1. Andrea Sullivan OT/L Occupational Therapy Supervisor Out-Patient Services Burke Rehabilitation Hospital White Plains, NY

2. Why are driver evaluations needed?  Medical changes Stroke, Traumatic brain injury, Neurological impairments, SCI  Normal Aging changes  Physical changes Amputation, Arthritis, joint problems, postural changes  Diabetic conditions Peripheral neuropathy, diabetic retinopathy  Mental Illness/Attention Deficit/Learning Impairment  Dementia/Alzheimer’s

3. “Normal” Aging  Vision  Hearing  Strength/stamina  Memory  Processing speed  Divided attention

4. Presence of AD  Loss of time  Topographical orientation  Working memory  Visual perceptual abilities

5. Presence of AD con’t  Problem solving/reasoning skills  Judgment  Motor planning  Self awareness

6. 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)

7. 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

8. 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  Part 2: In-vehicle Evaluation On the road test with trained individual May include and adapted van/car evaluation

9. 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

10. 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

11. 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

12. Areas evaluated by OT 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

13. Visual Components  Acuity 20/40 minimum (NYS requires 20/40 in 1 eye)  Convergence  Scanning  Saccades  Pursuits/ ROM/ Fixation  Depth Perception  Peripheral Fields (NYS 140 degree minimum)  Contrast Sensitivity  Color Recognition  Glare Recovery

14. Perceptual Components  Spatial Relations Block design-3D and copy Copy lines 2D  Figure Ground(Ayres Figure Ground Test) 3 pictures overlapping  L/R discrimination (Directionality)  Motor Planning Skills (Non-routine response)

15. Cognitive Components  Visual Vigilance/Dual Attention single and dual stimuli  Auditory Attention  Sequencing  Memory test 20 minute recall of 3 items  Safety/Judgment/Problem Solving  Sign Symbol Identification  Direction Following/ Insight

16. Motor Components  Cervical, UE & LE ROM, Muscle Strength, Sensation, Tone & Coordination, Posture  Reaction Time: Reaction Time Tester to determine Simple and Complex Reaction Time  Motor Response and Planning

17. Reaction time  SIMPLE Respond to red light in presence of distraction  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

18. In-Clinic Evaluation Results  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  Factors that go into recommendations Overall performance Combination of deficits Quality of performance

19. In-Vehicle Driving Evaluation  On-the-road test from a local driving school with trained individual for up to 60 minutes  Back road, highway, traffic  May include evaluation for adaptive devices Spinner knob Hand controls Left foot gas pedal Panoramic mirror Adapted van/car

20. In-Vehicle Evaluation Results  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

21. Recommendation to no longer drive  A letter is sent to physician to inform them of the results as well as a Physician’s statement for medical review ( DS-6)  A letter is sent to the patient along with resources for transportation

22. Automatic suspension of individuals license Driving retesting performed by DMV MD must approve revoking suspension of license

23. Reporting By A Citizen To DMV (DS-7)  Form can be given to individual (family, concerned citizen) to alert DMV.  DMV will initiate investigation following 3 letters of concern.  DMV MAY disclose i dentity o f c oncerned c itizen

24. Patient and Family Education  Provide Family and Patient with Transportation Options  Clearly State Whether There Is A Chance for Re-testing or Driving is Not a Future Option (6 month minimum)  Family Support and Acknowledgment Are Key to Success of Intervention  Explain Liability To Patient and Family If Recommendation Are Ignored.

25. 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

26. 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“