Driver Rehabilitation Program - Evaluation and After Evaluation Part

Introduction

Driving plays a vital role in one's independence and quality of life. Driving is considered the most complex instrumental activity of daily life. Driving skills can be affected due to aging, diseases, visual impairment, cognitive impairment, or neurological problems.

Driver rehabilitation programs help evaluate driving skills and provide appropriate treatment to people with conditions affecting their ability to drive safely. The program has three parts:

• Evaluation of mental and physical abilities required for safe driving.

• Behind-the-wheel driving evaluation.

• Appropriate treatment if needed.

• The goal of the driver rehabilitation program is to help individuals with disabilities and senior citizens with functional impairment to maintain driving skills by making use of specialized driving equipment and training.

• In simple words, it helps in making fitness to drive decisions. The program is usually conducted in an adult of age above 18 years having a valid license and physician's referral.

Who Are the Ones Who Benefit From the Program?

The ones who benefit from the program include people with the following conditions, including new and experienced drivers:

• Stroke (a life-threatening situation due to blockage in blood supply to the brain).

• Multiple sclerosis (an auto-immune disease that affects the brain, optic nerves, and spinal cord).

• Cerebral palsy (a neurological condition that impacts motor skills, posture, and coordination).

• Spinal cord injury.

• Muscular dystrophy (a genetic disorder characterized by muscle weakness).

• Parkinson's disease (a progressive neurodegenerative disorder).

• Brain injury.

• Orthopedic impairment (a severe muscular, skeletal, or neuromuscular impairment).

• Amputation (surgical removal of limb).

• Learning disability.

• Memory problems.

• Visual impairments.

• Spina bifida (a gap in the spine due to neural tube defect).

• Short stature.

• Aging drivers.

• Autism.

• Anxiety.

• Arthritis.

• Older adults with physical, visual, and or cognitive impairment.

Who Are Driver Rehabilitation Specialists?

Driver rehabilitation specialists, certified driver rehabilitation specialists, are occupational therapists with specialty certifications in Driving and Community mobility.

The responsibilities of driver rehabilitation specialists include the following:

• Applies medical knowledge (knowledge of medical conditions) with implications to driving.

• Evaluate the physical, visual, behavioral, and cognitive limitations that affect driving performance.

• Compares clinical findings with on-road performance assessment.

• Driving is considered part of occupational therapy as a person needs to become independent and improve their quality of life.

• The therapist evaluates the psychological and social well benign of the person.

What All Are Assessed in the Evaluation Part?

The following things are assessed in the evaluation part:

1. Physical and Mental Evaluation: The physical and mental evaluation step involves computerized testing and a driving simulator. The skills and information evaluated include:

A) Review of Driving History: This step evaluates the driving history and assesses the following:

• The frequency, duration, reason, and location of trips.

• The timing of driving (night driving or driving during rush times).

• Vehicle maintenance history.

• Driver's knowledge about the location and roadways.

• Type of roadways used.

• License status.

B) Review of Medical History: This step assesses the medical history and history of prescribed and non-prescribed medications.

C) Assessment of Vision: Assessment of vision or perception includes evaluation of the following:

• Contrast sensitivity.

• Visual field.

• Visual closure.

• Convergence/divergence of vision.

• Ocular range of motion.

• Depth perception.

• Saccades (rapid and ballistic eye movement that abruptly changes the fixation point).

• Phorias (misalignment of eye axes in certain situations).

D) Assessment of Physical Ability: Assessment of physical ability involves the evaluation of the following:

• Motor strength.

• Range of motion.

• Balance and Coordination.

• Sensation.

• Reaction time.

E) Assessment of Cognition: Assessment of cognition involves the evaluation of the following:

• Memory.

• Judgment.

• Multitasking.

• Executive function.

• Processing speed.

• Insight.

F) Assessment of Communication Abilities: Assessment of communication abilities includes evaluating the ability to speak, read road signs, and interpret symbols.

2. On-Road Evaluation:

The on-road evaluation is done on a specially equipped vehicle with another set of brakes for the therapist. The vehicle also has added devices and equipment needed for the driver. These include dual brakes, a rearview mirror, and an eye check mirror for the therapist. The vehicle will be fitted with a device to assist with steering, hand control, build-up pedal, and other accessories. The following are assessed during on-road evaluation:

• The ability of the driver to get in the car.

• The power of the driver to start the car and control the vehicle while driving.

• The power of the driver to adjust the equipment(mirrors, seats, etc.).

• The ability of the driver to recognize hazards.

• How does the driver communicate? (signal communication).

• The distance the driver keeps from other vehicles and objects.

• The speed, position, and path of the vehicle on the road.

• Defensive driving.

• Adherence to traffic rules.

• Evaluation of vehicle preparation and maintenance.

What Happens After the Evaluation Part?

The recommendations made following the comprehensive evaluation include the following (it can be any one of the next):

1. If the driver (older citizen) shows adequate driving skills and has no underlying medical condition which increases risk over time, then a no-restriction recommendation is given.

2. The evaluated person may return to driving after the vehicle has adaptive equipment.

3. Reevaluation is recommended in those cases where the person has adequate driving skills but has a progressive disorder like Dementia, Parkinson, etc., that can decrease the driving skills in the future.

4. The person may continue to drive but with restrictions consistent with state laws(e.g., geographic restrictions).

5. Temporary cessation of driving is recommended in cases where there is a chance for improvement in driving skills in the future. In such cases, after interventions to improve vision, cognition, and other limitations, a reevaluation is required.

6. Permanent cessation of driving is recommended in cases where the driver does not demonstrate adequate driving skills and the potential for improvement with interventions to improve vision, cognition, or other limitations is poor. Alternative transportation options should be addressed in such cases.

If required, the driver may request the Driver Rehabilitation Specialists(DRS) for a reevaluation. The DRS may also reevaluate the driver in cases where DRS receives physical or mental information about the driver based on a report from the police, doctor, accidental report, or other citizens.

Conclusion

Driving skills are essential for one to have an independent life and to carry out normal daily activities like going to school, the office, college, etc. It is considered a complex instrumental activity of everyday life. However, aging and other conditions which affect one's vision, cognition, behavior, and physical health can significantly affect one's ability to drive safely. Driver rehabilitation programs evaluate the driving skills of such persons and recommend treatment interventions if needed for safe driving.