Megan Robbins outlines the legal requirements for health care professionals with regard to TBI patients and driving rehabilitation.
next we're gonna change gears a little bit and uh and talk about driving rehabilitation for for patient. And we have Megan Robbins who is an occupational therapist uh here at uh at scripts. She's uh has 24 years of experience. She has received her bachelor's degree in South Africa and has been fortunate to work as an OT in multiple countries in many different settings. Uh She started working at Scripps Memorial Hospital and Senators in 2005, working in the acute rehabilitation and brain injury day treatment program. And in 2016 she was trained as a driving rehabilitation specialist and transitioned full time to the driving program at scripts and Sonatas Uh in 2018 and her areas of clinical interests are brain injury, driving rehabilitation, vision assessment and retraining. Um I have a lot of respect for the O. T. Dr driving instructors. I recently taught one child to drive and trying to do the same for another and being in the car and having all the worries of being behind the wheel without actually being the one in control. I think that's maybe one reason why my hair is thunder nail than it was a couple of years ago, but Megan has the right personality for it. And one common thing that I hear back from my patients is how much she puts them at ease to do the whole process. So I'd like to uh, introduce Megan Robbins. Thank you very much. Hi there. Good morning. Well, dr Jack for the good thing is that I have controls. I have a break in an accelerator because I get that question a lot. So I, I have full control. Um Good morning. Hi. Yes, my name is Megan, um, getting used to this whole zoom. I got a bit of a frank this morning when I saw my, what I looked like on a, on a zoom. So good morning. I look forward to us actually being in person soon, but um, yes, driving rehabilitation. Um, oh, not let me, there we go. Um, so no advances. I mean no disclosures. Um, like dr jeffers said I was educated in South Africa, worked in lots of different places. Um, my current now, my kind of thing that I do most is um driving, so that's where the accent is coming. Um, I do speak far, so I'm going to try and slow it down a little bit, but if I am speaking too quickly or if people are not understanding, please feel free just to send a quick message and I'll try and slow it down a little bit. So driving the objectives of this. I really wanted to look at everyone being able to identify the skills that we need to operate a vehicle, our legal requirements as health care professionals regarding driving and understanding the role that each team member plays in determining when someone is ready to drive. So final step to independence. Um I am sure that anyone who works with patients, it is a big question that anybody wants to know is when am I ready to drive? So it really is a final step that we as a team can help our patients get to, but also understanding the gravity of the skill of driving and how to know when they're ready and how to actually get them there. So, like I say, everybody wants to drive, but for patients to understand and I get this all the time. You know, I have driven for 60 years since I was 16 and I'm such a great driver. So yes, you know, they were great drivers, but looking at the actual complexity of the skill of driving, it is the most complicated, complex skill that we perform. We don't think about it because we do it every day, but it's when you really break it down into the skills that you can understand the level of multitasking, task shifting that's required. So it really is a complicated skill while you're driving, there's no time to rest and take a little break. All your systems have to be on and working to really be a safe driver and obviously it's our responsibility because public safety is something that we're obviously concerned about. So I've broken it down into three areas for the skills. I'm gonna just go through these quickly because I'm actually gonna go through them in more depth when I look specifically at to discipline specific. So I put it into what skills are really needed for driving, right? So there are three categories that we look at the first is cognition, vision and physical. So when we're looking at the cognition and again there is so much involved, I've kind of put it into you know, highlighted areas, but I'm sure that you could think of a whole lot of other areas as well, but big ones, so attention, memory, multitasking, task shifting. I put it like that because I know in the industry there's a lot of kind of um there's a lot of debate between is it really multitasking while we're just shifting quickly between tasks. So I kind of put it like that because I know there's that those words kind of can be interchangeable, but a huge amount of being able to shift very quickly between different activities, abstract thinking, executive functioning, obviously speed of processing the vision. Um and again I'm going to be only talking about California guidelines. Every state actually has different guidelines for vision requirements. Um Our California so all that I know is this is what our California are. If you wanted to look at that it is worth going into the D. M. V. Of your state Because a lot of states have different requirements but in California these are our requirements for acuity. It's 2040 but we look significantly at color perception, depth perception, contrast sensitivity. That has just been able to see in low lighting, visual processing, scanning, teaming and obviously big ones on the visual field deficits. Um And then blair kind of feeds into a lot of a lot of our senior vision which is no glaucoma cataracts all of that. So vision is a really big one when we're looking at driving and then obviously the physical coordination, sensation, pro perception, speed of movement. A big one that patients don't really think about is being able to move your upper and your lower body separately, right? So your feet are doing something very different from your arms and your left and your right is doing something very different. So being able to look at all of those things together and then obviously strength, active range of motion. So I'm going to go more in depth in the actual discipline specific here, of each team member's role, of um of how a team, how the team comes into play here and what each role is. So therapists come to me all the time to say, okay, how do I know if my patient is ready? So this is kind of and and again, there's a lot of crossover as you'll see between all the team members, it's very hard to two totally separate each team member. But when I when it's kind of a physical therapist, this is what this is what they're looking at when they are considering that a patient is I'm ready for driving. So looking specifically at that. So obviously pt right range of motion, strength, coordination, speed of movement. Um Our PTS really look very carefully at that left foot, right, can do they have rapid movements? Can they go from break to accelerator accurately consistently? Um If they can't, then they start looking at okay, the strength and everything and the other foot? Right? Um So the right foot is a really big one, but we do obviously consider controls and and left foot accelerator. Um that progress section and sensation in that lower extremity is a really big one with driving obviously. And we see that a lot with our patients, especially the elderly are stroke Parkinson's that they really they feel like it's on that brake and the accelerator but it oftentimes it's not what slips off. And so that accuracy and speed consistently. So if they do it once or twice, okay, that's great. But when you're driving we have to do that constantly. So the big ones for PT and then that dynamic visual acuity and vestibular system, another really big ones for our Pts that look at that. So dynamic visual acuity, can they keep in focus when they're moving their head? Um super important when we're driving we have to be moving that head all the time and you can really see that with drivers who are uncomfortable and then you can see them just keeping their neck and their heads straight. They are very dangerous on the road. Um And then that dynamic visual security obviously leads a lot into the vestibular system. Um These are our patients who movement is really uncomfortable for them. And at a car you're moving in speed but you also moving separately to your environment. So that's a really big one for PT. Really seeing how they're feeling with that. Are they nauseous? Are they dizzy? A lot of our vestibular patients really get extremely anxious and feel really out of control when they start having those symptoms. So someone like that is probably not ready to drive. So those are really big ones for PT and then of course the multitasking right being able to move that body within, doing a cognitive task, adaptive equipment. You know, our front wheel walkers, wheelchair, single point canes. Um If a patient is using something like that, that's awesome. Doesn't include them from driving but how they're going to store it. So if they're using a wheelchair can they put it in the back of the car and still walk themselves safely to get into the car? Right? So pts like a lot of the transferring and cars looking at storing that equipment. Um And then they really help with what is going to be the right equipment for the patient, right? So if they need that wheelchair, but they can just walk very short distances, okay, can we put the wheelchair in the car and then they've got a cane that works himself around? So important things to be thinking about and fatigue. So the big ones that you're going to see throughout all the disciplines, right? And that really is obviously the multitasking the fatigue. Um fatigue is a really big one. As our speaker yesterday was really talking about the fatigue that she had after a brain injury. Um fatigue is a huge thing we look at with our patients. Um As I said in one of those previous slides, the actual act of driving is the most complicated multitasking thing that we do. So when there is that complexity and all your systems are working, fatigue is an enormous barrier for patients returning to driving. So this is something that all disciplines should be really looking at is the fatigue that a patient is experiencing. And these are again, doesn't mean they can't drive, but it is looking at how they're managing that fatigue. Um And can they drive, you know, five hours somewhere or should they just be going short distances until that fatigue gets better and then what to do if you're not feeling kind of well and if you're feeling really tired, they're making the decision to drive at that point, it's probably not the right decision. So looking at occupational therapy so the same thing, right? Um Range of motion speed, per perception. All of those kinds of things. Um O. T. R. One of our really big areas is vision. So the O. T. Um And again I'm speaking from my kind of team but oh t. That's really a big one is the vision. So to determine early on what the vision deficits are that the patient has um you know looking at that contrast sensitivity, their color, um that visual processing, looking at all of those kinds of things and then obviously the field deficits right. Really big one. Those field deficits um in California in the state of California, a patient can drive even with a harmonic a semi anoxia in other states. As soon as a patient actually gets that diagnosis, they are totally they license gets revoked. So again it's looking into your state and seeing what your DMV guidelines are. But in California you actually only have to have one healthy i to drive and having field deficits does not include you but you have to have good um um strategies obviously so a patient who has those vision deficits typically the D. M. V. Is going to want to see an occupational therapy evaluation or a optometrist ophthalmologist report to make sure that yes this patient has a deficit but they're able to still drive. So vision is a big one for O. T. Um And then obviously teaching them strategies if they do have visual problems then teaching them strategies um and how to overcome that. Um I actually a patient right now who were trying to train and it is it's a having that deficit. You know the name anoxia is really a very uncomfortable situation for patients. Um and putting them behind a car behind the wheel, things are happening at such a speed that it takes a lot of training and experience for those patients to be comfortable behind the wheel and then ot cognition is a really big one, and we look at it with the home skills and community skills and I'm actually gonna talk a little bit more about that a little later, so I'm going to touch on that for a minute. Um, so looking at our patients, right, if they need to be able to manage themselves at home and in the community safely and without any help, right? So we've got to think about, okay, if they're not able to be at home alone and they're not really managing themselves super well, then they're definitely not ready for driving. So looking at the safety at home, the cognition with home skills and community skills really important. And obviously pt and speech look at that is to emotion control is the one that I don't think that that's kind of things that that in fact, even when I started during this career, it wasn't really something I looked at a lot of until I actually started driving, and I've had a couple of patients that I've had to stop them driving because managing that frustration, right? So when you're behind the wheel, it's not just you driving, but it's anticipating everybody else and being okay, that someone's going to catch you off. So I've had a couple of patients that we've actually had to stop driving because they were not able to actually manage that frustration, that they were becoming dangerous behind the wheel. So looking at that is a really big one, and oftentimes that emotion control is tied in with fatigue. So the patient is just getting tired and that brain is overloaded All the amount of um multitasking that they're having to do. So a really big one. And something to really look at is emotion control. Like I said, speed of movement, obviously adaptation, the equipment that they need, whether they've got, you know, a sling, whether there's an embracing on the hands, any equipment like that obviously and then like I said safety fatigue, right, A really big one, We've got to look at speech therapy. Um Hearing is a big one, especially with our older population and are a lot of our brain injuries have hearing problems, right? Um Do they need hearing aids? Super important. Um They actually are really determining that this is one of the biggest reasons why a lot of our elderly population is actually having accidents because they're not hearing what's going on around them, so they're not hearing somebody, you know hooting at them, they're not hearing, you know, the emergency vehicles coming past them. So I'm able to hear people in the car giving directions. So hearing is a big one for speech therapy for sure. And then here it is with speech all of our cognitive stuff that they're looking at, right, that multitasking attention, that's you know, being able to divide it very quickly and to sustain attention for a long time on a task following instructions, Memory, fatigue, new learning. New learning is a big one. Um A lot of patients again was right how they say, but I've been doing this forever. I don't have to learn anything new. They do have to learn either they've got some new medical change, the disability that they're now having or they're just getting old and now they've got to learn how to do things a little bit differently. So new learning is important, obviously emotion control and problem solving. So those are really looking at um discipline specific skills for driving and obviously like we say there's a lot of kind of crossover between all of those. So when do you know that your patient is ready to drive? Right, so drive a readiness. Um We actually created this. So I work at scripts Encinas Hospital um like dr jennifer was saying and we have a full day brain injury program um full program. It's like full day I think I said that full day brain injury program um and it's Ot pt speech and of course everyone comes into the program. First thing they want to know is when they're going back to work and when they're driving. So we created this because it's hard to tell a patient. Um Oh well, you know when your problem solving skills are good enough and when your safety is good enough. Well when is that? Right? So being able to make it very concrete for patients to be able to know when am I ready. So these types of patients here, I'm speaking about specifically ones who have now gone through the whole acute care, right? They've gone through acute rehab and now they're coming in today programs. I'm going to talk a little bit about community people coming in but I'm speaking specifically here with people with injuries. Um so I put your model, I'm not sure. I'm so I made notes. I may not modified independent. It just means that you are doing things totally independently by yourself. But you are using some strategies whether it is using your phone to take notes or whether using a GPS system. So it's just doing or just generally a little bit slower to do things. So they're not doing it the way they used to do it. So that's why we call it modified independent when I was going through this last night is like I probably should have changed all of that. But um our program to back up here a minute. Um the hospital um is actually right across the wave. It's a very busy road our patients have to cross and then we have a whole shopping center. So when we say mod I to emulate the patient actually has to leave the hospital ambulance to the shopping center, sharp for certain items and return. So basically means that it's a concrete skill that shows us this patient can be in the community by themselves without assistance. They can cross a busy road by themselves. So visually they're good. They're scanning and they can problem solve themselves in the community. So that's one of our things we look at. And then we say here, plan sharp fel and cook with modified independence. So again, in our program trying to figure out skills right that they can achieve. We use cooking a lot right to to notice. Of course we like what they could cause we all enjoy a good cookie here and there. But it is also just if you are able to plan a meal, figure out what you need, walk across the road, get what you need, come back, cook it. Um, it's typically in a busy environment because hospitals are always busy. Lots of patients that they are cooking at with safety following a recipe not burning the hospital down. I'm not burning themselves down, cleaning up. So that again, when you're looking at all those skills, those are all basic skills that we need to drive the planning the organization, um, they've been able to complete a task, all of this, the attention all of that is skills to drive home alone. Like I spoke to a little bit earlier with occupational therapy, Home alone is a safety thing. So, and this we don't just look at if a patient says, oh yeah, I'm fine to be a home, it's really comes into the family. So if the family does not have concerns with the patient being home alone, they're not going to run away, get lost in the community, they're not going to burn the house down. So these are basic skills, right? But again, it shows a level of um, of cognitive abilities when we're thinking about driving, managing medications and appointments, right? Um, that's a big one. So if we're thinking that driving is the highest skill of independence that we need. But if you're not able to manage your basic medications and making a doctor's appointment right, there's a disconnect. So whether they're managing medications using a pill box, but again, if you think about the skills that are needed to know, okay, I only have a weeks left. I need a call to to um what are some more medication they're taking it at the right time of the day. So managing medication requires an enormous amount of cognitive abilities and then making an appointment. These patients are not driving. So when they making a doctor's appointment that they have to now not only make the appointment, but now, you know, converse with the person who is going to be taking them and organizing that. So a lot of organization, a lot of planning, a lot of executive functioning goes into that. And then again, this is just what we created in our program, making sure that the vestibular system is okay, bye Petey and visual and tax system. So and when we say visually intact, that basically means that the acuity is is good for driving that they've seen an optometrist at least to make sure that everything is good, that the color is good that we've checked the visual, the peripheral fields. So if you are in a program and I know we have some therapists on the on the conference, this is a very helpful thing and it has helped a lot of conversations that we have around driving. I can assure you we talk enormously about driving. We write without brain injury population. It is um, this is a really nice concrete thing to have for patients and we actually have a whole checklist that we actually go through with the patients. Um But they can check off what they've achieved and what they still need to work on. So I would really recommend doing something like this to make it very concrete for patients. So now when we're thinking about that those are kind of our patients that come through the hospital. We do a lot of our patients, but anybody in a hospital setting now when we're looking at patients that come in from the community for driving, common signs that driving needs to be evaluated is getting lost, whether they're getting lost within the home community environment, whether they're driving and getting lost. Um I've had a couple of patients that family members have asked me to do evaluations on because they have accidentally got on the freeway and driven all the way down to the border and not been able to get themselves out of that. So they get on the freeway and they can't problem solves how to get themselves off. So getting lust is a really big one that perhaps it's time to get that evaluated. Having a lot of falls is another big one, right? So patients at home, we're having frequent falls, scratches and dents on a car. It if you is um, it is really interesting to see patients and obviously I'm talking about kind of maybe the elderly population or even, you know, younger brain injuries that have just gone back to driving. It is interesting to have a look at their car because, you know, getting into that parking lot may just be a little bit harder. Right? So they're scratching it, getting into their own garage, just being able to, to problem solve. The special is really interesting. So lots of little scratches and dents on the car. So that can really be a huge towel sign that perhaps it's time. And these patients are interesting because when you ask them about it, obviously it's always somebody else's fault. Right? Well, you know, that car was too close so they didn't see me. So, always a good thing to look at somebody's car. And then here are we talking about, I mentioned before about the medications, the finances. This is a big one when you start seeing that the family is taking over medications, finances, making appointments. So when the family is doing those kinds of things, that's a really big sign as well that potentially it's time to be evaluated. Um, it's something I look at a lot when I get um patients from the community and, and even in hospital, I have um, some questionnaires that I need the patient to fill in. Just general stuff about how they're doing. And there's a little box at the bottom that I ask who filled this in. And it's always telling when it is typically, you know the spouse that's making the appointment, the spouse brings them there, they're doing the finances. So that is again if you and I mean I'm not talking about managing big investments just day to day find, you know day to day finances, day to day medications and an appointment. There's another big sign memory issues of course that all leads into that and in frustration and emotion control that can again that's a really big one for driving. So they're getting super frustrated. That is really something to you can be a frustrating place. Uh Oh sorry I think I went to sorry let me go here. So important things to consider and this is definitely something that I'm looking at. But also obviously from the, you know from that this is kind of more from the physician side of it too is the medications that they're on, a really big one to think about, right? So here's some of the side effects. Obviously I'm sure you all well aware of those of the impact on driving. Um really important of when they're taking it, how much they're taking, what are their own um what are they feeling from it? It's really interesting when I talk to the Parkinson's patients and they can tell me exactly how they're feeling right. Well I don't feel so good afterwards or just before I get really shaky. So those are great conversations to have again, it doesn't stop them from driving. But if the patient cognitively is able to know that that's not that two hours before my medication, that is not a good time for me to be driving. So really important that the patient understands that. And I actually talk a lot to the doctors about this. If I'm seeing medications that I'm a little worried about, um I will talk to the doctors about kind of looking at that a little bit and then obviously seizures, seizures is a really big one, and seizure actually comes under the whole loss of consciousness. So when you're looking at the D. M. V. Website, it doesn't necessarily talk specifically. You kind of, it's a, it's a complicated website some time to really find the information, but seizures really fall under the loss of consciousness. Um and in California, again, we have, there's actually probation kind of licenses that they put patients on, depending on how long um that they haven't had seizures for. So it's the type obviously of seizure, you know, what brings it on would manifest. It's how long it's been since the last one. Whether they're on medication, whether they're not, so seizures is a really big one for, I'm considering what's driving. Um, big one here in California right now is cannabis, right? So in California, again, it is legal to, to have cannabis in the driving world. It is really, there's a lot of kind of work going on about this to try and determine how much is enough, how much is too much. So, this is something that we really do have to look at as well. So, the risks obviously with cannabis is actually the uncertain variability and dosage. So this can totally, you know, um, depend on the time of day they're having it, how big the patient is, right, what they eat and whatever it is. So there's a lot of variability in that dosage overdose due to the delayed onset and specifically edibles. This is something that they really seeing in the driving world that people you know have inedible and they feel absolutely fine, get behind the wheel and an hour later they are not doing well. So cannabis is something we really do have to look with our patients and what it does for our driving is it slows our reaction time, increases distractibility, decreased visual spatial skills, poor decision and replanning. So some really big concerns with and we're thinking about driving and you know, I hear it all the time, especially the younger population, you know like they, a lot of our younger people are taking cannabis and driving and thinking it's fine. They kind of, I think it's been so ingrained in us that drinking and driving isn't okay but taking you know taking you know smoking is fine. So that's something we really need to look at it in in California right now. Specifically this has been a hot topic and then obviously it goes without saying, you know and we're now drinking and and doing cannabis so who can benefit from a driving evaluation truly anybody. I mean these are all the diagnoses that we do see um in our program but really you don't have to have a diagnosis, right? It's really anybody that's just concerned with their loved one driving, right? Um Like I say all of these diagnoses here really do need to be evaluated for driving. But we do also see um like I say community patients just coming in because their family is concerned um To back up a little bit. I should have explained this in the beginning. We are and I should I think most driving programs do see patients as inpatient outpatient. Um Not so much in patient, I've seen one or two impatient but typically are patient and then community. So the community referrals that come in. So truly anybody that has whether they've had an injury um or just concerned about driving. So in California the requirements for us to do an evaluation we do need a doctor's referral only because I work in a hospital. If you are in a private practice you do not need a doctor's referral. And then obviously we have to have an active driver's license um or permit. So if a patient has already been reported to the D. M. V. And I'm going to talk a little bit about the D. M. V. A little bit later but we can actually apply for a permit for them. Which honestly we are having a little bit more trouble with getting through the D. M. V. And this is just our referral process from you know from California. It's just either internal from our epic referrals and obviously just faxing in. So just some information there. So our driving evaluation is actually three our evaluation. So we break it up into two portions are first portion of what we call the clinic and that is where we are looking at all the skills that you need to safely drive. So there's a whole list of them there. This is all the stuff that we um are looking at. We are very lucky to have a simulator. I'm actually gonna show it to you. It's a brand new one that we've we've had our old one for many many years. It was top of the line at the time but we have now just got a new one that should be coming in with the next week or so. So we're very lucky to have that. It gives us a huge amount of information about a patient. It's just far more real life in driving. Um But obviously there's there's a lot we when we're looking at our younger patients right, are great because they're very used to computer games and they used to technology are older patients. We have to be a little bit more careful about not if it gives us a lot of information but it is much harder obviously for our older patients to jump them on a simulator. But it does give a lot of information just above that brake accelerator, looking at impairments that need adaptations. Really awesome clinic portion everything is standardized. It is a totally objective evaluation. Um It is all research based. So if a patient is failing that clinic, then they do not get in the road in the car with us. We have again, we have beautiful, amazing equipment and we are very lucky to have a brand spanking new car with dual controls. The only thing I don't have is a steering wheel, but I do have a brake and accelerator, but we do not get, if a patient is failing the clinic, if they do not have the skills to get behind the wheel, then um, we don't get them in the car. And again, we're very careful with that because I always air on if there, I always try and give them the opportunity of getting in the car because oftentimes patients do much better in the real life situation. But if that clinic is just terrible and they're horrendously failing that I'm not getting in the car with them. Um, we do have adaptations in our cars, so we have a lot of hand controls. We do have left foot accelerator. So we do what we call low tech adaptations. There are programs that do more the high tech stuff. They are the ones who doing the vans, adaptations with wheelchair spinal cord injury. We don't do that, we just do the low tech. So here is our fancy car. We are very lucky to have that car. So here is our new simulator. I'm going to show you a quick little video. It's just a couple of minutes for this new simulator. The technology is pretty amazing. Um, is this sound Oh, there is hope there isn't. Oh sorry, the original had audio. Um, so just a couple just things that you can do on these simulators nowadays are pretty amazing. And then this one does have the option of doing that. You can actually place adaptations on the simulator so that you can start training with the patient um in the simulator as well so you can attach hand controls. So this is our new simulator that hopefully is coming soon there. You can see him with his hand controls over there. So he's using a brake and accelerator with his left hand. All right, I'm gonna move on if there's no sound on that one. So what are some of the outcomes of our evaluation and all evaluations? So obviously the one everybody wants is passed with no restrictions. Right. So everybody wants that. Um our next one that we have is that we pass but you have some restrictions. So when we're looking at night driving there's actually three components to that. We're looking at obviously that contrast sensitivity being able to see in low lighting, we're looking at reaction time and we're looking at depth perception. So when a patient has all those three issues, night driving is not um, it's not a good place for them to be. Um, and there's no freeway driving. So this freeway is a whole different ballgame as I'm sure everybody knows. And again, just looking at the amount of speed, some, some states have much quieter freeways here where we live and where our program is located. We we have a significant freeways. So that is something to really consider. And then we have the patients who need training. So whether they have controls, hand controls, foot controls, that those take a significant amount of training behind the wheel. And also just our patients who you know, have had an injury a long time ago and now they are finally ready to drive. So sometimes patients just need just a couple of sessions behind the wheel to get more comfortable and then passed in restricted areas. And those of our elderly patients fail, they need to continue therapy and come back to the evaluation and then some of our really older right dementia alzheimer's that they really are just driving is not in their future, this is just the cost. Unfortunately, no driving is in California, Driving is not covered by insurance. Medicaid is not demand a necessity to drive. So the only um the only insurance companies that do cover driving in California is worker's comp and active duty. So D. M. V. Reporting, I'm going to go through this quickly. This is a big one. Patients get very upset when they get reported. Um We, it is a legal requirement that we report patients again. I'm only talking for, you know, for California, the health and safety code states to the doctors insurgents to report any person that has a condition that may affect someone's cognitive physical ability to operate a motor vehicle safely. Well what is that? Right? So looking at what medical conditions cause that you know cognitive and physical impairment. And this is what the D. M. V. Is expecting us to be reporting. So I hear a lot of some of our doctors will say well they had a stroke but there is no loss of consciousness. So we don't need to report them. And looking at a stroke and loss of consciousness are actually two entirely different reportable diagnoses. So this is in the in the state of California. These are the things that we do need to be reporting. And I think these people, you know I have doctors talk to me about this. I patients talk to me about this. Why do we need to report them? Right. Why should we be reporting? Well, two reasons because it is our, you know, it is actually, it's not the it's the physician, so it's the doctors who are actually are legally required in California. Um therapists were only very strongly obviously recommend to doctors and and a patient can self report themselves as well, but so it is the right thing to do. It is the legal thing to do. Um and it was also just our responsibility. So when we're looking at these patients, how do we determine that they really safe to drive without honestly putting them behind the wheel? So I think it is really part of our responsibility to look at that. Um and it's public safety. So here we are sending these patients out into the world with potentially that they could be doing some damage. So it is really our it is our responsibility to do that. Um There are this is again this is California. There are two again is going to go through this very quickly. We have the way that it actually works is these are two forms that are found on obviously D. M. V. On websites. Um And that first one is really just one little page and that is letting the D. M. V. No that this driver has had a change in medical condition. And I think when patients here they've been reported I think the word reporting is probably not a good works. It sounds punitive and it's not it's just the D. M. V. Is the body who decides whether we drive or not. So it's just letting them know hey this person has had a change in medical condition and they need to be examined. So that's the first one that comes in. That second one that medical evaluate the driver medical evaluation is a five page medical document that the D. M. V. Is going to require from the doctor. And again that is just letting the D. M. V. No. So they all that they know is that patients had a medical condition change. Now this form is letting them know what exactly has happened. What medications are they on? R their visual changes have they had seizures. So that's that second form. So once the patient has been reported to the D. M. V. They will receive that five page dr and medical evaluation that comes to the patient. Um And the patient is actually given a date that that has got to be returned to the D. M. V. If it is not returned within that time they will suspend their license because all the DMV noses that basically this patient has had a change in medical condition and potentially they're driving around being dangerous on the road once that has been returned to them. Um They do want to do a zoom interview. They do do a little written test that actually show different road signs and the patient has to answer those. They do just a general I. Chart and then they do typically want to drive with the D. M. V. But they're doing very quick drives. They're not doing a thorough drive. They're not obviously they don't have any medical background to really understand what is happening with these patients. So D. M. V. Is ultimately the decision maker whether a person holds a valid driver's license or not. So where do we come into all this? Right. It is very hard for a physician to say yes you can drive. No you can't drive when truly Right. Unfortunately we don't have a huge amount of time with patients. So we come into that to be able to help really. The doctor. No okay this patient is safe to drive or no, they're not safe to drive. So that's kind of where we come into the hole um situation. But um yes, so that is the end of it. Um And um thank you for having me. I think I've got five minutes here for questions. Um Just some of my references. Thank you. Megan. Um There is a question about reporting. Um So I I was just coming from a therapist uh says that I have so many patients who want to drive again after tv. I they disclosed that they lost consciousness during their to be, but no one reported it to the DMV. So um what do you recommend that that I as a therapist do at that point regarding reporting it to the DMV? So what is the responsibility of uh the therapist that Absolutely. So A. T. B. I. And loss of consciousness firstly are two different they both reportable to to the D. M. V. Right? Um And that is often like I said that loss of consciousness does get a little bit complicated if you're not in California, if you're in another state, I would very much encourage you to go onto your web site um and see what their regulations are with lots of consciousness As a therapist we are not legally mandate, again in California we are not legally mandated to report. Um But I would very strongly recommend that they they have to be reported to the D. M. V. So whether you encourage the doctor to do it or you actually encourage the patient to do it themselves. So what is the benefit of that basically it is legally clearing their name. So from there on out the injury is not going to have any impact on any future accidents. If they're not cleared by the D. M. V. And they have an accident the lawyers on the other side. Typically we've had to tap into a lot of patients that the lawyer from the other side is found out they've had an injury they didn't get reported. They weren't cleared by the D. M. V. So naturally it must be their fault. So it clears the patient their name basically that they the injury was not they were not at fault for this accident because of their injuries. So to answer your question I would very strongly recommend that the doctor you can definitely get the doctor to report or the patient can self report themselves. So just uh in that vein um for the therapist, um don't assume that the doctor taking care of them on the outpatient knows everything that's gone on during their in patients day and whether or not they were reported. Um So uh you know, oftentimes I know from the rehab side, we're sending them to physicians that had no involvement in their care before discharge. So um if you see something like that, certainly contact the physician that's caring for them at that time, they may not even be aware of it, don't just assume that they already cleared the patient. Absolutely, and I think it's definitely, I know in California we're seeing an increase in patients that have been reported, which is fantastic. I know a lot of hospitals now as patients come in to er I see you that automatically they're getting reported. Which is it Is that that is the correct way. But I think you're absolutely right. Doctor Jeffrey. I think a lot of doctors are right there just trying to save the patient's life. They're not thinking about driving so oftentimes when a patient comes to you you are the first person that is kind of even looking at that as a therapist. So absolutely 100% get the doctors involved. They are you know obviously and I think it's a hard comp the whole D. M. V. Process. I spend a huge amount of my time chatting with the patients and also chatting with doctors. Understanding what is the next step what happens now? So it's a process. But yes it absolutely that get the doctors involved. Um uh we're kind of running out of time. Uh So we do have a few more questions will forward them to you. But just I guess one last question do you require neuropsychological testing prior to completing driving assessments and recommendations? We do not. It's very helpful. It's actually enormously helpful. But no we do not require that at all. But a lot of the patients by the time they got to me do have that um they do have neuropsychological testing. So but no we don't require it. Mhm. Well thank you very much again Megan. Um And uh we'll forward the other questions to you if you could kindly answer them and we'll get them get those responses back. Of course. Thank you for having me. Thank you.
