Assessing Driving

1. Assessing Driving M-CASTL Conference 2009 Paula Kartje, OTR, DRS UMHS Drive-Ability Program

2. Many Roads Lead to Evaluation..

3. Who’s Appropriate? • Typical Ages: 14.5 years old (pre-driver’s ed eval) up to 95+ years old • Anyone with whom driving concerns have been identified • Most Common Medical Diagnoses: -Neurological (TBI, CVA, SCI, MS, PD, ALS) -Orthopedic & Amputee populations -Older Drivers (Dementia, Alzheimers, Memory Impairment, Arthritis, Debilitation) -Teens with Disabilities (CP, ADHD, TBI, Autism)

4. Standard Practices in Driver Rehab • Provision of Clinical Assessment & On Road Evaluation • Followed by Post Evaluation Recommendations • Performed by: OT, DRS, Driving Instructor, other Healthcare or Teaching Professionals with Driver Rehab Training • May be one Evaluator for both portions or a Team • Physician & DMV may also be involved

5. Purpose of Clinical Assessment • Pinpoint Client’s Strengths and Weaknesses • Determine Appropriateness for On Road Evaluation • Establish if Client Meets State Licensing Requirements • Identify Education and Training Needs • Identify Adaptive Equipment Required

6. Key Elements of ClinicalAssessment • Medical & Driving History • Vision • Visual Perception • Cognitive Skills • Motor & Sensory Functions • Driving Knowledge • Attitude / Behavior

7. Medical History • Significant Past Medical History • Medical Diagnoses • Acute vs Chronic Health Issues • Medications & Potential Side Effects

8. Driving History • License Status • Tickets/Moving Violations • Driving Experience • Driving Frequency, Habits/Routines • Family Concerns • Client Driving needs • Self Restrictions • Type of Vehicle to be driven

9. Vision Assessment • Vision History • Far/Near Acuity with correction • Peripheral Fields • Depth Perception • Color Vision/Contrast Sensitivity • Night Vision/Glare • Visual Scanning

10. Vision Assessment Tools • OPTEC Machines • Snellen Eye Chart • Porto Clinic • Keystone Vision Tester • AAA Night Vision/Glare Tester Most states require minimum 20/40 in one eye

11. Visual Perception • Visual Discrimination • Figure Ground • Visual Memory • Visual Closure • Spatial Reasoning

12. Common VP Assessment Tools • Motor Free Visual Perception Test–Revised • Test of Visual Perceptual Skills • Clock Drawing • Block Design • Perceptual Worksheets: -directional concepts -design copy tasks • Topographical orientation

13. Cognitive Evaluation • Orientation • Attention/Concentration • Processing Speed • Memory • Problem Solving/Decision Making • Judgment / Insight • Driving Knowledge

14. Cognitive Assessment Tools • UFOV (Useful Field of View) • Trails A & B • Comprehensive Trail-Making Test • Mini Mental Status Exam • Memory Tests- Contextual, Short Blessed, Rivermead • Traffic Sign Recognition & Driving Situations • Observation

15. UFOV Testing

16. Motor & Sensory Evaluation • Range of motion, strength, coordination • Sensation & Proprioception • Transfers, balance and mobility • Endurance • Foot placement, coordination and reaction time

17. Physical Assessment Tools • Functional Range of Motion • Manual Muscle Test • Dynamometer & Pinch Meter • BTE Steering Wheel • Foot Reaction Timer

18. Attitude / Behavior • Impulsiveness • Distractibility • Anger Control • Risk Taking • Anxiousness • Depression

19. Post Clinical Assessment • Summarize Concerns • Suggest Treatment &/or Compensatory Strategies • Provide Education • Adaptive Equipment Recommendations • Determine Best Type of Road Test

20. Post Clinical Evaluation Decisions • Potential outcomes: • No Return to Driving at this time—Client is not an appropriate candidate for road testing. • On Road Evaluation with either a CDRS or referral to the DMV

21. On Road Evaluation Considerations • Type of Road Test • Client’s Needs • Where Available? • Cost • Time Frame • Whose Car?

22. On Road Evaluation Types • Fixed Route-Unrestricted driver, All traffic situations • Limited/Restricted Route-Restricted driver, May limit types of roads, routes, etc. • Individualized- Specific Destinations from home, can evaluate wayfinding

23. On Road Assessment Areas Assessed • Visual Components • Maneuvers • Vehicle Controls • Cognitive/Behavioral

24. Road Test- Visual Components • Awareness & Scanning the Environment • Use of Mirrors • Recognizing & Obeying signs and signals • Checking Blind Spots • Lane Placement • Preplanning • Stop Lines

25. Road Test- Maneuvers • Entering/Exiting Roads, Expressways, Lots • Right & Left Turns • Handling Different Intersections • Lane Changes • Parking

26. Road Test- Vehicle Controls • Pre-Ignition Skills • Pedal Use-Foot Coordination • Steering Controls • Following/Stopping Distance • Speed Control • Use of Equipment

27. Road Test- Cognitive/Behavioral • Attitude • Attention / Concentration • Processing Speed • Handling Multiple Directions • Distractibility • Decision Making • Impulsivity

28. Potential Outcomes • Unrestricted, Independent Driving • Independent Driving with Self Restrictions • Driving with Equipment Restrictions • Driving with Other Restrictions • Recommend Formal Training Sessions and Reassessment • No Independent Driving

29. How Bad is Too Bad?

30. How Bad is Too Bad?? Many Factors Influence This Decision…….. • Severity of Deficits • Impairments across many Performance Areas • Level of Insight • Ability to Remediate/Compensate for Deficits • Prior Driving History • Medical History: Acute vs Chronic/Deteriorating Decision primarily comes down to Therapist/DRS’s Clinical Judgment based on Experience

31. Opportunities for Education/Training Education: • To Identify Specific Difficulties-Relate to Driving • To Increase Self Awareness • To Improve Driving Habits / Knowledge • To Teach Compensatory Strategies Training: • To Improve Component Skills • To Teach Use of Adaptive Equipment

32. Thank You ! Paula Kartje, OTR, DRS Manager, MedRehab OT/PT Drive-Ability Program kartje@umich.edu 734-998-7898