1. Carol Blackburn, OTR/L, CDRS Susan Pierce, OTR/L, SCDCM, CDRS
FLOTA Conference
Febuary 8, 2009
The OT Generalist Shifting into Gear for the IADL of Driving and Community Mobility
Carol Blackburn, OTR/L, CDRS
Susan Pierce, OTR/L, SCDCM, CDRS
Adaptive Mobility Services, Inc.
Presented at FLOTA Conference
Orlando, FL
February 8, 2009
Susan Pierce & Carol Blackburn

2. The Objectives: At the end of the presentation, the participant will:
FLOTA Conference
Febuary 8, 2009
The Objectives:
At the end of the presentation, the participant will:
understand the value of OT in addressing driving & community mobility as an instrumental activity of daily living
recognize the OT process for addressing driving & community mobility.
understand the role of the OT Generalist and the OT Specialist in Driving &Community Mobility (SCDCM) regarding the occupation of driving
experience the emotions of our clients as they gain their freedom and independence with driving
Susan Pierce & Carol Blackburn

3. The OT Practice Framework – Driving & Community Mobility
FLOTA Conference
Febuary 8, 2009
The OT Practice Framework – Driving & Community Mobility
Sections adapted from the AOTA. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56,
NOTE: will be referenced in text as OTPF, 2002 with page number.
Susan Pierce & Carol Blackburn

4. Is Community Mobility within the Domain of Occupational Therapy?
FLOTA Conference
Febuary 8, 2009
Is Community Mobility within the Domain of Occupational Therapy?
“Occupation is everything people do to occupy themselves, including looking after themselves…enjoying life…and contributing to the social and economic fabric of their communities.”
OTPF (2002), pg 609–639.
Susan Pierce & Carol Blackburn

5. Engagement in Occupations
FLOTA Conference
Febuary 8, 2009
Engagement in Occupations
Occupational therapy supports “…engagement in occupations and in activities that allow desired or needed participation in home, school, workplace, and community life situations.” (OTPF, pg 611)
OT addresses engagement in occupation from a dual and holistic perspective:
Subjective (emotional and psychological)
Objective (physically observable)
Susan Pierce & Carol Blackburn

6. FLOTA Conference
Febuary 8, 2009
With this perspective, OT addresses “all aspects of performance (physical, cognitive, psychosocial, and contextual) when providing interventions designed to support engagement in occupations and daily life activities.”
(AOTA Framework, pg 611)
Susan Pierce & Carol Blackburn

7. The difference between activities & occupations:
FLOTA Conference
Febuary 8, 2009
The difference between activities & occupations:
“Activity describes a general class of human actions that is goal directed. A person may participate in activities to achieve a goal, but these activities do not assume a place of central importance or meaning for the person.”
(OTPF, 2002, pg 610)
Susan Pierce & Carol Blackburn

8. FLOTA Conference
Febuary 8, 2009
Occupations are…
“…activities having unique meaning and purpose in a person’s life…central to a person’s identity and competence, and they influence how one spends time and makes decisions.”
(OTPF, 2002, pg 610)
When individuals engage in occupations, they are committed to performance as a result of self-choice, motivation, and meaning.
(AOTA Framework, pg 611)
Susan Pierce & Carol Blackburn

9. Areas of occupation in OTPF:
FLOTA Conference
Febuary 8, 2009
Areas of occupation in OTPF:
Activities of daily living
Instrumental activities of daily living
Education
Work
Play/leisure
Social participation
Susan Pierce & Carol Blackburn

10. Instrumental Activities of Daily Living:
FLOTA Conference
Febuary 8, 2009
Instrumental Activities of Daily Living:
care of others
care of pets
child rearing
financial management
community mobility
health management & maintenance
home establishment & management
meal preparation & cleaning
safety procedures & emergency responses
shopping
“…are oriented toward interacting with the environment and that are often complex – generally optional in nature.”
(OT Practice Framework, pg 620)
Susan Pierce & Carol Blackburn

11. Relating the OTPF to Driving & Community Mobility:
FLOTA Conference
Febuary 8, 2009
Relating the OTPF to Driving & Community Mobility:
Performance Performance
Skills Patterns
motor habits
process routines
communication/interaction roles
Context Activity Demands Client Factors
adapted from OTPF, 2002, pg 611
Susan Pierce & Carol Blackburn

12. OTPF defines 2 Types of Mobility that are inter-related:
FLOTA Conference
Febuary 8, 2009
OTPF defines 2 Types of Mobility that are inter-related:
Functional Mobility as an BADL
Community Mobility as an IADL
Susan Pierce & Carol Blackburn

13. Functional mobility includes “mobilizing in the community” :
FLOTA Conference
Febuary 8, 2009
Functional mobility includes “mobilizing in the community” :
“…moving from one position or place to another (during performance of everyday activities), such as in-bed mobility, wheelchair mobility, transfers…
performing functional ambulation and transporting objects.”
(OTPF, 2002, pg 620)
Susan Pierce & Carol Blackburn

14. FLOTA Conference
Febuary 8, 2009
Community Mobility
“…moving self in the community and using public or private transportation, such as driving, or accessing buses, taxi cabs, or other public transportation systems.”
(OTPF, 2002, pg 620)
Susan Pierce & Carol Blackburn

15. FLOTA Conference
Febuary 8, 2009
Community mobility is a vital activity of life that allows a person to engage outside the home.
Vital: “essential to life, of greatest importance, & indispensable.”
(Webster’s dictionary)
Susan Pierce & Carol Blackburn

16. If community mobility & driving is an IADL…
FLOTA Conference
Febuary 8, 2009
If community mobility & driving is an IADL…
…then OTs have an obligation to treat it as any other ADL.
…we must include it as routinely as the ADLs of bathing and dressing.
Susan Pierce & Carol Blackburn

17. THE FACTS: Driving is one of most complex IADL
FLOTA Conference
Febuary 8, 2009
THE FACTS:
Driving is one of most complex IADL
Driving should be one of the last ADL addressed
Driving is an ADL skill that can kill so assessing readiness within a medical model is important.
Susan Pierce & Carol Blackburn

18. We have the skill set to address community mobility & driving.
FLOTA Conference
Febuary 8, 2009
We have the skill set to address community mobility & driving.
medical background.
understands primary/secondary diagnoses and implications.
understands aging process with or without a disability or chronic condition.
understands the concept of the “whole person and the whole picture.”
qualified to assess the motor, sensory and processing skills related to community mobility.
Can break down a task into its integral areas of function.
Susan Pierce & Carol Blackburn

19. The demographics of aging are changing dramatically.
FLOTA Conference
Febuary 8, 2009
The demographics of aging are changing dramatically.
Today: 35 million Americans are > age 65
By 2030: 70 million Americans will be > age 65
age 85 & > is growing faster than any other age group
There will be more licensed drivers who will drive later in life, more frequently and for greater distances.
Driving & community mobility will always be the key to independence in our society
Susan Pierce & Carol Blackburn

20. Client centered approach Consideration of: Performance skills
FLOTA Conference
Febuary 8, 2009
Our holistic view allows us to understand the BIG picture of community mobility.
Client centered approach
Consideration of:
Performance skills
Performance patterns
Context or contexts
Activity demands
Client factors
Susan Pierce & Carol Blackburn

21. The OT Specialist in Driving & Community Mobility
FLOTA Conference
Febuary 8, 2009
An OT Team is usually necessary to address driving on the IADL continuum.
The OT Generalist
The OT Specialist in Driving & Community Mobility
Susan Pierce & Carol Blackburn

22. During the ADL evaluation, the OT Generalist should:
FLOTA Conference
Febuary 8, 2009
During the ADL evaluation, the OT Generalist should:
Develop an occupational profile regarding the importance of community mobility & driving
Identify the client’s needs, problems & concerns about driving
Identify roles & priorities
Susan Pierce & Carol Blackburn

23. Evaluate occupational performance in regards to driving/CM skills
FLOTA Conference
Febuary 8, 2009
Evaluate occupational performance in regards to driving/CM skills
Consider client factors
Include treatment in the intervention plan to improve or enhance sub-skills needed for driving or CM
Susan Pierce & Carol Blackburn

24. Discuss process for addressing driving issues
FLOTA Conference
Febuary 8, 2009
Ask if person is or was a licensed driver or has interest in being evaluated for driving potential
Discuss process for addressing driving issues
Inform re: resources & referral to a specialist if necessary
Susan Pierce & Carol Blackburn

25. Communicate with other disciplines
FLOTA Conference
Febuary 8, 2009
Communicate with other disciplines
Determine readiness or appropriateness for referral to OT Specialist in Driving and Community Mobility
Serve as “gate keeper” until ready for formal evaluation or for a recommendation
Susan Pierce & Carol Blackburn

26. The client’s independence vs potential danger to self and others
FLOTA Conference
Febuary 8, 2009
If struggling with a decision about driving for a client, consider the conflicting values and exercise reasonable judgment.
The client’s independence vs potential danger to self and others
The public’s safety vs the client’s right to confidentiality and independence.
Susan Pierce & Carol Blackburn

27. In Considering Driver Readiness:
FLOTA Conference
Febuary 8, 2009
In Considering Driver Readiness:
Use your common sense about what you know about the occupation of driving.
Use critical thinking skills and what you know about your client.
The OT process can assist for a good outcome.
Susan Pierce & Carol Blackburn

28. FLOTA Conference
Febuary 8, 2009
Counsel, inform & educate family/client not to drive until it has been approved or until appointment with OT Driving Specialist
It is NOT the OT Generalist’s role to pass or fail for driving unless there are specific deficits that contraindicate safe driving
Susan Pierce & Carol Blackburn

29. Consider vision &/or visual skills:
FLOTA Conference
Febuary 8, 2009
Consider vision &/or visual skills:
State’s standards
VA – 20/50
FOV – continual 140 degrees
visual neglect ?
homonymous hemianopsia ?
needs cataract surgery
suspect for glaucoma, diabetic retinopathy, macular degeneration or other problem
Susan Pierce & Carol Blackburn

30. You can report an unsafe driver in Florida!
FLOTA Conference
Febuary 8, 2009
You can report an unsafe driver in Florida!
Click into driver license
Go to link for reporting an unsafe driver
Complete form and send to MAB with driver licensing
Susan Pierce & Carol Blackburn

31. If driving retirement is the answer….
FLOTA Conference
Febuary 8, 2009
If driving retirement is the answer….
Counsel and be a listening ear
Look at transportation alternatives in client’s community
Evaluate their ability to use transportation options
Document all actions & recommendations in regards to driving and community mobility
Susan Pierce & Carol Blackburn

32. The OT Generalist’s responsibility is:
FLOTA Conference
Febuary 8, 2009
The OT Generalist’s responsibility is:
to understand your role in addressing driving as an IADL as you do all other ADL.
to know how & when to refer to the OT specialist in driving in your area for a comprehensive driver evaluation.
to understand your limitations but to act when you should as the OT
not to recommend adaptive equipment or where they go to get the equipment
Susan Pierce & Carol Blackburn

33. FLOTA Conference
Febuary 8, 2009
Note of Caution:
If you are providing the clinical evaluation and referring to an outside source for the in-car evaluation:
YOU are acting in the role of the Specialist in Driving & Community Mobility
Susan Pierce & Carol Blackburn

34. FLOTA Conference
Febuary 8, 2009
Brief summary of the role of the OT specialist in driving & community mobility:
To assist the OT generalist in determining if person meets state requirements
When necessary, perform in-depth evaluation of performance skills & client factor and determine their effect on driving abilities
Susan Pierce & Carol Blackburn

35. The OT Driving Evaluation Process
FLOTA Conference
Febuary 8, 2009
The OT Driving Evaluation Process
Step 1: Occupational Profile
Step 2: Analysis of Occupational Performance
Step 3: Vehicle Assessment
Step 4: Equipment Assessment
Step 5: In-Traffic Assessment
Step 6: Intervention
Step 7: Prescription
Step 8: Final Vehicle Fitting
Susan Pierce & Carol Blackburn

36. Provide in-car training or specialized driver education
FLOTA Conference
Febuary 8, 2009
Provide on-road assessment with consideration of contextual factors, performance patterns and habits
Provide in-car training or specialized driver education
Determine if adaptive equipment is required and follow-up for vehicle adaptations
Determine if person is at-risk, can continue to drive safely or has potential to learn to drive
Susan Pierce & Carol Blackburn

37. Resources for finding an OT Specialist in Driving & Community Mobility
FLOTA Conference
Febuary 8, 2009
Resources for finding an OT Specialist in Driving & Community Mobility
Older driver link
Susan Pierce & Carol Blackburn

38. Don The power of occupational therapy 59 YO male with C7 SCI
FLOTA Conference
Febuary 8, 2009
Don
59 YO male with C7 SCI
had not driven since injury onset in 2004
married to RN , 3 dogs
power wheelchair
hospital administrator, on community boards
dependent upon wife for transportation as public bus was inadequate to meet his needs/schedule
The power of occupational therapy
Susan Pierce & Carol Blackburn

39. Margaret The functionality of occupational therapy
FLOTA Conference
Febuary 8, 2009
Margaret
The functionality of occupational therapy
41YO who had 10 TIAs in 1 year
Had CVA while putting in sprinkler system in yard alone
Traveling Insurance agent
Uses folding manual w/c
Missed being out and about, loved her Wal-Mart
Susan Pierce & Carol Blackburn

40. Christine The adaptability of occupational therapy
FLOTA Conference
Febuary 8, 2009
Christine
The adaptability of occupational therapy
15YO with dwarfism 3’8”, 59 lbs., scoliosis, hearing aids
multiple orthopedic surgeries
never driven
uses walker to carry school books
uses w/c in community
active with school & friends
supportive mother
now in college
Susan Pierce & Carol Blackburn

41. Rita The holistic approach of occupational therapy 33YO, 59 lbs., 3’9”
FLOTA Conference
Febuary 8, 2009
Rita
33YO, 59 lbs., 3’9”
born in Indonesia, transported only in taxi or bus, never could see out, never driven
married to a person who is blind
co-operates a courthouse cafeteria and a vending co
job requires frequent movement in the community for inventory and re-stocking
The holistic approach of occupational therapy
Susan Pierce & Carol Blackburn

42. Caroline The ultimate independence of occupational therapy
FLOTA Conference
Febuary 8, 2009
Caroline
18YO with OI, able to walk but has had numerous fx
uses rigid frame manual w/c
parents divorced, living with overbearing father
graduated with honors from high school and accepted and U of F for Fall
aspires to be architect
The ultimate independence of occupational therapy
Susan Pierce & Carol Blackburn

43. Celia The excitement of occupational therapy 36YO single mother
FLOTA Conference
Febuary 8, 2009
Celia
The excitement of occupational therapy
36YO single mother
SMA muscular dystrophy
caregiver for mother & aunt
power w/c
hospital administrator
transportation by bus/train
never driven
Susan Pierce & Carol Blackburn

44. Chuck The reality of occupational therapy
FLOTA Conference
Febuary 8, 2009
Chuck
46YO with incomplete SCI C4-5
Walked with cane then scooter and now power w/c
Traveling/consulting pastor
Lives with wife who has limited her income in order to transport him
Drove well for 30 yrs before began having driving difficulties
Fundraisers bought his van, VR modified the van
The reality
of occupational therapy
Susan Pierce & Carol Blackburn

45. Elyse The perseverance of occupational therapy
FLOTA Conference
Febuary 8, 2009
Elyse
adopted from Vietnam by parents who work with persons who are deaf
totally dependent, unable to walk or talk when came to U.S., learned sign language before she talked, now ADL independent
loves school, aspires to have college degree & teach special education
aspires to live on her own
Was first turned down for driving on 18th b’day but felt she was not giving a fair chance
The perseverance of occupational therapy
Susan Pierce & Carol Blackburn

46. Nancy The normal of occupational therapy 69YO, divorced, retired
FLOTA Conference
Febuary 8, 2009
Nancy
The normal of occupational therapy
69YO, divorced, retired
bilateral LE amputations
power w/c
moved into retirement center
enjoys outdoors, church choir, bridge, family & friends
learned to take bus but yearned for more freedom
working on second master’s degree
Susan Pierce & Carol Blackburn

47. Danny The teamwork of occupational therapy
FLOTA Conference
Febuary 8, 2009
Danny
The teamwork of occupational therapy
34YO with cerebral palsy, power w/c
never driven, was always told he couldn’t
lived with supportive parents who transported him to/from work as computer draftsman in county appraiser’s office
recently married
is now on 2nd adapted van
Susan Pierce & Carol Blackburn

48. Justin The simplicity of occupational therapy
FLOTA Conference
Febuary 8, 2009
Justin
The simplicity of occupational therapy
Spinal Meningitis when 13 months old
15YO with bil AE & LE amputations
ADL indep except w/ prostheses
active in sports, skateboard champion
excellent problem solver & quick learner
Susan Pierce & Carol Blackburn

49. Elizabeth The freedom of occupational therapy
FLOTA Conference
Febuary 8, 2009
Elizabeth
26YO with Werdnig Hoffman’s MD, had never driven
Manager of Shakespearean Festival, grant-writer
single, family up north, many friends, loves the arts and teaching
loves her scooter
has to live the distance to work that her scooter charge will take her
The freedom of occupational therapy
Susan Pierce & Carol Blackburn

50. Sara The WOW of occupational therapy 48YO, polio at age 3
FLOTA Conference
Febuary 8, 2009
Sara
48YO, polio at age 3
Married to a retired engineer
Has companion dog
Loves to socialize
Active in community
Recently moved to “The Villages”
The WOW of occupational therapy
Susan Pierce & Carol Blackburn

51. To learn more about the OT Generalist Role:
FLOTA Conference
Febuary 8, 2009
To learn more about the OT Generalist Role:
Driving and Community Mobility for Older Adults: Occupational Therapy Roles, AOTA Online CEU Course, 2005, ($ members)
Susan Pierce & Carol Blackburn

52. FLOTA Conference
Febuary 8, 2009
Free Information:
Physician’s Guide to Assessing and Counseling Older Drivers
How to Help an Older Driver: A Guide for Planning Safe Transportation
Driving Safely While Aging Gracefully
Drivers 55 Plus: Check Your Own Performance
When you are concerned: A guide for Families concerned about the safety of an older driver
Susan Pierce & Carol Blackburn

53. Websites www.beverlyfoundation.org Template of transportation options
FLOTA Conference
Febuary 8, 2009
Websites
Template of transportation options
Promoting safety and independence through older driver wellness
Driver refresher courses
Finding a driver rehab specialist
Alternative transportation options
Family resources
Older driver facts
(Transportation Research Board)
(Insurance Institute for Highway Safety)
Susan Pierce & Carol Blackburn

54. FLOTA Conference
References:
Febuary 8, 2009
American Occupational Therapy Association (2002). Occupational therapy practice framework: domain and process. American Journal of Occupational Therapy, 56,
American Occupational Therapy Association (2005). Driving and Community Mobility Statement. American Journal of Occupational Therapy, 59,
American Occupational Therapy Association (2005). Screening Driving and Community Mobility Status. OT Practice, March 21, 2005.
Pierce, S.L. Driving as an Instrumental Activity of Daily Living. Glen Gillen & Ann Burkhardt (Eds.), 2004, Stroke Rehabilitation: A Function-Based Approach, Mosby
Pierce, S.L. Restoring Competence in Mobility. C. A. Trombly & M. V. Radomski (Eds.), 2007, Occupational Therapy for Physical Dysfunction. Philadelphia: Lippincott Williams & Wilkins
Hunt, LA, Weston, K: Assessment of Driving Capacity. Handbook of Geriatric Assessment, New York: John Wiley and Sons, Inc, Lichtenberg, PA, 1999.
Driver Rehabilitation Across Age and Disability: A Occupational Therapy Guide by Sue Redepenning, OTR/L, CDRS. AOTA, 2006.
Driver Rehabilitation and Community Mobility: Principles and Practice by Pellerito & multiple contributors. Published by Elsevier Mosby, 2006
Susan Pierce & Carol Blackburn