Department of Rehabilitation Science and Technology
Driver Rehabilitation
Clinical Perspectives and Practice
Amy Lane OTR/L CDRS
School of Health and Rehabilitation Sciences
Department of Rehabilitation Science and Technology
Department of Rehabilitation Science and Technology
Driving and Independence
• Driving is an IADL-a cornerstone for independence
• Car ownership and driving are highly correlated with
independence and life satisfaction in adults1
• After injury, illness, safe community mobility and driving
skills can be impaired
• Lack of community mobility/driving can lead to social
isolation, and is associated with a variety of health
conditions including depression2
1Choi et al., 2014; Fonda et al., 2001; Marottoli et al., 1997; Ragland et al., 2005
2Ragland D, Satariano W, MacLeod K. Driving cessation and increased depressive symptoms. The
Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2005; 60(3):399-403.
Driver Rehabilitation OCT 2017
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Quality of Life-Social Health
• Social health decline after driving cessation was
greater among women than men1
• Over a 13- year period, driving cessation was
associated with a 51% reduction in the size of social
networks of friends and relatives
• Tendency to spend less time on social activities and
spend more time in solitary leisure or abandoned
former social activities2
1Edwards J, Perkins M, Ross L, Reynolds S. Driving status and three-year mortality among
community-dwelling older adults. The Journals of Gerontology Series A: Biological Sciences and
Medical Sciences. 2009; 64A (2):300-305
2Al-Hassani S, Alotaibi N. The impact of driving cessation on older Kuwaiti adults: implications to
occupational therapy. Occupational Therapy Health. 2014; 28(3):264- 276.
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Relationship to Independence
Evidence: The perception of Instrumental Activities of Daily
the meaningfulness and Living
performance of instrumental
activities of daily living from Shopping for groceries
the perspectives of the Planning a meal
medically-at-risk older adult Cooking
and their caregiver.
Driving
Planning trips
Source: Dickerson, Reistetter, & Community participation
Gaudy, 2012
Journal of Applied Gerontology Home management
Yard work
Financial management
Medication management
Phone use
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Meaningfulness of IADLs
30
26
24
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22 22 22
a 20
19
20 18
N r 17
16
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15
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Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Driving is a highly complex and
demanding task.
Medical conditions and age
related changes, either physical,
visual or cognitive, can affect
driving ability.
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Driver Rehabilitation
Consists of evaluation, training, and vehicle
modification recommendations for drivers and
passengers with disabilities and age-related
impairments as well as counseling and support
in the pursuit of maintaining mobility
within the community
Best Practice Guidelines for the Delivery of Driver Rehabilitation Services
(2016), Association for Driver Rehabilitation Specialists (ADED).
Driver Rehabilitation OCT 2017
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Driver Rehabilitation Specialists
(DRS or CDRS)
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Driver Rehabilitation
Best Practice & Guidelines
• Intake, driving and medical history
• Clinical assessment
• On-road assessment
• Training-when indicated
• Vehicle and equipment assessment
• Recommendations
Driver Rehabilitation OCT 2017
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Past Medical &
Driving History
Clinical
Assessment
On-Road
Assessment
Driver Rehabilitation OCT 2017
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On-The-Road Assessment
Best method to determine driver performance
within the context of a real traffic environment.
Driver Rehabilitation OCT 2017
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Comprehensive Driver
Evaluation Determines:
• Client ability, limitations
• Critical errors
• Equipment/vehicle mods
• Need for follow-up services
• Additional training needs
• Learning style, attitude, insight
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Clinical Diagnoses and their
Implications for Driving
Driver Rehabilitation OCT 2017
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Clinical Impairments and
their Implications for Driving
Driver Rehabilitation OCT 2017
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Visual Skills/Driving Impairments
Acuity • Unable to read road sign or lane markings
• Difficulty in seeing things in the environment,
Contrast
especially on gray/overcast days or poor light
Sensitivity
conditions
• Difficulty when light changes from light to
Night Vision dark
• Glare recovery
• Narrowed visual search
Visual Fields
• Poor scanning of environment
• Lane maintenance
Visual Neglect
• Fails to recognize oncoming traffic (L)
Driver Rehabilitation OCT 2017
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Vision Interventions
• Restorative changes: cataract or lens
surgery, corrective lenses
• Restrictions: Daytime only, no highway
specific routes
• Training strategies:
– Space management
– Scanning techniques
– Shape recognition
Driver Rehabilitation OCT 2017
Department of Rehabilitation
Department of RehabilitationScience andTechnology
Science and Technology
Vision Interventions
Sunglasses/Glare Reduction
Prisms
Bioptic
Mirrors
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Cognitive Skills/Driving Impairments
• Loses focus, distracted
Attention
• Lane position, maintenance, over-correction
Shifting • Difficulty in dividing attention between
attention relevant and non-relevant items.
Mood,
• Anger, frustration, road rage
behavior
Short term • Becomes lost, confused
memory • Relies on co-piloting
• Dismissive of signs, signals
Impulsivity
• Speeding, overtaking other vehicles
Driver Rehabilitation OCT 2017
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Cognitive Interventions
• Limit distractions
• Commentary driving
• GPS, maps
• Use of cognitive
aides/devices
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Cognitive Interventions
• Training strategies:
– Repetition
– Consistency of performance
• Use support systems to enforce
recommendations and restrictions
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Physical Skills
• Range of Motion, Strength, Coordination,
Sensation
• Balance
• Loss of limb
• Level of injury
• Ambulation, Mobility, Assistive Devices
• Transfers
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Equipment and Vehicle Options
*Disclaimer: there are many options commercially
available. The examples shown here are not intended
to endorse any specific manufacturer.
*Remember: Operating a motor vehicle is a complex
activity with many considerations and implications
for safety and independence.
It is best to seek out a driver rehabilitation specialist to
explore driving options before making a costly
investment that may not be suitable.
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Wheelchair Accessible Vehicles (WAV)
VMI-Honda Odyssey
BraunAbility MXV
Driver Rehabilitation OCT 2017
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Truck and SUV
Conversions
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Transfers from outside the vehicle
Bruno-Valet Seat
Adapt Solutions-XL Board
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Manual Wheelchair
Transfer /Stowage Options
Driver Rehabilitation OCT 2017
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Scooter Lift and Transport Options
Driver Rehabilitation OCT 2017
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Wheelchair Lift and Transport Options
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Wheelchair Securement
• 4-point tiedown systems are NOT designed for
independent use
• Automated docking systems allow independent
securement when riding in vehicle and seated
in a wheelchair.
– EZ-Lock
– Qstraint
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Power Seat Base-Driver Side
Driver Rehabilitation OCT 2017
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Mechanical Hand Controls
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Electronic Hand Controls
Driver Rehabilitation OCT 2017
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Driver Rehabilitation OCT 2017
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Left Foot Accelerator
Driver Rehabilitation OCT 2017
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Steering Devices/Secondary
Controls
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Driver Rehabilitation-Introduction
Technology that assists in one's quest for independence shows promise in promoting life satisfaction and improved quality of life.
Department of Rehabilitation Science and Technology
Technology that assists in one's
quest for driving independence
shows promise in promoting life
satisfaction and improved
quality of life.
Driver Rehabilitation OCT 2017
Department of Rehabilitation Science and Technology
Questions?
Amy Lane, OTR/L CDRS
amy.lane@pitt.edu
