Driving As a Valued Occupation: Returning to Driving After Brain Injury

Bethanie Skaggs-Manley, MS, OTR/L, CBIS, CDRS

Casey Humphrey, OTD, MHA, OTR/L, CBIS, CDRS

The Importance of Driving

• Independence • Employment • Community Integration • Leisure • Self efficacy • Social interaction • Symbolic (Brenner, Homaifar, & Schultheis, 2008)

Impact of the Loss of Driving

One of the most functionally disabling results of TBI (Benoit, 2011)

Difficulty maintaining employment Depression Isolation Limits return to independent living (Brenner, Homaifar, & Schultheis, 2008)

Skills Needed for Driving: It’s Complicated

Visual Skills Cognitive Skills Motor Skills Visual Acuity Visual Perceptual Skills Coordination Recognition of colors Judgement Motor Response Time Glare Recovery Memory Paralysis Eye Fatigue Emotional Stability Spasticity Divided visual attention Attention Motor Planning Visual Neglect Processing Speed

All of these can be impacted by a brain injury. All of these are necessary for safe driving.

(Benoit, 2011)

Driving Rehab Process

1. Discuss your goals with your doctor. Including your eye doctor.

2. Obtain a valid driver’s permit. Your Occupational Therapist or Certified Driving Rehabilitation

Specialist can help with this! 3. Consider your funding source

Vocational Rehab, Workers Comp, Private Insurance, Private Pay 4. Seek out a Certified Driving Rehabilitation Specialist (CDRS)

http://aded.site-ym.com/search/custom.asp?id=2046

Completing a Driving Evaluation

Off Road Evaluation Typically completed in the office prior to the driving portion Includes visual, cognitive, and motor assessments

On Road Evaluation Will complete driving in a car provided by the CDRS Will complete a pre-determined course in a variety of

environments Car adaptations may be available as needed.

What Happens Next?

• Pass – Unrestricted License • Pass – Restricted License • Further Training • No Pass

What about Physical Limitations?

Hemipariesis/Hemiplegia Spasticity/Tone Decreased AROM Unable to ambulate without a device

Available Compensatory Equipment

Can be simple or more complex Hand controls Mirrors Modified Seating Hi-Tech

Hand Controls

Images from M.C. Mobility

Modified Pedals For Use With Hand Controls

Image 3 from Sure Grip-HVL Images 1 and 2 from M.C. Mobility Systems

Mirrors

Images from Amazon

Adapted Seating

Images from Mobility Works and Adapt Solutions

Options for Drivers From Wheelchair

Image from West Virginia Division of Rehab Services and Wheelchair Accessible Buying Guide

Hi-Tech Controls

Image from Drive Master Mobility

Georgetown’s Driving Program

ACCEPTING REFERALS (502)863-3870 Ext. 2512 . Complete Pre-driving assessments Sedan for driver evaluation Have basic mechanical controls Private Pay, Vocational Rehab, Worker’s Comp

Georgetown Evaluation/Training Car

Georgetown Evaluation/Training Car

Success!!!!

References

Davis, E. S., & Dickerson, A. (2017, July 24). OT Drive: Integrating the IADL of Driving and Community Mobility Into Routine Practice. OT Practice, 8-14. Betz, M. E., Dickerson, A., Coolman, T., Davis, E. S., Jones, J., & Schwartz, R. (2014). Driving rehabilitation programs for older drivers in the United States. Occupational Therapy in Health Care, 28(3), 306-317. doi: 10.3109/07380577.2014.908336 Brenner, L. A., Homaifar, B. Y., & Schultheis, M. T. (2008). Driving, aging, and traumatic brain injury: Integrating findings from the literature. Rehabilitation Psychology, 53(1), 18-27. doi: 10.1037/0090-5550.53.1.18 Cox, D., Davis, M., Singh, H., Barbour, B. Nidiffer, F., Trudel, T,…Moncrief, R. (2010). Driving rehabilitation for military personnel recovering from traumatic brain injury using virtual reality driving simulation: A feasibility study. Military Medicine, 175(6), 411-416.

References

Lane, A., & Benoit, D. (2011). Driving, brain injury and assistive technology. NeuroRehabilitation, 28(3), 221-229. doi: 10.3233/NRE-2011-0651 Rapport, L. J., Bryer, R. C., & Hanks, R. A. (2008). Driving and community integration after traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 89(5), 922-930. doi: https://doi.org/10.1016/j.apmr.2008.01.009 Hand Controls. (2018). Retrieved March 03, 2018, from https://www.mcmobilitysystems.com/wheelchair-accessible-products/hand-controls/ Foot Controls. (2018). Retrieved March 03, 2018, from https://www.mcmobilitysystems.com/wheelchair-accessible-products/foot-controls/

References

Left Foot Gas Pedal. (2018). Retrieved March 03, 2018, from http://suregrip-hvl.com/leftfoot-accelerators-guards/removable.html Adapt Solutions XL-Board Wheelchair Vehicle Transfers Made Easier. (2018). Retrieved March 03, 2018, from https://www.mobilityworks.com/seating-solutions/adapt-xl-board.php LINK - Innovative Vehicle Access Solution. (2018). Retrieved March 03, 2018, from https://www.mobilityworks.com/seating-solutions/adapt-link.php Hi-Tech Driving Controls. (2017). Retrieved March 03, 2018, from http://drivemastermobility.com/products/hi-tech-driving-controls/ Rehabilitation technology services. (2013). Retrieved March 03, 2018, from http://www.wvdrs.org/index.cfm?fuseaction=home.displaystory&groupID=84&itemid=10

References

P. (2014). Wheelchair accessible Car Buying guide. Retrieved March 03, 2018, from http://wheelchairaccessiblevehicles.co/wheelchair-accessible-car-buying-guide/ Allview Rearview Mirror - Eliminate Blind Spots with a Seamless View: Automotive. (2018). Retrieved March 03, 2018, from https://www.amazon.com/Allview-Rearview-Mirror-Eliminate-Seamless/dp/B0015FYQ90 Fit System RM011 Clip-on Wide Angle Rear View Mirror: Automotive. (2018). Retrieved March 03, 2018, from https://www.amazon.com/Fit-System-RM011-Clip-Mirror/dp/B001A0J2JO/ref=pd_rhf_se_s_cp_1_2?_encoding=UTF8&pd_rd_i=B001A0J2JO&pd_rd_r=E9KH27SCM8N42CZH7J87&pd_rd_w=43KpX&pd_rd_wg=zSjIq&psc=1&refRID=E9KH27SCM8N42CZH7J87