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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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slide2

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.

slide3

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

slide4

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.
slide17
Behavior, Personality, Beliefs: Driver Risk Assessment (risk taking), impulsivity, empathy, aggression, cautiousness
  • Depression
  • Mania
unresolved issue the criterion problem
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
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
slide20

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
slide21

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?
slide22

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?
slide23

Unresolved issues: Sensorimotor

  • Should a balance (dizziness) test be used?
slide24

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?)