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323-08-04-17 – Fitness to Drive Evaluations – Suzanne Pritchard OT and Certified Driving Rehabilitation Specialist – ESC | aded.net
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Fitness to Drive Evaluations – Suzanne Pritchard OT and Certified Driving Rehabilitation Specialist –
www.EasterSealsCrossroads.org
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SUZANNE PRITCHARD: This is Suzanne Pritchard. I’m an occupational therapist and certified driver rehab specialist at Easter Seals crossroads, and this is your Assistive Technology Update.
WADE WINGLER: Hi, this is Wade Wingler with the INDATA Project at Easter Seals crossroads in Indiana with your Assistive Technology Update, a weekly dose of information that keeps you up-to-date on the latest developments in the field of technology designed to assist people with disabilities and special needs.
Welcome to episode number 323 of Assistive Technology Update. It’s scheduled to be released on August 4, 2017.
Today we are going to spend our time with Suzanne Pritchard who is an occupational therapist and certified driver rehabilitation specialist here at Easter Seals Crossroads in central Indiana. We are going to talk about a specialized evaluation they do to help people decide whether it makes sense for them to remain drivers.
We hope you’ll check out our website at www.eastersealstech.com, sent us a note on Twitter at INDATA Project, or call our listener line at 317-721-2124.
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Here in the US, it’s summertime and we are all spending time outside hopefully doing things like vacations. It’s pretty likely that you might be in an automobile or train or plane. Today we are going to talk about a thing called fitness to drive evaluations. I have been at Easter Seals crossroads for many years. One of the things we do here is a driving program where we work with people who have disabilities either driving for the first time or driving again. A good friend of mine, Suzanne Pritchard, is all occupational therapist and certified driver are both vision specialist. She’s one of two who do that kind of work. We have dragged her kicking and screaming down the hall into the studio. Hi Suzanne.
SUZANNE PRITCHARD: No, no!
WADE WINGLER: We are going to talk a little bit today about our driving program in general and something that I think is fascinating and interesting service that we offer, which we called fitness to drive or sometimes safety drives. Suzanne, how are you?
SUZANNE PRITCHARD: I’m good today.
WADE WINGLER: Right now at this moment we are okay. Everything else is questionable, right? How long have you been working here? I know it’s been a long time.
SUZANNE PRITCHARD: Yeah, I know, and I’m only 21. It’s so strange.
WADE WINGLER: You started when you were too?
SUZANNE PRITCHARD: I did. No, I’ve been here a little over 10 years.
WADE WINGLER: It seems like more.
SUZANNE PRITCHARD: You’re so tired of me already?
WADE WINGLER: Not at all. For people who aren’t familiar with what a certified driving rehabilitation specialist is and what a program like ours at Easter Seals crossroads would do, can you give us an elevator pitch on our program in general?
SUZANNE PRITCHARD: We are fortunate to have the sort of high level skill folks where Easter Seals crossroads has allowed us to become certified driver rehab specialist. We came to crossroads as occupational therapist. Becoming a certified driver rehab specialist means you are accredited by an agency called the Association for Driver Rehab Specialists. We had to take a certain number of classes and pass a board examination and we keep our credentials yearly through continued education and things like that. My coworker, Mary Foreman, and I are full-time just in the driving program. We see folks of all ages. Our youngest is going to be 15 and our oldest at this point is 97. We see folks of all ages and all disabilities. We have folks that are brand-new drivers. Obviously our younger folks are going to be brand-new drivers who have no or little experience, and then we see folks that might be one middle-aged – not like you and me, Wade. Much older than we are.
WADE WINGLER: 40 is the new 50. How does that work?
SUZANNE PRITCHARD: 40 is the new 20.
WADE WINGLER: Math.
SUZANNE PRITCHARD: Stick to radio. We see folks in their middle ages who might have had some type of injury who want to get back to driving, and then we see a lot of our senior drivers – who I believe we are going to focus on today – that might need what we call a safety evaluation to determine if it is to drive.
WADE WINGLER: We did an episode – I was looking in our show notes – it was March 2012 when you and I sat in the studio before and it the overview of the driving program. If people want to dial back in our archives, you can get those at www.eastersealstech.com. It’s episode 43 and was released in March 2012. We spent an entire show just talking about the program over all.
Today I thought it would be fun to dive into a very specific service that we offer typically to our older drivers. We call it the fitness to drive evaluations. Let’s start with the food part of the question first. Who needs this kind of service?
SUZANNE PRITCHARD: It could be anybody. If you look at our numbers, most of the folks that want this type of evaluation, the fitness to drive evaluation, tend to be older. The majority of them have some type of cognitive impairment, dementia. Maybe they’ve had a stroke and it’s affecting their cognitive abilities. Maybe they’ve had a brain injury of some sort. But also folks that are younger that have sustained a traumatic brain injury or someone who might have been hospitalized for a long period of time in their doctor or family is concerned that they are either frail or have lost some of the skills potentially that could affect their ability to drive safely.
They call us, and we offer an evaluation that is typically 2 to 3 hours. We like to be very thorough with that. There are two parts: we do a clinical piece to it, and we do and on the road assessment of their skills so they are actually in a vehicle. These folks typically don’t refer themselves. Those referrals either come from a concerned family member or perhaps a physician. When they are here, we also ask that those family members come with them to make sure that we are getting all the information that we need from these folks.
WADE WINGLER: Or both sides of the story.
SUZANNE PRITCHARD: Right.
WADE WINGLER: I like to tell a story about a situation where my family would have benefited from this service. I’ve told it to you before. My grandmother, when she was in her early 80s or so – she doesn’t drive anymore – she decided that she could only drive safely if she were driving 70 miles an hour and above because it forced her to stay focused. She said, “Anything under 70, my mind wanders and I wobble all over. Once I get over 70, and laser focused.”
SUZANNE PRITCHARD: She’s just tearing the parking lots.
WADE WINGLER: She lived in a rural area, so it was either country farm roads where you could probably get by with that a little bit better, or small towns with all of her old lady friends wandering across the street.
My assumption is that my grandmother would have been a pretty good candidate for such an evaluation.
SUZANNE PRITCHARD: Likely, yes. That’s where a lot of families start. They start by talking to themselves, the siblings talk to each other or talk to the elder parent that is not the one they are concerned about, maybe you have some conversations with their doctors. It is typically unlikely – you said it was your grandmother? – in your grandmother’s situation where she maybe had lost a little of her judgment, it was impaired.
WADE WINGLER: And her vision.
SUZANNE PRITCHARD: Let’s put it all in the pot and stir it up. In that case, we frequently are the ones that can give the family members the information that they are looking for in terms of what are things to be concerned about the things that maybe aren’t so concerning. In the case of your grandmother, perhaps she has a point where she is more focused when things are flying by her at 70 miles an hour, but that she’s lost the ability to know that that judgment piece is problematic in her small town or any town.
WADE WINGLER: There aren’t too many towns where 70 works.
SUZANNE PRITCHARD: No. So we might have been able to help her, which means we are helping family, to objectively look at the skills that she does have clinically and get her on the road to see how she really is performing truly. It’s interesting, sometimes we have families that call because the doctor has suggested this, but they don’t necessarily see that there is a problem with mom or dad either. They are hoping that everything goes well and that they are ” released to drive” by us. But then we also have the flip side which is maybe even more frequently where it’s the concerned family member and they really don’t want their family member to pass the drive test. They make that clear to us, and sometimes they struggle when actually the family member does okay.
WADE WINGLER: I want to come back to some of those conversations. In our situation, we resolved it without using such a service. My sister, Captain Amanda of the sheriff’s department, had a brief conversation with her that ended with her not driving. That was not easy. My sister would rather have had your assistance.
SUZANNE PRITCHARD: Right. It’s very hard for families.
WADE WINGLER: Talk to me about the process. A family member or physician reaches out, and you get to the point where your referral is made. I know there is some behind the wheel stuff and stuff that happens before that. What does the process look like?
SUZANNE PRITCHARD: Once someone makes contact with us, whether the consumer or doctor or family member, we get them on our calendar and ask that either the doctor supplies us with clinical information. So what exactly has gone on? Has there been a hospitalization? Is there a diagnosis? We like to look at clinical information from the healthcare workers that have been involved with this person. Then we always asked that a family member come because we like to make sure that we are getting both sides of the story, or a well-rounded story. They come with their valid license, and we do this 2 to 3 hour evaluation.
I want to go back to the valid license. Lot of times, folks have lost their license already. It’s invalid for some reason. Depending on why it’s invalid, we can sometimes help with that cat and get it validated specifically for the evaluation. If someone’s license is expired or they have fines or something like that, they have to be able to take care of those situations before they come to see us. We often can help if the license is valid. It’s not a reason to not call us.
WADE WINGLER: They get here –
SUZANNE PRITCHARD: They get here, family shows up, the consumer and family member are in the interview in our clinical room. We do a couple of things that are fairly standard in the industry. There are a few paper and pencil tests that will look at visual processing speed, their mental flexibility, their ability to scan. We get a lot of information from the interview. Are they oriented? Can they hold a conversation? Are they distractible? Are they impulsive? We get all this information and it takes about an hour or so. We do the qualitative chatting conversational piece, but we do gather these scores of these standardized tests that we are looking at so we can get an idea of how they are relating to the rest of the population, whether it be considered the normal scores.
If that goes well enough — and there is an asterisk I’m doing with my hand — then we give them in our vehicle. That always explained on the phone, but a lot of times people are surprised. They forget or hopeful that they can drive their own car. They drive our car because we have a gas and brake pedal on the passenger side so we are able to control the vehicle if we need to. The asterisk that I was doing is a lot of times, particularly folks even in the early stages of dementia, they don’t do well clinically. There are some critical scores they might not do well. But if they are oriented – I don’t just mean oriented to date and time but to the situation. Their judgment seems to be intact, and behaviorally they seem to be appropriate – then even if their clinical scores are poor, we put them in the car because we feel it is important to get a well-rounded look at what this person can do. A lot of times these folks have been driving for 60 or more years. We want to see what they can do on the road.
That drive is anywhere from 40 to 45 minutes. Again, air-quote asterisk, if that all goes well, we end up back here and make a conclusion at the end of the evaluation. If the drive does not go well, sometimes, on a few occasions, we will stop the driver early and switch to get us back so everybody is safe.
WADE WINGLER: Some drives don’t last long at all?
SUZANNE PRITCHARD: Know. I just recently had one of those. Didn’t last very long and had to switch.
WADE WINGLER: You talked about switching drivers, about the fact that you have gas and brake pedals on the passenger side for you guys. What other kinds of things do you do to make sure that everybody is safe in that environment? I know where you drive. I see you do it.
SUZANNE PRITCHARD: Do you turn the other way?
WADE WINGLER: I don’t but I won’t have that option. I wonder what we are doing to stay safe.
SUZANNE PRITCHARD: Definitely the gas and brake pedal are extremely helpful. Both of us here have gone through pretty extensive training by other certified driver rehab specialist. Before we were brand-new in the field, we were trained on courses trying to learn to control the vehicle from the passenger side. That’s obviously extremely helpful. You also learn to use your voice to control what’s going on. While it is an evaluation – if it’s an evaluation scenario, it’s not about instruction, it’s about letting this person show us what they can do. There is a certain amount of air that we have to be able to allow for and see. But when we can anticipate that something might be coming up that is critical, we just learn to use our voice is to control what’s going on.
WADE WINGLER: Give me an example of a command of where you would use your voice.
[Screams]SUZANNE PRITCHARD: Screaming, Stop! That’s what the break is for. That also allows us to stay calm because we have a break if my voice doesn’t end up helping.
Here’s a good example. It might be someone that has moderate stage dementia, after you take them through several stops and intersections, and then you have them come to a traffic light, it’s not uncommon to have that person treat that traffic light at a stop sign. They start scanning as if as soon as traffic is clear, even though their light is red car they are going to make this a left turn. You might use your voice saying something like, “Now tell me what type of intersection this is.” Just to snap them, okay, it’s a traffic light. You’ve allowed them to show that that was going to be an error without actually going through the intersection at the inappropriate time.
WADE WINGLER: Wow. I’m guessing there have been some white knuckle situations in your day. I know this because we talk about it, but my audience haven’t heard. Sometimes you’re like, okay, I’m going to shut my door and we can talk. Give me an example of what a bad day looks like for you.
SUZANNE PRITCHARD: As I said before, you have to allow for some type of error. There has to be some bit of white-knuckling. There have been times when perhaps you are telling the person that you want them to make a lane change to the right, and they put the right turn signal on – other than gas and brake pedal, we have lots of mirrors on our passenger side of the car so we can have a good sense of what’s going on around the car. You are checking to the right, right turn signal is on it, and all of a sudden they go to the left. I haven’t checked to the left because we aren’t going to the left. You have to quickly maybe grab the wheel because there is a vehicle there and say, “No, we are headed to the right here.” Or excessive speed on turns can be problematic. Again, you allow a little bit of that to see if they are going to self-correct or get a sense they are going to quickly, but then you have to get your foot over the pedal and slow the vehicle down a little bit.
WADE WINGLER: You don’t wait for the tires to chirp a little bit?
SUZANNE PRITCHARD: I do a little bit now, a little chirping.
WADE WINGLER: The older you get, the more tolerant you are.
SUZANNE PRITCHARD: I’ll never forget the first person I saw 10 years ago, I was so stressed. Even though I had had the training, I was brand-new. It was first that I was by myself in the car with the consumer. I had my foot, my right foot, over the pedal the entire drive. I was depressing on it but I was holding it over the break. My quad was shaking so terribly that I had to stretch out and put extra deodorant on that day. The gentleman did fine but I was so stressed.
WADE WINGLER: After the interview and observational conversational testing, and after time in the car, what are possible outcomes from this evaluation?
SUZANNE PRITCHARD: It’s a question we get a lot from family members before they come in to see us. There are three options.
WADE WINGLER: Yes, no, and mayb-so?
SUZANNE PRITCHARD: Exactly: yes, no, maybe. Obviously a “no” will be because there is some significant data that has been collected over the last few hours that the person is no longer fit to drive. While that is a decision we come too frequently, is not easy to come to. That is sometimes the case where we say it is time to retire from driving.
The other outcome is yes, you can continue driving. Typically that yes could come with some restrictions. Continue driving but only within a five-mile radius, only to familiar locations. A lot of our older adults, that’s all they want to do anyway. They want to get to church to see their family, a restaurant or two, hair done, grocery store, and it’s all typically, hopefully located close to their house.
WADE WINGLER: You can get there very quickly at 70 miles an hour.
SUZANNE PRITCHARD: You are there in 30 seconds, no problem. That’s a common outcome, yes, but let’s limit this a little bit. What we like to see is those folks are already limiting themselves. I don’t pick up multiple people anymore, or I don’t drive at night.
The third outcome is that we say it’s a possibility, but we want to do a bit of follow-up. An example of that might be someone comes in to see me – I’m making this up – maybe they’ve had a stroke. They’ve done a lot of rehab. It’s been 6 to 8 months since they’ve driven. They really haven’t driven at all in the amount of time. The come here, or a little anxious, their clinical scores are not terrible but okay, their drive was okay, but nothing stood out to be great, clinically or on the drive. I say, “We are in an unfamiliar area. You’re unfamiliar with me.” I might get a sense that this person isn’t necessarily driving, but they have to slowly return to driving. We see them for some follow-up sessions. That might be one, three. We go to them in their area. This is after the initial evaluation.
I did this a couple of weeks ago. I went to see a woman, lived in a smaller town outside of Indianapolis. Take me to your grocery store, take me where your granddaughter play softball, show me where your church is. We did those things. She did beautifully. Then we have the evidence, if you will, that this person is fit to drive. Let’s return slowly, take it in this small chunk which you are used to. She did okay.
Those are the three: yes, no, maybe so.
WADE WINGLER: We do this service – I say we as if I do anything.
SUZANNE PRITCHARD: When were you in the car?
WADE WINGLER: You won’t even let me in the car. I’ve asked and you say no. We do this in central Indiana, but obviously this need exists in every place. If people aren’t local – and we are going to tell them how to reach out to us if they want to do this – but if they aren’t local, what would you recommend? How do they get this help elsewhere?
SUZANNE PRITCHARD: Locally, we are going to be available. At crossroads, we are also able to drive within the central part of the state. We go as far west as Terre Haute. We go to the other side towards the Ohio border. We go north and south a little bit. We do cover within a couple of hours of where we are. We still cover a big part of Indiana. Indiana as a state is pretty lucky in that there are several of us that do what I do in different parts, as well as the rest of the country. Wherever you are, if you want to look into the service, go to the website ADED.net, and you can type in where you are and it will pull up state-by-state who is where in your state, what their credentials are, and their contact information. That way if you are in California, you have somebody. If you are in Connecticut, you have somebody. Again, Indiana is lucky. We have a number of people that do this. I know certain states don’t have that many people, but you can at least get hooked up with some facilities closer to you.
WADE WINGLER: If they want to reach out to us, they can go to www.eastersealscrossroads.org or call our front desk which is 317-466-1000.
We have about a minute left in the interview. Tell me a story.
SUZANNE PRITCHARD: I like to tell the story because it makes fun of me and shows that there is always room to learn. I was doing a safety evaluation with a gentleman who lived in a small town. He had done some of the clinical work with another facility, and I actually drove to him in his small town to see him drive. His diagnosis was a stroke. Part of a deficit he was left with was that he really wasn’t able to speak. He could understand what I was saying but was unable to speak, which made it difficult for him to communicate with me. His handwriting was also very poor. Obviously when he’s driving, that’s not an option. I said, “Let’s go to your local IGA.” That was about a minute and a half – not going 70, going 25 – from his house. It wasn’t open yet because it was early in the morning. He pulled up in this really whacky way. I thought, this guy has a visual perception stuff going on, he is not making any sense. We even got out of the car. What are those called, the cement blockers?
WADE WINGLER: The bumper things?
SUZANNE PRITCHARD: They were all in this perpendicular fashion and he put up diagonally. I got out and showed him and said, “Now, I really need to do to pull up perpendicularly.” He was shaking his head and looked frustrated. I thought, yeah, the guy is frustrated. He knows he’s not doing well. We went through his town. I had him drive to the bank and he totally nailed it perfectly, right through the drive-through. Pulled up to a gas station, to line up his tank easily with the gas tank. I thought why was this so bad? We drive back, are on our way to his house, we drive by the IGA which is not open. Everybody in this small town Parks diagonally at the IGA. That’s just how you do it. I burst out laughing and he just looked at me. I was like, I’m so sorry. That’s how you park in this small town! He was vigorously shaking his head. The poor guy I’m sure wanted to strangle me and be like that’s how we do it here. I was trying to talk to him about you need to square up your car. That was a happy ending. He did great and he knows how to park at the IGA and I don’t. Off he goes.
WADE WINGLER: Excellent. Give us the website one more time if people want to reach out to you.
SUZANNE PRITCHARD: ADED.net.
WADE WINGLER: That’s the one for the national. If they want to reach out to you locally, it’s eastersealscrossroads.org.
SUZANNE PRITCHARD: That’s right.
WADE WINGLER: It takes a team.
SUZANNE PRITCHARD: Thank you.
WADE WINGLER: Suzanne Pritchard is an occupational therapist and one of our certified driving rehab specialist here at Easter Seals crossroads. You’ve been delightful as always.
SUZANNE PRITCHARD: Thank you.
WADE WINGLER: Do you have a question about assistive technology? Do you have a suggestion for someone we should interview on Assistive Technology Update? Call our listener line at 317-721-7124, shoot us a note on Twitter @INDATAProject, or check us out on Facebook. Looking for a transcript or show notes from today’s show? Head on over to www.EasterSealstech.com. Assistive Technology Update is a proud member of the Accessibility Channel. Find more shows like this plus much more over at AccessibilityChannel.com. That was your Assistance Technology Update. I’m Wade Wingler with the INDATA Project at Easter Seals Crossroads in Indiana.
***Transcript provided by TJ Cortopassi. For requests and inquiries, contact tjcortopassi@gmail.com***
