Driving and Community Mobility
A medical doctor wrote and asked if we do "driving evaluations," and if so, what exactly it is we do. As the co-editor of a text published by the American Occupational Therapy Association, I was challenged to respond in a brief manner. I put together this response, and decided it was worth putting on our website for others to consider.
Our Occupational Therapy Evaluation collects information on the visual, cognitive, motor and emotional regulation skills that provide a basis for safe driving; depending on the skills and/or impairments of the client, we select tools that will screen and/or go in-depth to help a client recognize problem areas.
For most clients who have "driving" as an issue, we do the following:
TYPICAL TOOLS
Montreal Cognitive Assessment (MoCA) ---We use this to collect baseline information unless a neuropsychological battery has been done, then we would skip the cognitive assessments.
Visual Screening - (Acuity, oculomotor and peripheral skills; contrast sensitivity testing). We will ask for computerized perimetry testing to be done by an optometrist or ophthalmologist if we suspect a field loss.
The Useful Field of View (UFOV) is often administered to assess the visual processing speed, selective attention and divided attention skills of the client.
Trails A and Trails B - Or an iPad based NeuroTrails to assess client's ability to scan, switch mental sets, stay focused, and complete the task in a timely manner.
Traffic Signs and Rules - When needed, we provide clients with a computerized assessment of their ability to recall the meaning of traffic signs. If needed, we provide individualized training to take the Ohio BMV written test.
Motor Skills needed for Driving - We analyze the client's ability to enter/exit car safely, assess dynamic sitting balance, neck ROM, UE and LE function necessary for accessing primary and secondary controls. Our work helps determine the need to involve a Certified Driving Rehabilitation Specialist (CDRS)
Fitness to Drive Screening Measure
http://ftds.phhp.ufl.edu/ This is a well researched online tool that captures the concerns of family members, and provides a detailed list of items that were marked as providing concerns/organizing the information for the therapist to help clients see the problems.
Driving Habits Questionnaire Not always used, but useful in many cases; this can identify how LITTLE the client actually drives, and/or if there is a need for specific training related to their habits.
Assessment of Readiness for Mobility Transition (ARMT) - A self-report tool that provides the therapist and family with important information about a person's attitudes toward NOT driving, and feelings related to asking others for help regarding community mobility.
ANALYZING THE RESULTS
1. Fitness to Drive- If a client breezes through our evaluations, and holds a valid driver's license, we report back to the doctor that we have found no underlying cause to challenge his or her fitness to drive.
2. Concerns about Fitness to Drive- If we identify any concerns, we help the client understand how the impairments we have uncovered relate to safety on the road, and work with the client to either ADDRESS the problems we've identified, or if deficits are too risky, we guide the client into exploring alternative modes of transportation that will still support participation in the community. In either case, we would inform the MD of the areas of concern, and recommend specific OT intervention (we'd put together a plan of care, and submit that to the MD). Depending on how the client responds to therapy, we would either support their use of their state license, recommend an on-the-road evaluation, or describe why we believe they are not safe to be on the road.
3. On the Road Evaluation
If a client does NOT do at all well on our tests, we can SHOW the individual why we cannot even recommend an on-the-road evaluation. I had one client, to the surprise of the family, state---after seeing the testing results,
"Well, if all THIS is true, then I SHOULDN'T be driving!"
That was a great outcome; the client finally understood---through our OT evaluation and intervention—the problems that made the person not fit to drive. (The family was VERY surprised at the client's willingness to give up driving; the client had just not fully understood her problems until we slowly walked her though them, and helped her reflect on their relationship to safe driving.)
We sometimes use an interesting tool called the Assessment of Readiness for Mobility Transition (ARMT) (see link above) with some clients---to help them and their families understand their perceptions, and to guide our treatment planning.
If a client breezes through our evaluation, but family members or the MD still has concerns ---or if a client has questionable skills and we have explained the problems to the driver----we recommend a community based on-the-road evaluation.
We ride in the back of the car during some evaluations, when the case needs this, in order to really capture WHY the client is not driving safely; we are then able, after the on-the-road evaluation, to HELP the client recall and understand WHY driving is no longer safe. Then---we address the problems that a person has when they CAN'T drive.
To clarify, our group of Occupational Therapists does not do on-the-road evaluations; we evaluate a client's readiness for or need for on-the-road evaluation.
We are networked with the major organizations and Certified Driving Rehabilitation Specialists (CDRS) in town that provide on-the-road evaluations, and can refer clients to the appropriate driving evaluator or CDRS, when it is needed.
Questions? Contact Mary Jo McGuire at
330-620-3502 or email at: mjm@TherapyInAkron.com
A medical doctor wrote and asked if we do "driving evaluations," and if so, what exactly it is we do. As the co-editor of a text published by the American Occupational Therapy Association, I was challenged to respond in a brief manner. I put together this response, and decided it was worth putting on our website for others to consider.
Our Occupational Therapy Evaluation collects information on the visual, cognitive, motor and emotional regulation skills that provide a basis for safe driving; depending on the skills and/or impairments of the client, we select tools that will screen and/or go in-depth to help a client recognize problem areas.
For most clients who have "driving" as an issue, we do the following:
TYPICAL TOOLS
Montreal Cognitive Assessment (MoCA) ---We use this to collect baseline information unless a neuropsychological battery has been done, then we would skip the cognitive assessments.
Visual Screening - (Acuity, oculomotor and peripheral skills; contrast sensitivity testing). We will ask for computerized perimetry testing to be done by an optometrist or ophthalmologist if we suspect a field loss.
The Useful Field of View (UFOV) is often administered to assess the visual processing speed, selective attention and divided attention skills of the client.
Trails A and Trails B - Or an iPad based NeuroTrails to assess client's ability to scan, switch mental sets, stay focused, and complete the task in a timely manner.
Traffic Signs and Rules - When needed, we provide clients with a computerized assessment of their ability to recall the meaning of traffic signs. If needed, we provide individualized training to take the Ohio BMV written test.
Motor Skills needed for Driving - We analyze the client's ability to enter/exit car safely, assess dynamic sitting balance, neck ROM, UE and LE function necessary for accessing primary and secondary controls. Our work helps determine the need to involve a Certified Driving Rehabilitation Specialist (CDRS)
Fitness to Drive Screening Measure
http://ftds.phhp.ufl.edu/ This is a well researched online tool that captures the concerns of family members, and provides a detailed list of items that were marked as providing concerns/organizing the information for the therapist to help clients see the problems.
Driving Habits Questionnaire Not always used, but useful in many cases; this can identify how LITTLE the client actually drives, and/or if there is a need for specific training related to their habits.
Assessment of Readiness for Mobility Transition (ARMT) - A self-report tool that provides the therapist and family with important information about a person's attitudes toward NOT driving, and feelings related to asking others for help regarding community mobility.
ANALYZING THE RESULTS
1. Fitness to Drive- If a client breezes through our evaluations, and holds a valid driver's license, we report back to the doctor that we have found no underlying cause to challenge his or her fitness to drive.
2. Concerns about Fitness to Drive- If we identify any concerns, we help the client understand how the impairments we have uncovered relate to safety on the road, and work with the client to either ADDRESS the problems we've identified, or if deficits are too risky, we guide the client into exploring alternative modes of transportation that will still support participation in the community. In either case, we would inform the MD of the areas of concern, and recommend specific OT intervention (we'd put together a plan of care, and submit that to the MD). Depending on how the client responds to therapy, we would either support their use of their state license, recommend an on-the-road evaluation, or describe why we believe they are not safe to be on the road.
3. On the Road Evaluation
If a client does NOT do at all well on our tests, we can SHOW the individual why we cannot even recommend an on-the-road evaluation. I had one client, to the surprise of the family, state---after seeing the testing results,
"Well, if all THIS is true, then I SHOULDN'T be driving!"
That was a great outcome; the client finally understood---through our OT evaluation and intervention—the problems that made the person not fit to drive. (The family was VERY surprised at the client's willingness to give up driving; the client had just not fully understood her problems until we slowly walked her though them, and helped her reflect on their relationship to safe driving.)
We sometimes use an interesting tool called the Assessment of Readiness for Mobility Transition (ARMT) (see link above) with some clients---to help them and their families understand their perceptions, and to guide our treatment planning.
If a client breezes through our evaluation, but family members or the MD still has concerns ---or if a client has questionable skills and we have explained the problems to the driver----we recommend a community based on-the-road evaluation.
We ride in the back of the car during some evaluations, when the case needs this, in order to really capture WHY the client is not driving safely; we are then able, after the on-the-road evaluation, to HELP the client recall and understand WHY driving is no longer safe. Then---we address the problems that a person has when they CAN'T drive.
To clarify, our group of Occupational Therapists does not do on-the-road evaluations; we evaluate a client's readiness for or need for on-the-road evaluation.
We are networked with the major organizations and Certified Driving Rehabilitation Specialists (CDRS) in town that provide on-the-road evaluations, and can refer clients to the appropriate driving evaluator or CDRS, when it is needed.
Questions? Contact Mary Jo McGuire at
330-620-3502 or email at: mjm@TherapyInAkron.com
