Community Mobility

Public Transportation

services operated by public agencies or supported by public funds that are available to anyone

fixed route systems

use defined routes w/ predetermined stops that run on published schedule; most economical and predictable form of public transportation

e.g. bus, subway, train, light rail

Demand Responsive systems

transportation alternatives operated by transit systems for clients who have functional impairments limiting access to regular fixed route services

Transportation provided between specific point of origin and destination requested by traveler and generated by calling transit operator

Key words: requested route; reservations required

Paratransit service

Equivalent service as fixed route transportation but for those who can’t access the fixed route version

offered in form of van, shuttle, or microbus that picks up riders outside of house and transports to specific locations

Curb to Curb Paratransit

passengers picked up and dropped off @ point of origin / destination

Door to Door Paratransit

passengers may be assisted from doorway of point of origin to entrance of destination

Supplemental Transportation Programs

Fill the gap in services for those needing more assistance than paratransit services or are unable to use existing transportation services

Based on 5 As: availability, acceptability, accessibility, adaptability, and affordability

Types of Supplemental Transportation Programs

Door through door - passengers assisted to exit travel point and enter building at destination

arm through arm - passengers physically assisted by drivers to board, disembark, and safely reach destination

Personal Transportation

means of moving in community using one’s body capacity or vehicular/nonvehicular transportation tech, like walking, car, bike, WC, etc.

Commercial Transportation

services operated as for profit enterprises for which people pay privately

e.g. commercial carrier (airline, train), taxis, ride share

ADA

establishes accessibility guidelines for public transit, like WC lifts in buses, ramps around facilities, etc., and established mandate for complementary paratransit services

Safe, Accountable, Flexible, Efficient Transportation Equity Act (SAFETEA)

Funded safe routes to school program to facilitate state initiatives to create safe environments around schools and encourage kids to bike/walk to school

Medicaid

recipients may be eligible for subsidized transportation for health care and life maintenance trips

Evaluation

• gather occupational profile

• cognitive skills

• motor and praxis skills

• sensory perceptual skills

• communication and social skills

• money management

• Contextual considerations

Cognitive skills

• consider transit options

• figure out a route

• calculate time required for travel

• which stop to exit at

• determine departure time to arrive on time

Motor and Praxis Skills

• ability to ambulate to/from pick up location

• step on/off vehicle

• maintain balance while walking on moving vehicle

• postural control for standing/sitting on moving vehicle

Sensory Perceptual Skills

• identify obstacles on public vehicle

• judge spatial relationships to identify seats and stop-request control button

Communication and social skills

• ability to ask for directions and obtain info

Money Management

• have correct fare ready

• use change/ticket machines

• download/use ride share app

Contextual Considerations

• potential barriers (e.g. housing, socioeconomic status, etc.)

• design of streets/community, accessibility of transit systems

• performance must be considered in context, feasibility, and mode of transportation

Intervention - Fixed Route and Paratransit

• orientation to local system

• applying for paratransit services

• training in finding stops or making reservations

• scheduling/time management training

• cushioning/positioning for long trips

• training in transferring from and securing WC or other mobility device

Intervention - Taxi/Ride Share service

• practice using computer or phone to make appt, set up payment, track progress of vehicle

• transfer training from and securing a WC or other mobility device

Intervention - Personal Transportation

• understanding and following rules of road

• ensuring safety

• ensuring appropriate endurance for walking or other physical demands

Intervention - children + families

• WC users: vehicle constraints, passenger safety, school bus transportation

• Sensory processing disorder: adapting to community mobility challenges, occupational analysis of intersection between mobility and sensory processing, caregiver education/support

• NICU: car seats, parent education

Interventions - older adults

• dementia: driving cessation, community mobility alternatives, family/caregiver education

• healthy community dwelling adults: maintain driving fitness, personal safety, age related changes in function, education on community mobility options

• driving cessation: travel training, psychosocial support, community mobility alternatives

Hierarchy of Driving Behavior

• Strategic Behavior - goal decisions before or during driving; occurs in minutes to hours

• tactical behaviors - conscious decisions made while operating vehicle; occur in seconds to minutes

• operational behaviors - subconscious and occur in seconds (e.g. stay in lane)

Visual Skills

• Acuity - pts w/ vision worse than 20/40 should be referred to vision specialist

• ocular motor skills - fixation (holding eyes steady), saccades (change visual targets), and pursuits (following moving targets)

• Visual field - able to see side when looking straight ahead

• contrast sensitivity - distinguishing between stimuli

Visual Perception

• ability to see, evaluate, and respond to surroundings while driving

• filling in blanks when part of environment is occluded

• know where they are relative to other drivers and items in environment (visual closure, spatial skills)

Cognition

• road sign recognition

• dual task driving

• way finding

• distractions

• deficits in attention, processing speed, memory, and executive functioning call for driving cessation

Motor skills

• Strength/ROM

• endurance/balance

• manual dexterity

Evaluation / Common Screening Tools

• general assessment of driving related skills

• driving health inventory

• OT-DRIVE - presents spectrum of decision indicators for driving and community mobility

• MVPT for visual perception

• Clock Drawing for visual perception, attention, memory, executive functioning

• Useful Field of View - determines crash risk via assessing divided/selective attention, vision loss, and cognitive processing speed

• AMPS - assess performance quality in completing ADL tasks

• Trail making A and B - measures cognitive flexibility, motor control, perceptual complexity, visual scanning, and executive functioning

• Assessment of Readiness for Mobility Transitions - assesses readiness for community mobility transitions

Self Reports and assessments

• driving habits questionnaire - captures info about avoidance behaviors often identified as compensatory strategies in older adults

• fitness-to-drive screening measure - screening for at risk older adults

Driving intervention

• CarFit - educational program that ensures proper fit and use of one’s vehicle for safety and performance

• address predriving and community mobility skills, like impulse control, stress reduction, sensory input regulation, etc.

• education

• compensatory strategies/adaptive equipment - visual scanning techniques, leg lifter, handy bar for entering/exiting vehicle, manual/power lift seats

• education on other transportation options, community mobility resources, fixed route transit systems

• develop community mobility plan