Frequently Asked Questions

Although screens and assessments are often used interchangeably, there are important distinctions.

A screen is a process or test to identify the possible presence of an as-yet-undiagnosed health or safety risk in an individual. Screens are usually short in duration. In driving, a screen is used to identify individuals who have a higher probability of being an unsafe driver for further investigation and/or intervention. There are screens that look at different aspects of driving: cognitive, motor and sensory.

An assessment is a more comprehensive analysis or evaluation of a condition to facilitate a diagnosis and treatment plan. In driving, an assessment is used to determine if an individual has the functional abilities needed to be a safe driver. An assessment provides information that can be used to determine the most appropriate intervention for a specific driver.

Driving is a complex activity. It requires a combination of cognitive, motor and sensory functional abilities to work together.

Cognitive abilities include the thinking related to driving, it’s what happens in your brain:

• Process what you see and hear
• Decide on what action to take based on that interpretation
• Make that action happen effectively

Motor abilities include the physical part of driving:

• Operating the controls such as foot pedals, steering wheel and gear shift
• Moving your neck through a range of motion to allow you to see what’s around you
• Conducting shoulder checks to see what is behind you

Sensory abilities include:

• Seeing what is happening around you which requires good vision acuity and field of vision
• Feeling the controls such as foot pedals so that the appropriate amount of pressure can be applied
• Though not required to be able to drive, hearing can help you know what is happening around you

Driver fitness is the ability to perform all these functions in a way that allows you to operate a vehicle in a safe manner.

Any medical condition or injury that affects the three functional abilities (Cognitive, Motor and Sensory) related to driving can impact the ability to drive safely. Here are some common medical conditions and injuries known to impact a driver’s ability to drive safely:

• Dementia (e.g. Alzheimer’s Disease)
• Stroke with residual cognitive, motor or sensory defects
• Multiple Sclerosis (MS)
• Parkinson’s Disease
• Head injury including concussion
• Diabetes
• Epilepsy
• Anxiety disorder
• Post traumatic stress disorder
• Amputation or loss of limb
• Heart Disease
• Lung Disease

If you have any of these conditions it does not necessarily mean you have to give up driving. For some progressive conditions such as Alzheimer’s Disease driving cessation is an eventual reality. But for others, there are adaptations that can help a driver maintain their ability to drive safely.

For some medical conditions, the effect on driving is obvious. If you have lost a limb or the use of a limb the impact is evident and immediate. However, with conditions that cause cognitive impairment, the impact is not always so straightforward. Even mild cognitive impairment can affect the ability to drive safely. And mild cognitive impairment is not easy to diagnose.

The best way to determine if someone’s driving is affected by a medical condition or injury is through a functional assessment of those abilities. Though it might seem that an on-road evaluation would be best, this is not always the case, particularly with cognitive impairments. Road conditions and traffic volumes can affect the sensitivity of a regular on-road evaluation to effectively assess cognitive functional abilities. Choosing which assessment is appropriate for specific conditions is best done through consultation with a health professional. If you have a concern or question, give us a call 1-888-475-4666 or contact us.

People recover from medical events and injuries at different rates. When to return to driving will depend on if your functional abilities related to driving are affected. To be a safe driver you need the following abilities working together effectively:

Cognitive abilities include the thinking related to driving, it’s what happens in your brain:

• Process what you see and hear
• Decide on what action to take based on that interpretation
• Make that action happen effectively
• Pay attention to many things at once
• Control feelings in stressful situations
• Be realistic about your abilities and limitations

Motor abilities include the physical part of driving:

• Operating the controls such as foot pedals, steering wheel and gear shift
• Moving your body through a range of motion to allow you to see what’s around you
• Conducting shoulder checks to see what is behind you
• Coordination to steer, accelerate and brake smoothly

Sensory abilities include:

• Seeing what is happening around you which requires good vision acuity and peripheral vision
• Feeling the controls such as foot pedals so that the appropriate amount of pressure can be applied
• Though not required to be able to drive, hearing can help you know what is happening around you

Contact us for your confidential DriveFIT Evaluation to see if you are ready to return to driving.

Yes. There is one screen specific to driving, the SIMARD-MD. It looks at the cognitive or thinking abilities related to driving. For motor and sensory abilities, general screens for those can be used to determine if the requirements for driving are met, for example range of motion screening or field of vision testing.

A MoCA is the Montreal Cognitive Assessment and is a screen used to detect cognitive impairment. It is not a screen specific to driving. However, if you score below the range of normal your ability to drive should be evaluated. Note that the MoCA is only a screen and not an accurate reflection of a person's abiity to drive. The score can be affected by age and level of education.

The MMSE is the Mini-Mental Status Exam. It is used to screen for cognitive impairment. It does not correlate well with driving abilities. You can score in the normal range on an MMSE even when your cognitive abilities related to driving are impaired. If you score below the range of normal, your driving should be evaluated to determine if you need to stop driving.

Any substance that affects your brain, has the potential to impact your ability to drive. It's the THC in cannabis that gives you the feeling of being 'high'. And not enough studies have been done to know much about the levels of THC and driving. We do know that the effects on driving do last longer than the 'high' feeling. So don't think because you don't feel 'high' you're ok to drive. It is recommended to not drive for at least 6 hours after smoking marijuana and even longer after ingesting it.

There are two active ingredients in mariuana: CBD and THC. CBD does not affect your brain and so has no impact on your ability to drive safely. THC affects your brain and does have an impact on your driving abilities. If your medical marijuana has TCH, talk to your health professional to see if there is enough THC to impact your driving.

The Insight Post-Crash Anxiety Screen is an online screen used to identify and monitor symptoms related to anxiety and stress for motor vehicle crash survivors. It is a battery of evidence-based screens, each commonly used by mental health professionals. The Insight PCAS helps to support early intervention and ensure that treatment is helpful.

Contact us to learn more about post-crash screening.

The underlying cause of driver anxiety varies. A common cause is as a response to being involved in, or witnessing a motor vehicle crash or near crash. It can also be caused by other trauma or other disorders that cause panic attacks e.g. fear of losing control or being long distances away from home. Or the cause might not be so obvious.

Post-crash anxiety, including the feeling of fear and stress, Is a normal reaction to an unexpected event. For some crash survivors the symptoms begin to subside within a few weeks. But for many, the symptoms persist and without any intervention can develop into a chronic disorder like Post Traumatic Stress Disorder (PTSD).

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children (less than 6 years of age), these symptoms can include:

• Wetting the bed after having learned to use the toilet
• Forgetting how to or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult

Older children and teens are more likely to show symptoms similar to those seen in adults. They may also develop disruptive, disrespectful, or destructive behaviors. Older children and teens may feel guilty for not preventing injury or deaths. They may also have thoughts of revenge.

Though it can be hard to take the first step to help yourself, the good news is there are plenty of resources. The Canadian Mental Health Association recommends you take a stepped approach to support. Start with self-help resources like these free online resources:

• Kelty's Key www.keltyskey.com
• Bounce Back www.mindhealthbc.ca/bounceback

Or these evidence-based apps:

• PTSD Coach Canada
• Calm
• Mindshift (for adolescents)

If those don't help you, talk to your doctor about options or seek out a mental health professional like a psychologist or registered clinical counselor.

Other things you can do to help yourself includes:

• Engage in mild physical activity or exercise to help reduce stress
• Set realistic goals for yourself
• Break up large tasks into small ones, set some priorities, and do what you can as you can
• Try to spend time with other people, and confide in a trusted friend or relative. Tell others about things that may trigger symptoms
• Expect your symptoms to improve gradually
• Identify and seek out comforting situations, places, and people

Even though you won't be driving, knowing someone will be evaluating your abilities is stressful. Most people are nervous, we expect it. And we do our best to decrease your stress. But there really is nothing you can do to prepare execpt be as rested as possible. You don't need to read or memorize anything. But do remember to bring glasses if you need them to read and wear comfortable clothing that doesn't restrict your movement.

Contact us if you have any other questions about how to prepare for your evaluation.

It's stressful to anticipate someone is going to watch you drive. Everyone gets nervous. We expect it. And we will do our best to decrease your stress. But because a DriveFit Evaluation is not 'testing' you on your driving skill or understanding of the rules of the road, you don't need to prepare for it. You don't need to read anything or memorize anything. The best thing you can do is to be rested - which is not easy when you're nervous! And if you need glasses to drive, remember them! But some people feel better if they can do something in preparation. If you are one of those, then the best thing to do is to take yourself on your own driving evaluation. Drive on different types of roads - local road, roads in commercial areas and highways. Remember if you do something wrong in this evaluation, we will let you know, provide you with instruction and give you a chance to improve.

Contact us if you have any other questions about how to prepare for your evaluation.

The ICBC Enhanced Road Assessment or ERA is the on-road test used by the British Columbia driver licencing authority, RoadSafetyBC (RSBC). It is conducted by ICBC examiners on behalf of RSBC when RSBC needs it as part of a driver's licence review. The results of an ERA are provided to RSBC and reviewed along with other information in a driver’s file, so RSBC can make a driver licensing decision.

DriveFit is a confidential, private medical driving evaluation conducted by specially training, certified driving instructors to assess a driver’s functional abilities needed to drive safely. It is used by physicians, other healthcare providers, and drivers and their families to make informed decisions related to driving and to determine what, if anything, a driver needs to return to driving after a medical event or injury.

A DriveFIT On-Road Evaluation includes similar activities as the ICBC ERA but the route requirements, scoring and reporting processes are different. The ICBC ERA focuses on the driver’s skill, adherence to rules of the road and requires the driver to conduct some activities to screen cognitive abilities: remembering instructions and reverse route activity.

DriveFit uses a standardized route that includes a scientifically validated cognitive assessment. It does not focus on a driver’s technical driving skill or adherence to rules of the road. The assessor is not looking for minor habitual errors which are commonly made by experienced drivers. They do look for dangerous errors that are specific to functional impairment like drifting out of the lane or inability to effectively control the vehicle. Because the assessor is a certified driving instructor, they will provide instruction to improve driving and teach enhanced driving skills when appropriate. A detailed report is provided that includes findings and recommendations based on the driver’s functional performance and medical history.

Contact us to learn more or if you have any further questions.

A DriveFIT Evaluation has been specically developed to determine if a person has the functional abilities to be a safe driver. There are two DriveFit Evaluations: In-Clinic and On-Road.

In-Clinic: Consists of screens and assessments that identify if there are any risk factors associated with the functional abilities related to driving. If needed, it includes a DriveABLE in-clinic cognitive assessment. It can be used to determine is someone is ready to return to driving.

On-Road: Completed in a vehicle to evaluate real time driving. When needed, it includes a DriveABLE on-road evaluation. In addition, when appropriate, we teach enhanced skills that will help drivers remain safe.

Contact us to learn more or book a DriveFit Evaluation.

DriveABLE is an assessment of the cognitive functional abilities related to driving. It has two parts:

It was developed based on award winning university research and scientific validation. It is currently the most accurate cognitive assessment of driving performance available.

Part I: In-Office Cognitive Assessment (DCAT)

The DCAT is a standardized, objective assessment that includes a battery of six tasks measuring 22 variables relevant to the functional abilities related to driving. Though the interface for the DCAT is a computer touch screen, the driver does not need any computer skills. The scoring includes cut-points that are used to determine if the second part of the assessment, the on-road portion is required.

Part II: On-Road Cognitive Evaluation (DORE)

The DORE is an evidence-based driving evaluation that assesses the cognitive functional abilities related to driving. It uses a standardized road course that is designed to ensure drivers are assessed fairly and accurately.

Contact us to learn more or to book a DriveABLE assessment.

The DCAT (In-Office Cognitive Assessment) takes approximately 60 minutes which allows for practice time and questions prior to starting the assessment.

The DORE (On-Road Cognitive Evaluation) takes approximately 45 minutes.

The DCAT (In-Office Cognitive Assessment) measures the cognitive functional abilities needed to drive. The result is represented by a percentage - the higher the percentage, the more impairment of those functions.

The DORE (On-Road Cognitive Evaluation) assesses the driver’s cognitive functional abilities in real-time driving. The result is either a pass or fail based on the number and type of errors observed. Only errors that are consistent with cognitive impairment are considered in the result.

No, computer skills are not needed to complete this testing. The in-office portion of the assessment is presented on a computer screen with a simple three-button input. All you have to do is touch the screen or press a button.

DriveABLE is the most accurate assessment of the cognitive abilities related to driving. It was developed through years of university-based research and validation. It is highly predictive of actual on-road performance.

In some jurisdictions, DriveABLE is covered by the government or insurance. In British Columbia, DriveABLE is not covered by the Medical Services Plan or RoadSafetyBC and so is considered a fee for service. However, there are cases where the cost of the assessment is covered by insurance agencies e.g ICBC, WSBC.

The DCAT (In-Office Cognitive Assessment) assesses your cognitive or thinking abilities related to driving, not your skills or knowledge of the rules of the road. It includes six tasks that make your brain think the same way it does while driving. it is able to measure if your brain can think in a way that makes you safe to drive.

You should consider your patient’s ability to drive safely if your patient:

• Has a medical condition that could affect cognitive, motor or sensory function including:
  • Alzheimer’s Disease
  • Other Dementias
  • Parkinson’s Disease
  • Alcoholism or other substance abuse
  • Multiple Sclerosis
  • Diabetes
• Has had a medical event like CVA or MI where you suspect or have identified an impairment of their cognitive, motor or sensory functions
• Has an injury that affects cognitive, motor or sensory functions e.g Traumatic brain injury
• Is experiencing any decline in functional abilities related to driving
• Has mental health symptoms which could affect driving competence e.g. depression, anxiety, etc

Contact us to learn more or to refer your patient for a DriveFit Evaluation.

DriveABLE is the only scientifically developed and validated cognitive assessment specific to driving. It can be used to:

• Determine if a patient has the cognitive abilities to drive safely. 
• Support your need to warn a cognitively impaired patient not to drive 
• Monitor patients diagnosed with progress disorders (e.g. Alzheimer’s Disease) to ensure driving cessation happens at an appropriate time. Being proactive will also help your patient, their family and caregivers to manage driving and allow time to prepare for eventually stopping.

Some government driver licensing authorities use DriveABLE to help make driver licensing decisions for those with a cognitive impairment. DriveABLE is a fee for service assessment (see the DriveABLE referral form for information on fees in BC).

The prevalence of psychological distress following a motor vehicle crash is well documented in the research and widely known amongst those working with crash survivors.

Left unmanaged, psychological injuries can have a marked impact on a survivor’s quality of life and can contribute to the development of mental health disorders like post-traumatic stress disorder (PTSD) or Major Depressive Disorder (MDD), or exacerbate negative outcomes such as social disengagement.

Psychological injuries are often overlooked or not addressed. This can be due to the focus on physical injuries, fear of malingering or the stigma placed on mental health that prevents patients from self-reporting symptoms. Poor management can lead to a more difficult and prolonged recovery period.

The Insight Post-Crash Anxiety Screen can be used to identify symptoms and through it’s comparative reporting feature, monitor your patient through the recovery period and identify any latent onset of symptoms. This will help support timely interventions which is a factor in preventing a prolonged recovery

Most people depend on being able to drive to participate in many activities in their lives. Not being able to drive can result in health issues from the emotional stress, loss of independence, and financial consequences. And if your patient is an unsafe driver, it puts all other road users at risk. Therefore, determining the impact a medical condition or injury has on your patient’s ability to drive is important to your patient’s overall health and to the public’s safety.

There are a few situations you, as a health professional, could be faced with related to driving:

1. Your patient has a medical condition or injury that you:
   • Think could affect driver safety but you are not certain
   • Know will eventually affect their ability to drive
   • Know has affected their functional abilities to drive
2. A family member or caregiver has reported to you a concern about your patient’s driving
3. Your patient has recovered from a medical event or injury and you would to find out if they're ready to return to driving.

If you aren’t sure if a medical condition or injury is affecting your patient’s ability to drive then screening and assessments specific to driving could help make that determination. Some of these are specific to certain functions e.g SIMARD-MD and DriveABLE for cognitive functions related to driving, and others look at all the functions like a full functional driving assessment or on-road functional evaluation.

If you know your patient’s medical condition will eventually affect their driving then monitoring their driving through regular screening and assessment will help you determine when their driving becomes affected. In some jurisdictions it is mandatory for some health professionals e.g physicians to report certain medical conditions that are known to affect driving abilities. However, any health professional can report a patient they know or suspect is unsafe to drive. It’s the driver licensing authorities responsibility to make the definitive determination of whether a driver’s licence needs to be revoked, not the health professional.

If you know or suspect your patient’s functional abilities to drive are permanently affected either from results of driving assessments or your patient’s medical status, then you should warn your patient not to drive and report your patient to the driver licensing authority. If the medical condition affecting your patient’s functional abilities is temporary e.g. recovering from surgery or a medical event where recovery is expected, then you might not need to report to the driver licensing authority. Refer to the regulation in your jurisdiction to determine what needs to be reported.

According to the Canadian Medical Association's Driver's Guide (9th Edition):

Physicians have a statutory duty to report patients whom they believe to be unfit to
drive to the relevant provincial or territorial motor vehicle licensing authority. This duty
may be mandatory or discretionary, depending on the province or territory involved.
This duty to report is owed to the public and supersedes the physician’s private duty
with regard to confidentiality.

In British Columbia, according to Section 230 of the Motor Vehicle Act, reporting is mandatory if in your opinion your patient:

Has a medical condition that makes it dangerous to the patient or to the public for the patient to drive a motor vehicle, and continues to drive a motor vehicle after being warned of the danger.

However, remember that reporting a patient who you are concerned about their ability to drive safely is always permitted in any jurisdiction.

This can be confusing as there is some controversy over which screens to use for cognitive abilities related to driving. There is no paper/pencil screening tool that will tell you definitively if your patient's cognitive abilities are impaired. And no screen should be used alone to make driver fitness determinations.

A screening tool or tools should be used to provide you with some objective information on whether your patient potentially has an impairment of the cognitive abilities related to driving. This can help you determine if further testing is needed e.g. an in-clinic or on-road functional assessment of cognitive abilities related to driving.

It is important that no single screening tool be used to make driver fitness determinations. As with any screen, they should be used, along with other information to identify those who would benefit from further testing or investigations. Most commonly used screens are impacted by education and language and therefor have false positives and false negatives that need to be considered.

Following are commonly used screening tools related to cognitive abilities:

SIMARD-MD

Currently, the SIMARD-MD is the only validated screening tool specific to the cognitive abilities related to driving. There is some controversy related to it's use as since it's release, there have been some studies that question it's validity based on the methodology used. However, the quality and motivation of some of these studies have also been questioned. The bottom line is, if you use it as a screen and not to make driver fitness determinations, it can provide you with some objective information to help determine if further investigation is needed.

MoCA

The Montreal Cognitive Assessment is not validated specifically for driving. A MoCA score within the range of normal does not rule out impairment of the cognitive abilities related to driving. However, if your patient has a MoCA score outside the range of normal it is an indicator for you to consider their ability to drive safely. As with other screens, it should not be used in isolation to determine driver fitness.

MMSE

The Mini-Mental Status Exam has been the main cognitive screen for a long time to identify moderate cognitive impairment. Because it is not sensitive enough to mild impairments where driving can be impacted, it's correlation to driving is poor. However, that does not make it useless - if you are conducting an MMSE for other reasons and have a patient who scores outside the range of normal, driving safety should be questioned.

Trail Making Test A & B

Studies related to the reliability of these tests for driver fitness is somewhat mixed. However most agree that the correlation with driving is not strong and their use is better with healthy patients vs patients with known cognitive impairment. And as with other tools, they can be a useful tool to augment other information but not on it's own.

Clock-Drawing Test

The Clock Drawing Test has shown some correlation with ability to drive safely. It actually requires a high level of brain functioning to draw a clock. Errors can show impairment with visual perception and short term memory which are both important to driving. As with all the screens, it should not be used in isolation but can be an indicator that more investigation is warranted.

According to the Canadian Medical Protection Association:

Legislation provides protection for physicians from civil actions when a report is made in accordance with the legislation and in good faith, but it does not prevent patients from filing a College complaint. It may be helpful for physicians to inform other healthcare providers in the patient’s circle of care. Certainly, physicians should document the steps they have taken.

The Post-Crash Anxiety Screen will provide an independent, objective evaluation of whether or not your client is experiencing post-crash anxiety.

Insight provides screening and assessment services to help determine the impact your client’s injuries has related to driving in a motor vehicle. Anxiety, stress-related disorders and cognitive impairment are invisible injuries that can affect driving a vehicle or riding as a passenger. Left untreated or not treated until late in the recovery process can have a devastating impact on your client’s life.

Insight’s services can help you:

• Identify, document and monitor anxiety and stress-related symptoms your client is suffering from using the Post-Crash Anxiety Screen
• Determine if your client’s cognitive function related to driving has been impacted by their injuries using DriveABLE Cognitive Assessment - the only cognitive assessment specific to driving
• Identify and document your client’s rehabilitation needs related to driving or riding in a motor vehicle.

Psychological trauma is an intangible factor for any person who has been involved in a trauma such as a motor vehicle crash. As a legal professional you have most likely seen the signs of anxiety or heard about the symptoms from your clients. Though it is an expected reaction to trauma (like pain from a physical injury) anxiety and stress can negatively affect your client’s life either temporarily or in some cases permanently if not identified or treated appropriately.

The Post-Crash Anxiety Screen provides you with:

• Documented evidence of your client’s symptoms
• A report for your client’s physician with recommendations related to treatment based on the severity level of the symptoms
• A means to easily monitor your client’s symptoms over time

It is recommended to complete the PCAS as soon as possible after the crash to support early identification and intervention which is a key factor in preventing chronic anxiety and stress-related disorders e.g. Post Traumatic Stress Disorder and Phobia Disorder.

If you have confirmed that your client wants to pursue this injury, you can either have your client take the report to their physician or you can forward the report yourself. It’s important that the physician see this report as a legitimate medical report and not something the client has just found online themselves.

Yes. Insight can produce the metadata if needed.

The services at Insight Driving Solutions can help you:

• Make better hiring decisions by using a leading edge job fit assessment tool that helps you hire the employees that best fit your company
• Decrease risk and reduce costs using our screening, assessment and online training services
• Minimize claim costs, lost productivity and improve your insurance rating using our services that support a successful and sustainable return to work

Contact us to learn more about how Insight Driving Solutions can help your organization better manage driving in your workplace.

Whether a commercial driver or an employee that drives as part of their job, driver selection is important. Driving is one of the most dangerous activities in a workplace. In BC, motor vehicle crashes are the leading cause of traumatic workplace death¹. Yet most employers rely on a resume and driver’s abstract alone to determine driving risk.

Insight Driving Solutions take your hiring process to the next level. Insight uses a leading edge job fit assessment program to:

• Establish customized benchmark based on your organization’s top employees
• Compares job applicants to your organization’s benchmark
• Reveals relevant personality, traits and characteristics
• Evaluates important factors related to driver safety

¹Road Safety At Work