Learning to Drive

Video: Driving Evaluation

Automotive — Wed, 17 Sep 2008 20:14:00 GMT

How do you find a rehab driving specialist? When and why do you need one? What can you expect during the evaluation process? This video will answer those questions and more.

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Format: flv
Duration: 07:54

Are You Modeling Good Driving Behavior?

Tue, 01 Jul 2008 16:25:00 GMT

Over the last week there was an article in one of my local papers regarding a study looking at how kids emulate risky driving behaviors of their parents. This study concluded that while sons pick up habits primarily from their fathers, girls pick up behaviors from both parents. I thought this was interesting since last week I blogged about Preparing Your Child to Drive. This week I thought I would blog about being a good driving role model. Teens will look to their parents as models from which to learn driving. Are you modeling good driving behavior? What is good driving behavior?

Some of the most important driving skills to model are:

Drive within the speed limit. Don’t let you child think it is ok to drive 5 miles over the speed limit because police don’t pull you over. A new driver may encounter situations they can not handle at speeds in excess of the limit.
Stop prior to the crosswalk or stop line. A complete stop, before pulling forward to see if it is safe to make a right turn on red. A new driver may not see the bike about to cross the intersection as quickly as an experienced driver, because they do not have as efficient search patterns as an experienced driver.
Don’t drive too close. Maintain a proper following distance. A minimum of two seconds between the back end of the car in front of you and your vehicle is required in ideal conditions. You measure following distance by counting as the back of the car in front of you passes a fixed point – line in the road, a sign, shadow, etc.- until the front end of you car reaches the same fixed point. Count a steady “one and two”.
Don’t drive distracted. If you must use a cell phone, use a Bluetooth head set, but don’t let your child use one while driving. Other distractions can include texting, eating, ipod use and even other passengers.
Stop so you can see the bottom of both tires of the car in front of you. This gives you an out if the car in front stalls. You will be able to maneuver around it. You will also not be responsible if you are rear-ended and hit the car in front of you. You are responsible if you are struck and pushed into the car in front of you if you do not have the proper stopping distance.
Be courteous to other drivers. Allow others to merge or make lane changes. Don’t use rude gestures. Don’t cut off others.
Use you turn signals regardless if anyone is behind you. It is the law!

Modeling good driving behavior may make you child a safer driver, it’s up to you!

Preparing Your Disabled Child to Drive

Tue, 24 Jun 2008 17:24:00 GMT

Children with disabilities have unique issues with driving. In many cases children with disabilities may have not have many of the mobility experiences of their peers without disabilities. Some children with disabilities may need to delay their driving until their adulthood because the high tech adaptive equipment they need is cost prohibitive and they may need to wait until vocational rehabilitation funding is available to them. Many children with disabilities never see the world from the front seat of an automobile.

Every parent has to make the decision of whether they feel their child is ready for driver education and it is an individual decision. Sitting at the computer I can not make that decision for anyone, heck, after evaluating a child, I am not the best person to make the decision, I can only give advice.

But here is my advice on preparing a child with a disability to drive:

1. Provide your child with as much mobility experience as they can handle. There are bikes with helper handles, three wheeled bikes and arm operated bikes. If your child can use one and you can afford one, get it. There is even a side by side bike that allows your child to be next to you so they get the same view as a driver. www.flaghouse.com is one Web site that has adaptive bikes.

2. If your child can be safe with a go-kart or golf car, even bumper cars, give them the opportunity.

3. If they have a power wheelchair, teach them to cross the street and develop the visual spatial skills to time when it is safe to cross to help with decision making and judgment.

4. Give them video games that allow them to develop visual scanning and searching skills.

5. When they are getting to an age when they are interested in driving, begin to have them provide you with turn by turn directions on how to get to and from familiar destinations like school, grandma’s and other places they go frequently. This will develop navigation skills and they will be familiar before they start driving.

6. Use commentary driving with them. Let them know what you are looking out for and why you are making a lane change, slowing down, or coasting, so they begin to understand that they have to interpret other drivers actions. This is very important with kids with Aspergers Syndrome or Autism Spectrum Disorders where they may understand the rules and expect everyone to follow them.

7. Have you child use commentary driving, telling you the color of the light ahead, when it changes, add speed limit signs and warning signs as their competency improves.

8. Remember that you are their role model, drive as you would want them to drive. Model good driving behaviors

9. Think starting training earlier than later, they can have longer period of supervised driving. But again you must know your child. Prepare them for needing longer training period. They may not have met the developmental milestones at the average age, so they may not be able to drive at 16, but I guarantee that if they are a driving candidate, they will benefit from extended training.

10. Seek out a professional driver rehabilitation evaluation. Even though they can not drive yet, the clinical assessment may provide you with strength and limitations and help you know where to focus attention as well as let you know if your child is a candidate for driving. Some things such as a strong startle reflex or poor visual acuity or peripheral vision, severe ataxia may disqualify them from driving.

Other Useful Aftermarket Safety Items

Mon, 16 Jun 2008 22:33:00 GMT

Last week I wrote about auxiliary mirrors. This week’s blog will focus on other aftermarket items that may increase your safety while driving.

The first two items are back up sensors and rearview mirror camera. The back-up sensor works by sensing when something is behind your vehicle and emits a warning sound when you are close to an object. An example of the sensor system is the backtracker (www.raintracker.com).

An alternative to the back-up sensor is the rearview mirror camera (www.gentex.com – look under “what’s new”). In this system a small camera is mounted on the rear of the car which sends the picture to a small screen in your rearview mirror affording you the ability to see what is behind you and how close you are. Both of these items are helpful to people with limited neck mobility and to people who have one hand to steer such as those with hemiplegia or those who use hand controls.

Another helpful item is the raintracker (www.raintracker.com) made by the same company that makes the back tracker. It senses moisture and turns on your wipers so you don’t have to. This product can be more cost effective if you only need to change the location of the wipers. This can be helpful for people who have decreased sensation of movement or coordination in their arms which may make locating or operating the wiper switch when driving more difficult.

A Global Positioning System or GPS as it is more commonly be referred, can be a helpful item for all driver. There are many GPS systems and all will provide turn by turn direction from where you are to where you want to go. Depending on the system, it may also tell you were the nearest gas station or restaurant is. It may also let you know of current traffic conditions and detours. While a GPS may be helpful for people who have a disability that affects navigation abilities, I recommend that you be evaluated to determine that you are able to use it safely before purchasing one. For all people, using a GPS system can be distracting and confusing at first. Initially it is tempting to watch the screen rather than the road, so care must be made to make brief glances at the screen and look back through the windshield much as you would your speedometer. Also the directions can be a bit confusing. For instance, the TomTom (www.tomtom.com) that I have for work give me phrases such as “in 800 yards make a right turn”. This does not necessarily mean it is the next right. The Garmin (www.garmin.com) is the one I have for personal use may tell me “keep left in .2 miles”. This does not mean to get all the way to the left, but usually means the right lane will be an exit only lane or you are approaching an interchange.

I recommend that all people who get a GPS system use it initially while going to and from familiar destinations so that they get used to the quirks of their system. This should go without saying, but just as using you cell phone while driving is dangerous, routing or rerouting yourself using a GPS system while driving is equally dangerous. You should move safely off the road to activate and plan your route using the GPS. Teens and new drivers should use a GPS with supervision as the system adds a layer of distraction for new drivers who are at higher risk due to inexperience.

Useful After Market Items - Mirrors

Fri, 06 Jun 2008 18:26:00 GMT

There are several after market products that can be purchased and installed on your vehicles that may increase your driving comfort and may even increase your safety. They are not designed for people with a disability and do not require a physician prescription, though some of the equipment may require training for people with disabilities effecting visual perception or attention difficulties, so as I always say, this blog is no substitution for a driver rehabilitation evaluation by a qualified driver rehabilitation specialist.

Auxiliary Mirrors
The first category is auxiliary mirrors. These can be as simple as spotting mirrors, which can help you see your blind spot. Truckers have been using these for years and they can be very helpful, but I do not like the idea of blocking part of the side view mirror with the spotting mirror, so I like to recommend the Lanechanger II or III mirror (www.lanechanger.com).

Lanechanger III
I prefer the Lanechanger III mirror which would replace your original rearview mirror, but with vehicles with electronics such as, map lights, On Star or back-up camera in the rearview mirror, then you would need the Lanechanger II which sits on top your rear view mirror. The reason I like the permanent one is that there in no adjusting the top convex mirror, if you set the bottom mirror as you normally set your rearview mirror, the top mirror is automatically correct. I have had to adjust the stick on mirror to be sure it is getting the correct view in some cars. What is nice about the lanechanger mirror is that the top mirror allows you to see you blind spots. For parents it also allows a view of children or pets in the back seat.

Sonus
Another useful mirror is the Sonus (www.sonus-usa.com and look under accessories). This is an auxiliary mirror that you put on the windshield even with the side view mirror and it allows you to see your blind spot without checking over your shoulder. You never have to remove your field of view from the front, which can improve safety. I have trialed this mirror for training and have been disappointed with it’s quality, though to be fair I am removing and placing it on my vehicle almost daily. I think it would be fine if left in one place. It only is applicable to the driver side, so you would still need to check over your right shoulder to check the right side blind spot.

VisionPro
VisionPro is a mirror that attaches over the entire manufacturer’s rearview mirror. It also gives an expanded view and allows the driver to see rear passengers. I trialed this with a patient who had decreased peripheral vision after brain surgery and he liked it better than the Lanechanger mirror and it also allowed him to see the front passenger, which he was unable to do because of limited peripheral vision on the right. He did not like the lanechanger mirror because he had to look at two mirrors to get the information. This mirror makes vehicles behind look closer. It can be purchased in a set of 2 at www.qvc.com. It can be difficult to fit over mirrors with electronic devices in them or fatter style rearview mirror, but I have been able to get it on our training vehicle mirror. I still prefer the lanechanger mirror, but it may be because I have been using it as my training mirror for a long time and I am used to it.

Smartview Mirror
Smartview Mirror is a mirror you attach to the original side view mirror it is about 3x2 inches and mounted in the lower outside corner of the side view mirror. It is curved and angles so that you see crucial information. It can be purchased at www.skidmonster.com. Click on products and scroll down to find the mirror. This mirror can also be helpful in teaching timing for lane changes

Are Left Foot Accelerators Dangerous?

Fri, 30 May 2008 18:23:00 GMT

There has been a lot of talk about the safety of the left foot accelerator recently. The reason for the talk is that some mobility equipment dealers have stopped selling them. There is no real evidence that they are dangerous but mobility equipment dealers are responding to costly litigation resulting from accidents involving the left foot accelerator.

Experienced Driver Rehabilitation Specialists will probably tell you, it is the device that can be more difficult to become accustom to, but I do not believe the device itself is dangerous. In many cases it may be the only option for a person who has a right sided paralysis. In my experience people who have driven a stick shift or other mechanical equipment such as hi-lo’s seem to catch on earlier and there are some who seem to be independent from the get-go. But more often, the driver has to really concentrate not to confuse the gas pedal for the brake pedal. Errors often occur in training when coasting, it seems the trainee confuses the brake for the accelerator because they are neither accelerating nor braking. This is why I have a training brake on the car!

A while back, I was working with a woman who did very well during the evaluation in the parking lot and we quickly progressed from driving in a protected area to residential and highway environments. We were on her third and final training session and everything was going very well. She made no errors and was very consistent form the start. When we were approaching an intersection, an oncoming car made a left turn, immediately followed by the car behind him. The second car did not yield to our right of way, causing the woman I was working with to brake hard to avoid a collision. Unfortunately she did not remove her left foot off the accelerator and actually used her right foot for the brake, so we had simultaneous acceleration and braking. Fortunately I was able to bring the car under control to avoid an accident. But I was really stunned that someone doing so well would make such an error. I learned an important lesson about the left foot accelerator.

Now we do more training with the left foot accelerator. I do rule out people that have difficulty with motor planning and there is no discharging the patient to practice with another licensed driver to become independent. They must be independent with me. So while I do not believe the left foot accelerator is a dangerous device. I do believe that it can be more prone to operator error in the early stages of driving with one. It must be respected and like all new drivers, should not be used while participating in another task (conversation, eating, drinking use of GPS) until the driver has many miles of driving with it under their belt.

Menox: A Review of a New Hand Control

Fri, 23 May 2008 19:10:00 GMT

There is a new style of hand control that is relatively new to the market. I had the opportunity to have one installed in a client’s vehicle. It is called the Menox. There is a comparable hand controls manufactured Mobility Products and Design (MPD), but while I haven’t seen that one, consensus at a conference I attended recently was that many people have difficulty getting full brake with the MPD design unless reduced effort brakes are installed. The MPD is less expensive but with most people needing the addition of low effort brakes, the Menox may be more cost efficient if you don’t already need low effort brakes.

I would not advocate the use of the Menox when traditional less expensive hand controls will work, but in the situation with my client, we could not get a proper fit with traditional hand controls. He was 6-foot 6-inches and all leg. We tried him in our full sized sedan and in our minivan and we could not get proper acceleration before running the controls into his leg whether we used a right push-rock hand control or a right and left push-right angle hand control. The Menox was installed on the right hand side along side of the center console.

The advantage of the Menox over traditional right side hand controls, is that it has a brake lock which allows the driver lock the brake when using the gear shift so you do not have the awkward reach over the steering wheel with your left hand while holding the brake down because the brake lock allows you to let go of the hand control while stopped. This can also be a beneficial feature when stopped. You can let go of the hand control with the lock on and change your radio setting or not have to put the car in park while paying or waiting for your order at a drive through.

The Menox comes standard with accelerator brake and brake latch. The Menox Standard Plus adds buttons that can be set up to operate your cruise control and horn. The Menox Multifunction can be set up to operate cruise control, horn, turn signals, wipers and head lights and the buttons are conveniently located on the hand control grip. I understand that the hand control can be placed on the left for wheelchair users using a ramp van and entering the driver station from the right. If the car is used by an able bodied driver, the left configuration may make it difficult to enter the driver seat from the driver door, so that may be a consideration when considering this device.

You can obtain more information from www.drivingsystems.com or www.menox.org. It also comes in stylish colors that match your vehicle, so you have more choice.

Defensive Driving

Wed, 21 May 2008 20:54:00 GMT

Last week I said I would talk about defensive driving. If driving is a skill that requires life long learning then one of the most important topics should be defensive driving. Operator error is the leading cause of automobile accidents. 98% of all accidents involve a single distracted driver. The other two percent of all accidents are caused by things such as drunk driving, reckless drivers, automobile defects, poorly maintained roads, and malfunctioning traffic signals. Defensive driving skills will improve attention to the task of driving and therefore reduce accident risk

It seems obvious to say that using the cell phone and text messaging while driving are examples of distracted driving. In the media we are bombarded by this, but many of us still do it. Almost all teens admit to texting while driving yet they agree it's dangerous when others do it. I suspect many who use their cell phones in the traditional manner think they are safe too, but statistics prove otherwise. Even when it is hands-free, research proves there is an increase in the accident rate. I didn't believe this, but when I ran a red light while using the OnStar system to make a call in my driver rehab vehicle, I became a believer. I was stopped at the red and the light over the lane had turned green but I was in the left turn lane and there was also a blinking red arrow. Thank goodness the traffic had not started before I made my left and no police were around. Hard to explain that ticket to my boss!

Some other distractions the driver has control over are passenger distraction, eating or drinking while driving, adjusting the radio, and use of navigation systems. Passenger distraction has been studied in teen drivers. Having just one passenger in the car of a teen or novice driver within the first six months of driving increases accident risk but multiple passengers increased accident risk by 300% to 500%. While many of these statistics relate to teens, I believe than can also relate to adult drivers who are novice drivers and perhaps experienced drivers that are new to using adaptive equipment, perhaps at a lesser amount to account for experience with the driving task itself.

Beyond limiting distractions there are also other defensive driving strategies that when utilized improve driving safety significantly. The first is providing a 12 second visual lead. Look 12 seconds ahead to see what is happening in the environment. Remember that the faster you are driving the more ground you will cover, so be sure to increase the distance you are looking depending on the speed limit. I recommend that my clients search for the next traffic signal or sign and also look for speed limit, signs, warning signs, traffic density, and potential hazards they see after crossing each intersection. They should look out the middle third of the windshield and not at the end of their car. Look up and out, see what is happening.

The second is to have a minimum of a 2 second visual lead in ideal driving conditions. Driving in a new way or with adaptive equipment is not an ideal driving condition, so I recommend my clients use a 4 second following distance. Recent research indicates that use of a 4 second following distance reduces gas consumption as well because you do not have to brake in response to other vehicles speed and maneuvers. To measure your following distance begin counting "one and two and three and four" when the back end of the vehicle of the car in front of you passes a fixed point - say a speed limit sign a bridge over head even a seam in the pavement or a shadow will do. When the front end of your vehicle passes the fixed point you stop counting. If you did not reach "four" before you reached the fixed point you are too close and need more distance between yourself and the car in front. To avoid having the task create distraction, I have my clients first practice this as a passenger so they know how to do it before they do it while driving themselves.

Is Your Chair Crash Tested?

Wed, 21 May 2008 20:46:00 GMT

For those of you driving or being transported in a wheelchair, knowing whether your chair is crash-worthy is important. As I've said in previous blogs, the wheelchair-vehicle interface is important and one of those components should be whether the chair has been crash tested. Wheelchairs that have been designed and tested to be used as a seat in a vehicle are called a WC19. They meet the design and performance criteria by the American National Standards Institute and the Rehabilitation and Engineering and Assistive Technology Society of North America ANSI/RESNA. These chairs have four crash tested securement points so tiedowns can easily be placed.

Purchasing a wheelchair that meets the WC19 standard has four advantages over a wheelchair that does not meet the standards. The wheelchair is strong enough to protect in a variety of crashes. In laboratory testing the frame must not crack, it must have a firm supportive seat for the crash dummy and must remain well secured during the crash, keeping the wheelchair and the driver in the vehicle. It is also easier to use. Securement points where the tiedown is attached to the chair are clearly marked and accessible for one handed use in less than ten seconds. There is improved stability in the vehicle. The standard requires manufacturers to measure and report lateral stability of the loaded wheelchair when tipped at a forty-five degree angle. The fourth advantage is that they are more compatible with seatbelts and allow for a better lap and shoulder belt fit.

It is important that wheelchair users who drive or are transported from their chairs advocate for a wheelchair that meet these criteria. For more information on WC 19 standards go to http://www.rercwts.pitt.edu/WC19.html . There is information on writing a letter of medical necessity justifying the need for a wheelchair that meets the WC 19 standards at this link:

http://www.rercwts.pitt.edu/RERC_WTS2_KT/RERC_WTS2_KT_Stand/WC19_Docs/Justification_WC19.html

You may give this to your therapist or physician to request they use it as a template when writing a letter of medical necessity for your wheelchair.

Do you have to have a WC19 compliant wheelchair if you drive from your chair? No, it is like some of the optional safety equipment on you car. It may make you safer, but it is up to you to choose whether you want it and that can be based on a number of physical and financial factors. If you do not have a WC compliant wheelchair now, make sure you discuss it with your therapist, physician and durable medical equipment vendor before you purchase your next chair.

Young and Older Driver Safety

Thu, 15 May 2008 12:21:00 GMT

I went to a conference this week that was put on by the Michigan Center for Advancing Safe Transportation throughout the Lifespan, MCASTL at University of Michigan. The conference focused on young driver safety and older driver safety. While it didn't specifically cover driving with a disability, there were some interesting concepts that applied to all populations of drivers, including those with a disability.

One was the notion that we need to change people's perception on driving proficiency. Teens think that once they have their driver license, they are good drivers. They think they are skilled enough to handle difficult road conditions. The truth is driver education prepares you to pass an entry level driving test and the population that is involved in the most accidents are teens within the first six months of obtaining their driver license. Many accidents occur when the teen is using in vehicle technology or technology brought into the vehicle. The number of passengers also had a high correlation to accident rates for teen drivers.

Senior drivers on the other hand think they have good skill, due to the number of years they have been driving. They do have fewer accidents than teens by population, but when we compare them as a group using million miles driven, their accident rate is nearing that of the teen driver and they are more likely to sustain serious or fatal injuries when they do have an accident. Factors that affect senior driving proficiency are health, frailty and taking multiple medication or polypharmacy.

Many of these same factors are present with an individual with a disability. While you may have passed your driver rehabilitation course and obtained a license endorsing that you can use the adaptive equipment to drive, it is still a new experience and care should be taken to gradually increase experiences and not assume you can drive safely in all conditions. Reducing driver distractions, such limiting the use of in-vehicle technology and nomadic devices such as iPods, cell phones during the initial phase after returning to driving may allow you to maintain safety while increasing skill. Similarly health, frailty and taking multiple medications are often conditions that are true for those with a disability and may make driving an increased risk. Fortunately for most, using good defensive driving skills such as using a 12 second visual lead, using a four second following distance, and maintaining a proper stopping distance can reduce risk. Next week I'll go over defensive driving strategies in depth.

Regardless of age or disability, over the years the driving environment for everyone has changed. Traffic density is greater; vehicle design has changed to improve crash worthiness, more technology is available in vehicle or can be brought into the vehicle making the driving task more demanding. There for the concept of lifelong learning should be encouraged to make driving safe across the driving continuum. I know I became a better driver after taking the driver education course to be a driving instructor. Perhaps all insurance companies could offer a discount for taking a driving refresher course on a periodic basis to encourage lifelong learning for driving safety.

Funding Evaluation and Training for Driver Rehabilitation

Tue, 29 Apr 2008 17:45:00 GMT

Today I’d like to talk about funding of the evaluation and training session and funding of the adaptive equipment itself. All insurances are different and you should contact your insurance company to see if they pay for driver rehabilitation services such as evaluation and training.

Generally your health insurance will not pay for the evaluation and training but some organizations may charge your health insurance for an occupational therapy evaluation for the clinical assessment. This is not universal. Worker compensation and auto insurances may cover evaluation and training for people who were injured in a work or auto-related accident.

State vocational agencies may cover the services for people who have a goal to become employed, return to employment or remain employed. In some states the vocational rehabilitation agency may cover the cost of services for homemakers. The Veterans Administration may provide funding for veterans. Some programs may have grants or self-pay discounts for people who do not have insurance that will cover the cost of driver rehabilitation services.

There are many resources for funding the equipment for your vehicle. Like the evaluation and training, your health insurance generally does not cover the cost of adapting your vehicle. If you were injured at work or in an auto accident you should check with your auto insurance or worker compensation insurance to see if they are responsible to pay for the adaptations on your vehicle.

All of the United States car manufacturers will rebate the cost of adaptive driving aids up to $1000 for new vehicle purchase or lease. Many of the foreign car manufacturers do as well. Go to http://nmeda.org/consumers/rebateprograms.html for a complete listing of manufacturers rebate programs. If you are purchasing a vehicle from a manufacturer without a mobility rebate plan, ask the dealer to meet the offer from manufacturers that do have a rebate program.

Your state’s vocational rehabilitation agency may cover some or all of the costs associated with adapting your vehicle to assist you to get to and from work. The VA may cover the cost of adaptive equipment if the injury was service related, though they may pay for vehicle lifts regardless if your injury was service related. The Paralyzed Veterans Association is also a good resource. Their local association may have resources for used vehicles or donated vehicles. Go to http://www.pva.org and click on membership to find you local chapter.

Many of the people I see with MS have hand controls donated to them from the MS Society, so you may want to check with disability advocate agencies to see if they offer a similar program. In Michigan we also have a Michigan Technology Loan Fund which is a loan guarantee and interest rate subsidy to qualifying individuals. This will help to finance a vehicle for the useful life of the vehicle rather than the typical 48 to 60 month period. www.michiganloanfunds.org

Finally, I have seen friend and family throw benefit events; churches that have a potluck dinner with a silent auction where the proceeds go into an account for vehicle adaptations and maintenance or other household modifications and adaptive equipment.

What's Included in Your Driver Rehabilitation Evaluation

Thu, 24 Apr 2008 21:40:00 GMT

A driver rehabilitation evaluation is a comprehensive evaluation and is tailored to the individual. It should include:

Medical and Driving History: It is important that the Driver Rehabilitation Specialist have a complete medical history, including medications and supplements. This will allow the driver rehabilitation specialist to determine if there are other factors to consider that may have an impact on the persons disability that may not be evident with the primary diagnosis. Driving History lets us know what you are comfortable with or not and gives us clues to your previous driving abilities and behaviors.

Physical Assessment: The driver rehabilitation specialist may look at mobility of your limbs, neck and trunk, coordination of your arms and legs, sensation in your arms and legs, balance and transfer abilities. They may also look at your ability to break down and store your wheelchair or mobility device. Brake reaction time may be assessed.

Visual Assessment: Minimally visual acuity and peripheral vision should be assessed to determine you meet your states standards. Depending on diagnosis or age, other areas may be assessed and may include depth perception, color vision, scanning, and the ability of the eyes to work together.

Cognitive Assessment: Minimally screening for orientation to person place and time and ability to follow simple directions should be done. Depending on the persons diagnosis a number of other tests that are designed to look at things like concentration and attention, ability to pay attention, ability to pay attention to two or more things and visual perception; which is how the brain perceives what you see.

Behind-the-Wheel Assessment: Unless there is overwhelming reason to not take a person on a behind-the-wheel assessment, all individuals should be given an opportunity for a Behind-the-Wheel Assessment using a driver education vehicle with a training brake. While research may indicate people with scores below a certain level have a poor prognosis for driving, the research is looking a population of people but the research results do not have specificity to and individual. For instance, let's assume that 90% of the population who score above or below a certain level on a test are unable to drive. That means 10% can. Do we not let the 10% who can, drive? So it is important to give as many people possible the option of a Behind-the-Wheel test.

Reasons for not going on to the Behind-the-Wheel Assessment may include vision or medical conditions such as seizure that does not meet the states minimum driving criteria; the person has an inability to follow simple directions, so that the therapist can not be assured the individual will follow their instructions while driving, so that safety can not be assured; lack of valid driver license or permit, if required by state. In some cases the program may not have the proper equipment and may need to refer to a program that does. In our program we may also put the Behind-the-Wheel Assessment on hold until the person has identified funding resources, when adaptations are extensive. If you are unable to transfer to a vehicle or expect to drive from your wheelchair, you should make sure the program has a van with wheelchair entry access.

Cindi Burt Blog Archives

Tue, 15 Apr 2008 16:17:00 GMT

June 27th, 2008: Are You Modeling Good Driving Behavior?

June 20th, 2008: Preparing Your Disabled Child to Drive

June 13th, 2008: Other Useful Aftermarket Safety Items

June 6th, 2008: Useful After Market Items - Mirrors

May 30th, 2008: Are Left Foot Accelerators Dangerous?

May 23rd, 2008: Menox: A Review of a New Hand Control

May 21st, 2008: Is Your Chair Crash Tested?

May 15th, 2008: Defensive Driving

May 9th, 2008: Young and Older Driver Safety

April 29th, 2008: Funding Evaluation and Training for Driver Rehabilitation

April 21st, 2008: What's Included in Your Driver Rehabilitation Evaluation

April 14th, 2008: About Driver Rehabilitation Specialists

April 7th, 2008: Driver Rehabilitation Evaluations

March 31st, 2008: Driving with a Disability

About Driver Rehabilitation Specialists

Tue, 15 Apr 2008 16:11:00 GMT

After an illness or injury anyone with an impairment of one limb or more, such as loss of motion, strength, coordination or sensation; visual disturbance such as a visual field cut, where a portion of your peripheral or central vision is lost, double vision or impairments of the mobility of one or more eyes; or impairments in cognition, including things like memory, visual perception, problem-solving, behavior, attention and concentration, should have a driver rehabilitation evaluation.

The difference between a driver rehabilitation evaluation and driver training is the driver rehabilitation specialist has special training in the area of disability and medical conditions. Most often the driver rehabilitation specialist comes from a rehabilitation background, usually occupational therapy or they may have a driver education background. The professional from the rehabilitation background should have specialized training in driver education and the driver education professional should have specialized training in medical conditions and their implications on driving.

It is a good idea to question the professional's background and experience. There are two professional organizations dedicated to expanding the knowledge and skills of the driver rehabilitation specialist. The Association of Driver Rehabilitation Specialist is one of the organizations. They support professionals working in the field of driver rehabilitation through educational seminars and certification. Driver rehabilitation professionals who meet specific experience and continuing education criteria and who pass a certification examination are certified by the Association of Driver Rehabilitation Specialists and will have CDRS after their names. The Occupational Therapy Association is also dedicated to expanding the skills and knowledge of the occupational therapist working in this area. They offer continuing education opportunities at conferences and through professional journals and publications and offer Specialty Certification in Driving and Community Mobility. Driver Rehabilitation Specialists should have membership in one or more of these organizations. Although there are many good qualified driver rehabilitation specialists without certification, certification may be a good indication of continuing dedication to education in the field of driver rehabilitation

The American Occupational Therapy Association has a listing of Driver Rehabilitation Specialist on their website at www1.aota.org/olderdriver. It allows a variety of search criteria such as name, state, zip code and type of program. The Association for Driver Rehabilitation Specialists has a listing of Driver Rehabilitation Specialists on their website at http://www.aded.net/ and also allows search by name, company, state or email address.

Driver Rehabilitation Evaluations

Wed, 09 Apr 2008 19:15:00 GMT

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 (www.nmeda.org) 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.