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This paper reports a national survey conducted to explore the practitioners' use of theoretical models to guide their practice of occupational therapy with adults with mental retardation. Results from 145 returned surveys (54%) indicated that only 26% of the respondents considered theory important as a guide for their daily practice. The value placed on theory decreased as years of experience increased. The most frequently used theoretical model was a remedial approach, but the most frequently used intervention was based on a compensational approach. [ABSTRACT FROM AUTHOR]

This paper discusses the concept of occupation by summarizing the theoretical work of Wilcock, the recent discussions of the power of occupation by Pierce, and the by-products of occupation by Crabtree. Tying the idea of optimal experiences to occupation, photo scrapbooking is used as an illustration of the power and flow of occupation by using excerpts of individuals enjoying scrapbooking. [ABSTRACT FROM AUTHOR]

This paper addresses the issue of allowing clients the choice of activities to perform for evaluative purposes. Studies demonstrating that choice or control may improve performance in both occupational therapy and psychology literature are reviewed. It offers a description of the Assessment of Motor and Process Skills (Fisher, 1995) as an assessment that considers choice a critical component of the assessment process and describes a study that demonstrates client choice improves performance during the assessment process. [ABSTRACT FROM AUTHOR]

The purpose of this phenomenological study was to gain an understanding of the effect of disability, specifically a Colles' fracture, and the role of occupational therapy in the recovery of function. On three separate occasions, a person with a Colles' fracture was interviewed on videotape. Data from the interviews were transcribed and the emergent concepts were organized into themes. One theme, 'just the everyday things' illustrates the participant's frustration with her disability and another, 'standard program,' addresses the hand therapist's reliance on a canned program. Themes from the study are discussed in terms of the consumer's experience of dysfunction and receiving occupational therapy services. [ABSTRACT FROM AUTHOR]

Six hundred occupational therapy practitioners from seven states responded to questions inquiring about the perceptions of the occupational therapy clinical doctorate degree, both at the entry-level and post-professional positions. The majority of respondents does not approve of moving to the doctorate for entry-level practice, and are not interested in pursuing the degree personally. The most common reasons for the low interest are the respondents' belief that the degree will not further their careers, that practitioners cannot afford to stop working to pursue another degree, and that they cannot balance work, family, and education. The small number of respondents who are interested in the clinical doctorate degree want it for personal development and are interested in clinical practice specialization. [ABSTRACT FROM AUTHOR]

To examine change in driving and community mobility outcomes for teens and young adults with autism as a result of participating in an occupational therapy intervention designed as a Bootcamp as perceived by the participants and their parents. Matched questionnaires were completed by novice drivers with autism as well as their parents prior to and immediately after the intervention. The intervention consisted of a 5-day (32 h) intervention using interactive driving simulators, role playing, and highly interactive learning experiences. Sixty-seven participants and their parents completed the pre and post surveys. Of these, 52 (80%) were male and 13 (20%) were female, with a mean age of 17.8 ± 3.03 years. Wilcoxon signed rank tests was used for the Likert scale questions and paired t test for ratio level data. Results demonstrated participants perceived significant improvement in knowledge, skills and abilities related to both driving and community mobility. There were also significant differences in perception from the parents' perspective, but not as evident as the participants. Only a few significant changes were perceived in terms of executive functioning, which support accuracy of the results. Findings also showed significantly improvement in anxiety and confidence.As driving and community mobility is critical for young adults with autism to be successful in adult roles, intervention for improving knowledge, skills, and abilities in this complex daily task is essential. This study demonstrates statistically significant outcomes of a driving and community mobility occupational therapy intervention from the perspective of the participants and their parents., (© 2024. The Author(s).)

Importance: Although the Assessment of Motor and Process Skills (AMPS) is an excellent tool for evaluating the functional performance of instrumental activities of daily living (IADLs), a limited number of studies have used the AMPS for decisions regarding the IADL of fitness to drive and community mobility., Objective: To determine the specificity and sensitivity of the AMPS as a tool for determining a person's fitness to drive., Design: Cross-sectional observational design., Setting: Three driving rehabilitation programs in three states., Participants: Participants were 388 community-living adults (M age = 68.74 yr, SD = 11.53); 196 adults were recruited before completing a comprehensive driving evaluation, and 192 were recruited in two other studies of older drivers., Outcome and Measures: AMPS and results of comprehensive driving evaluation or on-road assessment., Results: Using a logistical regression, AMPS Motor and Process Skills scores yielded a sensitivity of 84.6% and a specificity of 88.8%. The odds ratio of the AMPS Motor Skills score was .347; for the AMPS Process Skills score, it was .014. Using cross-validations, the model with AMPS Motor and Process scores produced a cross-validation area under the curve of .918, with sensitivity and specificity of 84.6% and 88.4%, respectively, and a probability greater than .334 was used for predicting a fail or drive-with-restriction evaluation., Conclusions and Relevance: The AMPS Motor and Process Skills scores revealed significant differences between those who failed or had driving restrictions and with those who passed the driving evaluation, which supported the AMPS as an effective tool for predicting fitness to drive. Plain-Language Summary: This study demonstrates how the Assessment of Motor and Process Skills (AMPS), as a top-down occupational therapy assessment tool, can be used to differentiate between medically at-risk drivers who are likely to pass a comprehensive driving evaluation and those who are likely to fail or need restrictions. AMPS will assist occupational therapy practitioners in determining who is most appropriate to receive driving rehabilitation services and/or when to refer a person for a comprehensive driving evaluation., (Copyright © 2024 by the American Occupational Therapy Association, Inc.)

Background and Objectives: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation., Research Design and Methods: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies., Results: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented., Discussion and Implications: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable "ownership" of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles., Competing Interests: None., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

The leiomodin (Lmod) family of actin-binding proteins play a critical role in muscle function, highlighted by the fact that mutations in all three family members (LMOD1-3) result in human myopathies. Mutations in the cardiac predominant isoform, LMOD2 lead to severe neonatal dilated cardiomyopathy. Most of the disease-causing mutations in the LMOD gene family are nonsense, or frameshift, mutations predicted to result in expression of truncated proteins. However, in nearly all cases of disease, little to no LMOD protein is expressed. We show here that nonsense-mediated mRNA decay, a cellular mechanism which eliminates mRNAs with premature termination codons, underlies loss of mutant protein from two independent LMOD2 disease-causing mutations. Furthermore, we generated steric-blocking oligonucleotides that obstruct deposition of the exon junction complex, preventing nonsense-mediated mRNA decay of mutant LMOD2 transcripts, thereby restoring mutant protein expression. Our investigation lays the initial groundwork for potential therapeutic intervention in LMOD-linked myopathies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Pappas et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Importance: Driving and community mobility (DCM) is key to supporting independence in teens and young adults (TYA) with autism spectrum disorder (ASD)., Objective: To determine whether an intervention focused on DCM can effectively improve DCM knowledge and skills in TYA., Design: A pretest-posttest design using the same intervention and outcome measures., Setting: University research setting., Participants: Thirty-eight participants with ASD completed the program (M age = 17.76 yr, SD = 3.58). Twenty-six (68%) were male, and 12 (32%) were female., Intervention: A 5-day intensive intervention using group and individualized strategies, including driving simulation, focused on improving performance skills needed for DCM., Outcome and Measures: Total and category scores of the Performance Analysis of Driving Ability (P-Drive) were analyzed using a repeated-measures analysis of variance measuring time (pretest vs. posttest), gender, and year of intervention. Paired t tests were used to determine the outcomes of the Canadian Occupational Performance Measure (COPM), anxiety measure and perception survey., Results: Results indicated a significant main effect for time (p < .001) and year (p < .036), but not gender (p < .26), with no significant interaction effects, supporting the fidelity of the intervention. The COPM showed significant changes (p ≤ .001) in both performance and satisfaction, as well as a reduction in anxiety (p = .008)., Conclusions and Relevance: Outcomes suggest that the intervention successfully improved DCM knowledge and skills for TYA. This adds new evidence that an occupational therapy intervention specific to TYA with ASD is effective in developing independence in DCM. Plain-Language Summary: Driving is the primary mode of community mobility in North America and other Western countries. Adults with autism spectrum disorder (ASD) who have a means of community mobility have a chance of employment that is 5 times greater than that for those who do not. Driving and community mobility are key to supporting independence among teens and young adults with ASD. However, teens and young adults with ASD have significantly lower rates of getting a driver's license. The results of this study show that occupational therapy practitioners can play a critical role in addressing driving and community mobility. Occupational therapy interventions that are specifically designed for and unique to each teen and young adult with ASD can effectively improve driving and community mobility skills and increase independence., (Copyright © 2024 by the American Occupational Therapy Association, Inc.)

Community mobility is important for social participation and quality of life. Thus, it is important to sustain older adults in their communities by supporting their ability to drive as long as possible. Use of global positioning system (GPS) technology may provide such support. This descriptive study examined 89 healthy community older adults' perspective on using and programming a GPS after using it for wayfinding to unfamiliar destinations. Participants were equally divided between two age groups (60s, 70s) and familiarity with GPS (familiar, unfamiliar). The results showed age differences in problems following GPS directions and those who were familiar found it significantly easier to use. The majority of the unfamiliar group indicated an increased interest in using GPS and were significantly more interested in training to use a GPS. Preference for learning how to use a GPS included in-person delivery and practice with troubleshooting, using the menus and changing routes as topics critical for training. The implications of these results are discussed.

Background and Objectives: New technologies are being implemented in motor vehicles. One key technology is the electronic navigation system (ENS) that assists the driver in wayfinding, or actually guides the vehicle in higher level automation vehicles. It is unclear how older adults interact with ENSs and the best approach to train older adults to use the devices. The objectives of this study were to explore how older drivers interacted with an ENS while driving on live roadways and how various training approaches impacted older drivers' ability to accurately enter destinations into the ENS., Research Design and Methods: In Experiment 1, 80 older drivers navigated unfamiliar routes using an ENS or paper directions and completed a series of ENS destination entry tasks. In Experiment 2, 60 older drivers completed one of three training conditions (ENS video only, ENS video with hands-on training, placebo) to examine the impacts of training on destination entry performance., Results and Discussion: Driving performance was aided by the use of the ENS, but many older drivers had difficulty entering destinations into the device (Experiment 1). The combined video with hands-on ENS training resulted in the best overall destination entry performance (Experiment 2). Practical applications: The results suggest older drivers may experience problems entering destinations into ENSs, but training can improve performance. These performance issues may be especially important as more vehicle features require interaction with computer systems to select destinations or other automation related features. Further research is needed to determine how to prepare the next generation of older drivers who will interact with technologies aimed at increasing mobility., Competing Interests: Declarations of interest None., (Copyright © 2019 National Safety Council and Elsevier Ltd. All rights reserved.)

This article discusses what is currently known about three important topics related to older driver safety and mobility: screening and evaluation, education and training interventions, and in-vehicle technology. Progress is being made to improve the safe mobility of older adults in these key areas; however, significant research gaps remain. This article advances the state of knowledge by identifying these gaps, and proposing further research topics will improve the lives of older adults. In addition, we discuss several themes that emerged from the review, including the need for multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education/training for both older adults themselves and the variety of stakeholders involved in older adult transportation; and programs and interventions that are flexible and responsive to individual needs and differences.

Engagement in civic, social, and community life plays an important role in health, well-being, and quality of life, and requires individuals to be mobile in their environment. In this article, we review what is currently known about 2 areas relevant to safe mobility for older drivers and identify future research in these areas. Using a framework for transportation and safe mobility, 2 key areas were selected for review: the process of transitioning to non-driving and the maintenance of mobility after driving has ceased. This article serves as a companion to another article that used the same approach to explore safe mobility issues for older adults who are still driving. We found that although there has been progress in supporting transitioning process to non-driving and improving mobility options for older adults following driving cessation, many knowledge gaps still exist. We identified several research topics that would benefit from continued scientific inquiry. In addition, several themes emerged from the review, including the need for: multidisciplinary, community-wide solutions; large-scale, longitudinal studies; improved education and training for older adults and the variety of stakeholders involved in older adult transportation; and the need for programs and interventions that are flexible and responsive to individual needs and situational differences., (© The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background.: Route navigation is a high-level skill and requires intact executive functioning to successfully find one's way while driving in unfamiliar environments., Purpose.: Driving performances were compared while navigating using electronic devices and printed directions on unfamiliar driving routes as well as in an interactive driving simulator., Method.: Twenty-four participants drove two on-road routes using GPS and printed directions, and navigated using printed directions in the simulator, using a point system to evaluate performance. The two unfamiliar routes, order of simulator and on-road driving, and use of GPS and printed directions were counterbalanced. Paired t test were used to compare both GPS versus printed directions and performance between on-road driving and the simulator., Findings.: Participants' performance using GPS on the road was significantly better than with printed directions. There was no significant difference between performance in the simulator and on the road., Implications.: Using GPS may be an effective strategy for improving safety. Using a driving simulator may be an efficient means of evaluating the strategic level of driving, executive function, and readiness to drive.

Objective: Considerable evidence indicates that medical conditions prevalent among older individuals lead to impairments in visual, cognitive, or psychomotor functions needed to drive safely. The purpose of this study was to explore the factors determining driving difficulties as seen from the viewpoint of 30 older drivers with mild cognitive impairment (MCI) and 30 age-matched controls without cognitive impairment. Methods: Perceptions of driving difficulties from both groups were examined using data from an extensive questionnaire. Samples of drivers diagnosed with MCI and age-matched controls were asked to report the frequency with which they experienced driving difficulties due to functional deficits and knowledge of new traffic rules and traffic signs. Results: The analysis revealed that 2 factors underlie MCI perceptions of driving difficulties, representing (1) difficulties associated with late detection combined with slowed response to relevant targets in the peripheral field of view and (2) difficulties associated with divided attention between tasks requiring switching from automatic to conscious processing particularly of long duration. The analysis for healthy controls revealed 3 factors representing (1) difficulties in estimating speed and distance of approaching vehicles in complex (attention-dividing) high-information-load conditions; (2) difficulties in moving head, neck, and feet; and (3) difficulties in switching from automatic responses to needing to use cognitive processing in new or unexpected situations. Conclusions: Though both group analyses show difficulties with switching from automatic to decision making, the difficulties are different. For the control group, the difficulty in switching involves switching in new or unexpected situations associated with high-information-load conditions, whereas this switching difficulty for the MCI group is associated with divided attention between easier tasks requiring switching. These findings underline the ability of older drivers (with MCI and without cognitive impairment) to indicate probable impairments in various driving skills. The patterns of difficulties perceived by the MCI group and the age-matched healthy control group are indicative of demanding driving situations that may merit special attention for road designers and road safety engineers. They may also be considered in the design of older drivers' fitness to drive evaluations, training programs, and/or vehicle technologies that provide for older driver assistance.

This study examined whether a sign recall task on a driving simulator, self-report of driving ability, or age predicted differences in performance between drivers with mild cognitive impairment (MCI) and control participants. For the dependent measure, gathered using a driving simulator, working memory was subjected to interference at varying levels of driving task demands. Reliable between-groups differences in sign recall accuracy were demonstrated; recall declined under higher task demands. Recall scores, self-reported frequency of avoiding driving, and driver age did not predict MCI; only self-reported decline in global driving ability was significant. Findings support the use of driving simulators in practice and suggest that screening for age-related cognitive impairment should incorporate self-reported changes in driving proficiency for early identification of drivers who merit medical review. The results, although exploratory, have implications for practitioners., (Copyright © 2016 by the American Occupational Therapy Association, Inc.)

The objective of this pilot study was to investigate the effectiveness of combining an amputee limb cover to eliminate the effects of electromagnetic fields (i.e., pain) and a Mirror Therapy exercise program to improve functional outcomes for vascular amputees. A cross-sectional repeated-measures design was used with 14 participants with either acute amputations or surgery at least 8 to 24 months previously. The 4-week intervention included the use of an amputee limb cover and mirror therapy exercises each day. The outcome measures were activities of daily living interference (e.g., self-care, walking, car transfer, low chair transfer, sleep), and well-being (e.g., satisfaction, mood, quality of life) at three times (pre- and posttreatment and maintenance). Participants with acute amputations made significant improvements in the areas of self-care, walking, car transfer, sleep, mood, and quality of life, while the subacute participants improved significantly in sleep and satisfaction. A reduction in the time required before prosthetic fitting decreased from 12 weeks to 8 weeks for acute amputees and an improvement in wearing tolerance from 0-2 to 8-12 hours for the subacute amputees were unexpected results suggesting the combined intervention may improves the extent to which amputees can increase participation in their activities of everyday living.

This paper provides average brake reaction times for healthy community living adults from 16 to 90+ years of age, divided by gender. Using consistent directions and context, the RT-2S Simple Brake Reaction shows that average brake reactions for males is 0.50 seconds (median = 0.48, minimum = 0.25 maximum = 0.92) and for females is 0.53 seconds (median = 0.51 minimum = 0.30 maximum = 1.36). The use of a brake reaction timer to assess fitness to drive may be useful for clients recovering from orthopedic surgery, while use as a driving determinate of older adults should be done in conjunction with other tools.

This article examines the history and present state of the midwife as laborist. The role of the midwife and obstetrician laborist/hospitalist is rapidly evolving due to the need to improve patient safety and provide direct care due to reduced resident work hours, as well as practice demands experienced by community providers and other factors. Models under development are customized to meet the needs of different communities and hospitals. Midwives are playing a prominent role in many laborist/hospitalist practices as the first-line hospital provider or as part of a team with physicians. Some models incorporate certified nurse-midwives/certified midwives as faculty to residents and medical students. The midwifery laborist/hospitalist practices at Baystate Medical Center in Springfield, Massachusetts, are presented as an example of how midwives are functioning as laborists. Essential components of a successful midwife laborist program include interdisciplinary planning, delineation of problems the model should solve, establishment of program metrics, clear practice guidelines and role definitions, and a plan for sustained funding. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health., (© 2015 by the American College of Nurse-Midwives.)

This systematic review synthesizes the research on screening and assessment tools used to determine older adults' fitness to drive. After a comprehensive search of the literature targeting tools commonly used by occupational therapists, 64 studies were reviewed and synthesized. The evidence demonstrated that a single tool measuring cognition, vision, perception, or physical ability individually is not sufficient to determine fitness to drive. Although some tools have stronger evidence than others, this review supports using different and focused assessment tools together for specific medical conditions. Results indicate that behind-the-wheel assessment remains the gold standard for driving evaluation; however, emerging evidence for observation of complex instrumental tasks of daily living and driving simulation supports further investigation with these tools., (Copyright © 2014 by the American Occupational Therapy Association, Inc.)

Objective: The goal of this study was to provide a descriptive profile of midwifery in Paraguay., Design: The study involved three components: background research from official documents and key informant interviews to complete questionnaires, qualitative interviews with Paraguayan midwives and obstetricians, and participant observation. Data from official documents and questionnaires were tabulated using descriptive statistics. Individual interviews and small-group interviews of midwives, student midwives, and obstetricians were conducted in five health departments of Paraguay., Setting: The research took place in the capital of Paraguay, Asunción, and four additional health departments: Central, Cordillera, Guira, and Misiones., Participants: Twenty-two midwives, nine student midwives, nine obstetricians, and five leaders of professional health organisations in Paraguay participated in this study., Findings: Three salient themes were identified throughout the interviews. First was the understanding of the changing role of the midwife in the health system, particularly in and around the capital city of Asunción. Second, midwives and obstetricians both reported that women were not sufficiently prepared for labour and birth during the antenatal period. Limited antenatal education and childbirth classes existed and midwives felt that this was a major barrier to vaginal birth. Finally, access to midwife-provided antenatal care is perceived to be limited. A major barrier to accessing midwifery care for women in the capital is related to the midwives' changing role in practice. Obstetricians are now providing antenatal care more often than they used to, and in some public hospitals they also attend vaginal deliveries., Key Conclusions and Implications: Limiting the utilisation of midwives may well be a major contributor to the rising rates of caesarean sections. Women are not prepared for labour and birth in the antenatal period, or are scheduled for elective caesarean sections antenatal ly. Midwives are not fulfilling their potential to prepare women for labour and birth, despite their high-level professional training. Midwives have the potential to improve antenatal preparation for low-intervention birth. This transition in care provision would be a more effective use of human resources for both obstetricians and midwives., (© 2013 Elsevier Ltd. All rights reserved.)

Communication through a shared understanding is essential with multidisciplinary groups. The objective of this paper is to discuss and illustrate how licensing authorities, researchers, practitioners (clinicians), and consumers do not share the same understanding of key terminology related to safe and competent driving. Ongoing and planned work that aims to develop a resource to promote shared understanding of terms relating to driver testing, evaluation, and rehabilitation is then highlighted.

This paper offers occupational therapy generalists and specialists a new framework by which to consider clinical evaluation data and an older adult's driving risk and potential to resume this previously learned skill. Based on Michon's model describing the hierarchy of driving levels, clinical questions identify the factors that may affect a client's fitness to drive. The first part is intended to support clinical judgment of whether a client needs a driving evaluation by a driver rehabilitation specialist. The second part offers a framework to organize clinical data that are already known and determine what other evaluation information is justified and necessary to make a driving recommendation. Methods and rational for use are discussed.

With a brief introduction, 10 tables summarize the findings from the literature describing screening and assessment tools used with older adults to identify risk or determine fitness to drive. With a focus on occupational therapy's duty to address driving as a valued activity, this paper offers information about tools used by occupational therapy practitioners across practice settings and specialists in driver rehabilitation. The tables are organized into groups of key research studies of assessment tools, screening batteries, tools used in combination (i.e., as a battery), driving simulation as an assessment tool, and screening/assessment for individuals with stroke, vision impairment, Parkinson's disease, dementia, and aging. Each table has a summary of important concepts to consider as occupational therapists choose the methods and tools to evaluate fitness to drive.

Occupational therapists, both generalists and specialists, have a critical role in providing services to senior drivers. These services include evaluating fitness-to-drive, developing interventions to support community mobility, and facilitating the transition from driving to non-driving when necessary for personal and community safety. The evaluation component and decision-making process about fitness-to-drive are highly dependent on the use of screening and assessment tools. The purpose of this paper is to briefly present the rationale and context for 12 consensus statements about the usefulness and appropriateness of screening and assessment tools to determine fitness-to-drive, within the occupational therapy clinical setting, and their implications on community mobility.

The purpose of this paper is to document and give context to consensus statements for drivers with physical disabilities, and specifically chronic obstructive pulmonary disease, by expert clinicians in driver rehabilitation and researchers in the area of driver assessment. A brief introduction to the profession of driver rehabilitation sets the context for how individuals with physically based impairments have facilitated the development of the specialty area.

As one of the first papers in this special issue, this paper describes the expert meeting that established the goals of the Gaps and Pathways Project. Through a unique Audience response system (ARS), this expert panel established over 60 consensus statements grounded in evidence of either research literature or expert clinical practice. The paper describes the process and identifies the outcomes of the panel including gaps of need for occupational therapy service and potential ideas for future research.

This paper highlights the critical need for a diverse span of services targeted at older drivers that is clear and understandable to health care professionals, service providers, and consumers. The paper describes how a panel of expert driver rehabilitation specialists and researchers on older drivers affirmed consensus statements addressing the need for clarification of terms and services. It also presents a new document that describes a spectrum of driver services from education to specific driver rehabilitation services. The document will provide consumers, referral sources, payers, and stakeholders invested in older drivers' services, with the information to refer the right people to the right service at the right time.

Driving is the method of choice to maintain independent community mobility for most older adults. Therefore, occupational therapy practitioners need to evaluate and provide intervention for driver rehabilitation services. Since reimbursement is often seen as a barrier to providing these services, this paper underscores the value of occupational therapy practitioners providing driver rehabilitation services. Appropriate documentation and guidelines for reimbursement from Medicare are addressed with examples of how occupational therapy driver rehabilitation services can be funded by third party payers.

Driving is a highly valued instrumental activity of daily living, especially for the older adults who consider it part of their definition of independence and mobility. This paper discusses the issues associated with driving and older adults, including the difficulty of identifying when it is time to give up the keys. With a review of the latest research and need for specialized services for those with diminished capacity, the paper highlights how general practice occupational therapists must work in conjunction with driver rehabilitations specialists to meet the need of this growing population. A framework for referral and judgment is described and resources offered to practitioners to use.

Driving as a means of community mobility is an activity highly valued by individuals. When a medical condition impacts a person's ability to drive, occupational therapy practitioners should address this instrumental task of daily living with the client in order for the client to know if and when return to driving might be possible. This case review illustrates how the task of driving motivated a neurologically impaired client in therapy as well as how driving evaluation and driving rehabilitation intervention should not be done in isolation, but with the communication that will optimally assist the client to return to functional performance.

OBJECTIVE. This article describes the use of assessment tools by North American driver rehabilitation specialists (DRSs). PARTICIPANTS. Participants were 227 self-identified DRSs from the combined databases of two national associations. MEASURES. Information was solicited through a self-administered survey about the driving evaluation process, assessment tools, and process for making fitness-to-drive recommendations. RESULTS. More than 80% of the DRSs reported testing visual acuity, range of motion, muscle strength, and fine motor coordination. The most consistently used cognitive-perceptual tests were the Trail Making Tests, Motor-Free Visual Perception Test-Revised, and short cognitive screening tests. A client's behind-the-wheel performance was the main factor in making a fitness-to-drive recommendation. Few specialists are using computer-based tests or interactive driving simulators. CONCLUSION. Although use of the Useful Field of View(®) has increased, there continues to be no consistency in cognitive assessments or guidelines for behind-the-wheel assessment. Implications for practice are discussed., (Copyright © 2013 by the American Occupational Therapy Association, Inc.)

The purpose of the study was to understand the impact of chronic disability on the functional ability of older adults. Thirty older adult participants and their caregivers were asked to identify which instrumental activities of daily living (IADL) are most meaningful and how their disability affected performance. Data collected through individual analysis indicated that the most important IADL tasks were driving and managing medication. Both older adult participants and their caregivers similarly perceived the health condition as significantly affecting the performance of all of the IADLs. However, there was a difference in the perception of the prior level of functioning for managing medication (z = 2.45, p = .024) and phone use (z = 2.26, p = .014). Results arrived at, and to be discussed, were in agreement with previous research findings indicating that complex tasks of daily living, particularly driving, are significant to the older adult's quality of life.

The purpose of this translational research article is to illustrate how general practice occupational therapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008b). Evidence to support the model is offered by a research study. Participants were compared on their performance of complex instrumental activities of daily living (IADLs) and a behind-the-wheel driving assessment. A significant relationship was found between the process skills from the performance assessment and whether the driver passed, failed, or needed restrictions as indicated by the behind-the-wheel assessment. The evidence suggests that occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver. The algorithm addresses how driver rehabilitation specialists can be used most effectively and efficiently with general practice occupational therapy practitioners meeting the needs of senior drivers.

Purpose: We review what we currently know about older driver safety and mobility, and we highlight important research needs in a number of key areas that hold promise for achieving the safety and mobility goals for the aging baby boomers and future generations of older drivers., Design and Methods: Through the use of a framework for transportation and safe mobility, we describe key areas of screening and assessment, remediation and rehabilitation, vehicle design and modification, technological advancements, roadway design, transitioning to nondriving, and alternative transportation to meet the goals of crash prevention and mobility maintenance for older adults., Results: Four cross-cutting themes emerged from this review: safe transportation for older adults is important; older adults have a variety of needs, abilities, and resources; research to help meet the transportation needs of older adults may be of benefit to persons with disabilities; and transportation issues concerning older adults are multifaceted., Implications: Safe mobility is essential to continued engagement in civic, social, and community life, and to the human interactions necessary for health, well-being, and quality of life. When safe driving is no longer possible for older adults, safe and practicable alternative transportation must be available. Furthermore, older adults are individuals; they have specific needs, abilities, and resources. Not all older adults will have difficulty meeting their transportation needs and no single transportation solution will work for all people. Research and countermeasures intended to help meet the transportation needs of older adults will likely also benefit younger users of the transportation system, particularly those with disabilities. The issues surrounding the maintenance of safe transportation for older adults will require an interdisciplinary research approach if we are to make significant progress in the next decade as the baby boomers begin to reach age 70.

This study describes a single-subject design (ABA with follow-up evaluation) that demonstrated the possible effective use of constraint-induced movement therapy (CIMT) in producing gains in movement and function for a 24-month-old child with chronic hemiparesis. The noninvolved upper extremity was placed in a removable splint for 21 consecutive days. The child was involved in intensive occupational therapy in the home environment. Daily measurements were completed on the use and quality of motion of the involved upper extremity for eight specific fine and gross motor activities. Change in performance and quality of movement were measured and significant at the p < .05 level with the calculation of the C statistic for the motor activities with gains maintained after completion of the treatment and postsplinting phases. The results of the study contribute to the body of evidence finding CIMT to be effective for increasing movement and function in children with hemiparesis.