Anne E. Dickerson

Driving assessment tools used by driver rehabilitation specialists: Survey of use and implications for practice

OBJECTIVE. This article describes the use of assessment tools by North American driver rehabilitation specialists (DRSs). PARTICIPANTS. Participants were 227 self-identified DRSs from the combined databases of two national associations. MEASURES. Information was solicited through a self-administered survey about the driving evaluation process, assessment tools, and process for making fitness-to-drive recommendations. RESULTS. More than 80% of the DRSs reported testing visual acuity, range of motion, muscle strength, and fine motor coordination. The most consistently used cognitive-perceptual tests were the Trail Making Tests, Motor-Free Visual Perception Test-Revised, and short cognitive screening tests. A clients behind-the-wheel performance was the main factor in making a fitness-to-drive recommendation. Few specialists are using computer-based tests or interactive driving simulators. CONCLUSION. Although use of the Useful Field of View(®) has increased, there continues to be no consistency in cognitive assessments or guidelines for behind-the-wheel assessment. Implications for practice are discussed.

Decision Tool for Clients with Medical Issues: A Framework for Identifying Driving Risk and Potential to Return to Driving

ABSTRACT This paper offers occupational therapy generalists and specialists a new framework by which to consider clinical evaluation data and an older adults driving risk and potential to resume this previously learned skill. Based on Michons model describing the hierarchy of driving levels, clinical questions identify the factors that may affect a clients fitness to drive. The first part is intended to support clinical judgment of whether a client needs a driving evaluation by a driver rehabilitation specialist. The second part offers a framework to organize clinical data that are already known and determine what other evaluation information is justified and necessary to make a driving recommendation. Methods and rational for use are discussed.

Driving with Dementia: Evaluation, Referral, and Resources

ABSTRACT Driving is a highly valued instrumental activity of daily living, especially for the older adults who consider it part of their definition of independence and mobility. This paper discusses the issues associated with driving and older adults, including the difficulty of identifying when it is time to give up the keys. With a review of the latest research and need for specialized services for those with diminished capacity, the paper highlights how general practice occupational therapists must work in conjunction with driver rehabilitations specialists to meet the need of this growing population. A framework for referral and judgment is described and resources offered to practitioners to use.

Consensus Statements for Screening and Assessment Tools

ABSTRACT Occupational therapists, both generalists and specialists, have a critical role in providing services to senior drivers. These services include evaluating fitness-to-drive, developing interventions to support community mobility, and facilitating the transition from driving to non-driving when necessary for personal and community safety. The evaluation component and decision-making process about fitness-to-drive are highly dependent on the use of screening and assessment tools. The purpose of this paper is to briefly present the rationale and context for 12 consensus statements about the usefulness and appropriateness of screening and assessment tools to determine fitness-to-drive, within the occupational therapy clinical setting, and their implications on community mobility.

The Perception of Meaningfulness and Performance of Instrumental Activities of Daily Living From the Perspectives of the Medically At-Risk Older Adults and Their Caregivers

The purpose of the study was to understand the impact of chronic disability on the functional ability of older adults. Thirty older adult participants and their caregivers were asked to identify which instrumental activities of daily living (IADL) are most meaningful and how their disability affected performance. Data collected through individual analysis indicated that the most important IADL tasks were driving and managing medication. Both older adult participants and their caregivers similarly perceived the health condition as significantly affecting the performance of all of the IADLs. However, there was a difference in the perception of the prior level of functioning for managing medication (z = 2.45, p = .024) and phone use (z = 2.26, p = .014). Results arrived at, and to be discussed, were in agreement with previous research findings indicating that complex tasks of daily living, particularly driving, are significant to the older adult’s quality of life.

Clinical Reasoning, Looking Back

Expert clinical reasoning is a vital skill for occupational therapists, particularly in todays rapidly changing health care environment. Clinical reasoning may be the strongest building block of the profession as it diversifies and grows to meet the challenges of the new millennium. Therefore, it is a critical time to continue the research to understand, further develop, and expand occupational therapys knowledge of clinical reasoning. This article describes the development of the occupational therapy clinical reasoning process and compares it to that of medicine and nursing.

Screening and Assessment Tools for Determining Fitness to Drive: A Review of the Literature for the Pathways Project

ABSTRACT With a brief introduction, 10 tables summarize the findings from the literature describing screening and assessment tools used with older adults to identify risk or determine fitness to drive. With a focus on occupational therapys duty to address driving as a valued activity, this paper offers information about tools used by occupational therapy practitioners across practice settings and specialists in driver rehabilitation. The tables are organized into groups of key research studies of assessment tools, screening batteries, tools used in combination (i.e., as a battery), driving simulation as an assessment tool, and screening/assessment for individuals with stroke, vision impairment, Parkinsons disease, dementia, and aging. Each table has a summary of important concepts to consider as occupational therapists choose the methods and tools to evaluate fitness to drive.

Standardizing the rt-2s brake reaction time tester

The purpose of the study was to standardize the RT-2S brake reaction time tester as an alternative brake reaction timer to the American Automobile Associations (AAA) blue box that is no longer manufactured. Three hundred ninety-six subjects across the lifespan participated by using the RT-2S in a standard manner. Results were analyzed using the age groups used by AAA. Results indicated that male reaction times are faster, and as age increases, reaction times decrease. Although the RT-2S reaction times were slower than the norms for AAA, results suggest that the RT-2S is a reliable and valid tool for measuring simple brake reaction time.

Driver Rehabilitation Programs: Defining Program Models, Services, and Expertise

ABSTRACT This paper highlights the critical need for a diverse span of services targeted at older drivers that is clear and understandable to health care professionals, service providers, and consumers. The paper describes how a panel of expert driver rehabilitation specialists and researchers on older drivers affirmed consensus statements addressing the need for clarification of terms and services. It also presents a new document that describes a spectrum of driver services from education to specific driver rehabilitation services. The document will provide consumers, referral sources, payers, and stakeholders invested in older drivers’ services, with the information to refer the right people to the right service at the right time.

Driving Rehabilitation Programs for Older Drivers in the United States

ABSTRACT The objective of this study was to describe the services, referral and reporting practices, and barriers to utilization of driver rehabilitation programs (DRPs) for older drivers. Identified through two national association databases, 204 DRPs completed an online survey. DRP availability varies, with a median of one program per 64,151 older adults (range: 1,006–676,981). The median cost for a complete evaluation was