Phoenix Rehabilitation Occupational Therapy PreDrivers Evaluation Melissa Jaworski, MOT, OTR/L Outpatient Therapist Mount Pleasant and Latrobe locations

Predrivers Evaluation-What is it? A test that allows a client, the therapist, the family, and the physician to better understand the patient’s road worthiness and ability to be safe on the road.

Who’s Appropriate Individuals living with medical conditions that may affect the skills required for driving Anyone with whom driving concerns have been identified

Common Medical Diagnoses Neurological (CVA, TBI, MS, Parkinson’s) Orthopedic and amputee populations Older drivers (Dementia, Alzheimer’s, Memory impairment, Debilitation) Teens with Disabilities (Autism, ADHD, CP,)

Purpose of Clinical Assessment Pinpoint client’s strengths and weaknesses that may pose a risk to driving Indicate training and education needs such as ways you may strengthen skills or compensate for weaknesses Identify adaptive equipment required Establish transportation alternatives if necessary

Components of Driving Vision Cognition Motor Skills

Vision Main sense utilized in driving. Responsible for 95% of driving related input.

Cognition Two Critical areas Processing speed – a person’s ability to obtain information and quickly adjust. Ability to multi-task.

Motor Skills Range of motion Muscle strength Reaction capability

What do we test? Visual Acuity Peripheral Vision Oculomotor Skills Color Recognition Braking Reaction Time

What do we test? Visual Perceptual Skills Visual Processing Time Cognitive Skills Motor Skills

How do we examine these aspects of driving? Paper/pencil tasks Clinical Observation Use of the Vericom Stationary Reaction Timer Testing completed with client only and therapist present

Visual Acuity A standard eye chart assessment is completed for near and distance vision.

Peripheral Vision The ability to see or be aware of what is surrounding us. This is our side vision which allows us to see items to the side while looking forward.

Oculomotor Skills The ability to quickly and accurately move our eyes Eye alignment-position of the eye Esotropia-inward turning of the eye Exotropia-outward turning of the eye Pursuits-allows the eyes to closely follow a moving object Range of motion

Oculomotor Skills Convergence-simultaneous inward movement of both eyes toward each other usually to maintain single binocular vision when viewing object Direct fixation saccades- Move our eyes smoothly/quickly from point to point Searching saccades-rapid intermittent eye movements as attention switches from one point to another

Color Recognition The ability to recognize the colors utilized in driving, red, amber, and green.

Braking Reaction Time Assessed with the Vericom Stationary Reaction Timer. This device simulates a driving scene & measures the simple reaction of how quickly one brakes in response to a red light.

Braking Reaction Standards Simple braking reaction standard is 0.37 seconds  National Safety Council Average for all Ages

Visual Perceptual Skills The ability to organize and interpret information that is seen and give it meaning. This is assessed with the MVPT- Motor Free Visual Perception Test.

Spatial Relations The ability to judge the relative position of one object to another and the awareness of the 2 sides of the body.

Figure Ground The ability to recognize distinct shapes from their background, such as objects hidden in a picture

Form Constancy The ability to recognize that 2 objects have the same shape but different size or position.

Visual Memory The ability to remember and use visual information from the past. Important with road signs

Visual Closure The ability to recognize a symbol or object when the entire object is not visible. Highly linked to driving.

Visual Discrimination The ability to discriminate between visible likeness and differences in size, shape, form, position, and color.. .

MVPT Norms Age Raw Score Visual Processing Time 18-49 34-36 2.5-4.0 sec. 50-69 32-36 3.0-5.4 sec. 70-80 25-35 4.5-7.1 sec. 0.1- 0.5 sec. slower than normal is within limits

Cognitive Skills Assessed Orientation Attention/Concentration Processing Speed Memory Problem Solving/Decision Making Judgement/Insight Driving Knowledge

Cognitive Assessment Tools Observation Traffic Sign Recognition - match common signs with the appropriate meaning. Trail Making Test Part B

TRAFFIC SIGNS INSTRUCTIONS: Write the letter of the correct meaning under each traffic sign A. LEFT TURN ONLY B. NO LEFT TURN C. WINDING ROAD D. RAILROAD CROSSING E. STOP F. NO “U” TURN G. CROSS ROAD H. MERGING TRAFFIC I. MEDIAL STRIP J. TWO-WAY TRAFFIC K. PEDESTRIAN CROSSING L. YIELD M. SCHOOL CROSSING N. SLIPPERY WHEN WET O. KEEP RIGHT

Trail Making Test Part B Assesses working memory Visual processing Visual spatial skills Selective and divided attention Visuomotor coordination Association of poor performance on this test and poor driving performance.

Motor Skills Range of Motion including neck rotation, upper extremity, and lower extremity. Muscle strength of upper and lower extremity. Transfers and Mobility including balance and endurance required to go to/from and in/out of the vehicle. Also the endurance to actually drive.

What else do we examine? Discussion with the client and family are an essential aspect of the test…what are their feelings for this person’s safety on the road? Driving history: frequency, need for driving, accidents, and traffic violations are discussed

Attitude/Behavior Distractible Anxious Impulsive Depression Risk Taking Anger Control

What is in the report sent to the physician? The Occupational Therapist makes a recommendation to the physician based upon the results of the test. The physician makes the ultimate decision as to whether or not to recommend someone continue to drive.

Post Clinical Assessment Summarizes results Suggest treatment or further testing likely on-the-road assessment completed by certified driving rehab specialist Provide education Adaptive equipment recommendations

Adaptive Equipment

How does someone get referred to the Predriver’s Program? A physician referral is needed. Not covered by medical insurance. Workers compensation and OVR will cover costs of this test.

In order to operate a motor vehicle all drivers must do the following: Be able to react quickly. Be aware of traffic, road conditions, road signs, and potential hazards that may occur on the right/left/behind/front of their vehicle. Drivers must be able to make split second decisions. Drivers must be able to pass a vision test.

In order to operate a motor vehicle all drivers must do the following: Drivers must have depth perception in order to parallel park or to know how close objects are to their vehicle. Drivers must be able to follow directions, observe signals, and at the same time use their eyes, ears, hands, and feet simultaneously. Drivers must be alert at all times.

Warning Signs of Unsafe Driving Driving too fast or too slow for road conditions or posted speed. Requires assistance from passengers.

Warning Signs Does not observe signs or signals Makes slow or poor distance decisions

More Warning Signs Gets easily frustrated or confused. Gets lost in familiar areas.

Further Cause for Concern Has accidents or close calls. Drifts across lane markings into other lane

Pennsylvania Law A person will not be qualified to drive if the physician believes the condition is likely to impair the ability to control and safely operate a motor vehicle.

Provider Liability Providers who report persons with any medical conditions that may impair driving ability are immune from any civil or criminal liability. PA physicians who DO NOT comply with the legal requirements to report may be convicted of a summary criminal offense and possible civil actions should the patient cause an accident resulting in death, injury, or property loss.

HIPPA The reporting of individuals to PennDOT is also permitted under the Health Assurance Portability and Accessibility Act (HIPPA) to the extent that the use or disclosure of protected health information is required by law.

The Benefits of the Pre Driver’s test to the Occupational Nurse Determine road worthiness if driving is an essential function of the job. Determine if additional therapy is required for the employee. Documented information to support the need for the consideration for accommodations

Contact Information Melissa Jaworski OTR/L, MOT Phoenix Rehabilitation Mount Pleasant 724-542-9702 Latrobe 724-537-2784 mjaworski@phoenixrehab.com