Francesca Monachino, OTR/L

Melissa Werz, OTD, OTR/L

Audience will:

Identify areas of impairment related to ALS that impact driving safety.

State understanding of appropriate referrals for clinical driving assessment.

Examine opportunities to create structured driving assessments to be used in their ALS clinic.

State unique challenges when completing driving assessments with ALS clients.

Share ‘words that work’ when informing clients that they must cease to drive.

ADLs

Assessment of client’s roles

Upper extremity function

Instrumental ADLs

Community access to engage in activities

upmc.com

Impaired motor skills/muscle strength

Impaired eye-hand/foot reaction time

Impaired cognition

Decreased neck/trunk range of motion

Impaired pulmonary status

comfortcaredrivingschool.com

Manual Muscle Testing Safe Scores

Range of Motion Testing Safe Scores

Reaction Time Testing Toe-Tap-Test

Emergency Reaction Time

Cognitive Screen MOCA

Mini-Mental

Caregiver Rating

studyblue.com

Driving with adaptive equipment

Steering knob/ steering wheel adaptations

Left foot accelerator

Hand controls

Blind spot mirrors/Expanded view mirror

hadnet.org.uk ; mcmobilitysystems.com

Discontinue driving

Community accessibility

Family/Friends/Caregivers

wheelchairdriving.com; gotriangle.org

Full Clinical Evaluation On-road assessment

Driving with restrictions Daylight driving only

Drive on local, familiar roads

Drive within a ___ mile radius of home

Limit/No highway driving

Limit/No driving on roads with speeds over 45 mph

Avoid driving in inclement weather

Carry a cellphone for safety, other devices

Limit conversations with other passengers

txdot.gov

Initiate the conversation early in clinical relationship

Discuss impairments and how they affect driving

In a respectful manner, voice concern about the patient’s driving skills and results of screening

Take the responsibility as clinician away from a family argument

Schedule an evaluation by an OT or driver rehabilitation specialist

http://www.alsa.org/als-care/living-with-als/driving-challenges-with-

als.html

Cognitive issues

Impairment of executive processing skills impact understanding of impaired judgment/reaction time

Decreased insight to progressive weakness

Interaction of family members

Thoughtful planning is key to a smooth transition for mobility and transportation needs

Driving is a privilege /Public safety is a concern

http://www.alsa.org/als-care/living-with-als/driving-challenges-with-

als.html

Community access

Getting needs met

Getting from point A to point B in a different way

Safety of client and safety of others

Chauffeur – Driving Mr. Daisy

Final word – Liability

Their choice

Transportation Solutions for Caregivers

National Association of Agencies on Aging

American Occupational Therapy Association

ALS Association Nationwide Chapter Locator

AARP Mobility Resources

http://www.alsa.org/als-care/living-with-als/driving-challenges-with-als-

1.html

Arbesman, M., & Sheard, K. (2014). Systematic review of the effectiveness of occupational therapy-related interventions for people with amyotrophic lateral sclerosis. American Journal of Occupational Therapy, 68, 20-26.

Bedlack, R. S. & Mitsumoto, H. (Eds). (2013) Amyotrophic Lateral Sclerosis: A Patient Care Guide for Clinicians. New York, NY: Demos Medical.

Knoche, C. (2014). Driving challenges with ALS. Retrieved from http://www.alsa.org/als-care/living-with-als/driving-challenges-with-als-1.html

Schold-Davis, E. (2012). The occupational therapy role in driving and community mobility across the lifespan. Retrieved from http://www.aota.org/about-occupational-therapy/professionals/pa/facts/driving-community-mobility.aspx

U.S Department of Transportation (1999). Develop Tools Needed to Implement Model Programs. In Safe mobility for older people notebook (Section C). Retrieved from http://www.nhtsa.gov/people/injury/olddrive/safe/safe-toc.htm