Transcript DRIVER EVALUATION PROGRAM OCCUPATIONAL THERAPY

Andrea Sullivan OT/L
Occupational Therapy Supervisor
Out-Patient Services
Burke Rehabilitation Hospital
White Plains, NY
Why are driver evaluations
needed?
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Medical changes
 Stroke, Traumatic brain injury, Neurological
impairments, SCI
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Normal Aging changes
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Physical changes
 Amputation, Arthritis, joint problems, postural
changes

Diabetic conditions
 Peripheral neuropathy, diabetic retinopathy
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Mental Illness/Attention Deficit/Learning Impairment
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Dementia/Alzheimer’s
“Normal” Aging
Vision
 Hearing
 Strength/stamina
 Memory
 Processing speed
 Divided attention

Presence of AD
Loss of time
 Topographical orientation
 Working memory
 Visual perceptual abilities

Presence of AD con’t
Problem solving/reasoning skills
 Judgment
 Motor planning
 Self awareness
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Some Info…
20 major decisions are made during each
mile driven (AARP)
 .5 seconds to react to prevent potential
collision (AARP)
 The nation's 65-and-older population is
projected to reach 83.7 million in 2050,
almost double from the 2012 level of 43.1
million (U.S. Census)
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MD Role
Review medical history
 Medications
 Provide diagnosis
 Ethical and legal responsibilities
 No mandatory reporting laws in NYS
 Physician’s Request for Driver Review
(DS-6)
 Refer for Driver Evaluation
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Burke’s Driving Evaluation
2 parts

Part 1: In-clinic Evaluation
 Conducted by an occupational therapist
(OT)
 Evaluation of component skills needed for
driving
 Followed by in-vehicle assessment if
appropriate
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Part 2: In-vehicle Evaluation
 On the road test with trained individual
 May include and adapted van/car evaluation
Part 1: In-clinic Evaluation

Requires a prescription from the doctor,
not covered by Medicare, some
commercial insurances do cover

Reaction time tester, OPTEC and
various paper pencil tests

Length of test- up to 60 minutes
Benefits of Clinical test
Under the supervision of a physician
 Becomes part of medical record
 Possible future litigation and insurance
co. concerns
 Let us be the “bad guys”; assists
families
 Assists physician’s in making informed
decision

OT Evaluation
Observe performance of complex IADL
and assess vision, cognition, motor skills
and perception
 Help to guide CDRS/CDI on what to be
prepared for on the road test
 Use of clinical reasoning based on
evidence based practice
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Areas evaluated by OT
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Vision
Perception
Cognition /Attention
Problem solving/safety
Memory function
Reaction time
Motor skills and strength, coordination and ROM
Knowledge of traffic situations
Need for adaptive equipment
○ **If only vehicle modifications may go straight to driving
school
Visual Components
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Acuity 20/40 minimum (NYS requires 20/40 in 1
eye)
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Convergence
Scanning
Saccades
Pursuits/ ROM/ Fixation
Depth Perception
Peripheral Fields (NYS 140 degree minimum)
Contrast Sensitivity
Color Recognition
Glare Recovery
Perceptual Components

Spatial Relations
 Block design-3D and copy
 Copy lines 2D
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Figure Ground(Ayres Figure Ground Test)
 3 pictures overlapping
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L/R discrimination (Directionality)
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Motor Planning Skills (Non-routine response)
Cognitive Components
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Visual Vigilance/Dual Attention
 single and dual stimuli
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Auditory Attention
Sequencing
Memory
 test 20 minute recall of 3 items
Safety/Judgment/Problem Solving
Sign Symbol Identification
 Direction Following/ Insight
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Motor Components
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Cervical, UE & LE ROM, Muscle Strength,
Sensation, Tone & Coordination, Posture
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Reaction Time: Reaction Time Tester to
determine Simple and Complex Reaction
Time
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Motor Response and Planning
Reaction time
 SIMPLE
 Respond to red light in presence of distraction
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COMPLEX
 Same as above, but filter out yellow light
Looking for .5-.8 seconds Will accept more
based on performance on other tests.
Normal range for 66 years+ is .5-.6
seconds
In-Clinic Evaluation Results
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Recommendations
 Refer to the in vehicle evaluation
○ may need visual clearance
 No referral to in-vehicle evaluation
○ Driving is no longer a safe option or it may be an
option in the future
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Factors that go into recommendations
 Overall performance
 Combination of deficits
 Quality of performance
In-Vehicle Driving Evaluation
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On-the-road test from a local driving school
with trained individual for up to 60 minutes
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Back road, highway, traffic
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May include evaluation for adaptive devices
 Spinner knob
 Hand controls
 Left foot gas pedal
 Panoramic mirror
 Adapted van/car
In-Vehicle Evaluation Results
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In-Vehicle results are reviewed by the
Occupational Therapist before given to the
client/MD
 Pass with or without vehicle modifications
○ Recommend annual re-testing?
 Pass but due to safety concerns driving is not
recommended
 Did not pass and will need additional driver
training
 Did not pass and further training is not
recommended
Recommendation to no longer
drive
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A letter is sent to physician to inform them of the
results as well as a Physician’s statement for
medical review ( DS-6)
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A letter is sent to the patient along with
resources for transportation
•Automatic
suspension of individuals license
•Driving
•MD
retesting performed by DMV
must approve revoking suspension of
license
Reporting By A Citizen To DMV
(DS-7)
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Form can be given to individual (family,
concerned citizen) to alert DMV.
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DMV will initiate investigation following 3
letters of concern.
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DMV MAY disclose identity of concerned
citizen
Patient and Family Education
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Provide Family and Patient with Transportation Options
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Clearly State Whether There Is A Chance for Re-testing
or Driving is Not a Future Option (6 month minimum)
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Family Support and Acknowledgment Are Key to
Success of Intervention
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Explain Liability To Patient and Family If
Recommendation Are Ignored.
Useful Resources
www.nhtsa.dot.gov
www.aaafoundation.org
www.driver-ed.org
www.aota.org
www.ama-assn.org
www.aarp.org
www.nysdmv.com
Questions??

The one thing that unites all human beings, regardless
of age, gender, religion, economic status or ethnic
background, is that, deep down inside, we ALL believe
that we are above average drivers. ~Dave Barry,
"Things That It Took Me 50 Years to Learn“