A review of a major driver rehabilitation centre: a ten-year client profile

Older Drivers and Driving Cessation

Driving is a complex and valued instrumental activity of daily living, which is associated with a person's freedom, independence and autonomy. With an ageing population and various cohort effects, the number of older drivers is increasing at a nearly exponential rate. While drivers over the age of 65 years have attracted media and research attention because of accident statistics, research has also begun to focus on the outcomes for older people giving up driving.

The outcomes of older people driving or giving up driving need to be considered by occupational therapists because of the potential impact on quality of life, life roles, independence and safety. Occupational therapists must be aware of legislation pertaining to older drivers and health professionals, although this is complicated by the fact that it differs between and within countries. This literature review aims to investigate the issues associated with older drivers and with driving cessation and the implications for occupational therapists.

Physicians' role in the determination of fitness to drive in patients with Parkinson's disease: systematic review of the assessment tools and a call for national guidelines

BACKGROUND

Physicians are usually at the forefront when the issue of driving ability is raised by Parkinson's disease (PD) patients or their family members, even though few have been formally trained in this area.

OBJECTIVES AND METHODS

To identify relevant literature on driving assessment tools in patients with PD by performing a systematic review on this subject in order to provide background information for physicians on what types of driving assessment are available, and to delineate the role of physicians in providing fitness to drive recommendations.

RESULTS

Of 1,490 abstracts screened, 55 articles fulfilled the selection criteria that investigated assessment of driving ability in PD patients with questionnaires, off-road testing battery, driving simulators, and driving skill tests (on-road tests and naturalistic driving test). Despite different methodology across studies, PD patients were observed to commit more driving errors than controls. Poor driving performance correlated with motor, visual, and cognitive severity. Excessive daytime somnolence was common in PD drivers and the presence of falling asleep while driving was identified to be a significant predictor of car accidents.

CONCLUSION

Although the evidence indicated more driving errors among PD drivers as identified by various assessment tools, the extent on how physicians should be involved in the evaluation process and make related recommendations remain unclear. Driving safety is an important public health issue in PD that needs better-defined specific legal and medical guidelines. National guidelines that establish risk assessment protocols involving multidisciplinary assessments are needed to assist physicians in making appropriate referrals for additional evaluations and recommendations when patients are deemed to be unsafe drivers.

Predictors of Driving Ability Following Stroke: A Systematic Review

BACKGROUND AND PURPOSE

The objective of this review is to identify the most consistent predictors of driving ability post stroke.

METHOD

A computerized search of numerous databases from 1966 forward was completed. Measured outcomes included voluntary driving cessation or results of on-road driving evaluation. Studies were evaluated using the Newcastle-Ottawa Quality Assessment Scale.

RESULTS

17 eligible studies were identified. The most useful screening tests were tests assessing cognitive abilities. These included the Trail Making A and B tests, the Rey-Osterreith Complex Figure Design, and the Useful Field of View Test.

CONCLUSION

Cognitive tests that assess multiple cognitive domains relevant to driving appear to have the best reproducibility in predicting fitness to drive in stroke patients.

Gaining Insights to the Clinical Reasoning that Supports an on-Road Driver Assessment

Background. Researchers have yet to examine the clinical reasoning of occupational therapists undertaking driver assessments. Purpose. Conduct pilot research exploring the kinds of clinical reasoning used during an on-road driver assessment and to determine if the quality of the data supports further inquiry into the use of head-mounted video camera footage to prompt recall of clinical reasoning. Methods. Using a single-case, qualitative design, head-mounted video camera was used to record the on-road assessment and the therapist subsequently provided her reasoning using video-prompted recall. Findings. The video footage from the head-mounted camera provided an excellent prompt, and the therapist was able to give a thorough account of her clinical reasoning during the on-road assessment. Implications. This novel method of capturing on-road driver assessments and prompting recall of reasoning has the potential to aid expert and novice driver assessors understand and advance the clinical reasoning that guides fitness-to-drive recommendations.

Correlations of selected psychomotor and visuomotor tests with initial Dynavision performance

The current study investigated the relationship between Dynavision scores for 36 men and 52 women (M age = 20.5 yr.) and performance on six conventional psychomotor tests which presumably tap similar psychomotor abilities and visuomotor skills. Analysis indicated that initial Dynavision performance was significantly correlated with performance on these common psychomotor tests. These data extend findings that propose the effectiveness of the Dynavision apparatus to assess performance on basic visual-motor and visual-cognitive functions. Taken together with these new results, findings suggest that this apparatus might contribute to psychomotor assessment and may be potentially useful for effective selection and identification of individual differences in human behavioral performance.

An exploratory study on the predictive elements of passing on-the-road tests for disabled persons

OBJECTIVES

Driving evaluations are performed by Occupational Therapists to evaluate drivers with disability. They include both off-road and on-road assessments. Many aspects of driving are examined during the on-road assessment. The main objective of this study is to identify the elements of the Occupational Therapy on-road driving assessment that are most predictive of the overall driving evaluation.

METHODS

This retrospective cohort study took place at a provincially approved Driving Assessment Program. Records of 700 participants with various disabilities who completed a driving assessment between 1995 and 2003 were reviewed. Only clients who completed the on-road assessment were included in the study. At our center, 11 driving elements comprised of 34 items were used as independent variables and rated as pass (acceptable or good) or fail (borderline or poor). Analysis was completed with descriptive statistics and use of logistic regression to identify elements that contributed most significantly to the overall driving evaluation.

RESULTS

A total of 628 clients completed the on-road assessment with an overall pass rate of 50%. Logistic regression modeling identified poor anticipation of road hazards, observation of environment, improper stopping position, poor visual scanning, poor knowledge of the rules of the road, and increasing age as predictive of failure for all participants. Further analysis grouped subjects according to disability to identify similarities and differences between pass/fail predictors. Both similarities and differences in predictive elements were found between cognitive and physical diagnostic groupings. Most notably, the physical diagnostic grouping showed that cognitive, not physical elements of the on-road test, predicted failure of the overall driving evaluation.

CONCLUSIONS

Of the 11 elements considered in the on-road evaluation, specific cognitive ones such as anticipates potential hazards, scanning, observes for pedestrians, and proper stopping position tend to contribute more to the prediction of pass or fail than others. These elements should be considered as components of on-road assessments by other Driving Assessment Programs.

Perceptions of power mobility use and safety within residential facilities

BACKGROUND

Power wheelchairs enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities.

PURPOSE

As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for power mobility use.

METHOD

In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members.

RESULTS

A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions.

PRACTICE IMPLICATIONS

Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them.

Intelligent transport systems and occupational therapy practice

This paper explores some of the most widely available in-vehicle information technology systems (intelligent transport systems, or ITSs) and discusses their implications for occupational therapy practice. Therapists often evaluate the impact of functional impairment on driving ability and, with an ageing population, the need for such assessments is increasing. Concurrently, ITSs are becoming increasingly common and it is important that their potential effects on both driving task demand and crash risk are considered by therapists when assessing drivers. Interactions between drivers and ITSs are analysed in an information processing framework, highlighting the importance of drivers' cognitive functioning. It is evident that the ability to use an ITS while driving is influenced by a driver's sensory, perceptual, cognitive and motor capacities and skills, all of which are likely to vary with age, disability and/or driving experience. The compatibility of ITS interface design with drivers' capacities and needs is crucial in determining how effectively, and safely, a particular system will be used. Therapists need to analyse interface demands in relation to the ability of individual drivers to cope with or benefit from an ITS, and to consider the potential for calibrating particular products to the specific requirements of individual drivers. It is concluded that many ITSs are at an early stage of development and should not be recommended without critical evaluation of their utility, usability and safety for the intended users. Therapists face the challenge of understanding the parameters and implications of ITSs so that they can assist their clients to optimize their occupational performance despite functional limitations, while also protecting the safety of other road users. Standards related to interface design are still undergoing development, and there is an urgent need for further research to evaluate the impact of vehicle technologies on human behaviour and road safety.