“where the rubber meets the road:

The importance of Behind the Wheel Evaluations and Training”

The Association for Driver Rehabilitation Specialists

Annual ConferenceBuffalo, New York

Presented by: Tommy Crumpton, LOT, MOT, CDI, CDRS

August 3, 2014

ABSTRACT

When considering whether your patient should be referred for a Driving Evaluation, there is often a dilemma as to what should be included, and how thorough the evaluation should be. This presentation will provide insight as to the importance of a behind-the-wheel assessment and training in conjunction with a clinical assessment in determining a patient’s risk level for driving

LEARNING OBJECTIVES

1. The participant will understand the similarities and differences between a Driving Evaluation and a typical Occupational Therapy Evaluation

2. The participant will understand the role of the Driver Rehabilitation Specialist as outlined in the ADED Best Practices for the Delivery of Driver Rehabilitation Services

3. The participant will understand what is assessed in a Behind-the-Wheel Evaluation

4. The participant will understand the process involved in Behind-the-Wheel Training

5. The participant will understand the patient’s legal responsibility when learning to drive or returning to driving with a medical condition

ANATOMY OF AN EVALUATION

As Driver Rehab Specialists, we continually search for the

“perfect” clinical evaluation tool that will answer every question

about a person’s functional ability

Those of us who specialize in the field of Driver Rehabilitation have not found the clinical

evaluation tool that measures a patient’s true driving risk

potential

STANDARDIZED TESTING

The framework or “skeleton” of an evaluation is a collection of

various clinical assessment tools that we compile to determine if

there is a deviation from a “normal” response

WHAT DO WE DO NEXT?

Functional Observation

A patient’s functional ability is what we see or observe (the “skin) during an evaluation.

We then correlate the clinical findings with the functional

findings to get the whole picture

A Problem List is based on deficits identified during a

Clinical Assessment

A Treatment Plan is based on what we see through a

Functional Assessment

* WITHOUT OBSERVING THE PATIENT’S PERFORMANCE OF AN

ACTIVITY, THE EVALUATION IS INCOMPLETE *

Definition: “Where the Rubber Meets the Road”

Fig. at the point in a process where there are challenges, issues,

or problems.

McGraw-Hill Dictionary of American Idioms and Phrasal Verbs © 2002 by The McGraw-Hill Companies, Inc.

Additional common uses of the phrase:

Refers to the tire of a vehicle on the surface of a road

“where it really counts”

* WITHOUT OBSERVING A PATIENT PERFORM THE TASK OF

DRIVING, THE DRIVING EVALUATION IS INCOMPLETE AS

WELL *

ADED BEST PRACTICES ACT

The membership of ADED has developed the “Best Practices for the Delivery of Driver Rehabilitation Services”

As a Driver Rehabilitation Specialist, when performing a Clinical or Behind-the-Wheel Evaluation and/or Training, this is the guide that

should be used.

It is an invaluable tool to help you develop your documentation form and to progress your program to a higher level.

ROLE OF THE DRIVER REHABILITATION SPECIALIST

EvaluatorEducatorTeacher

WHAT DO WE DO IN A DRIVER REHABILITATION PROGRAM?

We evaluate and train both

experienced and inexperienced drivers with physical, cognitive, or

a combination of physical and cognitive deficits

WHAT DOES A DRIVING EVALUATION INCLUDE?

The evaluation actually consists of two (2) parts:

The Clinical Evaluation includes:

General Information Medical History Current Status of Driver License Driving History Current physical, visual, and cognitive status as they relate to driving

The Behind-the-Wheel Evaluation includes:

A performance based assessment

Safely performing a series of maneuvers (Foundation Skills) that every driver must be capable of doing

The setting is determined either by driving experience, or whether adaptive equipment will be needed

For inexperienced drivers or those needing adaptive equipment, a parking lot only evaluation is done

When evaluating a patient’s cognitive status, and/or minor physical deficits, the full evaluation route is 20 miles long, takes over an hour to complete, and is performed in a variety of normal driving settings

FOUNDATION SKILLS OF DRIVING

Steering Braking Accelerating Lane Positioning Left Turns Right Turns Backing Use of Turn Signals

Checking Blind Spot Reading the Terrain Changing Lanes Parking Decision Making

GOOD NEWS / BAD NEWS

When a person successfully demonstrates driving ability, there is :

GOOD NEWS: They are considered by you to be a safe driver.

BAD NEWS: They may still have to prove it to the Licensing

Agency.

RECOMMENDATION CHOICES BASED ON THE EVALUATION

1. Resume driving after completing required Department of Public Safety testing

2. Return for follow-up training, then complete required Department of Public Safety testing

3. Driving is not recommended and the patient should retire from driving

FOLLOW-UP TRAINING(THERAPY BEHIND THE WHEEL OF A CAR)

The number of hours will be estimated by the therapist

Training is specific to the needs of the individual patient

If adaptive equipment is needed, training will be recommended

In all cases of Behind-the-Wheel training, the core function of a

Driver Rehabilitation Program is to train the brain to do something

it has never done before or to perform it in a way different than

originally learned

LEGAL RESPONSIBILITY WHEN RETURNING TO DRIVING WITH A

MEDICAL CONDITION

Texas Department of Public Safety and

Texas Department of Health Services Guidelines

DEPARTMENT OF PUBLIC SAFETY TESTING

The Department of Public Safety (DPS) and the Department of Public Health (Medical Advisory Board) guidelines are that when there is a change in a person’s mental or physical condition that could affect his/her ability to operate a vehicle safely, they are responsible for informing the DPS and completing any testing that may be required

The Department of Public Safety is the only legal authority over a person’s Driver License

The Adaptive Driving Program does not substitute for DPS testing

QUESTIONS???