaluation should consist of
S c a n n i n g
Attention: Alertness and Attending
Oculomotor Control Visual Fields Visual Acuity
*Adapted from original work by Margaret Horger, OTRVision…
In a study by Fisk, G. D., Owsely, C., & Mennemeier, M. (2002), impairment of visual attention measured by the UFOV indicated greater impairment among post-stroke non-drivers versus post-stroke drivers
Useful Field of Vision (UFOV) : Test of visual attention, measuring information processing, ability to divide attention, and the speed of processing
Mazer, B., Korner-Bitensky, N. A. & Sofer, S. (1998) assessed the ability of the following perceptual tests to predict on-road driving outcomes:
Findings by Mazer, B., Korner-Bitensky, N. A. & Sofer, S. (1998):
Fisk, G. D., Owsley, C., & Mennemeier, M. (2002). Vision, attention, and self-reported driving behaviors in community-dwelling stroke survivors. Archives of Physical Medicine and Rehabilitation, 83, 469-477.
Hopewell, A. C. (2002). Driving assessment issues for practicing clinicians. Journal of Head Trauma and Rehabilitation, 17, 48-61.
Klavora, P., Heslegrave, R. J., & Young, M. (2000). Driving skills in elderly persons with stroke: Comparison of two new assessment options. Archives of Physical Medicine and Rehabilitation, 81, 701-705.
Korner-Bitensky, N. A., Sofer, S., Gelinas, I., & Mazer, B. (1998). Evaluating driving potential in persons with stroke: A survey of occupational therapy practices. American Journal of Occupational Therapy, 52, 916-919.
Lee, H. C., Lee, A. H., & Cameron, D. (2003). Validation of a driving simulator by measuring the visual attention skill of older adult drivers. American Journal of Occupational Therapy, 57, 324-328.
Mazer, B., Korner-Bitensky, N. A., & Sofer, S. (1998). Predicting ability to drive after stroke. Archives of Physical Medicine and Rehabilitation, 79, 743-749.