How OT Can Keep Older Adults Safe Behind The Wheel

Transcript

Hi my name is Marv Lawson, and I’m an occupational therapist with FOX Rehab, ready to begin my 15th year here. So I have board certification in geriatrics, and, most importantly, I’m a driving rehab specialist. That’s why I’m here because a lot of people are asking about the FOX driving rehab program.

What’s that about?

How does it work?

So I’m going to try to address that for you.

It can begin with the FOX community Mobility Program which is delivered by any OT generalist, and an OT generalist is any occupational therapist in the company who can deliver this series of screens that look at the patient’s vision and cognition just sort of as a precursor to determine whether or not they might be successful entering the FOX driving program.

So what is the FOX driving program?

That’s a program that must be delivered by a driving rehab specialist. So I’m a driving rehab specialist as I just said and I look at a series of abilities or lack of abilities that a patient needs in order to have what we call driving readiness or to address driving safety with this particular person.

So it’s comprised of many different things, and one of them is cognition.

So for cognition, we look at a couple of different things. One of them is short-term memory. Now for short-term memory, we look at something called the short blessed cognitive test. This test is highly correlated with the activity of driving.

Then for sustained and divided attention and concentration, we look at something called the trail making test.

This is in two parts part A and Part B. The trail making test looks at sustained and divided attention and concentration which we know from research is absolutely necessary for safe driving with older adults. And in fact: If someone does not perform well on that test and exceeds the allotted time, they could be at up to five times more likely to be involved in an at-fault crash.

So that’s driving safety with cognition.

So we also look at vision. And that means not just acuity: near acuity and far acuity. But, we look at all components of vision.

So what is this comprised of?

So we look at scanning, tracking. We look at confrontation testing. We look at convergence and divergence, and we look at depth perception very important.

We also look at visual organization, and for visual organization, we use the super visual organization assessment. We look at visual closure the visual closure portion of the MVPT. And, that’s how we know that we can connect their cognitive ability with their visual perceptual ability.

Additionally, we look at coordination and that’s diadochokinesis, and we have a specific test for that. Can they coordinate their hand movements with their foot movements? Very important to be safe in a vehicle being able to do that. We look at braking reaction time and there is a standardized machine actually that we use for that and that’s the Delta Integrated Braking Response Time Monitor. They have to be able to go from the gas pedal to the brake in a specific amount of time.

By the way, all of these assessments also have a correlation with increased, at-fault crash possibility, if they don’t perform well of all of these assessments.

In addition to those, we look at something called a stationary assessment. So that is the person’s ability to leave the chair that they’re sitting in and walk through their home, open the door, go out the door down the steps down to the sidewalk, to the driveway or the garage or wherever their vehicle is, and then they may need to get their assistive device — be it a cane or a walker or a rollator; they also have to be able to get that closed up and into the back seat or into the trunk, and then make their way to the driver’s door and open that door and get in the vehicle safely.

Then we look at components: what happens once they’re in that vehicle? Things like putting on their seatbelt, being able to reach the gearshift and have the car seat back far enough that the airbag in an accident would not harm them.

We also, most importantly, look at their ability to use their mirrors their driver’s side mirror, the passenger mirror, and the rearview mirror. Super important that they are able to adjust those and, at a moment’s notice, look in the mirror as effectively and use them.

So how do we know?

I actually stand behind the vehicle and I hold up an object or how many fingers am I holding up. And, I ask them to identify, not by turning around but by looking at those mirrors, can they see what’s behind them.

If they do well with all of this portion of the test, then we make a recommendation that they move forward to the on-the-road assessment.

If they do not do well with these and we find that too many areas don’t look good and they’re failing some of these assessments, then we make a recommendation to the physician that they contact the medical advisory board and have the patient’s license retire. The medical advisory board is a department of the DMV. But if they do well on all of those, then they move forward to the on the road driving assessment.

How does that work? So we use a vehicle from a driving school, and I use a local driving school that has been with us more than eight years. We have a professional driver. The state wants us to be in a vehicle that has a dual braking system so the professional driver sits in the passenger seat the driver drives the vehicle and the FOX DRS sits in the back seat, giving directions as we go so that we could really look closely at everything that person does. Can they follow our directions and maintain that vehicle in a safe format? And then also not only do we have them drive, but we also have them park because it’s equally important that once they reach their destination that they can park safely pull and back out of that space safely — not only drive but also park.

Let’s say they do do this they go through all of this on the road test which is the second part and they do well, then that recommendation to the physician would be that they can either resume driving or start driving again if they haven’t been driving.

The one caveat to that, though, might be: This may be a person that has a neurological condition, and if they do, let’s say it’s something like Parkinson’s disease or dementia which is a progressive illness, we want to be sure that they’re still okay in six months or a year. So, I might recommend that we passed them. Now let them resume driving for now but that they be retested in six months to a year.

So this is how we try to as best we can ensure that this person is safe now and in the near future.

So this is a quick look at the FOX comprehensive driving program: both the commuter and mobility section which can be done by an OT generalist, the first part the critical driving assessment which looks at all those first factors the cognition and the vision and so on, and then the actual gold standard: the road test.

So as you see, it’s very comprehensive and we really try our best to be sure that this person is safe and that we can then assure you, the physician of the referral source, that this person is safe behind the wheel and you don’t really need to worry about that.

So I realize this was a lot to take in today. If you would like further information, you can call us or log on to foxrehab.org and learn more about it.

Thanks for being with us today.