Transcript GOT LICENSE, GOT FREEDOM

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
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
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, 609-639.
NOTE: will be referenced in text as OTPF, 2002 with page number.
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.
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)

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)
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)
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)
Areas of occupation in OTPF:
 Activities
of daily living
 Instrumental activities of daily living
 Education
 Work
 Play/leisure
 Social participation
Instrumental Activities of Daily Living:

“…are oriented toward
interacting with the
environment and that
are often complex –
generally optional in
nature.”
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(OT Practice Framework, pg 620)
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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
Relating the OTPF to Driving & Community Mobility:
Performance
Skills
Performance
Patterns
motor
habits
process
communication/interaction
routines
roles
Context
Activity Demands
Client Factors
adapted from OTPF, 2002, pg 611
OTPF defines 2 Types of Mobility that
are inter-related:
 Functional
Mobility as an BADL
 Community
Mobility as an IADL
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)
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)
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)
If community mobility & driving
is an IADL…
 …then OTs
…we must
have an
include it as
obligation to
routinely as
treat it as any
the ADLs of
other ADL.
bathing and
dressing.
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.
We have the skill set to address community
mobility & driving.
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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.
The demographics of aging are
changing dramatically.
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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
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

An OT Team is usually necessary to address
driving on the IADL continuum.
The
The
OT Generalist
OT Specialist in Driving
& Community Mobility
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
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

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

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
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If struggling with a decision about driving for a
client, consider the conflicting values and exercise
reasonable judgment.
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The client’s independence vs potential
danger to self and others
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The public’s safety vs the client’s right to
confidentiality and independence.
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.
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Counsel, inform & educate family/client not
to drive until it has been approved or until
appointment with OT Driving Specialist
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It is NOT the OT Generalist’s role to pass or
fail for driving unless there are specific
deficits that contraindicate safe driving
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

You can report an unsafe driver in Florida!
www.myflorida.com
 Click into driver license
 Go to link for reporting an unsafe driver
 Complete form and send to MAB with
driver licensing
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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
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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
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Note of Caution:
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If you are providing  YOU are acting
the clinical
in the role of the
evaluation and
Specialist in
referring to an
Driving &
outside source for
Community
the in-car
Mobility
evaluation:
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
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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
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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
Resources for finding an OT Specialist in
Driving & Community Mobility
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www.aota.org
 Older driver link
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www.aded.net
Don
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 The
power of
occupational
therapy
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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
Margaret
 The
functionality
of
occupational
therapy
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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
Christine
 The
adaptability
of
occupational
therapy
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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
Rita
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 The
holistic
approach of
occupational
therapy
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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
Caroline
 The
ultimate
independence
of
occupational
therapy
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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
Celia
 The
excitement of
occupational
therapy
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36YO single mother
SMA muscular dystrophy
caregiver for mother & aunt
power w/c
hospital administrator
transportation by bus/train
never driven
Chuck
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 The
reality
of
occupational
therapy
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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
Elyse
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 The
perseverance
of
occupational
therapy
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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
Nancy
 The
normal
of
occupational
therapy
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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
Danny
 The
teamwork of
occupational
therapy
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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
Justin
 The
simplicity
of
occupational
therapy
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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
Elizabeth
 The
freedom
of
occupational
therapy
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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
Sara
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 The
WOW of
occupational
therapy
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48YO, polio at age 3
Married to a retired
engineer
Has companion dog
Loves to socialize
Active in community
Recently moved to “The
Villages”
To learn more about the OT Generalist Role:
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Driving and Community Mobility for Older
Adults: Occupational Therapy Roles, AOTA
Online CEU Course, 2005, www.aotalearning.org. ($112.50 members)
Free Information:
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Physician’s Guide to Assessing and Counseling Older Drivers
 http://www.ama-assn.org/go/olderdrivers
How to Help an Older Driver: A Guide for Planning Safe
Transportation
 www.seniordrivers.org
Driving Safely While Aging Gracefully
 www.nhtsa.dot.gov
Drivers 55 Plus: Check Your Own Performance
 www.aaafoundation.org
When you are concerned: A guide for Families concerned
about the safety of an older driver
 [email protected]
Websites
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www.aarp.org
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www.niapublications.org
www.usaaedfoundation.org
www.ctaa.org
www.seniordrivers.org
www.nia.nih.gov/news
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www.aaafoundation.org
www.trb.org (Transportation Research
Board)
www.uab.edu/safemobility
www.seniordrivers.org
www.thehartford.com
www.iihs.org (Insurance Institute for
Highway Safety)
www.beverlyfoundation.org
 Template of
transportation options
www.asaging.org
 Promoting safety and
independence through
older driver wellness
www.granddriver.info/
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Driver refresher courses
Finding a driver rehab specialist
Alternative transportation
options
Family resources
Older driver facts
References:
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American Occupational Therapy Association (2002). Occupational therapy
practice framework: domain and process. American Journal of Occupational
Therapy, 56, 609-639.
American Occupational Therapy Association (2005). Driving and Community
Mobility Statement. American Journal of Occupational Therapy, 59, 666-670.
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