a day in the life in driving rehab ot

A Day in the Life in Driving Rehabilitation OT

We are thrilled to finally get a day in the life of a driving rehab occupational therapist for our OT Day in the Life series! We are sharing Cara Harman, OTR/L’s typical day working in driving rehabilitation along with what you can expect when working in this outpatient OT setting. 

My name is Cara Harman, and I work as an outpatient occupational therapist in Atlanta, Georgia. Each day, I provide care to patients with a wide range of neurological and orthopedic conditions, and I am the sole therapist conducting clinical driver evaluations at my hospital.

A clinical driver evaluation is the first step of a comprehensive driving evaluation, which can be completed by a generalist occupational therapist; in fact, you do not have to be a Certified Driver Rehabilitation Specialist (CDRS) to complete the first step of a comprehensive driving evaluation! Read more about OT’s role in driving rehab here

This initial driving evaluation, that is not an on-the-road test, involves a series of clinical assessments reviewing the relevant skills required for driving, and targeting any limitations that may impact the patient and others’ safety with the task. Results are used to determine whether a behind-the-wheel driving assessment is necessary, and if any equipment, car modifications, driving aids, or specialist driving techniques need to be trialed during the on-road practical component of the driving assessment (the second step of a comprehensive driving evaluation).

Working in an outpatient clinic specializing in clinical driver evaluations can be emotionally challenging but also extremely rewarding. Some days I am overwhelmed with joy that I can help a patient return to the meaningful occupation of driving again after illness or injury, while other days it breaks my heart that I am recommending driving retirement to a patient who is unsafe to continue to drive.

However, even on the tough days, I know my role is essential in providing a safe community, and I may be saving not only the lives of my patients but others on the road as well. My overall goal is to preserve safety but also provide an emphasis on independence, social engagement, and an active lifestyle, as driving is essential for accessing our wants and needs in the community. I am excited to take you along with me on a typical day in the life as an OT working in this niche outpatient setting!

My Caseload and A Brief Overview

My driving evaluations are 2 hours in length compared to our usual one-hour slots for neurological rehabilitation and hand therapy. However, not every clinic allows this amount of time for the evaluation. Unfortunately, some clinics only allow 1 hour for the clinical driving evaluation. I have 30 minutes of documentation time with lunch and 30 minutes of documentation time at the end of the day, with 7 hours of treatment time out of my 8.5-hour shift from 8:00am – 4:30pm. We ask the patients to expect to be in the clinic for at least 2.5 hours with extra time allotted for paperwork and family/patient education as needed after the driving evaluation.

If a driving evaluation cancels, or I have at least 2 hours of open time in my schedule, I am floated to work in the main hospital’s acute care unit until my next patient. However, it is rare that a driving evaluation cancels due to the long wait times to see an OT for this service.

My Typical Day as a Driving Rehab OT

I typically chart review for my driving evaluations at least the day before the evaluation so that I am fully prepared and have all the assessment tools I need ready to go when the patient checks in. There is an extensive amount of chart review required for these evaluations, so I always expect to spend more time reading these medical records compared to my other ortho or neuro patients. Think about how not just physical but also mental, social, emotional, and behavioral factors all play a role in driving!

You must get a well-rounded picture of the situation before the patient even arrives and have the time to reach out to their healthcare providers for further information as needed (ex: contacting neurology for the date of the last seizure, as this is regulated by most states) and prioritize your time in the OT evaluation with the relevant assessment tools.

While a medical diagnosis and considerable chart review is helpful at formulating an idea of the patient’s condition/situation and how it can affect their driving abilities, it is also important to always go into the evaluation open-minded that a diagnosis or age does not predict driving fitness. You must always give your patients a fair shot at demonstrating the ability to continue, return to, or begin driving no matter their age or diagnosis.

I always arrive early on the day of the evaluations to have all assessment tools out and ready for the patient (ex: dynamometer, Optec machine, Snellen Chart, scoring forms for SLUMS, Trail Making A and B, Short Blessed Test, Road Signs, Road Rules, etc.), as well as a private treatment room reserved since this topic can be sensitive to discuss in front of other patients or therapists in the main gym. It is also important for me to have a quiet space for the cognitive testing.

OT driving rehab

The referral diagnoses for my driving evaluations are very diverse but most commonly being neurological conditions such as Parkinson’s disease, Alzheimer’s disease, dementias, ALS, MS, MD, stroke, spinal cord injury, traumatic brain injury, neuropathy, amputations, congenital deformities, cerebral palsy, ADHD, ASD, and learning disabilities.

Each evaluation outcome varies and can range from the following but is not limited to: no changes in their current driving patterns, driving restrictions, recommending adaptive equipment or car modifications and training, driving retirement, referral to specialists (ex: neuro ophthalmology due to visual field cuts) or referrals to other rehab professionals prior to the on-road assessment (ex: speech for cognitive deficits, PT for weakness/balance).

My Mid-day Break

I try to always take time for lunch to give myself the nutrition my body needs and give my brain a “break.” These driving rehab evaluations are time-consuming and mentally draining so if you start working in driving rehab (or in any setting for that matter) I highly encourage you to take at least some time for yourself during your break. Eat something good, call your parents, go for a short walk – whatever you need to be the best version of yourself and the most efficient and caring clinician you can be. I personally feel that I am a better therapist when I take the time to step away from work briefly and remember to also take care of myself so that I can better help others!

While I have the documentation time built in at the end of the day, it is rare that I finish driving evaluations in that time slot and leave work on time. I usually stay much later than my 4:30 pm “clock-out” time on evaluation days. Driving evaluation requires careful assessment of both the objective and subjective information gathered before and during the evaluation and you must also take the time to refer to the appropriate on-road provider or specialist afterwards. I personally always call the on-road provider I am referring to, to inform them of my client’s needs and make sure they can accommodate them. Some providers have longer wait times than others or are more expensive, so I try to always find the best fit for my patients based on their location, financial situation, and driving needs.

After I have completed all paperwork and fax the report to the referring physician and on-road evaluator, I will then chart review for the patients the next day. Each day looks very different depending on how many driving evaluations I have vs my regular outpatient neuro or hand therapy patients, so I must always be prepared!

What a Typical OT Clinical Driver Evaluation Looks Like

  1. Start with the interview: Introduce yourself, your role, and the driving evaluation process. Build rapport with the client. You want them to trust you!
  2. Client and family/caregiver interview: Medical, social, occupational, and driving history, all of which impact driving fitness uniquely.
  3. Vision testing (ex: tracking, scanning, depth perception, visual fields, visual acuity, contrast sensitivity, etc.)
  4. Physical testing (ex: strength, ROM, proprioception, coordination, sensation, reaction time, balance, etc.)
  5. Cognitive testing (ex: executive functioning, attention, memory, road signs/road rules knowledge, etc.)
  6. Write the problem list: The purpose of the clinical assessment problem list is to succinctly convey to the on-road evaluator the deficits that could potentially affect the client’s ability to drive.
  7. Final steps: Refer for on-road testing, recommend restrictions, driving retirement, re-assessment, as well as patient and family education/provide alternative transportation resources. Always send the referring physician the final report.

In Conclusion

As I mentioned above, driving evaluations can trigger both positive and/or negative emotions as a clinician. However, I must always remind myself that this service is essential for the client’s safety as well as the safety of others in the community. Occupational therapists are skilled at looking at a person not for their diagnosis but for them as a unique individual, finding ways to help improve their quality of life, and working around situations that are far from ideal.

Occupational therapists working in driving rehab can provide the education and resources, the encouragement, and hope people need to continue to live a safe, independent, and happy life, no matter what life has thrown at them. I love what I do and am happy to help others get involved in this amazing subset of occupational therapy that many do not know about!

You may also like

Leave a comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.