Rehabilitation

Introduction | Target populations | Physicians' Considerations | Physicians' Questions | When

Introduction

Many individuals for a variety of reasons have difficulty accessing the road system the way they would like to.  Drivers that have been involved in a crash or have developed some driving anxiety are often relegated to staying home.  The overall effects of this type of problem can be monumental.  The aging population may be facing some health issues and their physicians may be questioning their ability to drive safely.  This population is at greater risk for more serious injury or death since they are more frail than a younger person.  They learned to drive when the road system was less congested and vehicle and traffic demands were less mentally taxing.  Drivers that have degenerative disease may need help to remain driving by learning strategies to deal with the onset of such deficits.  Often if a young person that has received a traumatic brain injury wants to learn  to drive they require special instruction to accommodate their learning needs as do those that are developmentally challenged.

The first stage in any rehabilitation program is to measure the functioning of the client.  In some cases the driver may not even be able to sit in a car as a passenger while in other cases the full on-road assessment may be the driving force.  In either case the process is data driven and client based.

The Driver Competency Assessment is designed to answer the question, “How much is this person at risk when operating a vehicle, in comparison to others in a normal urban driving environment?”

DCA provides an on-road, in-vehicle, relative measure of those attributes which are most directly related to crash involvement: 1)  risk management,  2)  inattention, and  3)  distractibility.

Utilizing highly trained evaluators, the DCA is conducted systematically by standardizing the testing environment, distractor conditions and driving situations.  The DCA will profile a driver's risk and it can also direct what treatment or training would be most beneficial in becoming a safer driver.

Often those persons returning to driving after some traumatic event use the DCA2 as a very realistic outcome goal where they would strive for a DCA2 of greater than 5.75 or 6.0 if the drive professionally. 

DCA Service Providers employ a number of protocols and diagnostic measures designed to determine the most effective method of helping drivers achieve and maintain maximum independent transportation mobility  using qualified driving therapists to help them throughout this journey.  Once a realistic treatment plan is worked out the driving therapist using a number of exercises and strategies helps the client to meet their goals. 

When a driver must face the problem of having to give up their driving privileges counseling and planning with the client is recommended so the individual will be able to meet their transportation needs as close as possible.  Many full service Service Providers work with all special needs individuals.

For more information on the DCA please see the About Us page

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Possible Target Populations  For Rehabilitation from DCA Service Providers

  • Drivers that are physically challenged
  • Physically challenged or developmentally delayed individuals wishing to become drivers
  • Medical conditions:
  • Stroke victims
  • Individuals having suffered traumatic brain injury and/or acquired brain injury
  • Psychiatric patients
  • Individuals suffering from trauma
  • Individuals diagnosed as having a degenerative disease which may affect their driving
  • Individuals suffering from diminished capacities attributable to the aging process
  • Individuals taking certain medications
  • Drivers having taken some form of intervention, treatment, or educational program
  • Individuals complaining of problems while driving
  • Individuals caught in the system by the police, courts, or departments of Motor Vehicles
  • Individuals seeking employment as drivers.
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What should trigger a doctor's concern that his/her patient may be at risk of crash?

Affect:  anything that heightens or numbs one's emotional response to stimuli.
Examples: emotional upheaval, critical news, trauma, medical condition, stress, substance use etc.

Cognition:  anything that differentially effects one's ability to accurately process and respond  appropriately to information.
Examples: attentional problems, decrease in visual function, episodic neurological dysfunction etc. that could be brought on by stress, medical condition, substance use etc.

Behaviour:  physical or mental dysfunction that impairs the ability to correctly access, accurately  assess and respond appropriately to the functional tasks associated with driving.
Examples:  physical deterioration, injury, aging etc.
 

What patients' conditions should cue a doctor to consider the possibility that further assessment is required?

  1. Has the person fallen more frequently lately:  these do not have to be major falls but simply indicate that some psychomotor dexterity or balance has been lost.  This can also be seen by having a person present with bruises associated with banging into objects.
  2. Patients that have suffered any form of trauma, particularly to the head.
  3. Patients complaining about not wanting to go out like they used to or being afraid to participate in routine daily activities that require driving.
  4. Patients complaining about headaches.
  5. Patients complaining that they are not sleeping well.
  6. Patients that express suicidal ideation.
  7. Patients that are under moderate to severe stress.
  8. Patients that are using and/or abusing substances that affect driving.
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What questions should physicians and optometrists ask to assess if their patients are at an elevated level of risk of crash?

  1. Are you tired more than usual after driving ?
  2. Are you more nervous about driving than you used to be?  Can you identify what makes you nervous about driving?
  3. Do your eyes get red, blurry, watery, burning or tired more than usual after driving?
  4. Do you get headaches more after driving than at other times?  The driver may have some form of glare sensitivity.
  5. Do you ever find yourself falling asleep or being afraid that you may fall asleep at the wheel?
  6. Have you ever thought about using the car for something other than transportation?  Such things as using a car to remove stress, to get a thrill or to get cooled down after an argument may be symptomatic of an underlying pathology.  While using the car for Sunday drives may be healthy, using the car as a tool to elevate or depress emotional states may be problematic.
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Under what conditions should the patient be advised to have their driving assessed?

  1. If patient function is significantly affected.
  2. If the patient has had a stroke, a traumatic or acquired brain injury.
  3. If the patient has been involved in a number of driving incidents or mishaps, including minor ones  (I would suggest three in two years is worth investigating).
  4. If the patient suffers from any form of alcohol or drug abuse.
  5. If the patient’s mental status is suggestive of fear, anxiety, emotional elevation or depression or aggression.  This is particularly important if the patient is suffering from any form of driving anxiety or phobic response.
  6. If the patient suffers from deterioration of mental function.
  7. If the patient suffers visual deterioration particularly of dynamic visual acuity and/or Useful Field of View
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DCA rehabilitation is the process of helping drivers or potential drivers who have suffered physical or mental impairment to drive.  Additionally the concept of rehabilitation covers training current drivers in such a way that they unlearn dangerous or unsafe driving habits and learn (and practice!) safe driving habits. 

The rehabilitation process can include, but is not limited to, referrals from medical specialists, service centers that install equipment for special needs individuals, or courses offered by other organizations, e.g. police.

There are a series of differnt protocols that have been developed by DCA and many of the Service Providers are trained to adminster them.  These include pen and paper assessments of attention, visual search etc.  As well evaluators are trained to interview clients so they can help them to understand their limitations as well as their potential.

Typically the on-raod assessment used for seniors that have started to restrict their driving is the DCA1 while other drivers that use the entire system are evaluated using the DCA2.

Drivers that are returning to a working environment in a classified vehicle such as a bus or truck are evaluated in their working vehicle.  These assessments are standardixed so comparisons can be made between different vehicle classes.
 
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DCA 1
The first level of the assessment (DCA 1) is geared to those new or novice drivers that have limited experience.  It is also used to assess under what conditions the elder driver or medically fragile driver may wish to start restricting their own driving if training is not a viable option for their situation.

During the course of rehabilitation this assessment is very valuable particularly for individuals recovering from traumatic injury, stroke or from emotional trauma.  There are no task loading conditions and the complexity levels are more limited within this protocol.

DCA 2
The second assessment level (DCA 2) encompasses the entire gambit of both complexity and task loadings that are closely linked to the real life situations we face every day as drivers.  Both internal and external distractors are used to simulate task loading conditions found in any urban driving environment.  It is how the driver chooses to control his/her environment and react to these conditions that is of interest and which sheds valuable insight as to how this driver may handle complex driving tasks under varying conditions.

DCA 3
The third level assessment (DCA 3) has as well an evaluation for instructors and is used exclusively for those individuals carrying out duties as in-vehicle trainers.

 

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