Driving Assessment

7/29/2019 Driving Assessment

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Presented by: Ashlee Barbeau

Student Occupational Therapist, Queens University


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Overview of Presentation

When are Driving Ax required?

Legal Obligation to Report

Referral Process

List of Ministry Approved Driving Ax Centres What Does the Ax Involve?

Potential Outcomes of the Ax

Clinical Evaluation Evidence Based Practice

Questions???


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When are Driving Axrequired?A Driving Ax is required when

an individual has a medicalcondition that may affect

their ability to drive safely.

Driving Ax look at cognitive,

perceptual, & physical limitationsresulting from: TBI, Stroke, Dementia,MCI, Parkinsons Disease, Amputations,

Congenital Impairments, MS, etc.


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Legal Obligation to Report

In Canada, all provinces and territories impose astatutory duty on physicians to report patientsdeemed unfit to drive

Additionally, physicians across most provinces arerequired by law to report patients with medicalillnesses that may affect driving

Exception: in Alberta, Quebec, and Nova Scotia,physicians report at their own discretion, with noliability for reporting


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Referral Process

Physician notifiesthe Ministry of

Transportation ofpatients medical

condition

Ministrys MedicalReview Boardautomatically

suspends license

Patient compliesand stops driving

Patient attempts tohave licensereinstated byundergoing a

Driving Ax

Ministry notifiespatient that theyare required to

undergo aDriving Ax

Patient does notcomply and license

is suspended

Patient contacts aMinistry ApprovedDriving Ax Centreto book Driving Ax


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Ministry Approved AxCentres

Agency Contact Address Wait List Cost

Capital Region DriverRehabilitation Centre

Phone: (613) 744-4958Fax: (613) 744-4479

4-125 Springfield Rd.Ottawa, Ontario

K1M 1C5

None, but referralprocess takes

minimum 2 weeks $575

CVE Inc. Phone: (613) 237-7368Fax: (613) 237-0950

1825 Woodward Dr.Ottawa, Ontario

K2C 0P9


minimum 2 weeks $656.25

DriveAblePhone: (613) 224 -7480

Fax: (613) 224-02701893 Baseline Road,

Ottawa, OntarioK2C 0C7

None; Appointmentbooked within 48

hours $585

The RehabilitationCentre

Phone: (613) 737-8899Ext. 75311Fax: (613) 737-8463

505 Smyth Rd.Ottawa, OntarioK1H 8M2

Minimum 8 weeks(and up to 4 months)

$500 for Initial Ax& $150 for repeatevaluations

Swanson & AssociatesOccupational Therapy

Phone: (613) 260-1935Fax: (613) 260-9375

305-1729 Bank St.Ottawa, Ontario

K1V 7Z5


minimum 2 weeks $675


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Referral Process contd

Doctors Referral Form completed includingexplanation of medical condition

Ministry issued Vision Form indicating ahorizontal peripheral field of 120

Consent Form signed allowing drivingassessment centre to liaise with Ministry ofTransportation


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Referral Process contd

If the patient has a valid drivers license, the

Driving Ax Centre will book an appointment forthe evaluation

If the patients license has been suspended,

arrangements are made by the Driving Ax Centre

for a one day temporary license to be issued bythe Ministry for the day of the evaluation


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What does the Ax involve?

Clinical evaluation

Completed by an occupational therapist

Evaluates cognitive, perceptual, and physicalabilities relevant to driving

Takes approximately 2 hours

On-Road evaluation

Completed with an occupational therapist and alicensed driving instructor present

Uses a car equipped with a dual brake

Course is pre-determined

Takes approximately 1 hour


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Potential Outcomes of theAx

Assessment indicates thatpatient is not safe to drive

Assessment indicates thatpatient require more practice

Assessment indicates thatpatient is safe to drive


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The Clinical Evaluation

Review medical condition & medications

Collect a brief driving history

Evaluate knowledge of Rules of the Road

Road Sign Recognition

Driving Problem Solving


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The Clinical Evaluation contd

Physical Status

Active ROM

Strength

Tone

Coordination

Sensation

Pain

Activity Tolerance Sitting Balance

Mobility

Car Transfers


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Psychosocial Status

Anxiety

Impulsivity

Aggression

Frustration Tolerance


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Cognitive/Perceptual Status

Concentration/Distractibility

Attention

Visual Perception

Visual Scanning

Executive Function Insight

Initiation


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Evidence Based Practice

Motor Free Visual Perception Test (MVPT)

Trails A & B or

The Comprehensive Trail-Making Test(CTMT)

Bells Test

Charron Test

Useful Field of Vision

DriveABLE*


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Evidence Based Practicecontd


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Both Trails A & B show significant correlation toon-road performance (Unsworth et al. 2005)

Mazer et al. (1998) found the MVPT, the Bells

Test, & the Charron Test all have very goodpositive predictive value for on-road performance.

Each of these Ax have been found to correlatewith an increased risk of being involved in a crash

(Unsworth et al. 2005). Drivers who take more than 2 minutes for Trails B

are twice as likely to be involved in a crash(Unsworth et al. 2005)


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Useful Field of Vision:

Pictures are presented on a computer screenand clients are asked to identify the images at

increasingly rapid intervals. Response time is measured and the clients

ability to respond correctly within a specificvisual field is calculated

Older adults with 40% impairment on the UFOVtest are more than 2 times as likely to beinvolved in a crash (Owsley et al., 1998; Fisk etal., 2002)


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DriveABLE:

Computer program that was developed toassess those skills deemed crucial to safe

driving including ROM, motor speed and control,judgment, attention, and executive function.

A pass, fail, or indeterminate score isautomatically assigned by DriveABLE head

office. Research indicates that there is a strong

relationship between DriveABLE results and on-road performance (Unsworth et al., 2005)


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It is impossible to determine a persons fitness to

drive using any one Ax tool.

The assessments provide the OT with insight intothe nature of the cognitive/perceptual limitationsthat the client may present with functionally.

Clinical evaluation should always be followed byon-road testing prior to judging the persons ofdriving ability


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[email protected]


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References

Fisk, G. D., Owsley, C., & Mennemeier, M. (2002). Vision, attention,

and self-reported driving behaviors in community-dwelling strokesurvivors.Archives of Physical Medicine and Rehabilitation, 83,469-477.

Mazer, B., Korner-Bitensky, N. A., & Sofer, S. (1998). Predicting abilityto drive after stroke.Archives of Physical Medicine and

Rehabilitation, 79, 743-749.Owsley, C., Ball, K., McGwin, G., Sloan, M., Roenker, D. L., & White,

M.F. (1998). Visual processing impairment and risk of motor vehiclecrash among older adults. Journal of the American Medical

Association, 279, 1083-1089.

Unsworth, C.A., Lovell, R.K., Terrington, N.S., & Thomas, S.A. (2005)Review of tests contributing to the occupational therapy off-roadassessment.Australian Occupational Therapy Journal, 52, 57-74.

Wheatley, C.J, & DiStefano, M. (2008). Individualized assessment ofdriving fitness for older individuals with health, disability, and age-

related concerns. Traffic Injury Prevention, 9, 320-327.

Documents

Driving Assessment