Can I have the keys now? …Driving after TBI

1. Can I have the keys now?…Driving after TBI October 9, 2012 TBI Conference, Burlington, VT Heather C. Zuk, OTR/L Certified Driving Rehabilitation Specialist Driving School Instructor

2. The 6 Ws • Why shouldn't I just get in my car & go? • Who decides? • When can I return to driving? • What is a driver rehabilitation program? • Who pays for driver rehabilitation? • Where do I go for info/training/help?

3. 1. Why shouldn't I just get in my car & go?

4. America’s Driving Culture Because we take our driving skills for granted, it is easy to forget that driving is the most dangerous thing we do every day.

5. Rehabilitation Steps after TBI • Bathing/dressing • Walking • Meal Preparation • Living Independently • Driving (the one activity of daily living that can kill or injure others . . .) Research shows that 40-60% of people with severe brain injury return to driving after they are injured

6. Skills for Driving • Search the environment for specific information • Interpret what you see • Make a judgment • Physically React in a timely manner All at high speed ………

9. After a Brain Injury • Visual skills • Cognitive skills • Physical skills All can be negatively impacted and all can put an individual at risk for a driving accident . . .

10. Visual Skills • Loss of sight • Double vision • Difficulty with peripheral vision • Spatial relationships

11. Cognition/Thinking Skills • Memory • Judgment, safety awareness • Problem-solving, planning • Thinking speed • Impulsive decisions • Concentration

12. Physical Skills • Arm or leg paralysis or weakness or spasticity • Brake reaction time • Hand eye coordination

13. 2. Who decides? Me? My Doctor? The DMV? My Therapist?

14. Me? • Our strong desire to drive can get in the way of our safety and the safety of other’s… • Our own judgment and insight might have been affected by our brain injury. We may not know where we are having trouble…

15. My Doctor The American Medical Association • “Doctors have the moral and ethical responsibility to notify the DMV if they are concerned that an individual maybe unsafe to drive.” • “Doctor’s should utilize Occupational Therapists to aid in evaluating a person’s ability to drive if they are uncertain.”

16. The DMV Renewing a license after a medical injury: “Have you any physical or mental condition other than properly corrected eyesight that could affect your ability to safely operate a motor vehicle? If yes, send details.” You have a responsibility to notify the DMV

17. DMV: If I check Yes….. • The DMV may elect to do a written and road test. • They may request a medical evaluation form from your doctor • The DMV may utilize the report from a Driving Rehabilitation Program and forgo the written and road tests at the DMV.

18. DMV: Medical Requirements • Seizure: • Need okay from MD • Medical Suspensions: • Reinstated by a Restriction 8 that allows the Driver Rehabilitation Program to do the testing • Equipment: • Requires DMV testing unless the evaluation was completed by a Driving Rehabilitation Program

19. DMV: Vision Requirements • Visual Acuity: 20/40 with best correction • Visual Fields: Can not drive with half a visual field (120 degrees)

20. My Therapist • An Occupational Therapist that is specifically trained in driving rehabilitation . • Who has assessed your driving in the clinic as well as on the road. . . • And only when working in collaboration with the physician . . .

21. 3. WHencan I return to driving?

22. Physician: When can I return to driving? • The physician is the one most qualified to make that decision • The physician may decide to have you evaluated through a Driver Rehabilitation Program before returning to driving

23. 4. What is a Driver Rehabilitation Program?

24. Driver Rehabilitation • We are professional Occupational Therapists • We are driving instructors and certified driver rehabilitation specialists • We promote independence and safety • We want to help….

25. The Evaluation: Two Parts 1. Clinical Assessment • Visual • Cognitive • Physical skills 2. Road Assessment • Ability to safely manage intersections • Ability to safely react during predictable and unpredictable situations • Judgment in a variety of driving situations

26. The Road Assessment:The Route

27. What are the possible results? 1. Resume driving 2. Rehabilitation program for driving that may include on-road training with a therapist and a “coach”. 3. Further rehabilitation of skills in a clinic setting. Special equipment may be needed. 4. Hold off driving at this time.

28. 5.Who Pays for Driver Rehabilitation?

29. Reimbursement • Some medical insurance companies • Vocational Rehabilitation • Worker’s compensation • School Districts • TBI Waiver Program • Out of pocket

30. 6. Wheredo I go for information, training & help?

31. Fletcher Allen Health Care Driver Rehabilitation Program Medical Office Building 792 College Parkway – Colchester, VT 05446 Phone: 802-847-3140 Fax: 802-847-5151

32. Other testing sites • Association for Driver Rehab Specialist website: www.driver-ed.org to find Certified Driver Rehabilitation Specialists in your area.

33. How do you get started? Ask your doctor if you are ready to consider driving. Ask your doctor to give you a referral for an: Occupational Therapy Evaluation for Driving Have the doctor include your diagnosis on the prescription This can be faxed or sent to the Driver Rehabilitation Program to start the process…

34. Questions? ????????????

35. Thank you!