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Marilyn

Marilyn Di Stefano

Year of Award: 2013 Award State: Victoria Health And Medicine > Disabilities, Impairments And Injuries
Health And Medicine > Rehabilitation And Pain Management
The Jack Brockhoff Foundation Churchill Fellowship to examine advances in vehicle technology/rehabilitation applications to enable independence for drivers with disabilities - UK, Sweden, Italy, USA, Japan
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Independent vehicle mobility is often the preferred means of supporting access to work, recreation and social activities, contributing significantly to the life roles of many people in industrially developed countries.

Driving a motor vehicle is an activity of daily living that requires a combination of sensory, perceptual/cognitive and motor capacities. When combined, these enable a driver to develop the skills necessary to manoeuvre and navigate their vehicle through complex, dynamic environments. However, what happens to these skills when the ability to drive a motor vehicle is limited by congenital abnormality, or the permanent impairment and disability associated with accidents, illness or chronic disease? The driver may become unable to interact safely with the vehicle and other road users, becoming dependent on others, socially isolated and unable to participate in life roles.

In many countries, assessment and rehabilitation aimed at supporting the independence and safety of drivers with disabilities are provided by health and licensing authorities. In Australia, assessments for functionally impaired drivers are primarily conducted by occupational therapy driver assessors (OTDAs) with specialist training. In Victoria, standard driver assessment protocols, competency standards and post-graduate training for OTDAs were developed during the 1980s, accompanied by recognition of the specialist role within legislation (Road Safety Act 27 and Road Safety Procedures Regulations, 1988). OTDAs conduct off road screening and on road (in vehicle) evaluations, identifying impairments that can benefit from further remediation or rehabilitation, implementing interventions to support compensation and training, as well as prescribing vehicle modifications, adaptations and aides that support matching driver abilities with vehicle controls and optimizing vehicle access.

Screening and assessment systems need to be effective, evidence based and reflective of world’s best practice. There is a growing recognition that driver rehabilitation is dependent on standardized assessment practices and valid, reliable interventions. Furthermore, that for all drivers, including those managing a physical disability, the successful and safe completion of the driving task is reliant on an appropriate match between human capacities and a suitable physical task environment that comprises the vehicle-driver interface.

For example, body positioning in the vehicle cabin is important, even more so for individuals with reduced ability to move or reposition themselves. Head and neck position will influence visual access to mirrors and internal displays, as well as sight lines and viewing angles through the front, side and rear windows. These are critical as monitoring the external environment is a constant component of the driving task and underpins safety. Limb position determines access and use of manual and foot controls impacting on adequate, reliable vehicle movement and position on road.

Driver evaluation for “best fit” must be completed on a case by case basis, to ensure that the customized prescription of vehicle aides and modifications will address individual requirements to ensure safe, reliable and independent vehicle control functions.

Currently, advances in driver rehabilitation in Australia are hampered by:

  1. geographical distance from expert colleagues internationally
  2. lack of a dedicated professional OTDA national network and opportunities for professional education opportunities
  3. limited access to well established specialist mobility centres with multi-disciplinary staff which would support peer development, and
  4. a lack of driver independence vehicle and adaptation expos and trade shows and related access to vehicle aid manufacturers.

The purpose of this study tour was to:

  1. investigation rehabilitation applications currently applied with driver assessment services in the USA, UK and Sweden
  2. gather information about advances in vehicle technologies that support driving independence for drivers with physical disabilities
  3. attend the only international driver assessment professional association annual conference, and
  4. participate in a specialist vehicle modification 2-day workshop available only once per year in the USA.
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