Safety & Transition
Online Course
June 2018
Occupational Therapy, Driving
Rehabilitation, and
the Medically at Risk Driver
Elin Schold Davis, OTR/L, CDRS, FAOTA
Practice Manager: Community Access and Driver Initiatives
American Occupational Therapy Association
escholddavis@aota.org
Agenda
• Its about safety & mobility
– Anticipating changes
– Frailty and Fragility vs. Capacity (www.CarFit.org)
• Screening and evaluation
– Data driven decisions
– Address problems with solutions
• The role of occupational therapy
– Driving as an IADL
– Driving rehabilitation
• Interventions
– Drivers
– Caregivers
Driving: The Primary Mode
• Studies show a relationship between
health, sense of autonomy & driving.
• Loss of mobility can lead to
depression, low life satisfaction,
health problems, isolation, and loneliness
• Distinguish Driving from Car Dependence
Living Life To Its Fullest!
• The dominance
of the passenger
automobile is
changing
• Participation and
engagement are
critical to health
Older Adults - Heterogeneous
Healthy Older Adults
Awareness and/or Medically at Risk
Planning
Medical Providers:
Physician OT-DRS
Aging
ie Slower processing
Community based
Driving Enhancement
Plan for Retirement
Changes Associated with Aging
• Aging
– Changes in Vision, Cognition, & Physical
– Resilient survivors - experts at change
• Medical Conditions
– Medically related changes are not to be
confused with “normal aging”
– Certain medical conditions impact DRIVING
FITNESS
Risk due to Frailty and Fragility
“sustain injuries more easily & are
more frail which reduces their odds
at recovering from injuries.”
“At crash speeds of 31 mph, the risk of sustaining a serious
injury increases dramatically.
• A 50-year-old female has about a 10% risk of serious
injury in a frontal crash, but
• An 80 year old female has about a 40% risk.
2013 DOT HS 811 864 www.NHTSA.gov
• Adjust safety features
• Aftermarket solutions
• Awareness:
– Now
– Future
Implications for Aging in Place
• Men and women will outlive their driving
life by 7-10 years.
• Implications:
– A DECISION to stop
– Safety requires stopping BEFORE the crash
– When? There is no one universal test
– Its about mobility … embrace alternatives
Aging with Medical Conditions
• Living longer … transportation mode will
change
• Financial Planning, Living Wills ….
Transportation Planning
– When choosing housing & communities
– Walkability
– Car Dependence
• Be part of the decision to stop
11
Support
Cessation
Strategies:
Alter the keys
Move the hook
Disable car
Loan/ give/ sell
Physician note
NO
DRIVING
Understand Driving Capacity
• Screen
– To build awareness +/or justify more testing
– Cut point tolerates false positives or negatives
• Test (such as BMV test)
– Measures specific criteria with a Pass/Fail
• Evaluation – integrates and interprets tests
• Comprehensive Driving Evaluation
– integrates and interprets clinical plus on-road
Multiple services for “testing”
• Distinguish purpose and scope
– Driving School road test
– Test at state licensing agency
– The occupational therapy comprehensive driving
evaluation
Driving Skills & Behaviors
1. Operational – Human/machine interaction
– Steering, pushing brake pedal, turn signal,
– Physical skills to carry out the tactical maneuvers.
– Overlearned skills of driving
2. Tactical – Decisions/maneuvers made during driving maneuvers
– Slowing due to weather
– When to make the left turn or whether/where to pass.
3. Strategic – Decision making process
– Determining trip goals and mode or transport (e.g., bike or car?)
– Navigating/Way finding
• How to get there
• Change in “plans” while on the road.
*Circular of the Transportation Research Board (2016), Based on Michon, 1985
OT- DRIVE
• Understand the
importance of
driving & mobility
• Routine IADL
• Readiness &
intervention
• Address risk in
clinic or via CDE
• Data driven
actions
OT- Comprehensive Driving
Evaluation
• Involves 3 primary components:
– Occupational Profile
• History, current situation, the individual’s goals
• The importance of driving to the individual
– Administration, scoring and interpretation of
clinical tests, evidence-based measures of
driving capacity
– Functional on-road test where skills are
observed in context
Vision Screening
Tests for:
Visual Acuity
Visual Fields and
Neglects
Depth Perception
Night Vision
Glare Recovery
Contrast Sensitivity
Slide developed by Dr. Barco, Used with permission
Evidence Based Tools
Visual Spatial, Executive
Function, Semantic Memory
Attention
Executive Function
Memory, Orientation, Concentration
Slide developed by Dr. Barco, Used with permission
Physical Assessment
Underlying Physical
Potential Solutions:
Capacity:
Adaptive Equipment
ROM and Strength Testing Spinner Knob
for UE’s and LE’s Turn Signal Extension
Left Foot Accelerator
Neck ROM Hand Controls
Trunk Control and Sitting Supplementary Mirrors
Balance Transfer Aides
General Coordination (straps, grab bars)
Reduced effort steering devices
Testing Van Modifications
Sensation and & highly technical equipment
Proprioception Wheelchair lifts, Scooter Lifts
Reaction time and related systems
Caregiver: Swing out passenger
seat, WC equipped transport van
IADL Functional Performance Based
Assessment (on-road assessment)
All relate to vision, motor, and cognitive
functioning
Operational:
Using Controls
Lane Positioning
Visual Scanning
Lane Changes
Tactical:
Attending to signs
Speed/Reaction Time
Complex Intersections
Rules of the Road
Strategic:
Self Directed Driving
Problem solving (return to…)
Road construction?
OT- Comprehensive Driving
Evaluation
• Clinical & on-road data consolidated into report
• Strengths and limitations identified
• Solutions and recommendations:
– Remediation
– Adaptations and vehicle modifications
– Training
– Cessation (soon or now)
– Transportation Plan (preserve mobility as driver or
passenger)
• Therapy recommendations including cessation
support
Certified Specialists
SCDCM AOTA CDRS
ADED (Association of Driving Rehabilitation
Professional Portfolio of Education Specialists)
and Experience Pass Exam
Does not need to be an OT
2000 hours of experience as an a. 4 year health related degree + 1700 hours experience
occupational therapist in driving rehab
b. 2yr degree + 3400 hrs experience in driving rehab
c. No degree + 5000 hrs experience in driving rehab (role
Additional 600+ hours providing not defined)
Driving and Community Mobility http://www.aded.net/?page=215
services
https://www.aota.org/education-careers/advance-career/board-specialty-certifications/driving-
community-mobility.aspx
Certification is not required –
but recommended once
experienced
“Personal Paratransit”
• Mobility equipment to support caregiver
• Spontaneity and participation
The first full week in December, aims to widely promote awareness &
understanding through media stories, social media, local evants
• Monday: Family Conversations
• Tuesday: Screening/Evaluations
• Wednesday: Driving Equip/Adaptations
• Thursday: Taking Changes in Stride
• Friday: Mobility beyond the car
• Get Involved!!
Thank you!
For more information please contact
Elin Schold Davis
escholddavis@aota.org
