occupational therapy, driving rehabilitation, and the medically at … · 2018. 10. 10. · “at...
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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
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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
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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
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Living Life To Its Fullest!
• The dominance
of the passenger
automobile is
changing
• Participation and
engagement are
critical to health
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Older Adults - Heterogeneous
Medically at Risk
Aging
ie Slower processing
Healthy Older Adults
Awareness and/or
Planning
Community based
Driving Enhancement
Plan for Retirement
Medical Providers:
Physician OT-DRS
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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
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Risk due to Frailty and Fragility
“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
“sustain injuries more easily & are more frail which reduces their odds at recovering from injuries.”
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• Adjust safety features
• Aftermarket solutions
• Awareness:
– Now
– Future
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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
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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
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Support
Cessation
11
NO
DRIVING
Strategies:
Alter the keys
Move the hook
Disable car
Loan/ give/ sell
Physician note
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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
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Multiple services for “testing”
• Distinguish purpose and scope
– Driving School road test
– Test at state licensing agency
– The occupational therapy comprehensive driving
evaluation
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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
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OT- DRIVE
• Understand the importance of driving & mobility
• Routine IADL
• Readiness & intervention
• Address risk in clinic or via CDE
• Data driven actions
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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
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Tests for:
Visual Acuity
Visual Fields and
Neglects
Depth Perception
Night Vision
Glare Recovery
Contrast Sensitivity
Vision Screening
Slide developed by Dr. Barco, Used with permission
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Evidence Based Tools
Attention
Executive Function
Visual Spatial, Executive
Function, Semantic Memory
Memory, Orientation, Concentration
Slide developed by Dr. Barco, Used with permission
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Underlying Physical
Capacity:
ROM and Strength Testing
for UE’s and LE’s
Neck ROM
Trunk Control and Sitting
Balance
General Coordination
Testing
Sensation and
Proprioception
Reaction time
Physical Assessment
Potential Solutions:
Adaptive EquipmentSpinner KnobTurn Signal ExtensionLeft Foot AcceleratorHand ControlsSupplementary MirrorsTransfer Aides
(straps, grab bars)Reduced effort steering devicesVan Modifications
& highly technical equipmentWheelchair lifts, Scooter Lifts and related systems
Caregiver: Swing out passenger seat, WC equipped transport van
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IADL Functional Performance Based
Assessment (on-road assessment)
All relate to vision, motor, and cognitive functioning
Operational:Using ControlsLane Positioning
Visual ScanningLane Changes
Tactical:
Attending to signs
Speed/Reaction Time
Complex IntersectionsRules of the Road
Strategic:
Self Directed DrivingProblem solving (return to…)Road construction?
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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
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Certified Specialists
SCDCM AOTA
Professional Portfolio of Education and Experience
2000 hours of experience as an occupational therapist
Additional 600+ hours providing Driving and Community Mobility services
https://www.aota.org/education-careers/advance-career/board-specialty-certifications/driving-community-mobility.aspx
CDRS
ADED (Association of Driving Rehabilitation Specialists)
Pass Exam
Does not need to be an OT
a. 4 year health related degree + 1700 hours experience in driving rehab
b. 2yr degree + 3400 hrs experience in driving rehab
c. No degree + 5000 hrs experience in driving rehab (role not defined)
http://www.aded.net/?page=215
Certification is not required –
but recommended once
experienced
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“Personal Paratransit”
• Mobility equipment to support caregiver
• Spontaneity and participation
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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!!
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Thank you!
For more information please contact
Elin Schold Davis