1 The Keys to Driving Post TBINatasha Huffine, MS, OTRL, CBIS Kara Christy, MS, OTRL, CBIS Origami Brain Injury Rehabilitation Center
2 Objectives Understand the need for drivers rehabilitation following brain injury. Understand the skills impacted by traumatic brain injury that are needed for safe driving. Understand the evaluation and treatment methods available for people with traumatic brain injuries. NH
5 Perception Basic Visual Skills Acuity, visual fields, color vision, size and shape discrimination, depth perception, accommodation, saccades, pursuits, light sensitivity, etc Visual attention Visual anchoring/ scanning Visual sequencing Visual matching Figure ground perception Visual closure Visual information processing speed Visual organization Visual memory Proprioception Hearing Vestibular function Tactile sensation Stereognosis KC – introduce goggles
7 Psychosocial Skills Frustration tolerance Anxiety PTSDEmotional stability KC
8 Evaluation Subjective information Clinical evaluationClient and caregiver questionnaires Clinical evaluation Vision Screen Cancellation of H Alternating Dot-to-Dot Symbol Digit Modalities Test Other DTVP, MSRT, UFOV, TOMAL, Etc KC
9 Evaluation Cont. Assessment of Driving knowledge Functional EvaluationWhat Every Novice Driver Must Know Road Signs Functional Evaluation Road course with the Global Electric Motorcar (GEM) Driving Simulation https://youtu.be/IrtQ3A9ppX8 Behind the Wheel Evaluation KC
10 Treatment Remedial Approach: Selecting functional activities to target and improve specific deficit areas (performance components) Computer based tasks, iPad tasks, tabletop exercises, etc Compensatory Approach: Utilizing remaining abilities to achieve the highest level of functioning possible Active passenger activity, Driving simulations, and GEM vehicle activities https://youtu.be/Mg738ZVjVE0 Alter the task method Adapt the task objects or use assistive devices Modify the task environment NH
11 Outcomes Medical restriction from drivingReturn to driving without restrictions Return to driving with restrictions No night driving No heavy traffic Reduced distractions No poor weather Setting a radius from home NH
12 Legal ResponsibilitiesVisual Acuity 20/20 to 20/40 - Legal to drive unrestricted 20/50-20/70 - Legal to drive with restrictions Less than 20/70 - Not a candidate to drive (possibly with bioptic lenses) Seizure activity 6 month medical restriction from driving 12 month medical restriction for commercial driver license Peripheral Vision 180 degrees to 110 degrees - Legal to drive unrestricted 110 degrees to 90 degrees - Legal to drive with restrictions Less than 90 degrees - Not a candidate to drive. NH
13 Legal Responsibilities Cont.SOS re-examination for deteriorating conditions Alzheimer’s or Dementia Huntington Chorea Muscular Dystrophy Multiple Sclerosis Cerebral Palsy Medications Physicians Statement of Evaluation (DI-4P) DI-4P_16784_7.PDF Request for Drivers Evaluation (OC-88) OC-88_16727_7.PDF Written Letter of Concern Traffic Safety Division, MDOS, P.O. Box, 30810, Lansing, NH
14 Case Study 1 Driving simulation Clinical testing57 year old female involved in a roll over MVA. Decreased level of consciousness due to accident and medications with ventilator assistance needed. Left frontal hematoma identified with a diagnosis of mild traumatic brain injury. 58 day hospitalization with comprehensive services following return home (PT, OT, Vision Therapy, SLP, Psychology and Psychiatry). Clinical testing Cancellation of H- Moderate Impairment Alternating Dot-to- Dot- Severe Impairment (57% accuracy) Symbol Digit Modalities Test- Moderate Impairment Driving simulation Reaction Timer Steering- .62 Seconds Reaction Timer Stoplight- .76 Seconds Speeding, Poor Lane Positioning, Decreased control with turning, and Difficulty coordinating vehicle controls. NH
15 Case Study 1 Treatment Active Passenger Activity57 year old female involved in a roll over MVA. Decreased level of consciousness due to accident and medications with ventilator assistance needed. Left frontal hematoma identified with a diagnosis of mild traumatic brain injury. 58 day hospitalization with comprehensive services following return home (PT, OT, Vision Therapy, SLP, Psychology and Psychiatry). Treatment Remedial exercises via the iPad Tap the Frog, Temple Run, Driving Simulation Lane keeping, Functional Object Detection, Combined Controls, Obstacles, Speed control, Turns, Following Distance, Town and Country, Residential and Suburban, City and Highway Active Passenger Activity Hazard identification, sign identification, sequencing in construction, at intersections, and for lane movements, NH
16 Case Study 2 Clinical Testing Driving Simulation (objective)59 year old male involved in motorcycle accident, wearing helmet, with +LOC. Diagnosed with mild concussion. Cognition grossly intact, 3 vertebral fractures. Completed law doctoral degree, currently works as a life coach and drives charter buses for a large company. Completing physical therapy and referred for pre-driving evaluation and cognitive, perceptual, motor (CPM) evaluation. Subjective difficulties with fatigue, concentration, processing speed, and memory. Clinical Testing Cancellation of H – mild impairment (100% accuracy) Alternating Dot to Dot – high average (100% accuracy) Minnesota Spatial Relations Test – moderate impairment (high average accuracy) Visual Motor Search – mild impairment Visual motor speed – moderate impairment Driving Simulation (objective) Reaction Timer Steering – 0.54 seconds Reaction Timer Stoplight – 0.48 seconds Functional Object Detection – No Cruise Pop 100% target detection 83% Braking Task 78% Centered Lane Position Speed 34 MPH (target at 35 mph) Driving Simulation (clinical observation) KC
17 Case Study 2 Treatment iPad remedial59 year old male involved in motorcycle accident, wearing helmet, with +LOC. Diagnosed with mild concussion. Cognition grossly intact, 3 vertebral fractures. Completed law doctoral degree, currently works as a life coach and drives charter buses for a large company. Completing physical therapy and referred for pre-driving evaluation and cognitive, perceptual, motor (CPM) evaluation. Subjective difficulties with fatigue, concentration, processing speed, and memory. Treatment iPad remedial Connex, Tap the Frog, Spot It, Color Line Crusher, Glow Burst Completed with background music and conversation Driving Simulation Lane keeping, obstacles, naturalistic drives, endurance drives Completed with public bus noises audio, multiple conversation audio, and conversational paced questions On the Road Assessment Completed full 90 minute behind the wheel evaluation driving motorcoach with CDL trainer and therapist. No errors, fatigue continues to be a concern. Recommendations Return to driving motorcoach vehicles with the following discussed transition: Begin with airport transport trips with black car service with 2-3 passengers maximum When comfortable, transition to local motorcoach trips with breaks every 2- 3 hours When comfortable, transition to long distance motorcoach trips with breaks every 2-3 hours to accommodate for neurofatigue Transition, when appropriate, to full time unrestricted driving when comfortable KC
18 Objectives Understand the need for drivers rehabilitation following brain injury. Understand the skills impacted by traumatic brain injury that are needed for safe driving. Understand the evaluation and treatment methods available for people with traumatic brain injuries. KC
19 KC Natasha Huffine, MS, OTRL, CBIS Kara Christy, MS, OTRL, CBIS
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