1. Phoenix Rehabilitation Occupational Therapy PreDrivers Evaluation
Melissa Jaworski, MOT, OTR/L
Outpatient Therapist
Mount Pleasant and Latrobe locations

2. Predrivers Evaluation-What is it?
A test that allows a client, the therapist, the family, and the physician to better understand the patient’s road worthiness and ability to be safe on the road.

3. Who’s Appropriate
Individuals living with medical conditions that may affect the skills required for driving
Anyone with whom driving concerns have been identified

4. Common Medical Diagnoses
Neurological (CVA, TBI, MS, Parkinson’s)
Orthopedic and amputee populations
Older drivers (Dementia, Alzheimer’s, Memory impairment, Debilitation)
Teens with Disabilities (Autism, ADHD, CP,)

5. Purpose of Clinical Assessment
Pinpoint client’s strengths and weaknesses that may pose a risk to driving
Indicate training and education needs such as ways you may strengthen skills or compensate for weaknesses
Identify adaptive equipment required
Establish transportation alternatives if necessary

6. Components of Driving
Vision
Cognition
Motor Skills

7. Vision Main sense utilized in driving.
Responsible for 95% of driving related input.

8. Cognition Two Critical areas
Processing speed – a person’s ability to obtain information and quickly adjust.
Ability to multi-task.

9. Motor Skills
Range of motion
Muscle strength
Reaction capability

10. What do we test? Visual Acuity Peripheral Vision Oculomotor Skills
Color Recognition
Braking Reaction Time

11. What do we test? Visual Perceptual Skills Visual Processing Time
Cognitive Skills
Motor Skills

12. How do we examine these aspects of driving?
Paper/pencil tasks
Clinical Observation
Use of the Vericom Stationary Reaction Timer
Testing completed with client only and therapist present

13. Visual Acuity
A standard eye chart assessment is completed for near and distance vision.

14. Peripheral Vision
The ability to see or be aware of what is surrounding us. This is our side vision which allows us to see items to the side while looking forward.

15. Oculomotor Skills The ability to quickly and accurately move our eyes
Eye alignment-position of the eye
Esotropia-inward turning of the eye
Exotropia-outward turning of the eye
Pursuits-allows the eyes to closely follow a moving object
Range of motion

16. Oculomotor Skills
Convergence-simultaneous inward movement of both eyes toward each other usually to maintain single binocular vision when viewing object
Direct fixation saccades- Move our eyes smoothly/quickly from point to point
Searching saccades-rapid intermittent eye movements as attention switches from one point to another

17. Color Recognition
The ability to recognize the colors utilized in driving, red, amber, and green.

18. Braking Reaction Time
Assessed with the Vericom Stationary Reaction Timer.
This device simulates a driving scene & measures the simple reaction of how quickly one brakes in response to a red light.

20. Braking Reaction Standards
Simple braking reaction standard is 0.37 seconds 
National Safety Council Average for all Ages

21. Visual Perceptual Skills
The ability to organize and interpret information that is seen and give it meaning. This is assessed with the MVPT- Motor Free Visual Perception Test.

22. Spatial Relations
The ability to judge the relative position of one object to another and the awareness of the 2 sides of the body.

24. Figure Ground
The ability to recognize distinct shapes from their background, such as objects hidden in a picture

26. Form Constancy
The ability to recognize that 2 objects have the same shape but different size or position.

28. Visual Memory
The ability to remember and use visual information from the past. Important with road signs

31. Visual Closure
The ability to recognize a symbol or object when the entire object is not visible. Highly linked to driving.

33. Visual Discrimination
The ability to discriminate between visible likeness and differences in size, shape, form, position, and color.. .

35. MVPT Norms
Age Raw Score Visual Processing Time sec sec sec sec. slower than normal is within limits

36. Cognitive Skills Assessed
Orientation
Attention/Concentration
Processing Speed
Memory
Problem Solving/Decision Making
Judgement/Insight
Driving Knowledge

37. Cognitive Assessment Tools
Observation
Traffic Sign Recognition - match common signs with the appropriate meaning.
Trail Making Test Part B

38. TRAFFIC SIGNS
INSTRUCTIONS: Write the letter of the correct meaning under each traffic sign
A. LEFT TURN ONLY
B. NO LEFT TURN
C. WINDING ROAD
D. RAILROAD CROSSING
E. STOP
F. NO “U” TURN
G. CROSS ROAD
H. MERGING TRAFFIC
I. MEDIAL STRIP
J. TWO-WAY TRAFFIC
K. PEDESTRIAN CROSSING
L. YIELD
M. SCHOOL CROSSING
N. SLIPPERY WHEN WET
O. KEEP RIGHT

40. Trail Making Test Part B
Assesses working memory
Visual processing
Visual spatial skills
Selective and divided attention
Visuomotor coordination
Association of poor performance on this test and poor driving performance.

42. Motor Skills
Range of Motion including neck rotation, upper extremity, and lower extremity.
Muscle strength of upper and lower extremity.
Transfers and Mobility including balance and endurance required to go to/from and in/out of the vehicle. Also the endurance to actually drive.

43. What else do we examine?
Discussion with the client and family are an essential aspect of the test…what are their feelings for this person’s safety on the road? Driving history: frequency, need for driving, accidents, and traffic violations are discussed

44. Attitude/Behavior Distractible Anxious Impulsive Depression
Risk Taking
Anger Control

45. What is in the report sent to the physician?
The Occupational Therapist makes a recommendation to the physician based upon the results of the test.
The physician makes the ultimate decision as to whether or not to recommend someone continue to drive.

46. Post Clinical Assessment
Summarizes results
Suggest treatment or further testing likely on-the-road assessment completed by certified driving rehab specialist
Provide education
Adaptive equipment recommendations

47. Adaptive Equipment

48. How does someone get referred to the Predriver’s Program?
A physician referral is needed.
Not covered by medical insurance.
Workers compensation and OVR will cover costs of this test.

49. In order to operate a motor vehicle all drivers must do the following:
Be able to react quickly.
Be aware of traffic, road conditions, road signs, and potential hazards that may occur on the right/left/behind/front of their vehicle.
Drivers must be able to make split second decisions.
Drivers must be able to pass a vision test.

50. In order to operate a motor vehicle all drivers must do the following:
Drivers must have depth perception in order to parallel park or to know how close objects are to their vehicle.
Drivers must be able to follow directions, observe signals, and at the same time use their eyes, ears, hands, and feet simultaneously.
Drivers must be alert at all times.

51. Warning Signs of Unsafe Driving
Driving too fast or too slow for road conditions or posted speed.
Requires assistance from passengers.

52. Warning Signs Does not observe signs or signals
Makes slow or poor distance decisions

53. More Warning Signs Gets easily frustrated or confused.
Gets lost in familiar areas.

54. Further Cause for Concern
Has accidents or close calls.
Drifts across lane markings into other lane

55. Pennsylvania Law
A person will not be qualified to drive if the physician believes the condition is likely to impair the ability to control and safely operate a motor vehicle.

56. Provider Liability
Providers who report persons with any medical conditions that may impair driving ability are immune from any civil or criminal liability. PA physicians who DO NOT comply with the legal requirements to report may be convicted of a summary criminal offense and possible civil actions should the patient cause an accident resulting in death, injury, or property loss.

57. HIPPA
The reporting of individuals to PennDOT is also permitted under the Health Assurance Portability and Accessibility Act (HIPPA) to the extent that the use or disclosure of protected health information is required by law.

58. The Benefits of the Pre Driver’s test to the Occupational Nurse
Determine road worthiness if driving is an essential function of the job.
Determine if additional therapy is required for the employee.
Documented information to support the need for the consideration for accommodations

59. Contact Information
Melissa Jaworski OTR/L, MOT
Phoenix Rehabilitation
Mount Pleasant
Latrobe