Presented By: Ashlee Barbeau Student Occupational Therapist, Queen's University

Presented by: Ashlee Barbeau Student Occupational Therapist, Queens University
Overview of Presentation

When are Driving Ax required? Legal Obligation to Report Referral Process List of Ministry Approved Driving Ax Centres What Does the Ax Involve? Potential Outcomes of the Ax Clinical Evaluation Evidence Based Practice Questions???
When are Driving Ax required?
A Driving Ax is required when an individual has a medical condition that may affect their ability to drive safely. Driving Ax look at cognitive, perceptual, & physical limitations resulting from: TBI, Stroke, Dementia, MCI, Parkinsons Disease, Amputations, Congenital Impairments, MS, etc.
Legal Obligation to Report
In Canada, all provinces and territories impose a statutory duty on physicians to report patients deemed unfit to drive Additionally, physicians across most provinces are required by law to report patients with medical illnesses that may affect driving Exception: in Alberta, Quebec, and Nova Scotia, physicians report at their own discretion, with no liability for reporting
Referral Process
Physician notifies the Ministry of Transportation of patients medical condition
Ministrys Medical Review Board automatically suspends license
Ministry notifies patient that they are required to undergo a Driving Ax
Patient complies and stops driving
Patient attempts to have license reinstated by undergoing a Driving Ax
Patient does not comply and license is suspended
Patient contacts a Ministry Approved Driving Ax Centre to book Driving Ax
Ministry Approved Ax Centres

Agency
Capital Region Driver Rehabilitation Centre
Contact
Phone: (613) 744-4958 Fax: (613) 744-4479
Address
4-125 Springfield Rd. Ottawa, Ontario K1M 1C5
1825 Woodward Dr. Ottawa, Ontario K2C 0P9 1893 Baseline Road, Ottawa, Ontario K2C 0C7 505 Smyth Rd. Ottawa, Ontario K1H 8M2 305-1729 Bank St. Ottawa, Ontario K1V 7Z5
Wait List
None, but referral process takes minimum 2 weeks None, but referral process takes minimum 2 weeks None; Appointment booked within 48 hours Minimum 8 weeks (and up to 4 months) None, but referral process takes minimum 2 weeks
Cost
$575
CVE Inc.
Phone: (613) 237-7368 Fax: (613) 237-0950
$656.25
DriveAble
Phone: (613) 224 -7480 Fax: (613) 224-0270 Phone: (613) 737-8899 Ext. 75311 Fax: (613) 737-8463 Phone: (613) 260-1935 Fax: (613) 260-9375
$585
The Rehabilitation Centre
$500 for Initial Ax & $150 for repeat evaluations
Swanson & Associates Occupational Therapy
$675
Referral Process contd
Doctors Referral Form completed including explanation of medical condition Ministry issued Vision Form indicating a horizontal peripheral field of 120 Consent Form signed allowing driving assessment centre to liaise with Ministry of Transportation
Referral Process contd
If the patient has a valid drivers license, the Driving Ax Centre will book an appointment for the evaluation If the patients license has been suspended, arrangements are made by the Driving Ax Centre for a one day temporary license to be issued by the Ministry for the day of the evaluation
What does the Ax involve?
Clinical evaluation
Completed by an occupational therapist Evaluates cognitive, perceptual, and physical
abilities relevant to driving Takes approximately 2 hours
On-Road evaluation
Completed with an occupational therapist and a
licensed driving instructor present Uses a car equipped with a dual brake Course is pre-determined Takes approximately 1 hour
Potential Outcomes of the Ax

Assessment indicates that patient is not safe to drive Assessment indicates that patient require more practice Assessment indicates that patient is safe to drive
The Clinical Evaluation
Review medical condition & medications Collect a brief driving history Evaluate knowledge of Rules of the Road
Road Sign Recognition
Driving Problem Solving
The Clinical Evaluation contd
Physical Status
Active ROM Strength Pain Activity Tolerance
Tone
Coordination Sensation
Sitting Balance
Mobility Car Transfers
Psychosocial Status
Anxiety Impulsivity
Aggression
Frustration Tolerance
Cognitive/Perceptual Status
Concentration/Distractibility Attention
Visual Perception
Visual Scanning Executive Function
Insight
Initiation
Evidence Based Practice

Motor Free Visual Perception Test (MVPT) Trails A & B or The Comprehensive Trail-Making Test (CTMT) Bells Test Charron Test Useful Field of Vision DriveABLE*

contd

contd

Both Trails A & B show significant correlation to on-road performance (Unsworth et al. 2005) Mazer et al. (1998) found the MVPT, the Bells Test, & the Charron Test all have very good positive predictive value for on-road performance. Each of these Ax have been found to correlate with an increased risk of being involved in a crash (Unsworth et al. 2005). Drivers who take more than 2 minutes for Trails B are twice as likely to be involved in a crash (Unsworth et al. 2005)

contd
Useful Field of Vision:

Pictures are presented on a computer screen
and clients are asked to identify the images at increasingly rapid intervals. Response time is measured and the clients ability to respond correctly within a specific visual field is calculated Older adults with 40% impairment on the UFOV test are more than 2 times as likely to be involved in a crash (Owsley et al., 1998; Fisk et al., 2002)

contd
DriveABLE:
Computer program that was developed to
assess those skills deemed crucial to safe driving including ROM, motor speed and control, judgment, attention, and executive function. A pass, fail, or indeterminate score is automatically assigned by DriveABLE head office. Research indicates that there is a strong relationship between DriveABLE results and onroad performance (Unsworth et al., 2005)

contd
It is impossible to determine a persons fitness to drive using any one Ax tool. The assessments provide the OT with insight into the nature of the cognitive/perceptual limitations that the client may present with functionally. Clinical evaluation should always be followed by on-road testing prior to judging the persons of driving ability
abarbeau@toh.on.ca
References
Fisk, G. D., Owsley, C., & Mennemeier, M. (2002). Vision, attention, and self-reported driving behaviors in community-dwelling stroke survivors. Archives of Physical Medicine and Rehabilitation, 83, 469-477. Mazer, B., Korner-Bitensky, N. A., & Sofer, S. (1998). Predicting ability to drive after stroke. Archives of Physical Medicine and Rehabilitation, 79, 743-749. Owsley, C., Ball, K., McGwin, G., Sloan, M., Roenker, D. L., & White, M.F. (1998). Visual processing impairment and risk of motor vehicle crash among older adults. Journal of the American Medical Association, 279, 1083-1089. Unsworth, C.A., Lovell, R.K., Terrington, N.S., & Thomas, S.A. (2005) Review of tests contributing to the occupational therapy off-road assessment. Australian Occupational Therapy Journal, 52, 57-74. Wheatley, C.J, & DiStefano, M. (2008). Individualized assessment of driving fitness for older individuals with health, disability, and agerelated concerns. Traffic Injury Prevention, 9, 320-327.

Presented By: Ashlee Barbeau Student Occupational Therapist, Queen's University

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Presented By: Ashlee Barbeau Student Occupational Therapist, Queen's University

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Presented by: Ashlee Barbeau Student Occupational Therapist, Queens University

When are Driving Ax required?

Legal Obligation to Report

Ministrys Medical Review Board automatically suspends license

Ministry notifies patient that they are required to undergo a Driving Ax

Patient complies and stops driving

Patient attempts to have license reinstated by undergoing a Driving Ax

Patient does not comply and license is suspended

Patient contacts a Ministry Approved Driving Ax Centre to book Driving Ax

Ministry Approved Ax Centres

Phone: (613) 237-7368 Fax: (613) 237-0950

The Rehabilitation Centre

$500 for Initial Ax & $150 for repeat evaluations

Swanson & Associates Occupational Therapy

Referral Process contd

Referral Process contd

What does the Ax involve?

abilities relevant to driving Takes approximately 2 hours

Potential Outcomes of the Ax

The Clinical Evaluation

Driving Problem Solving

The Clinical Evaluation contd

The Clinical Evaluation contd

The Clinical Evaluation contd

Evidence Based Practice

Evidence Based Practice

Evidence Based Practice

Evidence Based Practice

Useful Field of Vision:

Evidence Based Practice

Evidence Based Practice

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