Driving and Community Mobility

One takeaway from the lecture today is that it is important how things are worded. Client centered care is important and kindness goes a long way when working with clients. This is especially true when dealing with something as sensitive as telling a client if they are going to be independent in driving or not. The three purposes of driving rehab are: 1) assessing individuals for safety and potential to drive, 2) evaluating people with physical disabilities for appropriate adaptive equipment, and 3) training individuals in the use of adaptive equipment and compensation techniques for driving. It is important to take into account common characteristics of certain diagnoses when working- frustration tolerance and hallucinations can be common in TBIs, left neglect can be common in strokes. Working with clients on autonomy and dealing with a loss of freedom after losing a license is important because it is a major life change. Procedural memory is something that can be lost in clients with Alzheimer’s, therefore it can be important to test to make sure they know the procedures in doing certain tasks such as starting a car. The Moro reflex is something that is often not integrated in clients with CP, it is something important to test when working on driving with these clients to make sure that they do not easily startle. A driving evaluation has two components- a clinical evaluation, and a behind the wheel assessment. If a client cannot pass the assessment in the clinic, they definitely should not be doing a behind the wheel assessment. Vision, sensory, grip, trail making A and B tests and rules of the road tests are important for the clinical evaluation. Trail making A is important because it works on sustained attention, and trail making part B is a test to see if the client can divide their attention between numbers and letters. Insight and awareness are important factors to consider for diagnoses like Alzheimers and TBIs. In a road test, it is important to look for time and distance judgements, scanning the environment, maintaining safety, and vehicle acclimation. 

An individual intervention for a client with a brain injury would be working on sequencing when driving. For example, we would first get into the car, check mirrors, put on seatbelt, put foot on break, and then start the car. The order of these steps while driving is important and something that OT can work on. We could work our way up to harder sequencing events as well as problem solving situations that are happening on the road.

A group intervention for clients who did not pass the driving examination would be a group on frustration tolerance to deal with emotions about this. We could talk about autonomy and self-confidence after losing their license.