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Assessment Group: Discussion and Unresolved Issues. An assessment flow. Why?: Identify drivers with functional changes that may compromise personal or public health or safety. Why?: Identify individuals who may benefit from prevention, education, remediation.
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An assessment flow Why?: Identify drivers with functional changes that may compromise personal or public health or safety Why?: Identify individuals who may benefit from prevention, education, remediation Who?: Many different sources of screening and referral (self, family, law enforcement, DMV, other agencies, health care professionals, driver rehabilitation specialists, driver educators, community-based agencies and groups, etc, etc) What?: Tier One: Brief screening of cognitive, motor, sensory and health/medication functions. The form of Tier 1, and its next steps, are contingent on who does the assessment.
An assessment flow What?: Tier One: Brief screening of cognitive, motor, sensory and health/medication functions. The form of Tier 1, and its next steps, are contingent on who does the assessment. At each tier, there should be appropriate referrals What?: Tier Two: In-depth assessment of cognitive, motor, sensory and health/medication functions, personality/motivation/awareness. The next steps, are contingent on who does the assessment. Often done with Tier 3. What?: Tier Three: Behind the wheel assessment
Candidate measures • The domains that follow in red come from the NHTSA/AAMVA recommendations • A goal is that a battery should be evidence-based (with regard to its predictiveness of driving performance, which could include crashes, on-the-road driving errors, or other performance measures). • There are alternative pathways. • One approach focuses less on specific domains, but tries to include a battery which—in combination—maximizes predictive salience. • A second approach tries to represent multiple domains. This will be more useful for making rehabilitation recommendations and identifying the sources of problems. • The two approaches are not mutually exclusive.
Behavior, Personality, Beliefs: Driver Risk Assessment (risk taking), impulsivity, empathy, aggression, cautiousness • Depression • Mania
Unresolved issue: The Criterion Problem • By which criteria should we evaluate the predictive salience of our battery? • Accidents? • Simulator? • Field driving tests? • Standardized driving courses? • Subjective driving evaluations? • Is the more sensible goal the multidimensional assessment of different aspects of driving?
Unresolved issue: Measurement selection • There is a wide variety of studies • Few multidimensional studies in which measures evaluated simultaneously • Great variation in dependent variables used across studies • It seems important to first identify demented individuals; different prediction equations likely for non-demented elders; more likely to predict subtle driving errors
Unresolved issues: Cognition • Should we do a gross check for dementia, and triage such individuals out of further assessment? Or do we need tests like Clock Drawing (special Freud scoring), Cognitive-Linguistic Quick Test, Boston Naming, Wechsler Memory Scale, WAIS Picture Completion • Some commonly used tests seem redundant with what we have shown (Stroop, Minnesota Rate of Manipulation, AARP Reaction Time) • Interesting dimensions not commonly studied, including Motor-Free Visual Perception Test, Unilateral Neglect
Unresolved issues: Sensory • Is there a better proprioception test for the lower extremity? • What amount of pressure is needed for breaking? • Should pain assessment be used and if so, which pain assessment is the most appropriate?
Unresolved issues: Motor • Should all ROM measurements be functional rather than exact? • Should upper extremity ROM be tested? • Should MMT be done on lower extremity muscle groups (such as knee extension) and if so, should it be quantified with hand-held dynamometry? • If we were to choose one gross mobility test only, which is the best?
Unresolved issues: Sensorimotor • Should a balance (dizziness) test be used?
Unresolved issues • Who is screened? (everyone? just at risk drivers? just older drivers?) • Who screens? (what kind of training is needed?) • Who pays? (what is the estimated cost, and what are some possible sources of funding?) • What are the legal implications? (what supportive policy/legislation is needed?)
