Driver Rehabilitation Research Articles

Exploratory Analysis of Driving Rehabilitation Services: COVID-19’s Impact on the Process

Abstract Date Presented 03/23/24 The objective is to examine the preexisting deidentified data from a driver rehabilitation program to determine human factors (vision, motor, and cognition) that contribute to driving performance. Primary Author and Speaker: Michael D. Justiss Additional Authors and Speakers: Katie Faulk, Bailee Schroeder, Warren Wall, Sierra Smith

Automated Vehicles: Future Initiatives for Occupational Therapy Practitioners and Driver Rehabilitation Specialists.

This article addresses a critically important topic for the occupational therapy (OT) profession and driver rehabilitation specialists (DRS), related to the introduction and deployment of personal and public automated vehicles (AVs); and discusses the current and corresponding changing roles for these professionals. Within this commentary, we provide an overview of the relevant literature on AV regulations, policy, and legislation in North America, the various levels of AV technology, and inclusive and universal design principles to consider in AV deployment for people with disabilities. The role of the OT practitioner and DRS is described within the context of the person-environment-occupation-performance model, and within the guidelines of the Association for Driver Rehabilitation Specialists and the American Occupational Therapy Association. The article concludes with considerations for an extended clinical agenda, a new research agenda, and a call for action to OT practitioners and DRS, as well as to educators, certification bodies, professional organizations, and collaborators.

Better understanding female and male driving offenders’ behavior: Psychological resources and vulnerabilities matter!

Although driving risk taking appears to be mainly male, an increase in driving violations has been observed in recent years among French female drivers. The main objective of the present study was to explore the driving behaviors, psychological resources, and vulnerabilities of female and male driving offenders participating in a French driver rehabilitation program. The second aim was to examine to what extent females’ and males’ resources and vulnerabilities predicted their violations, engagement in distracting activities while driving, and prosocial driving behaviors. In the course of 110 rehabilitation programs, 1686 driving offenders (22.4% females) completed a paper-and-pencil questionnaire. Compared to male offenders, females were more likely to have received a higher education, be divorced, or separated, and drive fewer annual kilometers. They also had had fewer demerit points than males in the last three years. They were more empathetic but also more impulsive than their male counterparts and less self-compassionate and mindful. Regression and moderation analyses revealed that, across genders, certain psychological resources such as mindfulness can be considered as protective factors for driving offenders as they tend to decrease dangerous behaviors and increase prosocial ones, while vulnerabilities such as aggressive driving anger expression seem to have the opposite effect. Our results provide a better understanding of driving offenders’ behavior and the influence of personal dispositions. They also open new interesting research avenues in the prevention of dangerous behaviors among this high-risk population.

Evaluation of Driver Rehabilitation Stakeholder's Perceived Needs and Barriers

<h3>Research Objectives</h3> To investigate the perspective of community healthcare stakeholders on driver rehabilitation needs and service barriers in a rural Midwest region. <h3>Design</h3> This short-term descriptive study used a quantitative survey research design to collect information from stakeholders on driver rehabilitation in a rural Midwest region. <h3>Setting</h3> Snowball sampling was used to distribute surveys to healthcare facilities, including inpatient and outpatient services in the region. <h3>Participants</h3> 53 participants included: occupational therapists, certified occupational therapy assistants, physical therapists, speech-language pathologists, ophthalmologists, optometrists, physicians, and physician assistants. <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Analyze stakeholders knowledge of driver rehabilitation services and the barriers to program development. Descriptive statistics including frequencies, percentages, and medians were used to analyze the data. <h3>Results</h3> Most participants, reported being somewhat familiar (n=20, 37%) with driver rehabilitation. Of healthcare providers who reported at least slight familiarity, 52.2% (n=24), most were slightly (n=6, 11.3%) to not at all familiar (n=7, 13.2%) with local driver rehabilitation services in their region. Awareness of local services (n=35, 85.4%) was the most identified barrier to utilization of driver rehab services. The top barrier to program development identified by professionals was funding to develop a program (n=33, 84.6%). With sampling from a rural region, transportation and distance from services were also top barriers identified in study results. Of 42 responses, a majority of providers (n=34, 81.0%) answered no services were being met. Further, 95.2% (n=40) of providers said their community could benefit from more driver rehabilitation programs. <h3>Conclusions</h3> According to the findings of this study, the perceived need for driver rehabilitation services is unmet by participants which may negatively affect individuals impacted by age-related challenges, neurological conditions, and disabilities. Barriers regarding funding, reimbursement, and the number of trained specialists were most prevalent, suggesting they have an impact on use of driver rehabilitation services. By bringing awareness to driver rehabilitation, providers and patients gain insight into community resources that promote independence and improve quality of life. <h3>Author(s) Disclosures</h3> N/A.

Feasibility of automated in-vehicle technologies on volunteers' driving performance.

Automated in-vehicle technologies, specifically in-vehicle information systems (IVIS) and advanced driver assistance systems (ADAS), are increasingly common in today's cars. Previous studies illustrate benefits of using IVIS and ADAS to improve safety, convenience, and comfort in healthy older drivers. However, research is sparse on the feasibility of such technologies for medically at-risk drivers, such as those with Parkinson's disease (PD). This study enrolled healthy volunteer drivers to examine the feasibility of the procedures and measures for evaluating the effects of IVIS and ADAS on their driving performance. During this feasibility study researchers compared drives completed with and without support of IVIS and ADAS, as participants drove a 2019 Toyota Camry XLE. The test vehicle was equipped with IVIS, ADAS, cameras, a telematics system, and sensors. Participants drove the road course supervised by a Driver Rehabilitation Specialist (DRS). Overall study procedures and vehicle equipment were feasible and provided sufficient data collection for measuring the impact of IVIS and ADAS on driving performance. Data observation by the DRS combined with data captured from cameras and telematics, facilitated comparisons to increase data reliability and validity. Feasibility study findings informed a randomized clinical trial, examining the use of IVIS and ADAS technologies as an intervention to support drivers with Parkinson's disease.

Low Vision and Driving

Driving an automobile is an important option for community mobility. Functional vision is a major consideration for safe driving, and age-related vision impairment may result in the loss of driving independence. Clinicians and older drivers would benefit from understanding current options for driving with low vision, including state laws, use of adaptive equipment, low-vision rehabilitation, and driver rehabilitation. This article reviews the concept of a bioptic telescopic lens system for driving with low vision, including an example of a collaborative interdisciplinary bioptic driving training program developed by the Pennsylvania Department of Transportation in conjunction with clinical experts.

脳障害者の自動車運転再開におけるドライバーリハビリテーション─福島県郡山地区における取り組み─

脳障害者の自動車運転再開におけるドライバーリハビリテーション─福島県郡山地区における取り組み─

Professional reasoning of occupational therapy driver rehabilitation interventions.

IntroductionDriver‐trained occupational therapists are advanced practitioners who work with people to help maintain their independence and autonomy through driving. There is a lack of investigation of professional reasoning processes for why interventions are recommended by driver‐trained occupational therapists. This research project sought to explore the reasoning of driver‐trained occupational therapists when they plan, implement, and reflect on driver rehabilitation interventions.MethodsIn‐depth semistructured interviews (n = 7) and one focus group (n = 5) were conducted with 12 experienced driver‐trained occupational therapists, comprising a wide range of experience, client populations, and licensing jurisdictions. Data were analysed using a modified template analysis approach.ResultsSeven higher order modes that reflect professional reasoning theory and hierarchical models were evident in the work of the driver‐trained occupational therapists, with no new modes of reasoning emerging. Ethical reasoning regarding the balance of safety versus client independence was an overarching shared framework, with therapists mostly using interactive and conditional reasoning in practice. Twenty‐three second‐level themes were identified that exemplify how the reasoning modes operate in practice. Therapists described assessment activity even when solely asked about intervention, indicating the importance of assessment to intervention design. The full hierarchy of reasoning was evident during the rehabilitation phase.ConclusionThese findings elucidate the application of professional reasoning in advanced occupational therapy practices and could support driver‐trained occupational therapists in making driving rehabilitation recommendations if used in reflective practices.

Identifying current driver rehabilitation practices for clients with physical impairments

Introduction Driving is an important occupation that influences a person’s ability to access community resources and participate in meaningful activities. Occupational therapists and other clinicians who are trained as driver rehabilitation specialists provide interventions to improve function and independence in driving. The objective of this study was to examine consistency of adaptive driving equipment prescription and driver retraining recommendations for clients with physical impairment and identify factors that influence driver rehabilitation recommendations. Methods Clinicians practicing in Canada and the United States were surveyed electronically. Data were analyzed using descriptive statistics and content analysis. Results Out of 36 respondents, the majority (97.2%) were occupational therapists. Completion of in-clinic (97.0%) and on-road (84.4%) evaluations were consistent among the majority of respondents, yet components comprising evaluations varied. Fewer respondents were in agreement in equipment recommendations for secondary controls. Respondents emphasized the importance of clinical reasoning skills when making equipment and intervention recommendations. Conclusion Further development of clinical guidelines and advanced training in driver rehabilitation may be beneficial to facilitate clinical reasoning and improve consistency of practice.

Rater-Reliability of Assessing Driving Errors with a DriveSafety 250 Simulator

This study aimed to establish inter-rater reliability among three raters while training new driver rehabilitation specialists to correctly identify driving errors on a DriveSafety 250 driving simulator. Five participants completed adaptation, residential and suburban, and city and highway scenarios. Intraclass correlation coefficients indicated scores between .623–.877 (p = .003–.122) for the total driving errors recorded in the two scenario drives with rater agreement initially ranging between 7–8%. When analyzing the data for types of driving errors, the intraclass correlation coefficients ranged from .556–.973 (p < .05) and rater agreement between 15–100%. Through proper training and strategy development, raters reached 100% consensus on all aspects of inter-rater reliability while assessing driving errors.

Understanding clinician strategies for discussing driving fitness with patients: An initiative to improve provider-patient discussions about safe driving

Objective: A frequently overlooked factor contributing to traffic crashes is driver medical conditions, including cognitive and physical impairments, which can compromise individuals’ ability to drive safely. Clinicians are in a critical position (and often legally mandated) to identify patients with impairments that may affect their driving ability and counsel them on appropriate next steps. However, prior studies revealed that provider-patient discussions about driving occurred relatively infrequently and that clinician recommendations about when patients could resume driving varied substantially (Chen et al. 2008; Drazkowski et al. 2010). This research aimed to document current driver fitness assessment practices among neurology and neurosurgery clinicians at an academic medical center, with the overall purpose of informing quality improvement efforts. Methods: A cross-sectional, anonymous survey was distributed to physicians and advanced practice providers working in the neurosurgery and neurology departments of a large, Pennsylvania-based academic medical center. Survey question domains included: 1) frequency of discussions about driving, 2) comfort discussing driving with patients, 3) criteria used to assess patient fitness to drive, 4) driver rehabilitation program referral practices, and 5) Pennsylvania Department of Transportation (PennDOT) reporting. Results: The survey revealed that although most providers (68%) had high levels of perceived responsibility for counseling patients about driving, a minority regularly discussed driving issues with their patients (19% prior to discharge, 49% during clinic visits). In addition, only about half (54%) of providers reported having ever filed a report about a patient with the PennDOT, despite Pennsylvania’s mandatory driver reporting law. Likelihood of PennDOT reporting was found to be strongly associated with provider knowledge of Pennsylvania unsafe driver reporting laws (p < 0.001). Conclusions: These findings highlight a need to enhance standard of care practices related to driver screening, counseling, and reporting. Overall, providers recognized the importance of their role in advising patients about safe driving and desired standardized protocols for guiding conversations about driving with patients, PennDOT reporting, and referring patients to driver rehabilitation services.

Implementation of the E-Learning Model for Sustainability of Driver Rehabilitation Program

In this work, we show the experience of the driver rehabilitation process in the Republic of Serbia, with the analysis of the rehabilitation process and the changing of the drivers’ attitudes. Before performing the analysis, we define the basic hypothesis (implementation of the sustainability model of E learning for the driver rehabilitation process will impact the driver attitude and minimize the mistakes). In the analysis, we take the most recognized mistakes in the process of education. Implementation of this model is exclusive for a group of candidates who finished the driver rehabilitation process. Using the database of drivers who made mistakes, we made the electronic database (video material with comments) and subsequently implemented the driver education model to assess who made mistakes in the rehabilitation process. In the test process, we used the two groups of candidates (age 18–30 and 31–40), before and after the implementation of this e-learning model. In order to process the data, taking into account the small number of observations further in the research, correlation analysis was used, which determines whether there is a correlation between the amount of alcohol in blood (expressed in g/kg) and the reaction time (in seconds) of a driver. In the second part of the work, correlation analysis was performed with the aim to examine which type of relation exists between the candidates who participated in the driver rehabilitation program and candidates that participated in the program of the proposed e-learning model. The results of this study offer a direction in which learning takes place by itself and affects the effective environment of e-learning, multimedia teaching, virtual practical content, and learning under the instruction of the lecturer in this target group of participants in the rehabilitation program. How many times have we believed that we have an ability and overestimated our-selves in that? You can be convinced in traffic only if you have to prove that ability. The results of the application of this model make it possible to prove that ability and change the opinion about the stated mistakes. The key goal of this work is to make the sustainability e-learning model based on mistakes, which will eliminate the same mistakes made by drivers. The result would be top training and high-quality performance in traffic.

Survey of Occupational Therapy Driver Assessors' Rehabilitation Interventions With Older Drivers.

The rehabilitation strategies used by occupational therapy driver assessors with older drivers with age-related decline or health conditions are not well understood. The objective of the study was to describe driver rehabilitation interventions used by Australian driver assessors, identify factors that guide rehabilitation choices, and identify barriers and facilitators encountered. An online survey was emailed to 300 driver assessors. Descriptive statistics were used to summarize and to rank order participant responses. A total of 148 respondents selected from a combined total of 655 interventions. The four most common rehabilitation methods were (a) graded driving (18%, n = 118), (b) practicing specific maneuvers (17.7%, n = 116), (c) using a modified vehicle (16.9%, n = 111), and (d) graded driving in local areas only (15.1%, n = 99). The most common barrier limiting driver rehabilitation was cost (M = 2.92, SD = 1.24). The most frequently used driver rehabilitation method was on-road training. Practice can be enhanced by collating and evaluating resources, and ensuring effective interventions are more accessible.

Identifying Current Driver Rehabilitation Practices for Clients With Physical Impairments

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. Currently, there is a lack of clinical guidelines to support clinicians working in driver rehabilitation. This study aimed to identify intervention practices and factors that influence driver rehabilitation recommendations by surveying driver rehabilitation specialists practicing across the United States and Canada. Results revealed both consistencies and inconsistencies in practice, which may be related to jurisdictional differences and relatively low levels of evidence in this area. Primary Author and Speaker: W. Ben Mortenson Contributing Authors: Brittany Langereis, Sarah Semeniuk, and Lisa Kristalovich

Rater Reliability of Assessing Driving Errors Among Returning Combat Veterans

Abstract Date Presented 04/13/21 As part of a larger study to determine the effectiveness of an OT driving intervention to improve returning combat veterans' driver fitness, researchers measured interrater reliability among three driver rehabilitation specialists. We present the training process, results, and strategy to achieve strong rater reliability for the assessment of driving errors on a DriveSafety 250 high-fidelity simulator. Primary Author and Speaker: Mary Jeghers Contributing Authors: Amber L. Stober, Elisabeth Popoviciu, Gabriella Nieves, and Magaret Norton

Behind the Wheel: Specialized Driving Instructors' Experiences and Strategies for Teaching Autistic Adolescents to Drive.

In the transition to adulthood, driving supports independence. For autistic adolescents, training provided by specialized driving instructors, including occupational therapists, may establish fitness to drive and continued independence. To examine specialized driving instructors' experiences providing behind-the-wheel instruction to autistic adolescents. We recruited participants through purposive and snowball sampling of members of ADED, the Association for Driver Rehabilitation Specialists. Interviews investigated experiences providing instruction, autistic students' strengths and challenges, strategies used, and recommendations to improve the learning-to-drive process. We coded transcripts using a directed content analysis approach. Telephone interviews. Specialized driving instructors (N = 17) trained as occupational therapists, driver rehabilitation specialists, or licensed driving instructors with recent experience providing behind-the-wheel training for autistic adolescents participated. Behind-the-wheel challenges included mental inflexibility, distractibility, and difficulties with social cues and motor coordination. Instructors acknowledged students' strengths, including adherence to rules of the road, limited risk taking, and careful observations. Instructors scaffolded learning to help students develop skills. Although licensure and driving outcomes were sometimes unknown to instructors, students who became licensed frequently drove with supervision or restrictions. Licensure is possible for autistic adolescents, although developing fitness to drive requires individualization and rigorous specialized instruction, which may culminate in delayed or restricted driving. What This Article Adds: This article highlights challenges and strengths encountered by specialized driving instructors teaching autistic adolescents. Despite requiring prolonged training, autistic adolescents can achieve licensure when supported by specialized instruction that is individualized to their needs and strengths.

Driver Rehabilitation Utilization and Need Among Community-Dwelling Older Adults.

Importance: Driving is one of the most important instrumental activities of daily living. As adults age, many face challenges with maintaining independent driving, leading to risk for decreased occupational engagement and quality of life. The extent to which occupational therapy services meet the driver rehabilitation needs of older adults is unknown.Objective: To characterize driver rehabilitation service utilization among a nationally representative sample of community-dwelling older adults.Design: Exploratory, descriptive cross-sectional study using the National Health and Aging Trends Study 2016 wave.Participants: Community-dwelling adults age 65 and older who received rehabilitation services in the past year (N = 1,173).Outcomes and Measures: Sociodemographic information, comorbidities, rehabilitation use, community mobility, and participation restrictions were collected using self-report and performance-based measures.Results: Of this sample of older adults, 63.0% reported driving as their primary mode of transportation, 25.8% reported limitations in community participation related to transportation, and 9.2% reported having received rehabilitation focused on driving or other transportation goals in the past year. Findings from this study suggest a discrepancy between utilization of driver rehabilitation and self-reported need.Conclusions and Relevance: Many older adults reported limitations in community participation for transportation-related reasons, yet driver rehabilitation represented only a small proportion of services used. As experts in driver rehabilitation, occupational therapy practitioners should lead the way in advocating for increased utilization of driver rehabilitation and development of innovative, accessible transportation options to promote community mobility and participation among older adults.What This Article Adds: The results of this study illustrate an important discrepancy between self-reported need for and utilization of driver rehabilitation services. Occupational therapy practitioners can play an important role in meeting older adults’ driving and transportation needs to enable them to fully participate in their community and daily routines.

Face and Content Validity of an Automated Vehicle Road Course and a Corresponding Simulation Scenario

Introduction: Automated vehicle use is rapidly expanding globally. Florida is one of the leading states for researching, testing, implementing, and operating automated vehicles. Although driving simulators may create an opportunity to assess user behaviors related to automated vehicles, their use in this context is not well-documented.Objectives: This study examined face and content validity of an on-road automated shuttle route and its congruence to a driving simulator scenario representing the on-road route.Methodology: Face validity (i.e., clarity, understandability, congruence) was examined directly by members of the Institute for Mobility, Activity, and Participation. Content validity was assessed via a content validity index (CVI) based on inputs from experts who represented a variety of disciplines. These included computer and information science, engineering, transportation engineering, rehabilitation science, industrial and systems engineering, experimental psychology, and driver rehabilitation science.Findings: Face validity resulted in feedback pertaining to traffic, environment, hazards, fidelity, and “other” recommendations. Six of the recommendations were used to enhance the simulator scenario. For content validity, the CVI scale was equal to 0.83 and was above the acceptable threshold of 0.80. However, on the item level, two items, i.e., traffic flow (I-CVI = 0.57) and seat direction (I-CVI = 0.67), were rated lower than anticipated. The ratings resulted in implementing enhancements to the driving simulator scenario.Conclusion: Automated vehicle on-road routes can be replicated in a driving simulator scenario but require a process of examining the face and content validity and refining the developed scenario as needed to ensure reasonable accuracy.

Establishing the Predictive Validity of the ScanCourse for Assessing On-Road Driving Performance.

Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person's ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown. To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. Retrospective chart reviews were conducted over a 6-mo period. Four Canadian driver rehabilitation programs. Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis. Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity. The ScanCourse had an AUC of .702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%. Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use. Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people.

Exploring Utilization and Need of Driving Rehabilitation Among a National Sample of Community-Dwelling Older Adults

Abstract Date Presented 03/26/20 This descriptive, cross-sectional study aims to characterize current need and utilization of driver rehabilitation services among a nationally representative sample of community-dwelling older adults. Overall findings suggest that the need for driver rehabilitation services is unmet within this population. Results from this study provide empirical evidence to support future OT practice and policy recommendations to improve older adult community mobility and participation. Primary Author and Speaker: Elizabeth Marfeo Contributing Authors: Amelia Coffey, Nathan Ward