1 / 53

Safe Mobility at Any Age Identifiers of High-Risk Drivers: An Occupational Therapy Perspective

Safe Mobility at Any Age Identifiers of High-Risk Drivers: An Occupational Therapy Perspective. Wendy Stav, PhD, OTR/L, CDRS University of Florida National Older Driver Research & Training Center. Topic Areas. Assessment options What the government wants Florida Programs

evania
Download Presentation

Safe Mobility at Any Age Identifiers of High-Risk Drivers: An Occupational Therapy Perspective

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Safe Mobility at Any AgeIdentifiers of High-Risk Drivers:An Occupational Therapy Perspective Wendy Stav, PhD, OTR/L, CDRS University of Florida National Older Driver Research & Training Center

  2. Topic Areas • Assessment options • What the government wants • Florida Programs • The realities of safety thresholds • The National Older Driver Research and Training Center

  3. Assessment Options • Consider what should be assessed • Vision • Cognition • Motor Performance • Reaction Time • Roadway knowledge • Are older drivers different from rehabilitative clients? • What level assessment is being done?

  4. Assessment of Vision • Snellen Chart • OPTEC series • Keystone Vision Tester • Perimetry Testing • Visual Perception Tests

  5. OPTEC • Interchangeable slides • Static Acuity • Peripheral Fields • Depth Perception • Color Discrimination • Phorias • Road Signs • Contrast Sensitivity • 3000 version- glare recovery

  6. Perimetry Testing • Useful in identifying blind spots/field cuts • Gross deficits obvious • Unknown effect of mild deficit on driving • Need referral to eye care practitioner

  7. Porto-Clinic / Glare • Tests: • Visual Activity • Field Of Vision • Depth Perception • Color Perception • Simple Reaction • Complex Reaction Response • Glare Recovery • Night Vision

  8. Contrast Sensitivity

  9. Visual Perceptual Tests • MVPT – 3 • TVPS • TVMS • Bender – Gestalt • Block Design

  10. Cognitive Assessment Tools • Trails A and B • ACLS Leather Lacing • Digit Symbol • Stroop • UFOV • Map Skills • Problem solving scenarios

  11. Trailmaking A & B • Paper pencil test • Quick and easy to administer • Trails A – connect numbers sequentially • Trails B – connect numbers/letters alternatively and sequentially • Assesses:

  12. Trails B

  13. Allen Cognitive Level Screen • Leather lacing • Quick / easy to administer • Level 5.6 to drive safely • Poor face validity

  14. Neuropsychological Screen Paper test Quick to administer Assesses selective attention mental flexibility Stroop

  15. Useful Field of View • Visual Processing Speed • Divided Attention • Selective Attention • Per test fee • Psych Corp • Visual Awareness, Inc.

  16. Block Design • Identifies issues with: • Planning • Organization • Problem solving • Frustration

  17. Symbol Digit

  18. Motor / Sensory Assessments • Functional Quick Screen • Manual Muscle Testing • Dynamometer • Diadochokokinesis • Posture/Stature assessment • Proprioception / Kinesthesia

  19. Reaction Time • Combination of: • Sensory awareness • Cognitive processing • Execution of a motor response

  20. Assessment of Driver-Vehicle Fit • Ergonomic Perspective • Small drivers in large vehicles • Prevent injury through: • Proper positioning • Appropriate use of vehicle safety features • Address positioning with regard to: • Seat • Seat belt • Mirrors • Air bag • Foot pedals

  21. Driver – Vehicle Fit Guidelines • Sit 10-12” from airbag • Angle steering wheel at chest • Eyes at least 3” above steering wheel • Access to foot pedals • Mirrors positioned to allow greatest visual access to environment • Head rest positioned no lower than ear level • Seat belt- shoulder belt crossing middle of clavicle • Seat belt- lap belt low across hips on ASIS on pelvis

  22. Safe Not Safe Clinic testing will NOT produce definitive answer whether a person can drive safely or not!! Clinic testing WILL provide a picture of how the client will likely perform in the vehicle.

  23. What the Government Wants • Federal and State governmental agencies • Looking for a “silver bullet” • Assessment that identifies high risk drivers • Inexpensive • Fast • Reliable • High Sensitivity • High Specificity • Non-Biased • Politically acceptable

  24. Government’s Unrealistic Expectations • Inexpensive • Validated tools cost money to develop/ test • Fast • Too fast and things are missed • Reliable • Inexpensive to administer = non-professionals • High Sensitivity and Specificity • Does not yet exist • Non-Biased • A possibility in a perfectly homogonous society • Politically Acceptable • An oxymoron in older driver testing

  25. Florida’s Programs • Florida Aging Driver Council • Florida At-Risk Driver Council • Florida Senior Safety Resource Centers • Tiered Assessment Model • Screening – Community level • DriveABLE, UFOV, GRIMPS • Assessment – DMV / physician • AMA screen • Evaluation – Occupational Therapist / DRS • Comprehensive clinic based and behind-the-wheel

  26. Florida Senior Safety Resource Centers • Website • http://fssrc.phhp.ufl.edu/index.php • Self Assessment • Transportation resources • Listed by county • Name, eligibility, cost • Links

  27. The Realities of Safety Thresholds • Study conducted as part of the Elder Mobility Project • South Florida – elder dense area • Funded by FL Dept of Transportation • Comprehensive program • Education • Assessment & feedback • Counseling & Mobility Management

  28. The Clients • 323 Well elderly drivers from South Florida • Voluntary program • Most self-referred • 74% participated after reading newspaper • 6% referred • Physicians • Traffic court judges • Law enforcement • Local Memory Disorder Centers

  29. newspaper family friend physician court law enforcement radio 74% television 55 Alive presentation other agency unknown Referral Source of Clients

  30. Data • Results from all assessments collected • Only certain tools had established safety thresholds • Performance on those tools compared to safety thresholds

  31. Tools with Thresholds Trialmaking B 2m 30s (Staplin,1999) 2m (Raleigh, 2000)

  32. Tools with Thresholds Useful Field of View Category 4 or 5 (Ball, Owsley, Sloane, Roenker, Bruni, 1993)

  33. Tools with Thresholds AAA Brake Reaction Timer Slower than .5 seconds

  34. Tools with Thresholds Stroop Neuropsychological Screen >2 minutes (Trenerry, Crosson, DeBoe, Leber, 1989)

  35. Analysis • Data analyzed with descriptive statistics • Compared to industry accepted safety thresholds • Secondary analysis • Correlation of assessment results with age • Pearson product-moment coefficient for interval data • Spearman’s Rho correlation coefficient for ordinal data

  36. Mean = 2:15 (SD 1:41) 2:00 Cut-Off 40% of Clients 2:30 Cut-Off 23% of Clients Trails B Distribution for Older Adults 40 35 30 25 Number of Clients 20 15 10 5 0 .24-.33 .54-1.03 1.24-1.33 1.54-2.03 2.24-2.33 2.54-3.03 3.24-3.33 3.54-4.03 4.24-4.33 4.54-5.03 5.34-5.43 6.04-6.13 6.34-6.43 7.04-7.13 7.34-7.43 8.04-8.13 8.34-8.43 9.04-9.13 9.34-9.43 10.04-10.25 Time for Completion

  37. Cat 5 Cat 4 UFOV Category Ratings of Older Drivers 20.2% are High Risk Cat 1 Cat 3 Cat 2

  38. >2:00 Impaired Cognition (82.4%) Mean = 3.01 (SD 1.17) Mean 3:00 SD (1:17) Stroop Performance of Older Drivers 60 50 40 Number of Clients 30 20 10 0 1.00-1.19 1.40-1.59 2.20-2.39 3.00-3.19 3.40-3.59 4.20-4.39 5.00-5.19 5.40-5.59 6.20-6.39 7.00-7.19 7.40-7.59 8.20-8.39 9.00-9.19 9.40-9.59 Time for Completion

  39. Brake Reaction Timer > .5 sec 53% “Safe” 47% “Unsafe” < .5 sec

  40. Age Correlations *.01 Significance level

  41. Safety Thresholds • Set by establishing predictability of crashes • Typically prospective studies • The problem: crashes are rare occurrences • Driving is human performance • Need to study the predictability of driving performance

  42. Conclusion • Age is not necessarily related to decreased performance • Significant discrepancies between “normal” and safe performance • Well elderly may be high risk drivers • Current assessments / thresholds are problematic

  43. More Questions • Are older driver stereotypes correct? • Have we identified the wrong assessments? • Are the tools valid to assess driving? • Are the tools sensitive enough, or too sensitive? • Are these large segments of the older population really at risk? • Do we need a paradigm shift from crash risk to driving performance?

  44. National Older Driver Research and Training Center • University of Florida • Funded by • Center for Disease Control • Federal Highway Administration • Multidisciplinary team • 10 team members (OT, computer engineering, public health, transportation safety) • 9 support staff (grant writers, budget preparers, computer support, administrative support)

  45. NODRTC • International Consensus Conference (12/03) • Assessment Panel • Remediation Panel • Alternate Transportation Panel • Reports from committees shaping future

  46. NODRTC • Federal Highway Administration • Older driver performance and problematic roadway conditions • Instrumentation of vehicles for objective performance measures • Replication with Driving Simulator

More Related