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Toni Talks about PT Today

Guess Who is Behind the Wheel?

Published June 3, 2008 10:15 AM by Toni Patt

I got a surprise when I went to work the other day. The electric doors were broken. An elderly woman had backed her car into them. I'm not sure how she did it. She would have had to hop a curve, turn 90 degrees and then hit the accelerator while the car was in reverse. Fortunately she was able to drive away and no one else was hurt. The incident brings up something that really worries me. Lots of people are behind the wheel who shouldn't be and nothing is done about it. 

This has me thinking. There can be high costs associated with poor driving: replacement of damaged items, repair or replacement of cars and medical expenses for those involved. Lives can be changed forever by a careless driver. Yet, this is one of those topics that is rarely discussed. PTs don't necessarily have anything to do with driver retraining. My experience is that someone who wants to drive will get behind the wheel as soon as possible. I worked in a neuro OP clinic for awhile. Many of the patients drove themselves to therapy. Most of those scared me to death when I thought about them driving. 

I asked some of those drivers about it. Everyone assured me he or she was being careful. They stressed how they use the uninvolved side and looked in all directions. They swore they didn't speed. Every single one of them swore to me they wouldn't be in an accident. I sort of believe that. But I wonder about all the accidents they cause to the cars around them by their erratic driving. I find it hard to believe someone with neglect is looking in all directions. I don't see how a person lacking sensation can monitor pressure on the gas pedal adequately. Following a brain injury, reflexes are slowed. In the case of an elderly person you have the addition of the normal process of aging. That scared me. Something else scared me more. None of the other therapists were concerned about those people driving. 

Driving represents independence to people. In Houston the only way to get around town is to drive. If you take that ability away, a person is practically homebound. While transportation exists for medical needs, very little is available for errands such as grocery shopping. I had an uncle who continued to drive much longer than he should have. He eventually had an accident that nearly killed him when he fell asleep at the wheel and went off the road into a garage. I don't know which upset me more; my brother returning his keys or the ease with which he was able to purchase another car. He was very lucky. An innocent bystander could have been hurt or killed.  If it happened to him, it is happening to others.

As PTs, we have a responsibility to keep our patients as safe as possible. We work on safety training. We strengthen them to prevent falls. We educate families on making the home safer. Yet, driving is rarely addressed. There are some things we can do, such as alerting the family and/or physician to the situation. We can bring in OT to help. We can work on skills specific to driving. Taking away a license won't work. My uncle didn't have one when he crashed. The biggest thing we can do is be aware this is happening and begin addressing it in treatment plans and discharge planning. The elderly lady was lucky this time. She only hit a door. Next time it might be much worse.


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