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Julie Huerbin, OTR/L, MSCSMatt Abisamra, OTR/L, CDRS

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Identify 5 clinical considerations for clients with MS in regards to driving

Identify 4 clinical assessments to address appropriateness to drive

List some of the in-vehicle adaptations that can assist with independence and safety for driving

Identify 3 resources for driving/ transportation to refer MS patients to

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Why is driving so important???Freedom IndependenceAbility to get from point A to point B

Fear Resistance Concern over cost, etc. Interface of vehicle and mobility device

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OT’s focus on enabling participation, they are natural professionals to address driving and community mobility across the lifespan

Driving requires readiness, skill, ability, and competence-activity demands that are addressed across disciplines & practice areas

Driving has been identified as one of the top 10 emerging practice areas for the new millennium

"All practitioners.... should look at the skills needed for driving and offer ideas for these clients to either drive safely through rehabilitation, make modifications with a program such as CarFit, or explore alternative community mobility options"-Wendy Stav PhD, OTR/L, SCDCM, FAOTA(http://www.aota.org/en/Practice/Productive-Aging/Emerging-Niche/Older-Drivers.aspx)

Everyone needs to address it, we all drive on the same roads!

Gail video

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FATIGUE Weakness Spasticity Altered sensation Visual disturbances Cognitive deficits Emotional changes B and B dysfunction/ sexual dysfunction Speech and swallowing difficulty Pain Heat sensitivity

Physical Visual Cognitive

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Muscle Weakness Poor Muscle Endurance/ Fatique Spasticity Decreased Motor Coordination Loss of Ambulatory Abilities Sensory Deficits

Muscle Weakness/ Spasticity P/ AROM MMT Dynamometer Fxnl. transfer Ashworth Observation gait 6-minute walk Vestibular check Driving simulator

Video Clip

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Coordination 9-hole peg test Box and Blocks test Proprioception Observation Dynavision Driving simulator

Sensory Semmes-Weinstien Stereognesis Pt. report Observation

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Clinical Judgement! Self Report- concretely ask if they have

had troubles with the pedals i.e.: ”Have you ever pressed the wrong pedal?” “Are you planning on getting a new vehicle soon?” “Has your foot ever fell off the pedal?” “Do you ever have trouble finding the pedals?” “Have you changed your driving habits”

STM Attention Sequencing Problem solving Processing speed Initiation Emotional Potential side effects of meds

Visual Perceptual

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Get access to NEURO-PSYCHOLOGY report if it’s available may address driving, or at minimum address the

visual/ cognitive components for driving Speech Therapy

Decrease acuity Nystagmus/ Opsoclonus Blurred vision Loss of color vision Field cuts, hemianopsia Central visual loss Diplopia/ double vision Sensitivity

Video Clip BG

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Motor Free Visual Perception Test (MVPT)* Short Blessed Cognitive Screen SLUMS mental examination Useful Field of View Assessment* Trails A and B* KELS Evaluation Glen Gillan Dynavision Driving Simulator

*Tests researched for validity for predicting likelihood of driving success Mazer, Barbara Msc, Korner-Bitensky Nicol PhD, A. Sofer, Susan BSc Predicting ability to drive after stroke, Arch Phys Med

Rehabiliation: Vol 79, July 1998 Zoltan, Barbara, Vision Perception and Cognition: A manual for the evaluation and treatment of the adult with Acquired

Brain Injury, 4th edition, Slack Inc. Thorofare, NJ 08086, 2007

Interview Full Visual Screen (OT) Acuity Saccades Pursuits Scanning Light reflex Convergence Attention Visual fields

Detail Scanning Letter cancellation test

Midline Orientation – line bisection test Useful Field of View Observation (ability to follow/ retain directions)

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The Low Vision Centers of Indiana have served as beta test sites for the UFOV test. UFOV is supported by sixteen years of research by, Karlene Ball, PhD. and Daniel Roenker, PhD. UFOV has received over 25 million dollars in research funds from the National Institute of Health and other agencies. It has been the subject of numerous scientific studies, which have demonstrated that UFOV has a high correlation to crash risk. It is particular sensitive to cognitive impairments of early Alzheimer’s and acquired brain injury.

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Neuro-psychology Neurologist MS physician Optometrist Neuro-opthamologist Case manager Physical therapist Recreational therapist Exercise specialist DRIVING SPECIALIST

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www.aded.net

This site contains a link that will direct you to Certified Driver Rehabilitation Specialists in the client’s home state. The CDRS will help to provide specific evaluations for the Dependent Passenger or Transportation Vehicle Evaluations. These specialists will also evaluate and train persons with disabilities to enable safe return to independent driving. (A physician’s referral may be required.)

THESE GUYS CAN EVALUATE OUR CLIENTS!!!!!

Starts with a clinical evaluation (typically an occupational therapist) Followed by an on road driving evaluation, with or without adaptive driving equipment

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Addresses: Physical Cognitive Visual Interface of vehicle and mobility deviceAvoid costly mistakes!

Helps determine the method and or equipment to be used for the on the road evaluation

Helps determine route to take and what type of traffic situations to expose them to

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Helps determine: the method and or equipment to be used for the on

the road evaluation the route to take and what type of traffic situations

to expose them to

UE and LE AROM, Sensation, Strength, Coordination, Tone

Reaction time Endurance Cervical rotation Trunk control/ balance

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Assess: simple, divided and selective visual attention

and comprehension of multi step directions visual closure, visual memory, figure ground,

spatial relations, position in space, midline orientation, visual attention and visual processing speed

Video

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Dimensions:Interior TrunkMobility DeviceLoading Device

Weight:Mobility DeviceLoading device

Other: Powered / Non powered swivel

Dimensions:DoorwayMobility DeviceLoading Device

Weight:Mobility DeviceLoading device

Other:Sliding/ArticulatingVans (mini; full size)3 door cars trucks

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Need to protect chair from the elements Check hitch capacity Be aware of hydroplaning issues Does not allow for full client independence unless client can walk

Supports 300#, provided the vehicle can handle that weight.

Need to check with NMEDA vendor for compatibility.

Wheels back with vehicle Does impede rear view

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Grab handles

Sliding board Stationary transfer

seats Powered transfer Seats

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Video

Video

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Inside (extended cab and “third door” required ) Loads folding manual wheelchair behind seat in extended cab Wheelchair not exposed to elements

All converted vans have 10, 12, and 14” lowered floors creating ground clearance of 6”.

May be possible to convert some used vans In Floor ramp or Fold out ramp Payload capacity in pounds- 1050 to 1375 (side

entry)1200 - 1600 (rear entry) Overloading vehicle - weight-wise, can cause:

poor braking & handling, and overwork transmission

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A: Floor to top of head or headrest M: width from one wheel to the other, unless armrests are wider B: length from rear-most part of chair to front of feet or footplate G and F are important measurements for E-Z lock compatibility Combined weight of person and the chair

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These are specialty dealers that sell and modify vehicles for people with disabilities.

Site for dealers in patient’s home statewww.nmeda.com

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Disabled dealer magazine http://www.disableddealer.com

NMEDA dealers also sell used vehicles http://www.nmeda.com/locate-a-dealer/

Vocational Rehabilitation Automobile Mobility Programs Trust Funds MS Funding Society/ Associations Private Insurance, Medicare, Hartford

Insurance Self Pay

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Bus line Handicap transport Train Cab Scooter/ PWC Church Senior services Family/ Friends AARP AOTA website: www.aota.org

Video of Stacy

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Mazer, Barbara Msc, Korner-Bitensky Nicol PhD, A. Sofer

Susan BSc Predicting ability to drive after stroke, Arch Phys Med Rehabiliation: Vol 79, July 1998.

Zoltan, Barbara, Vision Perception and Cognition: A manual for the evaluation and treatment of the adult with Acquired Brain Injury, 4th edition, Slack Inc. Thorofare, NJ 08086, 2007.

http://www.aota.org/en/Practice/Productive-Aging/Emerging-Niche/Older-Drivers.aspx)