Our team of Occupational Therapists planned a Development Day to further develop their skills in using certain standardized assessments and also to explore external services, such as the Disability Living Centre (DLC) and SMART Centre, both these national services are based at the Astley Ainslie Hosptial in Edinburgh.
Disability Living Centre (DLC)
The DLC is a great resource for anyone wishing to seek advice, or trial various pieces of equipment ranging from small handheld items for daily living to more specialist items such as profiling beds, wheelchairs or Closomat hygienic toilets. The DLC is accessible to any healthcare professionals, or members of the public, living anywhere in Scotland, by appointment only. There is a bathroom and kitchen available for carrying out an assessment. Equipment available to trial includes manual, self-propel and powered wheelchairs, stairlifts, mobile hoists, walking aids, seating, beds and various small aids for daily living. Advice is given on how to use the various products, as well as how to source them. The DLC does not supply any products but allows people to trial products before making any purchasing decisions. Regular seminars are held, for anyone to attend, with suppliers demonstrating their products or organisations such as Housing Departments giving information on their services.
Driving Assessment Centre
The SMART Centre manages applications for Blue Badges and all Scottish Driving Assessments.
Blue Badge Scheme – those applicants who are called for assessment would attend at the SMART Centre. Eligibility criteria includes pain, breathlessness and mobility. Blue badges are awarded for 1, 2 or 3 years at a time. A temporary badge for up to 12 months may be awarded, e.g. for someone undergoing cancer treatment. A separate application may be made for a “Risk in Traffic” situation where the applicant needs a sponsor (such as an OT), to give evidence that the person is a risk to either themselves or others. Such circumstances include conditions such as dementia, autism and brain injury.
Referrals are accepted from GPs, Consultants, DVLA and the police and any types of physical or cognitive conditions are assessed. A DVLA document “Assessing Fitness to Drive, a guide for Medical Professionals” gives guidance regarding the protocols for different medical conditions and when the DVLA needs to be notified of changing medical conditions. CLICK HERE FOR MORE DETAILS
The waiting list for driving assessments is currently around 18 weeks. The assessment explores cognitive and physical ability and general safety under various different situations. This takes into account the person’s medical condition and how they cope under stress. The assessment typically lasts around 2 hours. Prior to any formal assessment, eyesight is tested according to the DVLA standard of being able to accurately read a registration plate from 20m away. This must be achieved before any assessment can continue. Visual Impairments assessments include peripheral vision, double vision and bilateral visual tests. Many people adapt well and can accurately compensate for their visual deficit, however, visual neglect results in a complete ban for driving. The first hour of the assessment involves discussion around the medical condition, the persons recovery to date, and includes some cognitive assessment, such as the Montreal Cognitive Assessment (MOCA) which assesses visuospatial and executive functioning, animal naming, attention, language, abstraction, delayed recall (short-term memory) and orientation. “The Rig” is a simulator setup which is used to determine a person’s physical abilities such as reaction times, power, ranges of movement and coordination. Any difficulties identified here can determine whether adaptations are needed, such as hand controls.
The second hour involves driving in a car, first around the hospital grounds, then (if appropriate) in the local area and finally, on the bypass. The assessment cars have dual brake controls so that the assessing OTs can take control if absolutely necessary. The cars are not usually marked with L-plates or as under assessment, to allow for the most normal driving experience for all the road users.
Adaptations for physial impairments can range from using a smaller steering wheel to enable energy conservation for arthritis, using a ‘joystick’ or having button controls on the steering wheel to compensate for reduced range of movement. Generally, physical deficits are easier to accommodate than cognitive deficits. People are always advised to take driving lessons with an approved adapted car instructor, to gain the necessary skills and confidence to start driving under different conditions to what they are probably used to. Also if someone is new to driving with hand controls only, they should always have a driving assessment first to ensure the safety of themselves and other road users. It is the person’s own responsibility to inform the DVLA of any changes to their medical condition and also whether they are now driving an adapted car as this will affect the validity of their driving licence.
Following assessment a person may be deemed safe or not safe to drive – with effect from that very moment and the referrer would be informed.