Driver Rehabilitation for the Neurologically Impaired Patient

Driver Rehabilitation for the 
Neurologically Impaired Patient

Lisa Thorpe  MS, OTR, DRS

Objectives

1. Effectively identify neurologically impaired 
patients who require a formal driver evaluation.

2. Improve communication and/or documentation 
regarding ability to return to driving with the 
patient, family and health care team.

3. Understand the driver evaluation process 
including recommendations for continued 
driving.

Framework 

• Driving = an occupation = functional outcome
• Driving is an IADL
• Skill assessment for “other” IADL are same 

factors that impact driving

– Motor
– Sensory
– Vision/perception
– Cognitive
– Insight

Michon Model of Driving

• 1. Strategic

– higher level decisions
– Route planning
– Trip goals
– Mode of transportation
– Navigation
– Decisions effect all aspects of driving

Michon (1985)

Michon Model of Driving

• 2. Tactical

– Decisions made during driving
– Adjusting speed to conditions
– Judging gap distance
– Left turns

Michon Model of Driving

• 3. Operational

– Human‐ machine interaction
– Vehicle control
– Visual‐motor skills needed to achieve tactical level

Tactical

Strategic Operational

Safe 
Driving

Screening for the Neurologically 
Impaired patient

• Consider patient skill sets related to level of 
driving

• Determine if impairment level exceeds the 
threshold for safe driving
• If unclear‐‐‐‐‐ refer

• Concomitant age related changes

Dickerson and Schold Davis, 2013, modified 

Clinical Screening

• No set of assessment tools is considered 
scientifically valid for predictor of driving 
performance

• Over and under estimating driving ability
• Best to include evidence based tests that 

predict crash or on road performance

Screening Measures

• TMT A and B * • AD‐8 Dementia Screening 
• MMSE Tool
• Rapid Pace Walk
• Contrast Sensitivity * • Coordination tests
• Visual Acuity • Glare recovery
• UFOV * • Sensory testing
• Brake Reaction time • Confrontation
• IADL measures • Visual search scan
• Draw a clock • Divided attention
• MMT/ROM • Functional reach *
• UPDRS “off” motor scores *

On Road Assessment

Driver Eval Process
In‐Clinic Evaluation

• Patient Interview
• Motor System
• Sensation
• Visual/ Visual Perception
• Cognition/Insight
• General Endurance

Driver Eval Process
In‐Vehicle Evaluation

• Entering and Exiting Vehicle
• Closed Course Driving
• Residential Driving
• Commercial Driving
• Expressway Driving
• Cognitive challenge/self navigation

Assessment/ Recommendations

• Pass or Fail

– Substantiate clinical strengths or weaknesses as related to 
driving performance

• Counsel

– Driving restrictions– formal/informal
– Vehicle modifications (if needed)
– In‐Car retraining
– Alternative community transportation options
– Supportive driving retirement

Assessment/ Recommendations

• Vehicle Modifications

– What/why needed
– Where to purchase
– DMV requirements

• Driver Training

Immediate clinical Implications

• Start the conversation(s)
• Document on pre‐driver skills
• Make recommendations on level of risk
• Recommend a formal driver eval if needed
• Consider ‘community mobility’ as more than 

driving
• Use of benefit money
• Be an advocate……..