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"Part of it is giving people enough time to act before we step in."









Driving Ambition

A new occupational therapy program comes to the aid of people who want to stay on the road.

Occupational therapist Annette Lavezza, the prime mover behind the Johns Hopkins Driving Program, wanted an objective way to answer one of her patients' most pressing questions: Can I still drive?
The biggest misconception people hav

Hopping behind the wheel is the American way of life. That little plastic-coated card in your wallet-the one with the bad photo?-is your ticket to ride wherever you want, whenever you want. It means you can live in Carroll County and work at Hopkins Hospital, zip to the store for a gallon of milk, make it to all your kids' games, head to Arizona.

A driver's license is a badge of adulthood that no one surrenders easily.

Yet every year, thousands of formerly competent motorists face the possibility that an illness or injury is going to keep them in the parking lot for good. And it's not only the elderly dealing with hearing and vision impairments or lagging reaction times. People recovering from a stroke, cardiovascular event or serious injury, or coping with neurological or cognitive deficits need help if they hope to get back in the driver's seat.

To Hopkins senior occupational therapist Annette Lavezza, providing that service seemed an obvious add-on for Hopkins' Department of Physical Medicine and Rehabilitation. Only a handful of hospitals around the state offer driver rehab, and growing demand has contributed to appointment backlogs ranging from six weeks to eight months. Furthermore, Lavezza, who specializes in geriatrics and dementia, realized that it wasn't just her own patients who could benefit from having Hopkins OTs evaluate their ability to continue driving. Such a program could serve patients from the low-vision service, the Alzheimer's clinic, neurology and other departments as well.

In February, the project Lavezza's been spearheading for the last five years-called the Johns Hopkins Driving Program-opened at Green Spring Station. Business has been brisk ever since.

Whether they arrive on their own or on the recommendation of a physician, family member or the Motor Vehicle Administration, all clients need a physician referral that includes their current medical status. Lavezza and the two other occupational therapists who staff the program are certified driving instructors with extensive training in evaluating previously licensed drivers with cognitive or physical impairments. (The exception is drivers with spinal cord injuries that require remaining in a wheelchair to operate a van, which the Hopkins program doesn't have.)

The two-part, three-hour assessment can be done in one day. First, there's a detailed clinical exam focused on such factors as cognition, balance, range of motion and visual acuity. Next, clients get a road test to demonstrate their reaction time, depth perception, glare recovery and other abilities.

"Our philosophy," says Lavezza, "is that everyone deserves a chance in the car regardless of their clinical assessment. We start in the parking lot and gradually increase complexity and the amount of traffic. If it's unsafe, we can terminate at any time."

Program manager Traci Archibald specializes in cognitive and visual occupational therapy. Adding rehab driving instruction to her repertoire, she says, taps all the skills she's developed.

The car itself (a sedan provided by Bob Bell Ford at cost) is equipped with both assistive devices-hand controls, left-foot accelerator, spinner knob for one-handed steering-and instructor aids like a training brake and a mirror to keep tabs on what the client's doing visually.

"We sit near the middle of the front seat to reach the steering wheel if we have to," says program director Traci Archibald. "We draw on our clinical experience to make judgments about intervening. Part of it is giving people enough time to act before we step in. But it's also reassuring to know I can control the situation from my side."

The point of including a behind-the-wheel evaluation, says Lavezza, is to help physicians and clients make a well-educated decision about the next step. "Everyone's uncomfortable with an automatic decision that a person can no longer drive, and having an OT assessment takes some of the responsibility from the family and physician. People who are forced to stop driving seem to have much stronger responses. They're devastated. The ones who self-limit have made a cognitive choice."

Still, the primary motivator for clients is to keep their independence. And with the right adaptive equipment and the individualized training to use it, which the Hopkins program provides, many can get back in the driver's seat.

"There definitely is a global picture," says Archibald, "but cognition is the most important factor. Driving is the most difficult activity of daily living, because it incorporates so many components: vision, hearing, reaction time, judgment, memory. Clients who are aware of their limitations are more likely to be able to compensate for them."


The Johns Hopkins Driving Program is located at 10753 Falls Rd. in Lutherville. The initial clinical and driving evaluation is $320; driving training is $80 per hour. Because Medicare and insurance companies do not cover these services, payment is due at the time of the appointment. For more information, call 410-583-2643.



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