• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10

I often have people who come in to see me who ask why they need a driver rehabilitation evaluation.  Truth be told, it can be difficult to determine.  In some cases it is easy for the patient to see, but in other cases it may be more difficult to determine.   Some people may find it easy to determine.  I can't drive therefore I need to learn to drive using adaptive equipment.  

Sometimes however the first person the patient sees is a vehicle modification salesperson and if the salesperson is not following the National Mobility Equipment Dealers Association guidelines they may be prescribed their equipment by the mobility dealer.  While most dealers are very knowledgeable in the equipment they may not be knowledgeable of the medical conditions of the patient.  With other patients it may not be obvious to them that they are not able to drive. 

Patients with neurological conditions, such as stroke, multiple sclerosis, traumatic brain injury and dementia may have impairments which make it difficult for them to acknowledge the impairment.  Some impairments may have improved so that it does not affect other areas of their lives, but may still impact driving.

I have had an elderly patient with peripheral neuropathy who came to see me after she hit a brick wall enclosing the parking lot to her condo.  When getting her history, I found out her doctor wrote her a prescription for hand controls because she was having problems locating the brake pedal.  The mobility equipment dealer installed the hand controls, but she was never referred for training.  The problem; she also had an existing condition of fibromyalgia.  She could not steer one handed while backing so reverted to using her feet. Since she could not locate the brake she ran into a wall.

In another case, I had a patient who had had a stroke and had recovered all physical skills.  He had returned to work in a professional capacity.  After completing the clinical assessment, I identified underlying impairments in visual perception.  He reported he was back to all activities he enjoyed prior to his stroke and was not having any difficulties. 

When I did the behind-the-wheel assessment he demonstrated difficulty with left sided attention.  He failed to enter the left turn lanes and continually entered a right sided passing lane because he thought is was a travel lane.  Once while traveling in the right passing lane he abruptly turned right into the driveway of an apartment complex because he thought the lane had ended and did not see the travel lane to the left.  Imagine what could have happened if he had begun driving without an evaluation.

In both cases the driver rehabilitation evaluation identified subtle impairments that would not be visibly noticeable and I am happy to say both clients were eventually able to resume driving.  The elderly patient with the peripheral neuropathy received proper instructions in using the hand controls for both acceleration and braking and was prescribed a spinner knob for one handed steering and the gentleman with the stroke was reevaluated 6 months later and provided with strategies to improve attention and restricted driving was recommended.

Next week we will discuss what a driver rehabilitation evaluation should include.