Driver rehabilitation

Driver rehabilitation is an aspect of driver education and is a specialized type of rehabilitation that helps individuals facing challenges caused by a disability or the aging process achieve safe, independent driving or transportation options, through education or information dissemination. Professionals who work in this field use specific skills, evaluation and training techniques, as well as adaptive equipment and modified vehicles to help people attain independent transportation.

History
Many driver rehabilitation programs began in the early 1970’s through the Department of Veteran Affairs (VA). The VA only offers driver rehabilitation services and funding to its veterans who seek transportation options. The VA currently offers driver rehabilitation services in 43 driver rehabilitation centers (source: VA handbook and VHA 2009 directive).

The field has since expanded beyond the VA to serve clients of all legal driving ages. The Association for Driver Rehabilitation Specialists (ADED) was founded in 1977 to support and advance the profession of driver rehabilitation. Thirty people, from ten states, representing professionals in the field of driver evaluation and training of persons with disabilities attended ADED’s first official meeting. The initial meeting determined the type of organizational structure, the official name, initial officers, standing committees and membership fees. Today, ADED is the primary professional organization in the specialized area of driver rehabilitation. The organization’s membership continues to grow with a mission to promote excellence in the field of driver rehabilitation in support of safe, independent, community mobility.

In 2003, the American Occupational Therapy Association (AOTA) developed an Older Driver Initiative to develop services for the older driver population. The Web sites for both ADED and AOTA provide search options to find driver rehabilitation programs in a given locality. The National Mobility Equipment Dealer’s Association (NMEDA) was founded in 1989 to broaden the opportunities for people with disabilities to drive or be transported in vehicles modified with adaptive equipment.

Scope of Practice
The goal of driver rehabilitation is to enhance the lives of individuals with disabilities or age-related impairments through the attainment of safe, independent driving and transportation.

This goal may be accomplished through the use of specialized mobility equipment and training. The process begins with a clinical assessment of an individual’s visual, visual-perceptual, cognitive and physical skills that are necessary for driving. If the individual meets criterion, then an on-road assessment is conducted, in which the evaluator uses a vehicle equipped with adaptive driving equipment, as well as auxiliary brake and mirror on the passenger’s side of the vehicle. Accommodations can be made via the use of mechanical or electronic steering, acceleration and braking equipment, which are based on the results of the clinical assessment. If it is determined that the person has the potential to drive, training is offered to enable the individual to develop skill and proficiency in the use of the equipment in a range of driving situations. For individuals who are novice drivers, driver’s education is included in the services. Following training, a vehicle equipment prescription is provided, with a referral to a mobility equipment dealer for installation of the equipment in the vehicle. When the installation is completed, the vehicle is checked for proper fit, with additional training provided as needed. In other instances, an assessment of the person’s capacity for safe driving is required, following an illness or injury. No adaptive driving equipment may be needed, but the concern is a change of the individual’s sensory, motor, visual, perceptual or cognitive ability. The clinical assessment is conducted initially, followed by the on-road assessment, using a vehicle equipped with the passenger brake, mirror, and in some instances, an auxiliary steering wheel. An assessment of the individual’s capacity for safe driving is conducted, with possible recommendations for continuation of active driving, training in driving strategies or driving cessation.

If an individual does not currently possess the skills and abilities required for driving, driver rehabilitation specialists often refer, when appropriate, to various other therapy programs to enhance skills. These might include wheelchair seating programs, occupational therapy, vision therapy, physical therapy or cognitive therapy programs.

Driver rehabilitation services are often recommended for persons who plan to be transported only as a passenger in a personal vehicle. In those cases, it is crucial to determine the person’s ability to get in and out of the vehicle, to evaluate the vehicle’s appropriateness for safe transportation, and to evaluate the safe transportation of mobility aids or devices, e.g. scooters, manual or power wheelchairs, including proper securement of the mobility device. Often recommendations for vehicle modifications may include the use of a wheelchair accessible van, wheelchair lift or wheelchair ramp.

Personnel
The term driver rehabilitation specialist signifies one who “plans, develops, coordinates and implements driving services for individuals with disabilities”. Driver rehabilitation specialists work closely with physicians, allied health personnel, Department of Motor Vehicles personnel and mobility equipment dealers to provide the optimum outcome for their consumers.

Driver rehabilitation programs are offered in a variety of settings, such as Rehabilitation hospital, hospital outpatient therapy departments, Veteran’s hospitals or as private driving schools. Professionals who work in this field are often members of ADED. The professional fields represented in ADED consist of:


 * Driver education/training
 * Equipment manufacturers
 * Equipment dealers
 * Kinesiotherapy
 * Occupational therapy
 * Physical therapy
 * Speech-Language pathology
 * Rehabilitation engineering
 * Rehabilitation specialists
 * Rehabilitation technology
 * Vocational rehabilitation

Education/Training
Driver rehabilitation is a specialty service provided by a variety of professionals with backgrounds in allied health and traffic safety. Occupational therapists and driver educators comprise the two largest groups of professionals, with other professionals from the fields of rehabilitation counseling, physical therapy, kinesiotherapy, rehabilitation engineering and psychology. Occupational therapists may utilize the term driving rehabilitation, reflecting the profession’s focus on the occupation of driving.

Many driver rehabilitation specialists obtain specialty certification from ADED by fulfilling education and experience qualifications and passing a certification exam. The purpose of the certification process is to protect the public by providing measurement of a standard of current knowledge desirable for individuals practicing driver rehabilitation.

Additionally, it encourages individual growth and study, thereby promoting professionalism among driver rehabilitation specialists. Finally, the certification process allows for formal recognition of those driver rehabilitation specialists who have fulfilled the requirement for certification. While many driver rehabilitation specialists hold certification as a CDRS or are in the process of obtaining the necessary education and experience to sit for the examination, certification is not required to practice driver rehabilitation. Those holding the CDRS certification subscribe to continuous educational and learning opportunities to maintain their specialty credentials.