Presentation 225 a francesca monachino & melissa werz_the keys to driving - one clinics approach...
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Transcript of Presentation 225 a francesca monachino & melissa werz_the keys to driving - one clinics approach...
Francesca Monachino, OTR/L
Melissa Werz, OTD, OTR/L
Audience will:
Identify areas of impairment related to ALS that impact driving safety.
State understanding of appropriate referrals for clinical driving assessment.
Examine opportunities to create structured driving assessments to be used in their ALS clinic.
State unique challenges when completing driving assessments with ALS clients.
Share ‘words that work’ when informing clients that they must cease to drive.
ADLs
Assessment of client’s roles
Upper extremity function
Instrumental ADLs
Community access to engage in activities
upmc.com
Impaired motor skills/muscle strength
Impaired eye-hand/foot reaction time
Impaired cognition
Decreased neck/trunk range of motion
Impaired pulmonary status
comfortcaredrivingschool.com
Manual Muscle Testing Safe Scores
Range of Motion Testing Safe Scores
Reaction Time Testing Toe-Tap-Test
Emergency Reaction Time
Cognitive Screen MOCA
Mini-Mental
Caregiver Rating
studyblue.com
Driving with adaptive equipment
Steering knob/ steering wheel adaptations
Left foot accelerator
Hand controls
Blind spot mirrors/Expanded view mirror
hadnet.org.uk ; mcmobilitysystems.com
Discontinue driving
Community accessibility
Family/Friends/Caregivers
wheelchairdriving.com; gotriangle.org
Full Clinical Evaluation On-road assessment
Driving with restrictions Daylight driving only
Drive on local, familiar roads
Drive within a ___ mile radius of home
Limit/No highway driving
Limit/No driving on roads with speeds over 45 mph
Avoid driving in inclement weather
Carry a cellphone for safety, other devices
Limit conversations with other passengers
txdot.gov
Initiate the conversation early in clinical relationship
Discuss impairments and how they affect driving
In a respectful manner, voice concern about the patient’s driving skills and results of screening
Take the responsibility as clinician away from a family argument
Schedule an evaluation by an OT or driver rehabilitation specialist
http://www.alsa.org/als-care/living-with-als/driving-challenges-with-
als.html
Cognitive issues
Impairment of executive processing skills impact understanding of impaired judgment/reaction time
Decreased insight to progressive weakness
Interaction of family members
Thoughtful planning is key to a smooth transition for mobility and transportation needs
Driving is a privilege /Public safety is a concern
http://www.alsa.org/als-care/living-with-als/driving-challenges-with-
als.html
Community access
Getting needs met
Getting from point A to point B in a different way
Safety of client and safety of others
Chauffeur – Driving Mr. Daisy
Final word – Liability
Their choice
Transportation Solutions for Caregivers
National Association of Agencies on Aging
American Occupational Therapy Association
ALS Association Nationwide Chapter Locator
AARP Mobility Resources
http://www.alsa.org/als-care/living-with-als/driving-challenges-with-als-
1.html
Arbesman, M., & Sheard, K. (2014). Systematic review of the effectiveness of occupational therapy-related interventions for people with amyotrophic lateral sclerosis. American Journal of Occupational Therapy, 68, 20-26.
Bedlack, R. S. & Mitsumoto, H. (Eds). (2013) Amyotrophic Lateral Sclerosis: A Patient Care Guide for Clinicians. New York, NY: Demos Medical.
Knoche, C. (2014). Driving challenges with ALS. Retrieved from http://www.alsa.org/als-care/living-with-als/driving-challenges-with-als-1.html
Schold-Davis, E. (2012). The occupational therapy role in driving and community mobility across the lifespan. Retrieved from http://www.aota.org/about-occupational-therapy/professionals/pa/facts/driving-community-mobility.aspx
U.S Department of Transportation (1999). Develop Tools Needed to Implement Model Programs. In Safe mobility for older people notebook (Section C). Retrieved from http://www.nhtsa.gov/people/injury/olddrive/safe/safe-toc.htm