Evaluating Your Driving Skills

A self-appraisal is necessary whenever your medical status changes. It is vitally important that you recognize when fatigue is overwhelming your abilities and acknowledge if it is no longer safe for you to drive. Ask your family and friends if they see a change in your abilities relative to your decision making and ability to respond to traffic, or if they are concerned about your safety when you drive. You may think that the next step is to go to your state licensing agency, but be aware that state examiners may not have sufficient medical knowledge to evaluate your abilities objectively or to suggest options that may enable you to continue driving safely.

The role of driver's assessment has become an advanced skill of occupational therapists and certified driver rehabilitation specialist (CDRS). "All occupational therapists possess the basic skill set necessary to help clients achieve and maintain community mobility, instrumental activities of daily living (IADL) that includes driving. Driving requires readiness, skill, ability, and competence—activity demands that are addressed across practice areas," says Elin Schold Davis, OTR/L, CDRS, coordinator of the American Occupational Therapy Association (AOTA) Special Interest Section Driving Network Listserv.

You can obtain a comprehensive assessment from a rehabilitation professional that has special skills in driver evaluation and training. The Association for Driver Rehabilitation Specialists and the National Mobility Equipment Dealers Association have established model practices for driver's rehabilitation. These practices define the credentials of the rehabilitation professional and the services of:

• Driver evaluation

• Driver training

• Vehicle consultation

• Vehicle modification recommendations

• Vehicle inspection

• Functional inspection with the consumer

Major rehabilitation medical centers and Department of Veterans Affairs hospitals can refer you to an evaluation center. You may also find a resource person through your local American Automobile Association or through the organizations listed in Appendix A, Resources.

A formal evaluation of driving skills typically includes the following:

• Motor skills tests, especially reaction time, sense of position, balance, endurance, coordination, strength, spasticity, range of motion, fine motor ability, and sensation.

• Visual tests, including acuity, tracking, field of vision, depth perception, color vision, spatial orientation, night vision, glare, double vision, and figure-ground perception.

• Cognitive skills tests, to determine the speed of decision making, the ability to focus simultaneously on multiple tasks, distractibility, and the ability to see the "big picture" while maintaining attention and emotional control.

The assessment usually starts with a clinical screening of the three areas listed above, then moves to a passenger car or modified van in a safe, nontraffic area. The evaluation vehicle may be equipped with a dual-control braking system or other assis-tive technology.

After completing the evaluation, you should have a clear idea of your driving ability and have recommendations that may include vehicle options, assistive technology, and training with adaptive driving equipment. Your rehabilitation professional may be able to train you to use new equipment; your family members and local driving schools may also be able to help you. Your rehabilitation professional can make referrals and recommendations for training and advise whether your state agency requires you to demonstrate competence with the new equipment through relicensing.

If driving independence is not safe or financially feasible, then your focus may shift to other means of mobility and transportation. Critical to your sense of safety and freedom is the ability to participate in your mobility plan. The communication process between you, your family, and healthcare professionals must be facilitated to meet your goals. When using power mobility such as a scooter or wheelchair, your vehicle transportation needs must be reviewed.

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