Drivers Class for the Disabled
Interviewed by Rasa Fournier
Wednesday - May 25, 2011
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Occupational therapist at Rehabilitation Hospital of the Pacific
Where did you receive your schooling/training?
I went to the University of Puget Sound and I’ve been an occupational therapist at Rehab Hospital of the Pacific for about 13 years. I am also a certified Drivers Rehabilitation Specialist - there are only two of us here in Hawaii.
Can you provide an overview of Rehab’s drivers Program?
Our Drivers Program has been in existence since the mid-‘70s. Last year the hospital, in partnership with our foundation, upgraded the program to meet the changing needs of our community. With generous support from organizations such as Longs Drugs, we were able to purchase cutting edge technology to improve our driving laboratory to a state-of-the-art facility.
In our drivers laboratory, we now have the Doron 400RA Driving Simulator and the DynaVision D2 visual motor assessment/training system. From observing how someone performs on the Driving Simulator, we can glean tremendous information about their driving abilities and how they will react in emergency situations. The DynaVision allows us to test reaction time, balance, physical abilities such as reach and strength, scanning ability and overall vision status. We also have a new Stereo Optical machine that tests not only vision but color and depth perception, as well as glare and contrast sensitivity. We can precisely evaluate how well someone will drive in heavy rains and if they are able to see a white car against a white background or if headlights are shining at you, can they make out objects? Using technology in the assessment process allows very precise evaluations of these specific skills that are critical to safe driving.
do you also test with an actual car?
Yes, we have a specially adapted car for testing and training. It can be driven normally or custom adapted for people with special needs. We can adjust it with a left gas pedal for clients who cannot use their right leg due to a stroke or we can fit it with only hand controls if they have paralysis of their legs. With the hand controls the client can accelerate and brake with one hand and steer with the other. Other specialty adaptations include a spinner knob for those who can only use one hand to turn, which is important when making U-turns or with cross-over turn signals, allowing clients who can only use one arm to access the turn signal easily.
Who are the primary clients for the program?
Historically, our primary clients have been patients from Rehab Hospital who have survived a stroke, spinal cord injury or head injury. With these types of injuries, the client will often have cognitive difficulties where processing information and making accurate decisions can be challenging. In addition, they often have visual and motor impairment. The combination of both cognitive and visual motor impairments makes driving a major challenge. Yet, for so many of us driving is critical to how we function day to day and therefore a high priority for our patients who are recovering from these types of injuries.
Other clients we often get referrals for are senior drivers. The normal aging process affects our vision, our reaction time and how fast we processes information to respond in an emergency situation. With this population, we believe that age alone is not a determining factor for how safe someone is behind the wheel. Rather it is how aware they are of their vulnerabilities and physical deficits and the precautions they take to keep themselves and others safe. Our goal is to find their areas of deficit, determine how it pertains to their driving safety and if possible, provide solutions such as adaptive equipment or avoiding situations such as driving in heavy rains.
The last population we see are those with congenital disabilities who can’t go through the standard Department of Transportation drivers education program.
do they get certified through your program?
We do the training on how to use the appropriate adaptive equipment safely. They still have to go through the DMV to meet the requirements to get a license from the state.
do they use their own specially equipped car for the driving test?
Yes, and we assist each client with that process. We have them trial various types of equipment on our car, train them on it and then work with their selected vendor so they receive the recommended type of equipment. We often do a vehicle checkout once their car has been adapted to make sure they know how to use it and that everything works properly.
How long does the drivers Program take to complete?
We work under the care of physicians so we require a prescription for an evaluation to ensure they are cleared to begin the driving evaluation process. The evaluation is in two parts. First is an evaluation in our laboratory where we do the clinical measurements and vision evaluation, cognition evaluation and physical functional status. That can take up to two hours. From there we determine if the second step is appropriate, where our trainers take the client out on the road in our car. We evaluate different traffic scenarios, and based on how they manage each scenario, we determine their potential and ability to drive safely.
After an injury, we recommend all clients retake their road test. Even though we assess them to be safe, we prefer they get retested with the DMV. This is especially critical for clients who may present some issues but not enough to prevent them from driving. For those individuals, we also offer additional training sessions. Our goal is always to ensure the safety of the driver and the community.
Is there anything else you want to mention about the program?
We understand how important driving is to our sense of independence and our goal is to help each client get back to driving as soon as possible after a major injury. However, sometimes, for the client’s own safety, we may recommend they no longer drive, and this is always a difficult discussion. Fatalities among senior drivers are the highest, often because they are simply unaware of their physical deficits. This is also true for patients who have had a major injury.
For patients who are interested in our program, we strongly suggest you speak with your physician first. Unfortunately, this is often not an expense covered by medical insurance plans because driving does not fall under medical necessity. Given the depth and intensity of the drivers evaluation, it is $300 for each of the two phases.
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