driving assessment
TRANSCRIPT
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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
None, but referralprocess takes
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
None, but referralprocess takes
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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The Clinical Evaluation contd
Psychosocial Status
Anxiety
Impulsivity
Aggression
Frustration Tolerance
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The Clinical Evaluation contd
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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Evidence Based Practicecontd
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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Evidence Based Practicecontd
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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Evidence Based Practicecontd
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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Evidence Based Practicecontd
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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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.