OT Strategies: Using the Driving Pathways by Diagnosis Sheets for OT Practitioners to Increase DCM in Your Own Practice

The Driving Pathways by Diagnosis Sheets for OT Practitioners was developed by American Occupational Therapy Association (AOTA) and Genesis Rehab Services through support from the National Highway Traffic Safety Administration (NHTSA). to be used when developing client specific interventions for driving.

The resources are based on common medical diagnosis groups including arthritis, cardiac conditions, stroke, mild cognitive impairment, Dementia, neurological, orthopedic, and others.

  • They may be used by the OT to help guide assessment & objective measurement selection, clinical reasoning and intervention approaches related to driving while developing and facilitating a plan of care.
  • The Driving Pathways by Diagnosis Sheets include recommendations for treatment interventions, assessment tools, recommendations, considerations, and guidance on when to refer to the DRS.

Here are two examples to highlight the use and application of the Driving Pathways by Diagnosis Sheets.

Nancy is an 86 year old female with rheumatoid arthritis. During her Outpatient OT evaluation, she discloses she is the primary driver in the family. She lives in a rural area with limited other options. She reports that occasionally she has days where her arthritis pain is so great that she has difficulty pressing the brake and gripping the wheel, due to pain in her right knee and hand respectively. She reports that her pain has become increasingly worse during her ‘flare ups’ and when it is especially bad, she won’t drive. She said this is one of the reasons her daughter has temporarily moved in with her so she can do the driving

You, as her OT, reinforce her good judgement with driving self-restrictions. Then, you review the Driving Pathways by Diagnosis Sheet: Arthritis and identify the importance of fully assessing Margaret’s pain, the presence of joint deformities, and their impact on her functional abilities, including driving.

From a treatment intervention perspective, this sheet guides you to expand your review of joint protection technics to address driving related tasks such as gripping the steering wheel and being able to open the gas cap, as well as how to load and unload her personal mobility device from the vehicle.

Here’s another example using the Driving Pathways by Diagnosis Sheets:

Matt is a 46 year old male with a recent right below knee amputation, who is being seen in a post-acute rehab setting. His traumatic (R) BKA was less than a month ago. He has a long road of recovery ahead of him, but he is focused on the big picture items – like returning to driving and work.

While completing his occupational profile, you gain a better understanding of Jason’s passion for driving as well as his knowledge related to the potential use of alternative transportation options, such as shared rides. Jason is still primarily in a wheelchair, has several baseline deficits that need to be addressed first, and you are uncertain what options lie ahead for him with driving without having a right leg.

You review the Driving Pathways by Diagnosis Sheet: Amputation and quickly realize that there could be options for Jason in the future with learning to drive with adaptive driving equipment such as hand controls or a left foot pedal. You 1) identify the importance of ensuring Jason has intact cognition and vision, 2) communicate the safety concern that any future prosthetic should not be used for driving, and 3) prioritize his independence with any mobility device prior to returning to driving.

From a treatment perspective, this sheet guides you to assess and treat for balance, strength, coordination, and tone; address ability to transfer into vehicles as well as load/unloading mobility device, and to ensure endurance for community mobility. This sheet also reminds you of the importance for addressing Matt’s pain with therapy interventions to reduce any medication impact on cognitive performance needed for driving.

Remember it is the role of all OTs to initiate the conversation about D&CM, to assist with identification of appropriate alternative modes of transportation during driving restrictions, and to facilitate appropriate referrals to the DRS and referring physician.

The Driving Pathways by Diagnosis Sheets is a helpful resource available to all OT practitioners. OTs can use this resource to grow their own skill sets and knowledge as they address driving and community mobility goals.


Susie Touchinsky

Susie Touchinsky, OTR/L, SCDCM, CDRS is an occupational therapist and certified driver rehabilitation specialist offering decades of experience, knowledge, and professional support for drivers, families, caregivers, and practitioners.