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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 l.jpg

Assessing Driving

M-CASTL Conference 2009

Paula Kartje, OTR, DRS

UMHS Drive-Ability Program



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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)


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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


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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


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Key Elements of ClinicalAssessment

  • Medical & Driving History

  • Vision

  • Visual Perception

  • Cognitive Skills

  • Motor & Sensory Functions

  • Driving Knowledge

  • Attitude / Behavior


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Medical History

  • Significant Past Medical History

  • Medical Diagnoses

  • Acute vs Chronic Health Issues

  • Medications & Potential Side Effects


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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


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Vision Assessment

  • Vision History

  • Far/Near Acuity with correction

  • Peripheral Fields

  • Depth Perception

  • Color Vision/Contrast Sensitivity

  • Night Vision/Glare

  • Visual Scanning


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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


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Visual Perception

  • Visual Discrimination

  • Figure Ground

  • Visual Memory

  • Visual Closure

  • Spatial Reasoning


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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


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Cognitive Evaluation

  • Orientation

  • Attention/Concentration

  • Processing Speed

  • Memory

  • Problem Solving/Decision Making

  • Judgment / Insight

  • Driving Knowledge


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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



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Motor & Sensory Evaluation

  • Range of motion, strength, coordination

  • Sensation & Proprioception

  • Transfers, balance and mobility

  • Endurance

  • Foot placement, coordination and reaction time


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Physical Assessment Tools

  • Functional Range of Motion

  • Manual Muscle Test

  • Dynamometer & Pinch Meter

  • BTE Steering Wheel

  • Foot Reaction Timer


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Attitude / Behavior

  • Impulsiveness

  • Distractibility

  • Anger Control

  • Risk Taking

  • Anxiousness

  • Depression


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Post Clinical Assessment

  • Summarize Concerns

  • Suggest Treatment &/or Compensatory Strategies

  • Provide Education

  • Adaptive Equipment Recommendations

  • Determine Best Type of Road Test


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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


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On Road Evaluation Considerations

  • Type of Road Test

  • Client’s Needs

  • Where Available?

  • Cost

  • Time Frame

  • Whose Car?


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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


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On Road Assessment

Areas Assessed

  • Visual Components

  • Maneuvers

  • Vehicle Controls

  • Cognitive/Behavioral


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Road Test- Visual Components

  • Awareness & Scanning the Environment

  • Use of Mirrors

  • Recognizing & Obeying signs and signals

  • Checking Blind Spots

  • Lane Placement

  • Preplanning

  • Stop Lines


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Road Test- Maneuvers

  • Entering/Exiting Roads, Expressways, Lots

  • Right & Left Turns

  • Handling Different Intersections

  • Lane Changes

  • Parking


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Road Test- Vehicle Controls

  • Pre-Ignition Skills

  • Pedal Use-Foot Coordination

  • Steering Controls

  • Following/Stopping Distance

  • Speed Control

  • Use of Equipment


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Road Test- Cognitive/Behavioral

  • Attitude

  • Attention / Concentration

  • Processing Speed

  • Handling Multiple Directions

  • Distractibility

  • Decision Making

  • Impulsivity


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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



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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


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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


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Thank You !

Paula Kartje, OTR, DRS

Manager, MedRehab OT/PT

Drive-Ability Program

[email protected]

734-998-7898


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