Are you thinking about becoming a driver rehab specialist? Are you looking for ways to refine your evaluation and assessments?
If you are, you’ve chosen an exciting career that’s about to explode.
Today there are more older adults behind the wheel than any other time in history. According to the CDC, in 2030 adults ages 65 and up will make up 20% of the U.S population, and most of them will be licensed drivers.
In the next 30 years there will be 35 million more drivers on the road. Those drivers who are 75 years and older are having about the same amount of accidents as ages 15-24.
That’s why there is such a huge demand for driver rehab specialists!
In this guide, I’ll go over the basics to better understand how to get started in driver rehab and how to complete a driver rehab evaluation and assessment.
Table of Contents
How to become a driver rehab specialist?
If you’re looking to become a driver rehab specialist (DRS) there are various ways to get certification, but in most cases you don’t need it.
The majority of DRS are occupational therapists, but anyone can become a DRS. All you need to do is take a few courses on driver rehab and start marketing your business. AOTA has a great library of resources to get started.
If you’re serious about certification, check out ADED.net.
ADED has partnered with medbridge to offer online courses to help you get stared. Use my referral code: OTFOCUS to get $150 off.
What you need to know before beginning a driver rehab evaluation
Most driver rehab evaluations require a clinical assessment of functions related to driving. This will include
- Clinical at home assessment
- Behind the wheel assessment.
- Client education and supportive materials to assist with safe goals for driving
Usually you’ll begin with an assessment at home or at your facility. You’ll want your client’s medical history, reason for consultation, and driving history.
You’ll also want to use various assessments to check cognition, vision, motor functions, and reflexes.
Before driving, your clinical assessments should help you to know if the client is safe to drive.
Next you’ll begin a behind the wheel assessment. This is where you see if your client is physically able to get into the car, prepare for driving, and drive. We will talk more about this in the next section.
What older adults need to know about driver rehab
Many drivers feel that they are independent and don’t need a driver consultation. They may be asking for your services because a doctor is requiring it.
Here is some additional information you can provide to help them.
- Driving is the leading cause of accidents for ages 65-74 only second to falls.
- Older adults are less likely to label themselves as high risk drivers
Physiological changes
- Vision loss
- Increased medications (illegal and non-illegal)
- Cognitive changes
- Decreased reflexes
- Medical conditions (Heart disease, sleep apnea, PVD, arthritis, CVA, Cancer)
Warning signs
- Less confidence
- Spouse does most of the driving
- Use of copilot (Passenger tells them when to react)
- More agitated when driving
- Dents and dings on the car
- Avoiding left hand turns
Clinical driving evaluation
Your clinical evaluation should include information related to health, family concerns, and driving history. You might have your client fill out this information before meeting with them in person. You may want to have them fill out a form that includes the following.
Personal History
- Primary diagnosis
- Secondary diagnosis
- Upcoming procedures
- List of medications
- Driving history
- License status (Current restrictions)
- How often do the drive
- Where do they usually drive
- Family concerns
Questions to ask
- Why did your doctor refer you to driver rehab?
- Do you have any neurological, vision, memory, or problems?
- How often do they happen? Do they happen while driving?
- Have you ever been lost on the road and had to ask for help?
- Any incidents when someone honks at you on the interstate? How often?
- Do you notice drifting in your lane?
- Any accidents (Including parking lot)?
Clinical Assessments
After you know your client’s medical history and profile, you should begin your assessment of the following.
- Vision
- Cognition
- Range of motion
- Reaction time
Vision
Before assessing vision, ensure the client is using the correct glasses. The patient should have already visited their eye doctor and met the state requirements for near and far acuity. You might also test
- Glare recovery
- Night vision
- Peripheral fields
- Contrast sensitivity (Pelli-Robson)
- Phoria (When eyes deviate from norm)
- Depth perception (Can grasp items)
- Fusion (Can both eyes fuse or do they have double vision)
One of the most popular tests for visual perception is the MVPT.
The Optec vision screener is another great resource to test for vision in your practice, but it’s expensive.
Range of motion, strength, coordination, sensation
You might also include the following in your assessment
- Neck ROM
- Upper extremity ROM
- Shoulders, elbows, wrists, and hands
- Proprioception and kinesthesia
- Orthotics/prosthetics
- Reaction time tests
- AAA brake reaction timer
- Vericom brake reaction test (simulator)
- Delta integration reaction time test
- Mobility assessment
- Ambulation
- Use of wheelchair
- Ability to stow wheelchair in vehicle
Cognition
Your Cognition assessment should assess:
- Judgement
- Memory (long and short)
- Impulse control
- Problem solving
- Planning
Here are a few dementia rating scales and mental status tests for testing cognition. The MOCA test is usually the quickest to perform but is now requiring certification to administer.
- Short blessed test
- Clock drawing test
- Mini mental status
- SLUMS
- MOCA
- Trail making tests
- UFOV
- Symbol digit modalities tests
- Letter cancelation
Language and Hearing
Language and hearing do not need formal testing but deficits should be noted. Hearing aids should be used in testing.
Perceptual screening
- MVPT (Most used)
- Benton constructional apraxia test
- Hooper test of visual organization
MVPT will test for form constancy which impairments will have a higher correlation to crashes.
Behind the wheel assessment
Before doing a behind the wheel assessment, ask if the driver is avoiding any types of driving. This might include avoiding left turns, merging on the freeway, parallel parking, etc.
Driving skills that must be addressed in a behind the wheel evaluation include the following.
- Vehicle entry (accommodations, fastening seat belt)
- Parking
- Shifters
- Brake reaction
- Backing up
- General skills
- Acceleration
- Correct braking
- Keeping lane position
- Anticipating other vehicles and situations
- Managing hazards
- Complete lane changes or avoiding
- Following distance
- Signaling
- Left hand turns
- Merging on highway
- 4 way stops
Observation skills
- Looking at the speedometer
- Looking at signs and arrows
- Anticipating curves
- Endurance
- Physical, mental, cognitive
- Can they drive without gps
Other Assessments for driving
Here is a list of additional driving assessments that may be helpful in your clinical evaluation. Most of these tests check for memory, processing, and awareness. Be aware that some drivers may memorize the answers.
Driving health inventory
- 30-45 min to administer
- Able to complete individual sections
DORA (OT DORA)
- 60 min to 2 hours to administer
The OT Dora is an off road driving assessment that tests sensory, behavioral, cognition, physical skills. Portions of the tests are timed. Some of the test questions include
- Route planning
- Road laws assessment
- Vision
Click the image above for pricing.
Client centered goals
After completion of a behind the wheel assessment, you will want to make a list of recommendations and/or goals.
For example, if a client is safe to drive, but they need vehicle modifications, you could write a goal for them to be able to safely drive with vehicle modifications.
Recommendations
You might also provide written materials or courses for your clients to review. This might include.
- Driver refresher courses
- AAA driver improvement courses for seniors
- Coaching mature drivers
- Talking with family about dementia and driving (includes warning signs)
Here are a few self assessments.
Your DMV may have additional programs.
Additional Resources
Listed below are a few additional resources for you and your clients.
Carfit is an operation to help drivers properly fit in their car. This can include making sure mirrors are aligned properly and correct seating.
Resources for driver rehab or modifications in your area.
Video and handouts for older drivers and driver safety.
Provides information on ventor equipment needs and training that can be done in your area.
Research related to driving
Online courses
Resources and handouts for driving cessation
Conclusion
It’s an exciting time to become a driver rehab specialist, and right now there are more resources than ever. All this information can be overwhelming, but to get started you don’t have to know everything.
For now, start reading through the resources, take a couple courses from medbridge, and see if becoming a driver rehab specialist is something you really want to do.
David is the lead editor of OT Focus. He has been practicing as an Occupational Therapist since 2013. He specializes in acute care, hand therapy, and ergonomics.
