Effectiveness of a Driving and Community Mobility Intervention for Teens and Young Adults With Autism Spectrum Disorder.

IMPORTANCE: Driving and community mobility (DCM) is key to supporting independence in teens and young adults (TYA) with autism spectrum disorder (ASD). OBJECTIVE: To determine whether an intervention focused on DCM can effectively improve DCM knowledge and skills in TYA. DESIGN: A pretest-posttest design using the same intervention and outcome measures. SETTING: University research setting. PARTICIPANTS: Thirty-eight participants with ASD completed the program (M age = 17.76 yr, SD = 3.58). Twenty-six (68%) were male, and 12 (32%) were female. INTERVENTION: A 5-day intensive intervention using group and individualized strategies, including driving simulation, focused on improving performance skills needed for DCM. OUTCOME AND MEASURES: Total and category scores of the Performance Analysis of Driving Ability (P-Drive) were analyzed using a repeated-measures analysis of variance measuring time (pretest vs. posttest), gender, and year of intervention. Paired t tests were used to determine the outcomes of the Canadian Occupational Performance Measure (COPM), anxiety measure and perception survey. RESULTS: Results indicated a significant main effect for time (p < .001) and year (p < .036), but not gender (p < .26), with no significant interaction effects, supporting the fidelity of the intervention. The COPM showed significant changes (p ≤ .001) in both performance and satisfaction, as well as a reduction in anxiety (p = .008). CONCLUSIONS AND RELEVANCE: Outcomes suggest that the intervention successfully improved DCM knowledge and skills for TYA. This adds new evidence that an occupational therapy intervention specific to TYA with ASD is effective in developing independence in DCM. Plain-Language Summary: Driving is the primary mode of community mobility in North America and other Western countries. Adults with autism spectrum disorder (ASD) who have a means of community mobility have a chance of employment that is 5 times greater than that for those who do not. Driving and community mobility are key to supporting independence among teens and young adults with ASD. However, teens and young adults with ASD have significantly lower rates of getting a driver's license. The results of this study show that occupational therapy practitioners can play a critical role in addressing driving and community mobility. Occupational therapy interventions that are specifically designed for and unique to each teen and young adult with ASD can effectively improve driving and community mobility skills and increase independence.

Improving Functional Outcomes for Vascular Amputees Through Use of Mirror Therapy and Elimination of the Effects of Electromagnetic Fields.

The objective of this pilot study was to investigate the effectiveness of combining an amputee limb cover to eliminate the effects of electromagnetic fields (i.e., pain) and a Mirror Therapy exercise program to improve functional outcomes for vascular amputees. A cross-sectional repeated-measures design was used with 14 participants with either acute amputations or surgery at least 8 to 24 months previously. The 4-week intervention included the use of an amputee limb cover and mirror therapy exercises each day. The outcome measures were activities of daily living interference (e.g., self-care, walking, car transfer, low chair transfer, sleep), and well-being (e.g., satisfaction, mood, quality of life) at three times (pre- and posttreatment and maintenance). Participants with acute amputations made significant improvements in the areas of self-care, walking, car transfer, sleep, mood, and quality of life, while the subacute participants improved significantly in sleep and satisfaction. A reduction in the time required before prosthetic fitting decreased from 12 weeks to 8 weeks for acute amputees and an improvement in wearing tolerance from 0-2 to 8-12 hours for the subacute amputees were unexpected results suggesting the combined intervention may improves the extent to which amputees can increase participation in their activities of everyday living.

Typical Brake Reaction Times Across the Life Span.

This paper provides average brake reaction times for healthy community living adults from 16 to 90+ years of age, divided by gender. Using consistent directions and context, the RT-2S Simple Brake Reaction shows that average brake reactions for males is 0.50 seconds (median = 0.48, minimum = 0.25 maximum = 0.92) and for females is 0.53 seconds (median = 0.51 minimum = 0.30 maximum = 1.36). The use of a brake reaction timer to assess fitness to drive may be useful for clients recovering from orthopedic surgery, while use as a driving determinate of older adults should be done in conjunction with other tools.

Assessment tools predicting fitness to drive in older adults: a systematic review.

This systematic review synthesizes the research on screening and assessment tools used to determine older adults' fitness to drive. After a comprehensive search of the literature targeting tools commonly used by occupational therapists, 64 studies were reviewed and synthesized. The evidence demonstrated that a single tool measuring cognition, vision, perception, or physical ability individually is not sufficient to determine fitness to drive. Although some tools have stronger evidence than others, this review supports using different and focused assessment tools together for specific medical conditions. Results indicate that behind-the-wheel assessment remains the gold standard for driving evaluation; however, emerging evidence for observation of complex instrumental tasks of daily living and driving simulation supports further investigation with these tools.

Screening and assessment tools for determining fitness to drive: a review of the literature for the pathways project.

With a brief introduction, 10 tables summarize the findings from the literature describing screening and assessment tools used with older adults to identify risk or determine fitness to drive. With a focus on occupational therapy's duty to address driving as a valued activity, this paper offers information about tools used by occupational therapy practitioners across practice settings and specialists in driver rehabilitation. The tables are organized into groups of key research studies of assessment tools, screening batteries, tools used in combination (i.e., as a battery), driving simulation as an assessment tool, and screening/assessment for individuals with stroke, vision impairment, Parkinson's disease, dementia, and aging. Each table has a summary of important concepts to consider as occupational therapists choose the methods and tools to evaluate fitness to drive.

Driving with dementia: evaluation, referral, and resources.

Driving is a highly valued instrumental activity of daily living, especially for the older adults who consider it part of their definition of independence and mobility. This paper discusses the issues associated with driving and older adults, including the difficulty of identifying when it is time to give up the keys. With a review of the latest research and need for specialized services for those with diminished capacity, the paper highlights how general practice occupational therapists must work in conjunction with driver rehabilitations specialists to meet the need of this growing population. A framework for referral and judgment is described and resources offered to practitioners to use.

Driving experts address expanding access through pathways to older driver rehabilitation services: expert meeting results and implications.

As one of the first papers in this special issue, this paper describes the expert meeting that established the goals of the Gaps and Pathways Project. Through a unique Audience response system (ARS), this expert panel established over 60 consensus statements grounded in evidence of either research literature or expert clinical practice. The paper describes the process and identifies the outcomes of the panel including gaps of need for occupational therapy service and potential ideas for future research.

Consensus statements for screening and assessment tools.

Occupational therapists, both generalists and specialists, have a critical role in providing services to senior drivers. These services include evaluating fitness-to-drive, developing interventions to support community mobility, and facilitating the transition from driving to non-driving when necessary for personal and community safety. The evaluation component and decision-making process about fitness-to-drive are highly dependent on the use of screening and assessment tools. The purpose of this paper is to briefly present the rationale and context for 12 consensus statements about the usefulness and appropriateness of screening and assessment tools to determine fitness-to-drive, within the occupational therapy clinical setting, and their implications on community mobility.

Decision tool for clients with medical issues: a framework for identifying driving risk and potential to return to driving.

This paper offers occupational therapy generalists and specialists a new framework by which to consider clinical evaluation data and an older adult's driving risk and potential to resume this previously learned skill. Based on Michon's model describing the hierarchy of driving levels, clinical questions identify the factors that may affect a client's fitness to drive. The first part is intended to support clinical judgment of whether a client needs a driving evaluation by a driver rehabilitation specialist. The second part offers a framework to organize clinical data that are already known and determine what other evaluation information is justified and necessary to make a driving recommendation. Methods and rational for use are discussed.

Documentation and reimbursable for driver rehabilitation services.

Driving is the method of choice to maintain independent community mobility for most older adults. Therefore, occupational therapy practitioners need to evaluate and provide intervention for driver rehabilitation services. Since reimbursement is often seen as a barrier to providing these services, this paper underscores the value of occupational therapy practitioners providing driver rehabilitation services. Appropriate documentation and guidelines for reimbursement from Medicare are addressed with examples of how occupational therapy driver rehabilitation services can be funded by third party payers.

Driving for adults with acquired physical disabilities.

The purpose of this paper is to document and give context to consensus statements for drivers with physical disabilities, and specifically chronic obstructive pulmonary disease, by expert clinicians in driver rehabilitation and researchers in the area of driver assessment. A brief introduction to the profession of driver rehabilitation sets the context for how individuals with physically based impairments have facilitated the development of the specialty area.

Can clinicians, researchers, and driver licensing officials build a shared vocabulary?

Communication through a shared understanding is essential with multidisciplinary groups. The objective of this paper is to discuss and illustrate how licensing authorities, researchers, practitioners (clinicians), and consumers do not share the same understanding of key terminology related to safe and competent driving. Ongoing and planned work that aims to develop a resource to promote shared understanding of terms relating to driver testing, evaluation, and rehabilitation is then highlighted.

Driver rehabilitation programs: defining program models, services, and expertise.

This paper highlights the critical need for a diverse span of services targeted at older drivers that is clear and understandable to health care professionals, service providers, and consumers. The paper describes how a panel of expert driver rehabilitation specialists and researchers on older drivers affirmed consensus statements addressing the need for clarification of terms and services. It also presents a new document that describes a spectrum of driver services from education to specific driver rehabilitation services. The document will provide consumers, referral sources, payers, and stakeholders invested in older drivers' services, with the information to refer the right people to the right service at the right time.

A Systematic Review of Effective Interventions and Strategies to Support the Transition of Older Adults From Driving to Driving Retirement/Cessation.

Background and Objectives: In most western countries, older adults depend on private cars for transportation and do not proactively plan for driving cessation. The objective of this review was to examine current research studies outlining effective interventions and strategies to assist older adults during their transition from driver to driving retirement or cessation. Research Design and Methods: A search was completed across 9 databases using key words and MeSH terms for drivers, cessation of driving, and older adult drivers. Eligibility screening of 9,807 titles and abstracts, followed by a detailed screening of 206 papers, was completed using the Covidence platform. Twelve papers were selected for full-text screen and data extraction, comprising 3 papers with evidence-based intervention programs and 9 papers with evidence-informed strategies. Results: Three papers met the research criteria of a controlled study for programs that support and facilitate driving cessation for older adults. Nine additional studies were exploratory or descriptive, which outlined strategies that could support older drivers, their families, and/or healthcare professionals during this transition. Driving retirement programs/toolkits are also presented. Discussion and Implications: The driver retirement programs had promising results, but there were methodological weaknesses within the studies. Strategies extracted contributed to 6 themes: Reluctance and avoidance of the topic, multiple stakeholder involvement is important, taking proactive approach is critical, refocus the process away from assessment to proactive planning, collaborative approach to enable "ownership" of the decision is needed, and engage in planning alternative transportation should be the end result. Meeting the transportation needs of older adults will be essential to support aging in place, out-of-home mobility, and participation, particularly in developed countries where there is such a high dependency on private motor vehicles.

Meeting the occupational needs of a neurologically impaired client for driving: a case review.

Driving as a means of community mobility is an activity highly valued by individuals. When a medical condition impacts a person's ability to drive, occupational therapy practitioners should address this instrumental task of daily living with the client in order for the client to know if and when return to driving might be possible. This case review illustrates how the task of driving motivated a neurologically impaired client in therapy as well as how driving evaluation and driving rehabilitation intervention should not be done in isolation, but with the communication that will optimally assist the client to return to functional performance.

Evaluating driving as a valued instrumental activity of daily living.

The purpose of this translational research article is to illustrate how general practice occupational therapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008b). Evidence to support the model is offered by a research study. Participants were compared on their performance of complex instrumental activities of daily living (IADLs) and a behind-the-wheel driving assessment. A significant relationship was found between the process skills from the performance assessment and whether the driver passed, failed, or needed restrictions as indicated by the behind-the-wheel assessment. The evidence suggests that occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver. The algorithm addresses how driver rehabilitation specialists can be used most effectively and efficiently with general practice occupational therapy practitioners meeting the needs of senior drivers.

Use of GPS for Older Adults to Decrease Driving Risk: Perceptions from Users and Non-Users.

Community mobility is important for social participation and quality of life. Thus, it is important to sustain older adults in their communities by supporting their ability to drive as long as possible. Use of global positioning system (GPS) technology may provide such support. This descriptive study examined 89 healthy community older adults' perspective on using and programming a GPS after using it for wayfinding to unfamiliar destinations. Participants were equally divided between two age groups (60s, 70s) and familiarity with GPS (familiar, unfamiliar). The results showed age differences in problems following GPS directions and those who were familiar found it significantly easier to use. The majority of the unfamiliar group indicated an increased interest in using GPS and were significantly more interested in training to use a GPS. Preference for learning how to use a GPS included in-person delivery and practice with troubleshooting, using the menus and changing routes as topics critical for training. The implications of these results are discussed.

Teaching older drivers to navigate GPS technology.

BACKGROUND AND OBJECTIVES: New technologies are being implemented in motor vehicles. One key technology is the electronic navigation system (ENS) that assists the driver in wayfinding, or actually guides the vehicle in higher level automation vehicles. It is unclear how older adults interact with ENSs and the best approach to train older adults to use the devices. The objectives of this study were to explore how older drivers interacted with an ENS while driving on live roadways and how various training approaches impacted older drivers' ability to accurately enter destinations into the ENS. RESEARCH DESIGN AND METHODS: In Experiment 1, 80 older drivers navigated unfamiliar routes using an ENS or paper directions and completed a series of ENS destination entry tasks. In Experiment 2, 60 older drivers completed one of three training conditions (ENS video only, ENS video with hands-on training, placebo) to examine the impacts of training on destination entry performance. RESULTS AND DISCUSSION: Driving performance was aided by the use of the ENS, but many older drivers had difficulty entering destinations into the device (Experiment 1). The combined video with hands-on ENS training resulted in the best overall destination entry performance (Experiment 2). Practical applications: The results suggest older drivers may experience problems entering destinations into ENSs, but training can improve performance. These performance issues may be especially important as more vehicle features require interaction with computer systems to select destinations or other automation related features. Further research is needed to determine how to prepare the next generation of older drivers who will interact with technologies aimed at increasing mobility.