Safe Driving Requires….

• Memory

• Concentration

• Adequate motor and cognitive response time

• Visual perception, visual processing, and visuospatial skills

• Executive function

• Mental flexibility/multitasking

• Physical strength, coordination, and flexibility

• Adequate hearing

• Adequate vision

• VALID DRIVERS LICENSE

Red Flags for Increased Risk of Unsafe Driving:

►Medical Conditions:

• Dementia

• Hearing Impairment

• Seizures

• Psychosis

• Alcoholism

• Cardiac disease

• Parkinson’s disease

• Diabetes

• Visual Impairment

• Arthritis

• Obstructive Sleep Apnea

• Cerebrovascular disease

Table 1: Examples of medical conditions can adversely affect driving ability:

►Medications:

• Opiates

• Muscle Relaxants

• Hypnotics

• Tricyclic antidepressants

• Antipsychotics

• Antihistamines

• Insulin

• Anticholinergics

• Anticonvulsants

• Antiemetics

• Antihypertensives

• Stimulants

• Glaucoma agents

PEARL: Don’t forget about the dangers of polypharmacy as these classes of medications can have an additive effect on impaired driving ability when combined.

►Review of Systems:

1. General:

   • Weakness, fatigue

2. HEENT:

   • Impaired vision, vertigo, head trauma, hearing loss

3. Respiratory:

   • Shortness of breath, use of oxygen

4. Cardiac:

   • Syncope, palpations, chest pain, dyspnea on exertion

5. Musculoskeletal:

   • Muscle weakness, muscle pain, joint pain, decreased range of motion

6. Neurologic:

   • Dizziness, seizures, focal weakness, tremors, decreased sensation, numbness, memory loss

7. Psychiatric:

   • Depression, anxiety, psychosis, substance abuse

►Concern of impaired driving by "informant" (patient, family member, friend…):

►Hx of traffic crashes, near misses, tickets, and/or episodes of getting lost while driving

►Caregiver’s perception of impaired driving skills

Ask your patient:

1. Do other drivers honk or pass you frequently, even when traffic is moving relatively slow?

2. Do you become nervous or anxious when approaching intersections?

3. Do you arrive at a location and not remember how you got there?

4. Do you notice dents and dings on your vehicle and do not know how they got there?

5. Have you found yourself in more close calls and near misses on the road?

6. Do family or friends comment negatively on your driving habits?

Ask the family/friend:

1. Would you feel safe riding with….?

2. Would you allow your children/pet to ride with ….?

Key Components of Clinical Evaluation:

1. Visual acuity and visual fields

2. Hearing

3. Range of motion:

   • Neck

   • Shoulder

   • Elbow

   • Plantar flexion/dorsiflexion

4. Motor strength:

   • Shoulder adduction, abduction, and flexion

   • Wrist flexion/ extension

   • Hand grip strength

   • Hip flexion and extension

   • Ankle dorsiflexion and plantar flexion

5. Sensory:

   • Light touch

   • Proprioception

6. Rapid Pace Walk:

   • Patient walks 10 feet in one direction, turns around, and walks back to starting place as quickly as possible

   • Scores greater than 9 seconds are abnormal and have been found to have a threefold increased risk of being in an at fault traffic accident

7. Cognitive Screening:

   • Clock Draw: Assess the patients executive skills, attention, abstract thinking, visual perception, visuospatial skills, long term memory, and short term memory

   • Montreal Cognitive Assessment (MOCA): Assess attention, executive function, visualspatial , memory

   • Trails B: Assess working memory, visual processing, visuospatial skills, selected and divided attention, and psychomotor coordination