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Assessing Driving. M-CASTL Conference 2009 Paula Kartje, OTR, DRS UMHS Drive-Ability Program. Many Roads Lead to Evaluation. Who’s Appropriate?. Typical Ages: 14.5 years old (pre-driver’s ed eval) up to 95+ years old

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assessing driving

Assessing Driving

M-CASTL Conference 2009

Paula Kartje, OTR, DRS

UMHS Drive-Ability Program

who s appropriate
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)

standard practices in driver rehab
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
purpose of clinical assessment
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
key elements of clinical assessment
Key Elements of ClinicalAssessment
  • Medical & Driving History
  • Vision
  • Visual Perception
  • Cognitive Skills
  • Motor & Sensory Functions
  • Driving Knowledge
  • Attitude / Behavior
medical history
Medical History
  • Significant Past Medical History
  • Medical Diagnoses
  • Acute vs Chronic Health Issues
  • Medications & Potential Side Effects
driving history
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
vision assessment
Vision Assessment
  • Vision History
  • Far/Near Acuity with correction
  • Peripheral Fields
  • Depth Perception
  • Color Vision/Contrast Sensitivity
  • Night Vision/Glare
  • Visual Scanning
vision assessment tools
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

visual perception
Visual Perception
  • Visual Discrimination
  • Figure Ground
  • Visual Memory
  • Visual Closure
  • Spatial Reasoning
common vp assessment tools
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
cognitive evaluation
Cognitive Evaluation
  • Orientation
  • Attention/Concentration
  • Processing Speed
  • Memory
  • Problem Solving/Decision Making
  • Judgment / Insight
  • Driving Knowledge
cognitive assessment tools
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
motor sensory evaluation
Motor & Sensory Evaluation
  • Range of motion, strength, coordination
  • Sensation & Proprioception
  • Transfers, balance and mobility
  • Endurance
  • Foot placement, coordination and reaction time
physical assessment tools
Physical Assessment Tools
  • Functional Range of Motion
  • Manual Muscle Test
  • Dynamometer & Pinch Meter
  • BTE Steering Wheel
  • Foot Reaction Timer
attitude behavior
Attitude / Behavior
  • Impulsiveness
  • Distractibility
  • Anger Control
  • Risk Taking
  • Anxiousness
  • Depression
post clinical assessment
Post Clinical Assessment
  • Summarize Concerns
  • Suggest Treatment &/or Compensatory Strategies
  • Provide Education
  • Adaptive Equipment Recommendations
  • Determine Best Type of Road Test
post clinical evaluation decisions
Post Clinical Evaluation Decisions
  • 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
on road evaluation considerations
On Road Evaluation Considerations
  • Type of Road Test
  • Client’s Needs
  • Where Available?
  • Cost
  • Time Frame
  • Whose Car?
on road evaluation types
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

on road assessment
On Road Assessment

Areas Assessed

  • Visual Components
  • Maneuvers
  • Vehicle Controls
  • Cognitive/Behavioral
road test visual components
Road Test- Visual Components
  • Awareness & Scanning the Environment
  • Use of Mirrors
  • Recognizing & Obeying signs and signals
  • Checking Blind Spots
  • Lane Placement
  • Preplanning
  • Stop Lines
road test maneuvers
Road Test- Maneuvers
  • Entering/Exiting Roads, Expressways, Lots
  • Right & Left Turns
  • Handling Different Intersections
  • Lane Changes
  • Parking
road test vehicle controls
Road Test- Vehicle Controls
  • Pre-Ignition Skills
  • Pedal Use-Foot Coordination
  • Steering Controls
  • Following/Stopping Distance
  • Speed Control
  • Use of Equipment
road test cognitive behavioral
Road Test- Cognitive/Behavioral
  • Attitude
  • Attention / Concentration
  • Processing Speed
  • Handling Multiple Directions
  • Distractibility
  • Decision Making
  • Impulsivity
potential outcomes
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
how bad is too bad30
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

opportunities for education training
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
thank you

Thank You !

Paula Kartje, OTR, DRS

Manager, MedRehab OT/PT

Drive-Ability Program

[email protected]

734-998-7898

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