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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.

Driving a motor vehicle is a common rehabilitation goal following acquired brain injury (ABI). There is increasing interest in the use of driving simulators for driver rehabilitation post-ABI; however, there is still limited research demonstrating efficacy and acceptability. This study sought to examine the user experience of a driving simulator intervention for ABI survivors. Semi-structured interviews were conducted with 14 individuals, including 12 ABI survivors (42% male; Mean age = 53.92 years, SD age = 17.63) who completed the intervention, and 2 occupational therapist driver assessors who facilitated the intervention. Thematic analysis was adopted to analyse interview data. Findings suggest that individual differences (e.g., anxiety, previous experience) influenced participant response to training. The intervention allowed participants to practise various driving skills, re-familiarize themselves with the task of driving, and prepare for return to on-road driving within a safe environment. The intervention was perceived to be useful for enhancing driver self-awareness, autonomy, confidence and patience. Fidelity and simulator sickness were considered limitations of the simulator technology. Subjective accounts of the appropriateness of intervention components are also documented. Overall, the simulator intervention was reported to be a positive experience for participants. Themes emerging from this study can inform future driving simulator interventions for ABI survivors.

Background: Traffic injuries involving vulnerable road users tend to be forgotten in the political prioritisation in many countries. The underreporting of traffic crashes in vulnerable road users is much higher than that of crashes involving cars. Sometimes, it is even argued that underreported crashes in vulnerable road users are costless. In this study, we aimed to estimate the hospital and home care costs, as well as the risk of long-term sickness benefits, associated with a traffic injury by road user type in the first year after the injury. Methods: The study used a complete sample of traffic injuries treated in emergency rooms and hospitals in Denmark. We applied a nationwide case-crossover design to the data, comprising 47,242 hospital-registered traffic injuries, of which 14,246 were cyclist injuries and 17,193 were pedestrian injuries, including pedestrian falls. We estimated the attributable hospital and home care costs following the traffic injuries in a two-part model and the excess risk of long-term sickness benefits beyond four weeks in a binomial regression model, taking into account that the data originated from a case-crossover design.Results: We found that cyclist injuries were as costly as car injuries. Comparing all road users, we found that the most expensive traffic injuries were those of motorcyclists, moped drivers and pedestrians involved in multiparty crashes. Conclusion: Traffic injuries involving vulnerable road users reach a price level similar to that of car injuries. The underreporting of crashes in vulnerable road users can, however, imply that road authorities choose safety measures that prevent car–car crashes instead of those that prevent crashes involving vulnerable road users, such as single-bicycle crashes or pedestrian falls. The outcome of this lack of knowledge and recognition is a biased prioritisation of the limited resources for road safety work. Highlights•Cyclist injuries are as costly as car driver and car passenger injuries.•Pedestrian falls are dominant in hospital data and cost as car injuries.•Injuries of MC and moped drivers the most expensive, however, relatively few.•Injuries of pedestrians in multiparty crashes also expensive.

Importance: 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. Objective: To examine specialized driving instructors’ experiences providing behind-the-wheel instruction to autistic adolescents. Design: 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. Setting: Telephone interviews. Participants: 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. Results: 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. Conclusions and Relevance: 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.

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.

Importance: 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. Objective: To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores. Design: Retrospective chart reviews were conducted over a 6-mo period. Setting: Four Canadian driver rehabilitation programs. Participants: 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. Outcomes and Measures: 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. Results: 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%. Conclusions and Relevance: 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. What This Article Adds: 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.

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 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.

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.

Context Literature suggests that cannabis legalization may increase fatal motor vehicle collisions. However, evidence on the effectiveness of interventions to prevent drugged driving is limited. Evidence Acquisition MEDLINE, PsycINFO, Web of Science, Embase, SafetyLit, Criminal Justice Database, Transport Research International Documentation, bibliographies, and relevant gray literature were searched systematically through May 2020. Randomized and nonrandomized studies of preventive interventions measuring drugged driving outcomes were included. Evidence certainty was judged per Grading of Recommendations Assessment, Development, and Evaluation guidelines to designate quality ratings from very low to high. Evidence Synthesis The search identified 11 RCTs and 17 nonrandomized studies conducted predominantly among youth (aged 15–25 years; n=33,711 of 37,117 active research participants). In the public, cannabis packaging with health warnings increases the knowledge about drugged driving effects (high certainty); roadside drug testing can reduce drugged driving among cannabis users (moderate certainty); media campaigns may increase deterrent attitudes and knowledge (low certainty); and state sanctions, including traffic offense criminalization, license withdrawal, and per se drugged driving laws, may have little or no effect on drug-related fatalities or injuries (very low–low certainty). For youth or previous offenders, motivational interviewing can prevent drugged driving and driver education programs can increase knowledge (moderate certainty), whereas drug abuse prevention, substance abuse treatment, and driver rehabilitation may prevent drugged driving (very low certainty). Conclusions Overall, there is evidence to support the interventions that may improve drugged driving knowledge, attitudes, and behaviors. However, the impact of such interventions on measures of drugged driving–related morbidity and mortality is uncertain. Further research is urgently required to address these gaps in knowledge.

This paper presents current ideas and information on inspection programs, effective NDE methods for early crack detection, case studies, fatigue analysis strategies, effective retrofit designs, ideas as to the cost effectiveness of rehabilitation vs. replacement, and other related topics.

Although many studies have applied the theory of planned behaviour (TPB) to predict a variety of risky behaviors, only a few of them have examined changes in TPB variables after a driver rehabilitation (DR) program. Moreover, drawing from the educational and training transfer literature, the present paper aims at investigating motivational variables related to DR program in order to understand more accurately the process of behavioral change. Due to the heterogeneity of drinking-driving offenders, the study examined intra-individual differences in the patterns of participants’ training motivation and assessed the impact of this diversity on success of a DR program. This study included a sample of 200 offenders arrested for driving under the influence of alcohol (DUI) who were enrolled in a DR program. Their participation was the consequence of a proposal by a prosecutor or a judge as an alternative to classic penal sanctions. Using a two wave panel data, questionnaire data were collected at the beginning and at the end of a DR program. A cluster analysis was used to classify DUI offenders according to their pre-training motivation (i.e. perception of mandatory enrollment and a priori subjective task value) and past behaviour. Results revealed six clusters representing different combinations of pre-training motivation and past behaviour. Moreover, analyses of variance showed that these profiles of DUI offenders differed on motivational variables and behavioral change process. The practical implications of this centered-person approach for DR program and possible avenues for further research are discussed.

Currently, driver rehabilitation involves use of fixed-base simulators. Such simulators are used infrequently and with little success. We hypothesize that the absence of motion feedback may be limiting the therapeutic effectiveness of driving simulation. During real, motor vehicle driving, the driver receives motion feedback that provides rich and real-time information about acceleration, deceleration and turning of the vehicle. Thus, motion feedback may be a key missing component that could dramatically increase the clinical pragmatism of simulator-based driver rehabilitation. In this pilot study, six young adult drivers participated in simulated driving tasks with or without motion feedback. Participants who received motion feedback completed faster laps on a racetrack and committed fewer driving infractions on a highway. They reported being more motivated and aware of the pressure of high speed driving. Particularly, they experienced substantially fewer symptoms of simulator sickness, a primary impedient to widespread use of driving simulators for driver rehabilitation. These preliminary finding motivate a full investigation of the impacts of motion feedback during simulated driving, and of the efficacy of lower cost, two degree of freedom driving simulators for clinical use.

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.

Aims: The purpose of this study was to identify and examine the current practices, strengths, and needs of clinicians who provide driver rehabilitation following stroke. Methods: In-depth, semi-structured interviews were conducted with occupational therapists from three major stroke rehabilitation hospitals in southwestern Ontario, Canada. Results: When determining medical fitness to drive after stroke, clinicians reported using office-based measures to screen physical-motor (e.g., strength, range-of-motion) and cognitive-perceptual abilities (e.g., Trail Making Test A and B). Interventions used to improve readiness to return to driving included a combination of tabletop (e.g., letter scanning worksheet), physical (e.g., throw and catch), and technology-based activities (e.g., driving simulator). Conclusions: This study provides information on clinical practices specific to driving rehabilitation after stroke. Results highlight the need for standardizing office-based approaches for assessment and ...

Increased crash incidence following deployment and veterans’ reports of driving difficulty spurred traffic safety research for this population. We conducted an interim analysis on the efficacy of a simulator-based occupational therapy driving intervention (OT-DI) compared with traffic safety education (TSE) in a randomized controlled trial. During baseline and post-testing, OT-Driver Rehabilitation Specialists and one OT-Certified Driver Rehabilitation Specialist measured driving performance errors on a DriveSafety CDS-250 high-fidelity simulator. The intervention group ( n = 13) received three OT-DI sessions addressing driving errors and visual-search retraining. The control group ( n = 13) received three TSE sessions addressing personal factors and defensive driving. Based on Wilcoxon rank-sum analysis, the OT-DI group’s errors were significantly reduced when comparing baseline with Post-Test 1 ( p < .0001) and comparing the OT-DI group with the TSE group at Post-Test 1 ( p = .01). These findings provide support for the efficacy of the OT-DI and set the stage for a future effectiveness study.

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

Learning to drive is a challenge for anyone. To drive safely, one must learn the basic rules of the road and how to handle various driving situations. Primary and secondary controls allow safe maneuvering of the vehicle. A disability may affect the driver–control interface. When a person with a disability must use the primary and secondary controls differently, special modifications and training are necessary once the driver's ability has been assessed. Driver rehabilitation for patients with disabilities whose goal is independent driving includes both evaluation and training. A driver rehabilitation specialist (DRS), often an occupational therapist, assesses patients, educates them on the process, and trains them with adaptive equipment. The DRS is involved in the decisions regarding the type of driving equipment and the necessary vehicle and wheelchair modifications. This overview addresses a variety of mobility devices and vehicle and adaptive driving controls. There must be a coordination of efforts so that the patient, the wheelchair, and the vehicle all function together in the safest way possible.

In Germany, license restoration after serious or repeated offenses requires a positive medical psychological assessment (MPA), a test to determine the driver's aptitude. Fulfilling the conditions necessary for a positive MPA often takes longer than the period of license revocation, which is perhaps due to the involvement of different personal, organizational, and environmental factors. To optimize the rehabilitation process, the present study analyzed the key aspects of successful rehabilitation after repeated or serious driving offenses.After participating in the MPA, 1,631 subjects completed a questionnaire about rehabilitation efforts. The selection of items for this questionnaire was made according to our own prior research, interviews with problem drivers, and the diagnostic criteria for the MPA. Participants were asked when and from whom they obtained certain information and how relevant this information was for their success. In contrast to other studies, which used reoffense rates as a criterion for successful rehabilitation, we used a positive MPA result (positive, negative, or training) as the criterion for success.Just over half (52%) of the participants considered themselves optimally informed about the rehabilitation process. The others (47.4% of participants) judged the adequacy of information received as less than satisfactory. Offenders who did not partake in counseling before the MPA achieved a successful result only about half as often (37.1%) as those who did (70%) and were around 3 times as likely to have additional courses imposed upon them (21 vs. 7.6%). Of the offenders who received crucial and helpful information at an early stage, 62.4% attained a positive MPA at the first attempt (regardless of having attended any training courses). The success rate for the first attempt rose to 81% for offenders who were well informed at an early stage and participated in counseling before their first MPA.The results clearly indicate that the provision of relevant information at an early stage combined with counseling has a beneficial influence on success rates for the rehabilitation process (an increase from 37.1 to 81%). As such, we recommend the introduction of obligatory license consultations, offered by MPA experts, involving a status assessment to customize offenders' rehabilitation and thereby provide more or less intensive guidance or coaching depending on offenders' characteristics throughout their progression through the MPA system.

To examine pre- and post-injury self-reported driver behaviour and safety in individuals with traumatic brain injury (TBI) who returned to driving after occupational therapy driver assessment and on-road rehabilitation.A self-report questionnaire, administered at an average of 4.5 years after completing an on-road driver assessment, documenting pre- and post-injury crash rates, near-crashes, frequency of driving, distances driven, driving conditions avoided and navigation skills, was completed by 106 participants, who had either passed the initial driver assessment (pass group n = 74), or required driver rehabilitation, prior to subsequent assessments (rehabilitation group n = 32).No significant difference was found between pre- and post-injury crash rates. Compared to pre-injury, 36.8% of drivers reported limiting driving time, 40.6% drove more slowly, 41.5% reported greater difficulty with navigating and 20.0% reported more near-crashes. The rehabilitation group (with greater injury severity) was significantly more likely to drive less frequently, shorter distances, avoid: driving with passengers, busy traffic, night and freeway driving than the pass group.Many drivers with moderate/severe TBI who completed a driver assessment and rehabilitation program at least 3 months post-injury, reported modifying their driving behaviour, and did not report more crashes compared to pre-injury. On-road driver training and training in navigation may be important interventions in driver rehabilitation programs.Driver assessment and on-road retraining are important aspects of rehabilitation following traumatic brain injury. Many drivers with moderate/severe TBI, reported modifying their driving behaviour to compensate for ongoing impairment and continued to drive safely in the longer term. Navigational difficulties were commonly experienced following TBI, suggesting that training in navigation may be an important aspect of driver rehabilitation.

Objective To examine assessment outcomes and factors associated with passing an occupational therapy (OT) on-road driver assessment after traumatic brain injury (TBI). Design Retrospective analysis of outcomes of on-road driver assessment completed by persons with TBI over an 8-year period. Setting Inpatient and outpatient rehabilitation hospital. Participants A consecutive sample of individuals (N=207) with mild to severe TBI who completed an on-road driver assessment and were assessed at least 3 months postinjury. Intervention Not applicable. Main Outcome Measure Outcome of on-road driver assessment. Results Of the drivers with TBI, 66% (n=137) passed the initial on-road driver assessment (pass group), whereas 34% (n=70) required on-road driver rehabilitation and/or ≥1 on-road assessment (rehabilitation group). After driver rehabilitation, only 3 participants of the group did not resume driving. Participants who were men, had shorter posttraumatic amnesia (PTA) duration, had no physical and/or visual impairment, and had faster reaction times were significantly more likely to be in the pass group. In combination, these variables correctly classified 87.6% of the pass group and 71.2% of the rehabilitation group. Conclusions PTA duration proved to be a better predictor of driver assessment outcome than Glasgow Coma Scale score. In combination with the presence of physical/visual impairment and slowed reaction times, PTA could assist clinicians to determine referral criteria for OT driver assessment. On-road driver rehabilitation followed by on-road reassessment were associated with a high probability of return to driving after TBI.

This study was involved in depth one-to-one interview. Seven road users who had experienced road traffic accident was interviewed using semi structured questionnaire. Data then analyzed using the Atlas.ti software. The themes that emerged shows that, majority of the respondent agreed that in order to maintain driver's competency, there is a need to re-assess and all qualified drivers and high risk drivers may need to attend driving rehabilitation program in the future. The data was translated into a proposed model called PreSiM. This study concluded that, human components have a high potential to be re-evaluated in the current licensing process

The ability to return to driving is a common goal for individuals who have sustained a traumatic brain injury. However, specific and empirically validated guidelines for clinicians who make the return-to-drive decision are sparse. In this article, we attempt to integrate previous findings on driving after brain injury and detail the cognitive, motor, and sensory factors necessary for safe driving that may be affected by brain injury. Various forms of evaluation (both in clinic and behind-the-wheel) are discussed, as well as driver retraining and modifications that may be necessary.

The objective of this study was to describe the services, referral and reporting practices, and barriers to utilization of driver rehabilitation programs (DRPs) for older drivers. Identified through two national association databases, 204 driver rehabilitation programs completed an online survey. DRP availability varies, with a median of one program per 64,151 older adults (range: 1,006–676,981). The median cost for a complete evaluation was $400; 36% of DRPs reported no third-party reimbursement. Participants thought barriers to DRP use include cost/reimbursement, lack of program awareness, and issues with evaluator training. Models for insurance reimbursement, and increased awareness of program benefits by healthcare providers and older drivers, are needed.

Introduction. – Les programmes d’éthylotests anti-démarrage (EAD) visent à prévenir le récidivisme de la conduite en état d’ivresse. Ils sont apparus en Europe dans les années 1990. Objectifs. – Le but de cette recherche était d’étudier si l’EAD est efficace pour diminuer le récidivisme et d’analyser quels sont les facteurs qui contribuent à un impact positif du programme. Méthode. – Nous avons effectué un suivi sur cinq ans des participants au programme d’EAD (n = 175) et d’un groupe témoin (n = 234). Les données ont été recueillies dans les dossiers des conducteurs en préfecture (telles que l’alcoolémie lors de l’arrestation, les infractions antérieures et postérieures pour alcoolémie, ou pour d’autres types d’infractions au code de la route). En ce qui concerne l’autoévaluation et l’évaluation du stage accompagnant l’installation du dispositif (à partir de novembre 2009 uniquement), nous avons utilisé des questionnaires s’appuyant sur deux modèles théoriques : le modèle transthéorique du changement de Prochaska et DiClemente (1984), le modèle du diamant du changement, issu du projet DRUID et construit pour expliquer quels sont les éléments d’un programme de réhabilitation qui favorisent la modification comportementale (Bukasa et al., 2009). Résultats. – Les données obtenues permettent une description de ces populations 'd’infractionnistes alcool' qui sont encore mal connues, que ce soit pour les participants au programme d’EAD ou pour les sujets du groupe témoin. Deux aspects sont notoires : le surrisque des conducteurs masculins et les alcoolémies très élevées qui sont relevées lors de l’arrestation (entre 1,5 et 2 g/L). Le programme d’EAD n’a pas provoqué de réduction significative de la récidive après l’enlèvement du dispositif. L’analyse des processus de changement à propos de l’autoévaluation des problèmes d’alcool montre que 'la prise de conscience' est activée plus précocement que la 'réévaluation environnementale' ou la 'gestion des renforcements' par ce programme. Conclusions. – L’application du modèle de Prochaska et al. au suivi des programmes d’EAD sera plus efficace lorsque des psychologues seront impliqués dans l’accompagnement de ces programmes. Nous avons vu en effet que l’accompagnement médico-psychologique était probablement insuffisant dans ce programme.

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.

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.

As part of an expert panel convened to examine evidence and practice related to diverse aspects of driving evaluation and rehabilitation, consensus statements were developed on ethics. This paper provides context for the ethical obligation of practitioners to assess and make recommendations about the ability of clients to safely perform the activity of driving. It highlights key articles from the literature as well as principles from the Occupational Therapy Code of Ethics and Ethics Standards (2010). The statements support the importance of identifying impairments affecting driving, which could result in harm to the client as well as to the public. The ethical and professional obligation of practitioners to evaluate, make recommendations, and possibly report and/or refer to a driver rehabilitation specialist for further services is reinforced.

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.

Date Presented 04/05/19 Primary Author and Speaker: Lori Breeden Additional Authors and Speakers: Brittany Finigan, Hannah Elliott, Brooke Householder, Hannah Klemp, Lesly Solares

Numerous studies have demonstrated that vehicle alcohol ignition interlocks installed on the cars of impaired-driving offenders reduce recidivism by approximately two-thirds in comparison to similar offenders whose licenses have been suspended. An unresolved issue is the extent to which the effectiveness of interlock programs can be improved by close monitoring of the offenders' performance while in the program. This article describes 5 types of monitoring currently being used in interlock programs in the United States.The programs reviewed vary from those that simply ensure that the interlock is on the offender's vehicle and functioning, to those that use the interlock log data to extend the length of time the offender is required to be in the interlock program, and those that use the interlock data to initiate special monitoring and treatment programs that must be completed before removal of the interlock device. The strengths and limitations of each type of program are described. Also reviewed are current technological developments that appear to be leading to the development of fully automated interlock monitoring systems.Initial evidence shows that more intensive monitoring provides benefits in improved performance on the interlock, as indicated by fewer high blood alcohol concentration (BAC) breath tests when attempting to drive. Although effective, supervision that is more intensive increases government program costs.The relative cost-effectiveness of the differing types of monitoring requires investigation. Treatment programs need to be integrated with the interlock installation period. New technologies can potentially reduce interlock offender monitoring costs and effectiveness. Integrating treatment with the interlock could have postinterlock benefits.

Parkinson's disease (PD) affects driving ability. We aimed to determine the most critical impairments in specific road skills and in clinical characteristics leading to failure on a road test in PD. In this cross-sectional study, certified driving assessment experts evaluated specific driving skills in 104 active, licensed drivers with PD using a standardized, on-road checklist and issued a global decision of pass/fail. Participants also completed an off-road evaluation assessing demographic features, disease characteristics, motor function, vision, and cognition. The most important driving skills and off-road predictors of the pass/fail outcome were identified using multivariate stepwise regression analyses. Eighty-six (65%) passed and 36 (35%) failed the on-road driving evaluation. Persons who failed performed worse on all on-road items. When adjusted for age and gender, poor performances on lateral positioning at low speed, speed adaptations at high speed, and left turning maneuvers yielded the best model that determined the pass/fail decision (R(2) = 0.56). The fail group performed poorer on all motor, visual, and cognitive tests. Measures of visual scanning, motor severity, PD subtype, visual acuity, executive functions, and divided attention were independent predictors of pass/fail decisions in the multivariate model (R(2) = 0.60). Our study demonstrated that failure on a road test in PD is determined by impairments in specific driving skills and associated with deficits in motor, visual, executive, and visuospatial functions. These findings point to specific driving and off-road impairments that can be targeted in multimodal rehabilitation programs for drivers with PD. © 2013 International Parkinson and Movement Disorder Society. Language: en

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.

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.

O presente artigo procura enquadrar e fundamentar a criação e a implementação do projecto de reabilitação de condutores infractores da PRP, abordando os pressupostos subjacentes, os princípios e os objectivos gerais e descreve a sua aplicação em Portugal nas vertentes criminal e contra-ordenacional do programa. This article addresses the structure and implementation of PRP’s traffic offenders rehabilitation project, by presenting the underlying presuppositions, the principles and general purposes and describes its application in Portugal, both for criminal and code infractions.

Background: Occupational therapy has taken a leading role in the screen- ing, assessment, and retraining of potentially unsafe older drivers. This investigation examined the attitudes, knowledge, and practices of occupational therapists (OTs) con- cerning drivers with dementia. Methods: A questionnaire that obtained perspectives about and experiences with drivers with dementia was mailed to licensed OTs from North Carolina and South Carolina. Results: The sample was comprised of 180 OTs. Therapists who had a strong perceived role regarding driver rehabilitation and inter- vention, believed that it was an important topic to address, and were knowledgeable about driving-related issues were more likely to address the issue with clients and their family. Conclusions: The growing concern about the safety of older drivers with demen- tia supports the importance of OTs addressing the driving needs of their clients. We recommend increasing the number of trained OT driving specialists as well as empha- sizing dementia-related continuing education training for OT generalists.