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OT Driver Rehab Presentation

Timothy Williams Principal Occupational Therapist Evolution Occupational Therapy March 2012
by

Tim Williams

on 17 October 2013

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Transcript of OT Driver Rehab Presentation

OT Driver Assessment and Rehabilitation
Conclusion/
Questions
Thank you for your attention!
We will talk about Licenses and Legal Aspects
Overview: Focus on 4 main areas:
Medical Conditions impacting ability to drive safely
Driving OT Role
Driver Trained OTs:
How we do it?
Being Medically Fit to Drive
OT Process and the training to become a driver trained OT
About me and about Evolution
Occupational Therapist (Registered and Accredited with OT Australia)
Primarily working in Occupational Rehabilitation field since 2005: Mining, Road-Fright, Manufacturing, Food Production, Clerical and Military Rehab
Working in boutique private practices since 2007
Driver Trained 2008
Senior OT in Community Transport service in North London, also involved in planning transport opportunities for 2012 Olympics
Worked with British "Forum of Mobility Centres", a collection of 17 independent organisations providing driver assessment services
Own private practice January 2009

Evolution is a private practice delivering OT Driving Assessments and Driver Rehabilitation, Vehicle Modification Consultancy, as well as Workplace Injury Management services.
Medical Conditions impacting ability to drive safely
Driving a motor vehicle is a complex task requiring perception, good judgement, responsiveness and reasonable physical capability. A range of medical conditions, as well as treatments, may therefore impair driving ability.

Common examples include:
Post stroke
Parkinson's Disease
Other neurological / cognitive limitations
Mental Illness
Vision problems
Diabetes
Epilepsy
Psychiatric disorders
Heart disease
Age-related decline
Musculoskeletal conditions
Equations
likelihood of the event x severity of consequences.
Commercial vehicle crashes = increased severity = increased fatality and associated dangers.
Commercial vehicle drivers = more time on the road = more crashes.
Commercial vehicle driver's must meet different and enhanced standards with AFTD.
Inherent job demands impact on driver role, for example distractions, company specific equipment and time pressures
Private vs Commercial Drivers
Medical Condition Reporting:
health professionals obligations
Health Professionals can voluntarily report a patient if they believe they pose a safety risk to themselves or others on the road

s.142 of the Transport Operations (Road Use Management) Act 1995 provides health professionals protection against civil action or any administrative processes for information provided that would normally breach patient confidentiality, where the information is provided in good faith.

Any person can report a driver who they consider to be unfit, however sufficient information will need to be provided to the department to ensure accuracy of claims.
Any medical condition which could affect the person’s ability to drive. Concerns regarding a client's suitability include functional capacity and medical status.
Deteriorating visual/physical and/or cognitive status
Self-reported driving difficulties (rare)
Family reported driving difficulties (common, sometimes groundless)
If your client stopped driving due to an injury or disease, and they wish to explore the possibility of returning to driving, or starting driving as a learner.
Where the activity of driving is aggravating the client's symptoms or the client's symptoms are impacting on their ability to drive.
Where they require ANY and ALL modifications
Other conditions as stated in Assessing Fitness to drive, 2012
Indications for Referral for Occupational Therapy Driving Assessment
New version released March 2012
Updated information and better layout
Improved descriptions of conditions
Significantly improved for Mental Illness
How do we make decisions on Fitness to Drive: Austroads
Driver Trained OTs role with AT
and Vehicle Modifications
Measure and Assess client
Identify any necessary modifications or aids
Be familiar with range of adaptions, aids and equipment that is available, and would be suitable for the client
Specify aid or adaptation (e.g forces, sizes, locations required)
Work with Vehicle Modifiers to complete trials, testing and final modification, and are reliant on Modifier to ensure that mods meet ASs or ADRs
May need to complete schematics or diagrams to assist with specification
Complete follow up practical or on-road assessment with client in-situ to ensure appropriateness and safety of modification
Risk Assessment and Management, and be aware of ADRs and ASs
Final reporting to GP to ensure medical clearance and ensure that client holds appropriate QLD DTMR Medical Certificate for Motor Vehicle Driver
Driver of car post Left side MCA stroke
Operator of tractor/slasher with R AKA
Driver in a standard car with schizophrenia
Driver of semi-trailer with lower limb arthritis and gout
16 year old learner with Cervical Tumor
Motorbike rider following head injury
Example Assessments
Clinical Assessment Components
Vision and Visual Field Assessment
Hearing Screen
Physical and Neurological Examination:
ROM / MMT
Coordination / Proprioception / Kinaesthesia
Sensation
Balance
Cognition and Perception Assessment:
Trail Making Test A and B
MOCA / MMSE
MFVPT / BRISC / UFOV
Drive Safe Assessment (Or slide test)
Reaction time testing
Physical Measurement for Vehicle Modifications, including body size, wheelchair size, grip strength, pushing/pulling strength
On Road Assessment Components
Operational, tactical and strategic control of vehicle - Using Michon's Model (or similar)
Self-Navigate and sign following
Standardised route where possible, encompassing all 24 required elements, allowing good re-test reliability and interpersonal comparison
Occupational therapy role in driving
Persons are required to report to DTMR a new medical condition or a change in a current medical condition as soon as it occurs (permanent or long term).
Previously people had to report this only when renewing a licence or applying for a licence.
Failure to report may result in loss of licence or fine ($5K!!).
Advise clients that they MUST discuss medical issue and its impact on driving with treating doctor/GP.
Just because you have a disease or condition that might affect your driving, doesn’t mean that you won’t be able to drive at all. It might mean that you have to see your doctor more often to check if your condition is well managed and it might mean that there are some restrictions placed on your driving
.No need to report temporary medical conditions, however during recovery period client may not be able to drive - Consult Assessing Fitness to Drive 2012 for guidance.
Legislative changes
Medical conditions = increased probability of events
Driver Trained OTs
Are based in hospitals, community health, disease specific support organisations, and in private practice
Are experienced practitioners, and hold a minimum of two years experience in a relevant field of occupational therapy practice
Have well established networks of GPs, Specialists, Primary Care Services, QLD DTMR, Driving Instructors, Vehicle Modifiers and Clients
Often have a waiting list (Between 2 weeks to several months)
May work in funding schemes (Commonwealth and State), as well as with insurers, workcover and employers.
Latrobe - Melbourne
1 or 2 courses run per year (Next is Nov 2012)
2-week, full time, including post-course assignment, post-course feedback with lecturers. Also, refresher day approx 6 months following course. Approximately 70-90 hours in total
10 participants
Costs: $3000
Uni of NSW - Sydney
1 course per year
9 full days, plus post-course study program
Costs: $3900
Very popular program
Also learn to use the "DriveSafe" assessment tool
Driver Assessment Course Content
The following subjects will be explored through formal lectures and a variety of practicums, several with disabled clients.

Biomechanical, sensorimotor, cognitive and psychosocial aspects of driving
Completing an evidence based driver assessment and using testing methodology with gold standard validity
Defensive driving in both manual and automatic vehicles
Road craft theory and application
Vehicle prescription
Modification appreciation and application
Off road assessment methodology
On road assessment methodology including evaluation, analysis and interpretation
Models of practical driver assessment (eg. Michon)
Driver remediation program design
Medico-legal issues including indemnity, report writing and duty of care
Licensing Authority policy and procedures
At the conclusion of the courses successful participants will qualify as ‘registered occupational therapy driving assessors’, a qualification which is mandatory when working in the is highly specialised field. A nationally recognised registration number will be issued together with a certificate of course completion.
Queensland Opportunities?
No course currently offered.
OT Australia QLD and the QLD OT Driver Safety Advisory Committee are currently developing a new course - no planned start date at this time
Would be very relevant, as QLD DTMR operates quite differently to other states and territories.
Collaborating with our driving instructor colleagues in a Driver Retraining service, focusing on areas such as driving behaviors, compensatory techniques and safety
Driver Cessation Programs
Driver Fatigue Management programs
Workplace Driver Assessment Programs, pre-employment assessments
Vehicle and Cab Design, eg. Mining Industry
In the event of an incident, post-accident injury management and return to driving, including counseling and PTSD support
What other great stuff you can do in OT Driver Rehab?
A Driver Trained OT is the only OT that is able to prescribe driver modifications, adapted driving controls / aids, or make comment on driving capacity.
There are not any circumstances where any non-Driver Trained OT could endorse a VOSS application for refitting of driver controls to a newer vehicle in situations involving change in vehicle or driving controls.
VOSS: Caution!
Partnerships: Working in tandem with Instructors
Work very closely with Driving Instructors:
Experts in Driver Training and Car Control
Assist us to develop assessment routes
Insight into on-road impact of clinical conditions
Keep us Safe!!

Some driving instructors have additional modifications:
spinner knobs, hand controls, left foot accelerator, etc.
Primarily based in larger centres, Brisbane, Gold Coast, Toowoomba and Townsville
Full transcript