Return to Driving

Driving is an instrumental activity of daily living (IADL) and participation in this activity is an important part of occupational therapy.

Driving is a complex IADL requiring dual tasking, divided attention, rapid processing speed, and executive function. Driving is an important part of community re-entry, maintaining socialization, and returning to the previous activity level. 

Outpatient Occupational Therapy Pre-driving and Community Mobility Program

An expert Occupational Therapist from Washington University Physical Therapy Clinical Practice will assess the following impairments and functional limitations and will provide skilled treatment accordingly:

• Clinical vision assessment and treatment
• Visual scanning speed and attention: multiple tools and tasks such as the Dynavision and BITS 
• Brake reaction time and decision making: driving simulator, computer-based pre-driving programs 
• Instrumental Activities of Daily Living training as driving is rarely the only area of IADLs that may be affected: money management, route finding, planning, time management
• Cognition: memory, divided attention, executive functioning

Full pre-driving assessments take up to 4 treatment sessions (all reimbursed by insurance), and treatment follows if the patient will benefit from further rehabilitation. Patients work toward meeting established thresholds for up to 20 clinical tasks consisting of standardized assessments, standardized treatment tasks, and home program options based on current research in the care of community mobility.

Risk determination is based on evidence and clinical judgment into three categories

1. Non-driver: impairments exceed thresholds for safe driving. Goals will be to promote driving retirement and mobility preservation through supportive transportation
2. At-risk driver: the degree to which impairments affect fitness-to-drive is addressed. Goals will be to provide occupational therapy to improve fitness-to-drive and to assess readiness for a comprehensive driving evaluation (CDE, on-road evaluation) “at the right time”.
3. Driver: no impairment indicators to report or recommend restriction on driving. The patient meets the majority of pre-driving thresholds. Goals will be to encourage fitness, strength, flexibility, promote driver safety programs, and to discuss warning signs for impaired driving in the future.

Benefits from Therapy focused on Pre-driving

• Patient participation and motivation improve with patient-centered goals
• Evaluation and treatment is covered by insurance
• Can be possible to avoid road evaluation and associated cost if appropriate
• Increased confidence of pre-driving skills or increased insight into deficits for patient and family 
• If unable to return to driving, skilled education in alternative transportation resources and training on how to use as needed
• For patients who have not driven for a length of time, therapy will help them re-engage in driving focused tasks as well also help prepare them for a CDE if needed
• Improved acceptance of overall driving recommendation for patient and family, especially if the recommendation is to retire from driving