AOTA: Community Mobility

*OT and Community Mobility* Assessment of Community Mobility: *Assessment of Skills and Capacities for Travel*

After completing the occupational profile, the practitioner continues the evaluation process with measures of client factors, performance skills, and contexts of the client's engagement in community mobility to determine areas of need. The same factors that limit the ability to drive may interfere with use of public transportation.

*OT and Community Mobility* Assessment of Community Mobility: *Community Mobility in the Occupational Profile*

An occupational profile should include consideration of community mobility relevant to the client and the client's context, leading to an analysis of occupational performance. The practitioner should refer clients to a certified driver rehabilitation specialist for further assessment of driving skills when indicated

*OT and Community Mobility* Occupational Therapy Interventions: Specific Community Mobility Interventions: *System-level Interventions*

Consultation with transportation systems on issues such as design of the travel environment for accessibility and creation of eligibility determination processes for paratransit service

*General Considerations* Legal and political issues related to community mobility: *Americans With Disabilities Act of 1990 --> Determination of Paratransit Eligibility*

Each entity required to provide complementary paratransit service is required to establish a process for determining ADA paratransit eligibility. The goal of this process is to ensure that only people who meet the regulatory criteria, strictly applied, are regarded as eligible. Best practice in eligibility determination encourages functional assessment of the traveler's ability to access transportation resources

*General Considerations* Legal and political issues related to community mobility: *Disparities in Availability of Public Transportation*

Fewer than 25% of U.S. rural residents are served by public transportation

*General Considerations* Personal Transportation: definition

Means of moving about in the community using either one's own bodily capacity or vehicular or nonvehicular transportation technology (a) Private automobile (b) Other motorized or nonmotorized vehicle (e.g., golf cart, bicycle, scooter, skateboard) (c) Walking and other nonvehicular travel (e.g., running, skiing, skating)

*General Considerations* Public Transportation: definition

Means of moving more than one person at a time from point to point that is available to all citizens of an area and funded, at least in part, by taxes

*OT and Community Mobility* Occupational Therapy Interventions: *Addressing Community Mobility as a Generalist*

Occupational therapists and occupational therapy assistants without specialty credentials in driver rehabilitation evaluate and intervene regarding general community mobility issues and refer clients to certified driver rehabilitation specialists as indicated

*OT and Community Mobility* Scope of Practice

Occupational therapy practitioners across all practice settings should consider the community mobility needs of their clients and follow a process consistent with that outlined by AOTA (in press) to address community mobility, including an occupational profile; analysis of occupational performance; intervention planning, implementation, and review; and determination of outcomes

*General Considerations* Terms Related to Paratransit and Supplemental Transportation: *Curb-to-Curb*

Passengers are picked up at the curb of their point of origin and dropped off at the curb of their destination. Drivers may assist riders with getting on and off the vehicle but do not assist riders into buildings or with things they are carrying

*General Considerations* Terms Related to Paratransit and Supplemental Transportation: *Door-to-Door*

Passengers may be assisted from the doorway of their point of origin to the entrance to their destination but are not assisted to enter

*General Considerations* Terms Related to Paratransit and Supplemental Transportation: *Door-through-Door*

Passengers may be assisted to exit their travel point of origin and to enter the building at their destination, as well as on and off the vehicle. This assistance may be direct physical assistance or assistance with packages.

*General Considerations* Terms Related to Paratransit and Supplemental Transportation: *Arm-through-Arm*

Passengers may be physically assisted by drivers to board, disembark, and safely reach their final destination (similar to door-through-door, but specifies physical assistance)

*General Considerations* Legal and political issues related to community mobility: *Medicaid Transportation Provisions*

Recipients of Medicaid may be eligible for subsidized transportation for health care and life maintenance trips

*OT and Community Mobility* Occupational Therapy Interventions: Specific Community Mobility Interventions: *Mobility Management*

Services that promote collaboration and cooperation among transportation providers and connect clients to those providers

*OT and Community Mobility* Occupational Therapy Interventions: Specific Community Mobility Interventions: *Travel Training*

Short-term, direct, and intensive training to teach older adults and people with disabilities to use fixed-route public transportation safely and independently

*OT and Community Mobility* Assessment of Community Mobility: *Assessment of Readiness for Mobility Transitions (ARMT)*

The *ARMT* is a means of assessing the readiness of older adults to make transitions regarding their mobility, such as driving cessation. Understanding how a client perceives transitions in community mobility allows the practitioner to use the most appropriate approach to address these changes.

*OT and Community Mobility* Community Mobility as an IADL

The Occupational Therapy Practice Framework: Domain and Process (4th ed.; AOTA, in press) includes community mobility as an IADL performance area in the domain of occupational therapy practice to be addressed by occupational therapists and occupational therapy assistants along with other IADLs (AOTA, 2016, p. 1). Occupational therapy practitioners are also encouraged to view community mobility as an enabler of other occupations

*General Considerations* Terms Related to Paratransit and Supplemental Transportation: *Demand-Responsive*

Transportation is provided between a specific point of origin and specific destination requested by the traveler. Demand-responsive service travels on a requested as opposed to a fixed route but may require advance reservations and may or may not include physical assistance for the client.

*General Considerations* Commercial Transportation: Definition and Examples

Transportation services operated as for-profit enterprises for which people pay privately (a) Commercial carrier (e.g., airline, train)\ (b) Taxi service (c) Shuttle and van service (small-vehicle fleet)

*General Considerations* Supplemental Transportation: Definition and the "Five A's" of Senior-friendly Supplemental Transportation

Volunteer, nonprofit, or community-based transportation options serving older adults and people with disabilities who either are unable to use existing transportation services or desire more flexible travel options (a) *5 A's* of Senior-Friendly Supplemental Transportation Services: availability, acceptability, accessibility, adaptability, and affordability (b) Supplemental transportation for seniors is particularly important because most U.S. older adults who cease driving ride as passengers in private automobiles rather than use public transportation

*General Considerations* Legal and political issues related to community mobility: *Americans With Disabilities Act of 1990*

a. Established accessibility guidelines for public transportation (e.g., wheelchair lifts in buses, wheelchair ramps or elevators around facilities) b. Included guidelines to provide for priority seating, handrails, public address systems to announce stops, stop-request controls, and clearly marked destination and route signs c. Established a mandate for complementary paratransit services under Title II (Transportation)—Part B

*On-the-Road Evaluation*: There are two levels of driving that must be considered when evaluation a person's abilities when they are behind the wheel and actually driving. These are:

(1) *Operational*: the ability to steer, brake, and turn (2) *Tactile*: the ability to respond to changes in road conditions and traffic/driving tasks

*General Considerations* Legal and political issues related to community mobility: *Economics of Public Transportation*

(a) The long-term financial viability of public transportation systems might benefit from investment in training younger people with disabilities to use available services (b) Lack of transportation alternatives for older adults may affect the economy of their communities when they can no longer easily access local businesses

*Community Mobility* The client, a nondriver, lives in a fourth-generation family homestead in a remote area and was referred to occupational therapy services after sustaining an above-knee amputation. The client is extremely concerned about community independence and being able to go shopping, attend church services, and make social visits to friends. The client has a strong emotional attachment to the homestead. Which intervention option is the best option to satisfy the client's community mobility needs? a. Develop a community mobility plan with acceptable, affordable, and reliable transportation options for the client to access multiple goods and services in the community. b. Adjust the physical environment for inclusiveness and accessibility specific to the client's needs. c. Ensure that the client is independent with the use of mobility devices including a wheelchair, scooter and transfer board. d. Suggest that the client interview volunteer drivers who can provide services as well as taxi vouchers

*A. Develop a community mobility plan with acceptable, affordable, and reliable transportation options for the client to access multiple goods and services in the community* (The client is socially and culturally connected to the area and the family homestead, and the OTR® needs to formulate goals to optimize the client's independence in community needs)

*Community Mobility* Every generalist occupational therapy practitioner should be prepared to address community mobility within his or her practice setting. What is one way to do so? a. Maintain a resource library or database about transportation options in the area b. Conduct on-road driving evaluations to determine fitness to drive c. Provide direct assistance to clients in boarding and riding public transportation vehicles d. Assist clients by providing rides to and from therapy sessions

*A. Maintain a resource library or database about transportation options in the area* (Making transportation resources or information available to clients is pertinent to every practice setting and does not require specialized training or certification) (B: Conducting on-road driving evaluations requires specialized training)

*Community Mobility* Older women who are members of an ethnic minority and live on lower incomes have been identified as using public transportation more than most people in their age cohort. How might their reliance on public transportation influence the engagement in community occupations of this population? a. Participation in community occupations will be limited by the hours of transportation service and the cost to use it. b. Access to taxi services will expand this population's access to community occupations. c. Public transportation offers access to more geographic areas than does a private automobile, so this population will have unlimited occupational opportunities. d. Participation in community occupations will be severely restricted for this population because they use public transportation.

*A. Participation in community occupations will be limited by the hours of transportation service and the cost to use it* (The relationship between transportation access and community engagement is determined by the cost and scope of transportation relative to the resources and desires of the person)

*Community Mobility* An OTR® is working with a student with autism spectrum disorder (ASD) to address impairments in social interaction skills, including turn taking, eye contact, and verbal and nonverbal communication. Which intervention embeds practice of these skills in the IADL of community mobility? a. Practicing interaction with the driver of a public transportation vehicle b. Practicing turn taking at an ice cream shop c. Asking the client to make eye contact five times during a therapy session d. Setting a goal for the client to sit without talking to anyone on the school bus

*A. Practicing interaction with the driver of a public transportation vehicle* (Interaction with a public transportation driver must take place within the realm of community mobility. Case-Smith and Arbesman (2008) observed that naturally occurring opportunities for social interaction are potential occupational therapy interventions for people with ASD)

*Community Mobility* Policies that severely restrict driver's licensing for older adult drivers but do not simultaneously provide for transportation alternatives affect not only older adults but also the well-being of the local community. Which statement is MOST accurate about these wider effects on the community? a. Restaurants and businesses in areas with dense populations of older adults suffer financially because they lose customers who can no longer easily travel to them. b. The Department of Motor Vehicles suffers financially from loss of revenues from the license renewals of older adults. c. Local K12 schools experience an increased need for bus service when older adults can no longer serve as student carpool drivers. d. Roadways in areas with dense older adult populations fall into disrepair because of lack of traffic.

*A. Restaurants and businesses in areas with dense populations of older adults suffer financially because they lose customers who can no longer easily travel to them* (Business and restaurants that rely on local patronage but are located in areas of high-density older adult populations risk losing proceeds when local residents can no longer travel to them)

*Community Mobility* An OTR® in an outpatient center is working with a client who has rheumatoid arthritis. The client, who is the parent of two children, has worked with a driver rehabilitation specialist on vehicle modifications that allow safer and more comfortable operation of the client's car. Which other aspect of community mobility might a generalist OTR® address? a. Securing the client's children safely in their car seats, including handling the car seats and positioning the children b. Training the client in adapted techniques for dressing and bathing the children with hand deformities c. Adjusting the foot pedals of the car to allow the client to minimize stress to the foot and ankle joints d. Recommending enhanced vehicle mirrors and techniques to accommodate for the client's reduced neck range of motion

*A. Securing the client's children safely in their car seats, including handling the car seats and positioning the children* (AOTA's (2010) "Statement on Driving and Community Mobility" addresses the issue of assisting parents with disabilities in managing passenger safety for their children)

*Community Mobility* The local department on aging has asked an OTR® to consult with them regarding transportation options for older adults in the county. At the first meeting, the department director expresses concern that some local older adults are choosing to pay for taxis rather than take the department-provided shuttle to appointments. The OTR® is aware, however, that some transportation experts have advocated taxis as appealing to older adults. Which statement BEST explains the appeal of taxis for older adults? a. Taxis offer greater spontaneity of travel because they are typically available without advance scheduling. b. Taxi companies use a wider range of vehicle options for transporting users who are older and have disabilities. c. Taxis can use routes that larger vehicles cannot travel. d. Taxis offer greater opportunities for socialization with other users

*A. Taxis offer greater spontaneity of travel because they are typically available without advance scheduling* (Taxis, by definition, provide on-call services to users on an as-needed basis)

*Community Mobility* An 85-year-old client cannot access fixed-route transit and has chosen to use a supplemental transportation program operated by volunteer drivers. What characteristics of such a program might make it more appealing to this client? a. The "Five As": Availability, accessibility, acceptability, affordability, and adaptability b. The convenience and privacy of traveling in the client's own automobile c. The use of large vehicles that transport multiple people between fixed stops d. Curb-to-curb services at low or no cost to the traveler because the transportation is paid for through grant funding

*A. The "Five As": Availability, accessibility, acceptability, affordability, and adaptability* (The Five As represent characteristics of best practice in the provision of senior-friendly supplemental transportation, as outlined by the Beverly Foundation)

*Community Mobility* An OTR® is working with a person who has disabilities that prevent safe driving. Which statement BEST explains why the OTR® cannot assume that the use of public transportation is an option? a. The same functional impairments that prevent safe driving may also present barriers to the use of public transportation. b. People with disabilities who are used to getting in and out of relatively low automobiles cannot board buses because of buses' greater height. c. Adequate visual acuity is the determining factor in whether a person can use public transportation. d. Public transportation is not a socially acceptable form of transportation for most people with disabilities

*A. The same functional impairments that prevent safe driving may also present barriers to the use of public transportation* (Many of the same medical and functional factors that interfere with driving may also interfere with the demands of using public transportation for example, impaired mobility, impaired vision, slowed processing speed, and cognitive deficits. Task unfamiliarity introduces an additional complication)

*Community Mobility* A generalist OTR® is working with a teenager with developmental disabilities who hopes to acquire a driver's license. Which intervention MOST appropriately addresses this client's community mobility needs? a. Training to improve the client's comprehension of travel rules tested in the licensing process b. Practice in driving skills in the OTR's vehicle in the school parking lot c. Practice in handwriting skills to improve the client's communication about driving skills d. Use of cognitive-behavioral therapy to address the client's beliefs about the ability to drive

*A. Training to improve the client's comprehension of travel rules tested in the licensing process* (AOTA's (2016) statement "Driving and Community Mobility" states that occupational therapy intervention for people with developmental disabilities may include evaluation, education, and training in preparation for obtaining a driver's license) (B: On-road driving practice would require specialist training as a driver rehabilitation specialist)

*Community Mobility* Which statement BEST describes supplemental transportation programs? a. Transportation services for older adults and people with disabilities who cannot use existing transportation options b. Commercial transportation providers who have specialized training in serving older adults c. Paratransit services funded by taxpayer money that serve specific regions d. Transportation services staffed by paid drivers who operate a fleet of limousines

*A. Transportation services for older adults and people with disabilities who cannot use existing transportation options* (The term *supplemental transportation program* describes a wide array of volunteer, nonprofit, or community-based transportation options serving older adults and people with disabilities who either are unable to use existing transportation services or desire more flexible travel options)

*Community Mobility* An OTR® is working with an 8-year-old client with muscular dystrophy who expresses the goal of being able to ride a bicycle with friends. Beyond addressing the client's physical capacities to ride a bicycle, what other intervention would be MOST appropriate? a. Work with the client on environmental awareness and knowledge of rules of the road for bicycle safety b. Provide strengthening exercises to boost the client's stamina for riding long distances c. Advise the parents not to encourage cycling because of the client's condition d. Suggest that the client use pedal clips to maintain good positioning of the feet while cycling

*A. Work with the client on environmental awareness and knowledge of rules of the road for bicycle safety* (AOTA's (2010) "Statement on Driving and Community Mobility" specifically suggests a role for occupational therapy in addressing overall safety awareness relative to cycling)

*Community Mobility* An OTR® is working with a client with a visual impairment who wishes to use public transportation buses. Which accessibility issue should the OTR® advocate for on behalf of this client? a. Use of a bus that lowers to the ground for boarding b. Announcement by the driver of the names of stops along the route c. Reserved seats near the front of the bus for clients with disabilities d. Discount vouchers for the client

*B. Announcement by the driver of the names of stops along the route* (Clients with a visual impairment rely on auditory cues for orientation. Announcing stops orients them to their relative position along the route and to arrival at their destination)

*Community Mobility* How does the Occupational Therapy Practice Framework: Domain and Process (4th ed.; AOTA, 2020) define community mobility? a. As a variety of ways to move about the world and the fit between these means and the client's abilities b. As moving around in the community using public or private transportation, such as driving, walking, bicycling, or accessing and riding in buses, taxi cabs, ride shares, or other transportation systems c. As selecting, testing, or adopting with the client and the client's family or support system the most appropriate transportation options d. As opportunities for occupational therapists to be involved in broader dialogue with transportation providers, health and human service agencies, and policymakers

*B. As moving around in the community using public or private transportation, such as driving, walking, bicycling, or accessing and riding in buses, taxi cabs, ride shares, or other transportation systems* (This definition is the exact one provided in the Framework)

*Community Mobility* The private automobile is the dominant form of transportation for most adults in the United States and is closely tied to occupational routines. Older adults who can no longer drive need viable options for other types of transportation to remain engaged in valued occupations. How do the majority of older adult nondrivers in the United States travel in the community? a. As riders on public transportation vehicles b. As passengers in private automobiles driven by someone else c. As operators of nonmotorized or small-scale vehicles such as bicycles and golf carts d. As pedestrians during daylight hours and not at all at night

*B. As passengers in private automobiles driven by someone else* (Multiple sources confirm that an overwhelming majority of older adults nondrivers travel in cars driven by someone else once they can no longer drive)

*Community Mobility* An OTR® working in a community hospital has been asked to serve on a team assessing the livability of surrounding communities. Which definition BEST describes the concept of livability? a. Provision of sidewalks, crossing signals, and curb cuts to ensure that all citizens of the community can move around the community without an automobile b. Community design that promotes maximum participation of all citizens, regardless of age or ability c. Mix of housing that allows families with and without children and people of all ages and incomes to live in inclusive neighborhoods d. Design of the physical aspects of a community to allow equal access to goods and services for wheelchair users

*B. Community design that promotes maximum participation of all citizens, regardless of age or ability* (Livability is a concept that extends beyond specific types of physical access or design to encompass all aspects of community life that may invite participation by all community dwellers, regardless of age or ability) (A: Walkability refers only to the built environment)

*Community Mobility* Even though some paratransit systems offer customized assistance, most require that the rider is functionally able to meet the vehicle at the street. What term is used to describe this type of service? a. Arm-through-arm service b. Curb-to-curb service c. Door-to-door service d. Demand-responsive service

*B. Curb-to-curb Service* (A transportation service that requires riders to meet the vehicle at the street is referred to as curb-to-curb service, reflecting the expectation that the traveler can enter and exit the home and the vehicle without assistance)

*Community Mobility* An OTR® consulting with a transitional living program housing adults with chronic mental illness is working with a resident to support the resident's new role as a part-time employee of the town library, which is located a few blocks from the residence. The client does not drive because of medication side effects. Which intervention BEST addresses community mobility skills relevant to this client's situation? a. Teach the client how to safely lift and move heavy loads of books b. Educate the client about pedestrian safety and practice the walk to work c. Educate the client about automobile safety in the event the client is able to find a ride to work d. Work with the client to obtain a driver's license

*B. Educate the client about pedestrian safety and practice the walk to work* (AOTA's (2010) "Statement on Driving and Community Mobility" includes in the OTR®'s role addressing walking to promote independence and prevent injury)

*Community Mobility* Which symptom of autism spectrum disorder (ASD) may have an impact on the use of public transportation? a. Motor impairments may make it difficult for people with ASD to board public buses. b. Impaired executive functioning may result in a person with ASD misjudging when to get on or off a bus. c. Visual impairments may result in a person with ASD not being able to read bus schedules or bus identifiers. d. Impairments in regulating autonomic functions may make it difficult for people with ASD to wait outside for a bus in extreme temperature conditions

*B. Impaired executive functioning may result in a person with ASD misjudging when to get on or off a bus* (Executive function deficits are a common symptom of ASD and may result in impaired judgment)

*Community Mobility* Independence in community mobility may have many benefits for clients. Which benefit is most important? a. It creates a variety of ways to move about the world. b. It represents connectedness to others, to goods and services, and to the occupations of everyday life. c. It helps to reduce traffic congestion. d. It carries economic implications based on access to goods and services.

*B. It represents connectedness to others, to goods and services, and to the occupations of everyday life* (This option is the major benefit of community mobility per Marottoli et al. [2000])

*Community Mobility* An OTR® is working with a client who is planning to take fixed-route transportation from home to school. The client sustained a closed-head injury 2 years ago and has difficulty with problem solving, especially related to changes in routine. What is the MOST important step for the OTR® to practice with the client? a. Walking from home to the train station b. Learning how to read the train schedule c. Obtaining exact change for the fare d. Getting on and off the train safely

*B. Learning how to read the train schedule* (A client with problem-solving difficulty should be provided with a strategy to address future changes in routine. Because both train and school schedules may change from time to time, it is important for the client to learn how to read the train schedule)

*Community Mobility* An 88-year-old client has given up driving as a result of decreased vision. The client has a history of carpal tunnel, diabetes mellitus (poorly controlled), congestive heart failure, and osteoarthritis in both knees and thumbs. The client has frequent medical appointments within a 20-mile radius of home. The client lives alone and is 10 blocks away from the closest bus station. What is the BEST choice for community mobility for this client? a. Fixed-route transportation b. Paratransit transportation c. Neighbors providing rides d. Volunteer driver program

*B. Paratransit transportation* (The most reliable transportation service for this client is paratransit. The client can call ahead of time to reserve rides for the frequent medical appointments)

*Community Mobility* Older adults who are familiar with using public transportation and enjoy it as an affordable and accessible alternative to driving may have concerns about their personal safety while traveling, particularly if their functional abilities are changing. How might an OTR® collaborate with well elders to address personal safety concerns at the level of community? a. Refer the older adults for individual therapy sessions to improve their functional abilities b. Partner with older adults to advocate for strategies to improve the safety of waiting areas and vehicles c. Write a letter on behalf of the older adults to the transportation authority stating the concerns the older adults reported d. Encourage the older adults not to use the public transportation system and instead to ask for rides from friends and family

*B. Partner with older adults to advocate for strategies to improve the safety of waiting areas and vehicles* (Partnering to advocate for strategies to improve safety is both collaborative and at the level of community rather than individual intervention)

*Community Mobility* Recipients of Medicaid may be eligible for subsidized transportation for health care and life maintenance trips. Why is it important for occupational therapy practitioners to be aware of this possibility? a. Most occupational therapy clients are funded by Medicaid. b. People with disabilities are disproportionately represented among Medicaid beneficiaries. c. Public transportation providers do not accept Medicaid vouchers for transportation. d. Medicaid covers transportation only to physician visits and not to therapy appointments

*B. People with disabilities are disproportionately represented among Medicaid beneficiaries* (According to Vanderbur and Silverstein (2006), people with disabilities are disproportionately represented among Medicaid beneficiaries and therefore may be eligible for transportation subsidies. Occupational therapy practitioners should be aware of the availability of this option so they can appropriately refer clients for transportation services)

*Community Mobility* An OTR® is working with a client with quadriplegia who has reentered a rehabilitation center to work on improving community mobility skills 1 year post injury. Which intervention would BEST address the client's treatment priorities? a. Maximizing the recruitment of motor units in partially innervated musculature through the use of functional electrical stimulation b. Practicing advanced wheelchair skills on community outings, including navigating doorways and uneven terrain c. Cotreating with the physical therapist to address therapeutic standing in long-leg braces d. Practicing the use of a power wheelchair in anticipation of a future need

*B. Practicing advanced wheelchair skills on community outings, including navigating doorways and uneven terrain* (AOTA's (2010) "Statement on Driving and Community Mobility" addresses community navigation by wheelchair users as a skill of the generalist OTR) (A, C: Functional electrical stimulation and physical therapy are interventions focused at the person level as opposed to the community level) (D: Practice in using a power wheelchair is not indicated as a need)

*Community Mobility* Which example offers the BEST way to incorporate community mobility exposure into psychosocial rehabilitation? a. Refer the client to a certified driver rehabilitation specialist. b. Provide opportunities for practice and role play before the client uses a mode of transportation. c. Provide the client with information on personal safety during travel. d. Educate the client on the availability of city or county pedestrian walkways or bike paths

*B. Provide opportunities for practice and role play before the client uses a mode of transportation* (This choice allows for skill training in choosing a mode of transportation) (A: This choice is expensive and may require out-of-pocket payment from the client; it can be addressed by the generalist, and therefore the specialist does not need to intervene) (C: Providing safety tips will not allow for community mobility exposure) (D: Providing education on walking or bike paths will not best facilitate the client's community mobility exposure)

*Community Mobility* In the United States, the dominance of the automobile as a mode of transportation has implications for public transit and, by extension, community mobility. What is the most comprehensive explanation of the impact on transit? a. Reliance on transportation by any means other than the private automobile is uncommon in all environments. b. Public transit options, despite legislation such as the American With Disabilities Act of 1990 (Pub. L. 101336), are primarily geared toward a fixed-route system. c. The urban sprawl phenomenon in the United States creates challenges for operational efficiency and financial solvency of transportation systems. d. Misconceptions about alternative transportation and stigma associated with medically necessary services limit the use of such transportation options.

*B. Public transit options, despite legislation such as the American With Disabilities Act of 1990 (Pub. L. 101336), are primarily geared toward a fixed-route system* (This option represents the most comprehensive explanation of this phenomenon) (A: Reliance on transportation by means other than private automobile is uncommon in most environments, excluding some urban environments that offer adequate alternative transportation options) (C: The vastness of geographic space in the United States creates challenges for operational efficiency and financial solvency of transportation systems) (D: This statement has an element of truth but is not the most comprehensive choice as a stand-alone option)

*Community Mobility* In 2005, Congress passed a federal transportation bill, SAFETEA-LU, which included funding for a program that encouraged children (including those with disabilities) to bike and walk to school, acted to reduce air-polluting traffic near schools, and encouraged healthy lifestyles from a young age. What was the name of this initiative? a. WalkFit to School b. Safe Routes to Schools c. Children With Disabilities Act d. Healthy American Students

*B. Safe Routes to Schools* (The Safe Routes to School program was funded from 2005 to 2012 as part of the SAFETEALU legislation (Pub. L. 10959) and provided 100% federal funding to facilitate states' initiatives to create safe environments surrounding schools and encourage children to bike and walk to school as part of developing a healthy lifestyle. In 2012 these initiatives were combined with others as part of the federal Transportation Alternatives Program)

*Community Mobility* An OTR® is working with a community organization to address child passenger safety and injury prevention, including car seat safety and pedestrian and bicycle safety. Which organization would be MOST appropriate for the OTR® contact? a. National Center for Senior Transportation b. SafeKids USA c. AARP d. National Mobility Equipment Dealers Association

*B. SafeKids USA* (SafeKids USA is a national nonprofit organization that provides resources and advocates for policy related to community mobility for children) (A: The National Center for Senior Transportation provides training and resources pertaining to transportation for older adults) (C: AARP addresses issues related to people age 50 and older) (D: The National Mobility Equipment Dealers Association is an industry group that provides adapted driving and mobility equipment for travelers with disabilities)

*Community Mobility* According to AOTA's (2010) "Statement on Driving and Community Mobility," what training must an occupational therapy practitioner have to address the IADL of community mobility? a. Advanced training as a driver rehabilitation specialist b. Successful completion of training as an OTR® or COTA® c. Specialized training with transportation systems and departments d. A specific number of courses that address driving and community mobility

*B. Successful completion of training as an OTR® or COTA®* (AOTA's (2010) "Statement on Driving and Community Mobility" states that all OTR®s and COTA®s possess the training and education necessary to address driving and community mobility as an IADL) (A: Although advanced training is necessary to become a specialist in driving and community mobility, every occupational therapy practitioner can address driving and community mobility from a general IADL perspective) (C: Specialized training with transportation systems and departments is not necessary to address a client's community mobility) (D: Occupational therapy educational standards do not mandate specific hours or credit in coursework addressing driving and community mobility)

*Community Mobility* The client, a nondriver, lives in a fourth-generation family homestead in a remote area and was referred to occupational therapy services after sustaining an above-knee amputation. The client is extremely concerned about community independence and being able to go shopping, attend church services, and make social visits to friends. The client has a strong emotional attachment to the homestead. The OTR® considers a variety of ideas regarding the client's community mobility. Which assumption or strategy would the OTR INCLUDE? a. The client should consider relocating to an area with adequate alternative transportation options. b. The client requires an evaluation to assess the intersection of the client's capabilities with a variety of mobility options. c. To ensure independence in mobility, the OTR will maximize the functional mobility of the client. d. The OTR will set the client up with paratransit

*B. The client requires an evaluation to assess the intersection of the client's capabilities with a variety of mobility options* (For this client to be independently accessing community mobility, the client requires an occupational therapy evaluation)

*Community Mobility* An OTR® is working with high school students who have autism spectrum disorder (ASD). Which statement BEST represents a model for travel training relative to public transportation use for these clients? a. The travel training program should be classroom based to build students' confidence in their ability to successfully travel in the community using public transportation. b. The travel training program should provide a combination of classroom instruction and repetitive community-based practice to build students' confidence and competence in using public transportation. c. The travel training program should be largely classroom based, with one practice session actually using public transportation to balance the students' need for practice with the financial constraints of the program. d. The travel training program should consist of providing the students with a bus schedule, accompanying them to the bus stop, and ensuring that they safely board the bus three times to ensure they are competent to ride independently

*B. The travel training program should provide a combination of classroom instruction and repetitive community-based practice to build students' confidence and competence in using public transportation* (Precin et al. (2012) noted that travel training is most successful for students with ASD when it combines classroom- and environment-based learning opportunities and builds in frequent repetition of skills)

*Community Mobility* Research indicates that older adults with stroke who previously used public transportation decrease their use of public trains and buses more because of changes in physical capacities than because of changes in cognitive capacities. Which statement BEST describes the relationship between stroke and public transportation use? a. The demands for mapping and following a travel route require attention and intact spatial relationships. b. The use of mass transit requires balance, the ability to safely move from sit to stand, and the ability to grasp and hold. c. The interpersonal demands of using public transportation require executive function skills. d. The use of mass transit requires visual and auditory skills to navigate the transportation environment

*B. The use of mass transit requires balance, the ability to safely move from sit to stand, and the ability to grasp and hold* (The use of trains and buses challenges balance, general mobility, and hand skills) (A, C, D: These cognitive and sensory capacities do not influence public transportation use as much as physical capacities)

*Community Mobility* Which community-level action can an OTR® undertake to address the walkability of the area in the practice's neighborhood? a. Teach a specific client skills related to pedestrian safety b. Volunteer to serve on a city planning advisory board c. Read pedestrian safety materials available from the U.S. Federal Highway Administration d. Assist older clients in writing letters to AARP describing the lack of walkability features of their area

*B. Volunteer to serve on a city planning advisory board* (Serving on a city planning advisory board is the only option that is a community-level action) (C: Reading pedestrian safety materials, although advisable for practitioners working in community mobility, represents personal knowledge development as opposed to a community-level action) (D: Letter writing is not a community-level action and does not represent effective advocacy relative to walkability. Although AARP is involved in walkability efforts and advocacy, it does not serve as a repository for community-level complaints)

*Community Mobility* The provision of paratransit services is a legal mandate for public transportation providers, who must provide complementary and equivalent transportation services to those who cannot access fixed-route transportation because of a disability. Which law provides this mandate? a. Olmstead Act b. SAFETEALU Act c. Americans With Disabilities Act d. Rehabilitation Act of 1973

*C. Americans with Disabilities Act* (The Americans With Disabilities Act of 1990 established the mandate to provide complementary paratransit services under Title II, Part B) (A: The Supreme Court's decision in Olmstead v. L. C., 527 U.S. 581 (1999), eliminated unnecessary segregation of people with disabilities and was not specific to transportation) (B: The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users (SAFETEALU; Pub. L. 10959) authorized federal surface transportation programs and did not address transportation rights) (D: The Rehabilitation Act expanded civil rights for people with disabilities but did not mandate access to paratransit services)

*Community Mobility* Community mobility has been described in the occupational therapy literature as a conduit for participation in valued occupations. In addition to being a means to move from one place to another, what is the relationship of community mobility to participation? a. An occupational performance skill b. An occupation aid c. An occupation enabler d. An occupational profile

*C. An occupational enabler* (Community mobility is a set of activities that allow access to and support participation in occupation. This characterization encourages practitioners to recognize community mobility as more than a discrete set of services that allow clients to move between two points, but rather an essential form of support for occupational engagement) (A: According to the Occupational Therapy Practice Framework: Domain and Process, community mobility is an instrumental activity of daily living, not an occupational performance skill) (D: The occupational profile consists of client information obtained during an initial evaluation rather than the content or outcomes of that process, which may include community mobility)

*Community Mobility* An OTR® consulting with a municipal transit provider seeks to address transportation provision at a systems level as opposed to providing service to individual clients. Which role would be MOST appropriate for this OTR®? a. Assisting older travelers in embarking and disembarking from a bus b. Reading and understanding policy related to the effects of arthritis on a client's ability to drive c. Designing and conducting a paratransit eligibility determination process d. Educating volunteer drivers in a faith-based community who wish to serve nondrivers with disabilities

*C. Designing and conducting a paratransit eligibility determination process* (AOTA's (2010) "Statement on Driving and Community Mobility" lists the role of involvement in paratransit eligibility determination for OTR®s addressing community mobility at the transportation system level)

*Community Mobility* An OTR® is working with a team in a neonatal intensive care unit to prepare a family for their infant's discharge home the next day. Which action addresses the MOST important occupational therapy-related consideration for these clients' community mobility needs? a. Ensuring that the parents have valid driver's licenses and a safe vehicle in which to transport the child b. Instructing the parents to consider the possible need for adaptive mobility equipment in their future vehicle choices c. Determining how the child will be transported in the immediate future and making recommendations regarding child passenger safety d. Educating the parents about future adaptive mobility options such as adapted strollers and tricycles

*C. Determining how the child will be transported in the immediate future and making recommendations regarding child passenger safety* (Occupational therapy practitioners address community mobility as an IADL (AOTA, 2008), and the immediate needs of this family are for safe transportation as they leave the hospital) (A: Ensuring that the parents have valid driver's licenses and a safe vehicle is outside the scope of occupational therapy practice) (B, D: Future mobility options are not the immediate intervention priority)

*Community Mobility* A school-based OTR® is serving several children who use wheelchairs as their primary means of mobility. All of the children ride the public school buses between school and home. The director of special education services has noted that the school's responsibility for the well-being of the children includes their use of school-sponsored transportation. What might the OTR® do to help ensure the safety of these children on the school bus? a. Offer to ride with the children on the school bus to ensure they are safely seated and are not exposed to danger along the school bus route b. Suggest to the children's parents that they seek transportation other than the school buses c. Develop knowledge of safe seating strategies and wheelchair restraint use and help train bus personnel in safe body mechanics while assisting wheelchair users d. Educate the children in how their wheelchairs should be restrained during travel and ask them to sign a waiver stating that they, rather than the school, are responsible for seating themselves safely

*C. Develop knowledge of safe seating strategies and wheelchair restraint use and help train bus personnel in safe body mechanics while assisting wheelchair users* (School-based OTR®s have skills in body mechanics, seating, and positioning and are part of the team addressing child school bus safety)

*Community Mobility* Which option can be viewed as a critical comprehensive priority for an OTR® who seeks to optimize community mobility for a client? a. Stay abreast of legislation and policy that influence independence in societal participation, community mobility and alternative transportation options. b. Attend continuing education seminars, and conferences on transportation to ensure up to date knowledge of community mobility practices. c. Include community mobility in the initial evaluation and intervention planning; and include actual or simulated practice in using community mobility options. d. Consult with the driver rehabilitation specialist, transportation providers, and volunteer driver organizations on a regular basis.

*C. Include community mobility in the initial evaluation and intervention planning; and include actual or simulated practice in using community mobility options* (This option contains the top two priorities to guide OTR®s in addressing community mobility) (A: Having knowledge of legislation and policy will not necessarily optimize the community mobility of a client) (B: Obtaining knowledge from conferences is important for professional development but will not, unless it is put into practice, optimize community mobility for a client) (D: Consultation with stakeholders is a needed strategy to understand how they operate, but application of that knowledge is necessary to optimize the community mobility of a client)

*Community Mobility* Transportation researchers advocate for the development of services that can foster coordination and collaboration among transportation providers both public and private and acknowledge that specially trained OTR®s can fulfill this role. What is this concept called? a. Mobility advocacy b. Mobility discovery c. Mobility management d. Mobility independence

*C. Mobility Management* (Mobility management is the term suggested by Eby, Molnar, and Pellerito (2006) and is based on developing projects across the United States)

*Community Mobility* Occupational therapy practitioners address community mobility as an IADL. Which document uses this terminology? a. AOTA Code of Ethics b. Occupational therapy state licensure laws c. Occupational Therapy Practice Framework: Domain and Process d. World Health Organization's International Classification of Functioning, Disability and Health

*C. Occupational Therapy Practice Framework: Domain and Process* (The Occupational Therapy Practice Framework: Domain and Process includes community mobility as an IADL performance area in the domain of occupational therapy practice)

*Community Mobility* A young adult client with complete C4 quadriplegia from a spinal cord injury is being discharged from inpatient rehabilitation to the family home in a rural area. Which community mobility intervention would be MOST relevant to this client? a. Teaching the client to drive an automobile using hand controls b. Educating the client on use of the wheelchair to access a subway system c. Providing training for the client and family on how to safely transfer and secure the client and wheelchair in the family vehicle d. Working collaboratively with the client to read and understand a bus schedule

*C. Providing training for the client and family on how to safely transfer and secure the client and wheelchair in the family vehicle* (AOTA's (2010) "Statement on Driving and Community Mobility" states that occupational therapy's role in addressing community mobility includes addressing passenger safety such as securing passengers and wheelchairs)

*Community Mobility* Several OTR®s working in a county public school system are planning interventions for middle school students that address goals for personal independence with community mobility and academic goals in reading and mathematics. Which student activities could the OTR®s use to address both goal sets? a. Doing math worksheets that include a word problem about automobile speed b. Interviewing a truck driver about that job and telling other students what they learned in the interview c. Reading and following an electronic search for a bus route that passes near their home and calculating distances between stops d. Passing out bus schedules in the cafeteria to encourage other students to use public transportation

*C. Reading and following an electronic search for a bus route that passes near their home and calculating distances between stops* (Precin et al. (2012) suggested using electronic searches to teach map-reading skills and trip distance calculation to address quantitative skills. Researching a bus route near the students' home adds the component of relevance to their search)

*Community Mobility* An OTR® is working with an adult client with sensory processing difficulties who finds it uncomfortable to commute to a job via train because of the noise of the train and of other passengers talking. Which environmental modification would allow the client to continue to commute and maintain employment? a. Encourage the client to obtain a driver's license and avoid train travel b. Petition the train system to allow the client to occupy a compartment alone and ask others to sit elsewhere c. Recommend the use of noise-cancelling headphones with a device that plays music or books the client enjoys d. Assist the client in seeking employment closer to home to avoid train travel

*C. Recommend the use of noise-cancelling headphones with a device that plays music or books the client enjoys* (Environmental modification in the form of assistive technology would allow the client to continue to commute and maintain employment. Benson (2009) specifically suggested the use of headphones to manage noisy environments for people who have sensory processing impairments)

*Community Mobility* An OTR® has determined that a visually impaired client can no longer drive. What should the therapist include in the occupational therapy intervention to help this client be independent in the use of community mobility? a. Familiarize the client with the procedures for using paratransit. b. Obtain a bus schedule and start training the client to use the bus for fixed-route travel. c. Select, test, adopt, and train the client and the client's family or support system in the use of the most appropriate transportation options. d. Educate the client on the need for driving cessation and the importance of maintaining independence in the community mobility

*C. Select, test, adopt, and train the client and the client's family or support system in the use of the most appropriate transportation options* (This is a comprehensive approach to follow after determining a client cannot drive. The client's family or other support system should understand the client's options for community mobility in order to support the client's independence) (A, B: The client may not want to use these methods of transportation) (D: This option may be part of the intervention process, but it is not adequate for independence in community mobility)

*Community Mobility* The Safe, Accountable, Flexible, Efficient Transportation Equity Act (Pub. L. 109-59) was signed into law in 2005. What is the basic premise of this law? a. This law includes providing transportation benefits to optimize access to the workplace and assumes that lack of transportation is a major barrier and challenge in sustainable employment. b. That people who can access fixed-route public transportation may travel more successfully compared with those who do not have such access. c. That state and local transportation decision makers play a role in bringing attention to safety concerns related to individual users of different transportation modes d. That people who can access public transportation in a sustainable fashion, are more likely to be successful in welfare-to-work initiatives

*C. That state and local transportation decision makers play a role in bringing attention to safety concerns related to individual users of different transportation modes* (This option describes the premise of the Safe, Accountable, Flexible, Efficient Transportation Equity Act) (A: This option describes the Personal Responsibility and Work Opportunity Reconciliation Act) (B: This option explains the implications of fixed- and flexible-route trips) (D: This option is an implication of the 1998 Transportation Equity Act for the 21st Century)

*Community Mobility* Parents of children with disabilities often report socioeconomic as well as personal challenges to involving their children in community-based physical activity programs. Which example represents a socioeconomic issue that needs to be considered when planning a community-based physical activity program? a. Some children have disabilities that don't allow them to be physically active. b. Parents of children with disabilities may prefer home-based activities to protect their children from harm. c. Transportation costs or availability can prevent access to community-based programs. d. Some facilities that sponsor physical activity programs may not be accessible to children with disabilities

*C. Transportation costs or availability can prevent access to community-based programs* (Transportation costs, whether related to operating an automobile or using public transportation, can be a barrier to access for families with children with disabilities) (A, B: Type of disability or desire to protect the child are personal and familial issues as opposed to socioeconomic issues) (D: Access issues related to the facility are physical accessibility as opposed to socioeconomic issues)

*Community Mobility* An OTR® is conducting a group for older adult clients on preparation for driving cessation. Several group members express a fear of using public transportation because they have never done so. Which action would BEST address these clients' stated needs? a. Referrals to a psychologist to address issues of fear and anxiety regarding public transportation b. Driving evaluations to ensure that the clients can continue to drive for as long as possible c. Travel training to practice use of public transportation with the clients until they feel comfortable on their own d. Simulation of public transportation by driving the clients along the same routes used by the transit system

*C. Travel training to practice use of public transportation with the clients until they feel comfortable on their own* (Travel training is short-term, direct, and intensive training to teach older adults and people with disabilities to use fixed-route public transportation safely and independently)

*Community Mobility* Which community mobility situation might pose a challenge for a person with an autism spectrum disorder (ASD) who is hypersensitive to auditory stimuli? a. Waiting alone at a bus stop on a highway with light traffic b. Scheduling a ride by entering information into the online database of a taxi service provider c. Waiting on a crowded subway platform at a time of day when multiple trains are running d. Bicycling to school in a suburban neighborhood

*C. Waiting on a crowded subway platform at a time of day when multiple trains are running* (Precin et al. (2012) noted that oversensitivity to sensory stimuli can be problematic for people with ASD and specifically mentioned loud transportation-related noises as difficult for people with auditory sensitivity)

*Community Mobility* An occupational therapy group for adults who are working on regaining occupational engagement 1 year post stroke is designed to include sessions on community mobility and to address participants' stated concerns regarding use of assistive devices in public places. Which activity would BEST address these goals? a. A session with a physical therapist in the clinic to practice ascending and descending stairs like those on public buses b. An interactive conversation about places in the community to which one can travel by public transportation c. An educational session about the advantages of different walkers, canes, and wheeled mobility options d. A field trip to the local mall using public transportation and practice in the use of walkers, canes, and scooters in the mall

*D. A field trip to the local mall using public transportation and practice in the use of walkers, canes, and scooters in the mall* (A field trip to the mall involving public transportation and practice using assistive devices best combines the goals for community mobility and use of assistive devices in public places) (A: Practice using stairs does not embed community mobility in a community context) (B, C: Conversation and education about public transportation or assistive devices only partially address the stated goals)

*Community Mobility* OTR®s occasionally work with transportation systems to provide consultation in determining eligibility for riders with disabilities to use paratransit services. Which characteristic of OTR®s is MOST valuable in this process? a. Experience in designing transportation technology to assist riders in scheduling trips b. Special expertise in budgeting to save the transit system money c. Knowledge to expand transportation services into rural areas d. Ability to assess the performance capacities of riders relative to the demands of travel

*D. Ability to assess the performance capacities of riders relative to the demands of travel* (OTR®s are trained in determining the fit between the capabilities of the person and the demands of the environment and the task at hand)

*Community Mobility* As part of the therapy process, an OTR® working with a client to access community transportation evaluates the community context to determine available travel options. Which component is MOST appropriate in this community assessment process? a. Lobbying state representatives to provide more funding for public transportation b. Teaching the client how to read public transportation schedules c. Educating the client in personal safety practices to follow when walking in the community d. Analyzing community transportation options in terms of availability, affordability, and accessibility to the client

*D. Analyzing community transportation options in terms of availability, affordability, and accessibility to the client* (AOTA's (2010) "Statement on Driving and Community Mobility" addresses assessment of community contexts and specifically includes analysis of availability, affordability, and accessibility of transportation options as components of this process)

*Community Mobility* An OTR® is seeking to understand how a client perceives an impending change from driving to use of other forms of transportation. Which assessment would BEST assist the OTR® in understanding the client's perception of this change? a. Canadian Occupational Performance Measure b. Motor-Free Visual Perception Test c. Rivermead Behavioral Memory Test d. Assessment of Readiness for Mobility Transitions

*D. Assessment of Readiness for Mobility Transitions [ARMT]* (The Assessment of Readiness for Mobility Transitions is a tool specifically designed to assess the willingness of older adults to accept changes in their use of transportation options)

*Community Mobility* The Beverly Foundation, a nonprofit group that promotes new ideas and options for older adult transportation, evaluates transportation programs using the Five As of Senior-Friendly Transportation. Which characteristic of a transportation system is categorized in the Acceptability category? a. Availability of transportation on evenings or weekends b. Affordability of the cost of travel c. Accessibility of the vehicles used for travel d. Cleanliness of the vehicles used for transportation

*D. Cleanliness of the vehicles used for transportation* (The Beverly Foundation categorizes cleanliness of vehicles, friendliness of vehicle operators, and safety of transit waiting areas as components of Acceptability)

*Community Mobility* An OTR® is assessing a client for safety in community mobility. The client is using a front-wheeled walker (FWW) and had a left total knee replacement 10 days ago. What client ability is the MOST important area to address in the assessment? a. Carrying a grocery bag safely while using the FWW b. Checking for traffic before crossing any intersection c. Handling the FWW while going up and down the curb in front of the building d. Crossing the crosswalk in a timely manner before the light changes

*D. Crossing the crosswalk in a timely manner before the light changes* (A client with a new total knee replacement and new to using a FWW walks at a slower pace than the average pedestrian. Crossing the crosswalk safely and before the light changes is a time-restricted task and should be checked out in the community mobility assessment) (A: For safety, a client using a FWW should not carry a grocery bag unless a walker bag is used) (B: Checking for traffic before crossing at an intersection is a general cognitive safety skill and is usually not a concern after knee replacement surgery unless the client has preexisting cognitive impairment) (C: Safety in handling the walker while going up and down the curb is important, but there is no time-restriction requirement to complete the task safely)

*Community Mobility* An OTR® is working with an elderly client in the early stages of Alzheimer's disease who qualifies financially for participation in an adult day program but cannot participate because of lack of transportation to the site. The local paratransit service feels the client needs one-on-one supervision when traveling, and providing such supervision is beyond the scope of their service. Transit system volunteers are willing to travel with older adults who need physical assistance, but they feel unprepared to travel with people with cognitive deficits because of dementia. What role might the OTR® play in helping the transportation system address this issue in a sustainable way? a. Volunteer to ride with the client on the paratransit van to the day care program three times a week b. Advocate for the day care program to fund and operate a separate transportation system for people who attend the program c. Drive the woman to the day care program and bill her family privately for mileage d. Design and carry out a training program for transit volunteers with an emphasis on facilitating the travel of people with dementia

*D. Design and carry out a training program for transit volunteers with an emphasis on facilitating the travel of people with dementia* (The transit system would benefit from a program that allows it to serve adults with dementia. Providing training for transit system volunteers that can be replicated ensures sustainability) (A, C: Volunteering to ride with or transport the client is not sustainable because the solution cannot be replicated for all clients in this position) (B: A separate transportation system for the day care center does not offer a solution for the public transit system)

*Community Mobility* An OTR® working with older adults facing driving cessation was concerned about ensuring their continued community mobility for psychosocial as well as functional reasons. What evidence does the literature provide that supports a psychosocial focus with this population? a. Older adults have been found to be more content once they no longer face the pressure to drive. b. Driving cessation has been linked to episodes of psychosis. c. Research indicates that families of older adults are relieved when older adults can no longer drive. d. Driving cessation has been linked to social isolation, depression, and early nursing home admission

*D. Driving cessation has been linked to social isolation, depression, and early nursing home admission* (Several studies have indicated a link between driving cessation and social isolation, depression, and early nursing home admission)

*Community Mobility* An OTR® is working with a community organization whose mission includes promoting universal access to transportation for people with disabilities. Which organization might the OTR® contact for training and technical assistance? a. Alzheimer's Association b. Association for Driver Rehabilitation Specialists c. Assistive Technology Industry Association d. Easter Seals Project ACTION

*D. Easter Seals Project ACTION* (Easter Seals Project ACTION is a cooperative project with the U.S. Department of Transportation's Federal Transit Administration that promotes universal access to transportation for people with disabilities under federal law and beyond. Project ACTION partners with transportation providers, the disability community, and others to provide training, technical assistance, applied research, and outreach and communication)

*Community Mobility* An OTR® is working in outpatient rehabilitation with a client with a spinal cord injury who is interested in using public transportation to engage in part-time work but is unable to use regular fixed-route services. The OTR assists the client in finding out about the eligibility process for paratransit services, and the OTR and client discuss the advantages and disadvantages of using such services. What is one possible disadvantage of using paratransit services from the client's perspective? a. Paratransit systems typically offer more flexible travel time options than do fixed transit routes. b. Paratransit operators are trained to assist riders with functional limitations in boarding vehicles. c. Paratransit systems use smaller and more accessible vehicles than fixed transit routes. d. Paratransit systems require that reservations be made in advance to use the service

*D. Paratransit systems require that reservations be made in advance to use the service* (The requirement by paratransit systems that reservations be made well in advance is a commonly cited disadvantage to paratransit users)

*Community Mobility* Public transportation systems might benefit in the long term from investing in greater accessibility and user training opportunities for young people with disabilities. Which statement BEST supports this argument? a. Public transportation providers will avoid financial penalties if they provide high-quality travel training for young people with disabilities. b. Better relationships between public schools and public transportation providers will result from more attention to the needs of young people with disabilities. c. Public transportation systems will have a larger pool of potential employees if they respond to the access and travel training needs of young people with disabilities. d. People who are taught early to use transportation systems that are accessible to their needs often become lifelong users of the system

*D. People who are taught early to use transportation systems that are accessible to their needs often become lifelong users of the system* (Precin et al. (2012) noted that people with autism spectrum disorder who are provided with travel training at a relatively young age often become lifelong users of public transportation if it is accessible to them)

*Community Mobility* SafeKids USA is a nonprofit organization dedicated to eliminating preventable childhood injuries, including those related to childhood community mobility, such as pedestrian, bicycle, and car seat accidents. Which SafeKids resource would be MOST useful for an OTR® working in an early intervention program? a. Statistics on safety while walking to school b. Educational brochures on cycling safety for adolescents c. Information about effective driver training for teens d. Videos addressing car seat safety for young children with special needs

*D. Videos addressing car seat safety for young children with special needs* (OTR®s working in early intervention are consulted about car seat fit and safety for children with developmental disabilities. SafeKids USA resources addressing this topic would be most useful relative to the age and needs of children in early intervention)

*Community Mobility* Many occupational therapy clients who can no longer drive are referred to public transportation programs. Clients from rural areas, however, may not be served by public transportation of any form. Approximately what percentage of the U.S. rural population does NOT have access to public transportation? a. 5% b. 25% c. 50% d. 75%

*D: 75%* (According to Eby, Molnar, and Pellerito (2006), about 75% of the rural population in the United States does not have access to public transportation)

*General Considerations* Legal and political issues related to community mobility: *Americans With Disabilities Act of 1990 --> Paratransit Eligibility Criteria (including 3 categories of eligibility)*

*Eligibility for paratransit* refers to the determination that a person, regardless of disability, cannot access fixed-route public transportation and is therefore eligible for complementary paratransit service. *The 3 Categories of eligibility are:* (1) Inability to navigate the fixed-route transportation system (2) Unavailability of the public transportation system at the time or place a person with a disability needs to travel (3) Impairment-related inability to board or disembark at a specific location

*OT and Community Mobility* Assessment of Community Mobility: *Assessment of the Travel Context: General Considerations, Walkability, and Livability*

*General Considerations*: AOTA (2016) emphasized the importance of assessing travel contexts when considering the IADL of community mobility—specifically, analysis of available transportation options, accessibility of resources, and policy review—as components of this process. *Walkability*: Extent to which the built environment is pedestrian friendly. Measures are available in the public domain that occupational therapy practitioners can use to assess walkability *Livability*: Extent to which a community fulfills principles outlined by the National Council on Disability (2006) regarding the physical, social, and transportation environments

*General Considerations* Public Transportation: *Paratransit Services: Definition, Performance Skills Required, OT Evaluation and Intervention*

*Paratransit Services*: transportation alternatives operated by transit systems for clients who have functional impairments that limit their access to regular fixed-route services. Paratransit is most typically offered in the form of van, shuttle, or microbus services that pick up riders outside their home and take them to specific locations rather than requiring them to be at a centralized bus stop. Even though some paratransit systems offer customized assistance, most require that the rider be functionally able to meet the vehicle at the street *Performance Skills Required* (a) *Cognitive Skills*: ability to plan and make reservation ahead of time, problem-solving skills for contingency when a ride does not show or is late, and ability to plan for and adapt to longer rides (b) *Motor and Praxis Skills*: ability to get on and off vehicle with limited or no assistance, ability to get from door to curb without assistance, and sufficient endurance for postural control during rides (c) *Sensory-perceptual Skills*: ability to judge spatial relationships in navigating between the vehicle and the curb or sidewalk (d) *Emotional Regulation Skills*: ability to handle unexpected events, such as a no show or late ride, and longer rides (e) *Communication and Social Skills*: ability to communicate needs on the telephone to reserve rides, communicate destination addresses clearly and accurately, and communicate with the driver about individual needs (f) *Money Management Skills*: ability to prepare fare or manage tickets *OT Evaluation and Intervention* (a) Familiarity with policies of the local transit company (b) Orientation and assistance to the client in the application process for paratransit (c) Assistance with planning for ride reservations and contingency and safety

*General Considerations* Personal Transportation: *Performance Skills Required, OT Evaluation and Intervention*

*Performance Skills Required for Walking* (a) *Cognitive Skills*: pathfinding ability, including selection of an alternate route when needed; ability to observe pedestrian safety, such as using the sidewalk, crossing the street at an intersection with a marked crosswalk, and waiting for the cross signal before crossing; safety judgment, including checking traffic thoroughly before crossing at an intersection without a cross signal; and multitasking ability (b) *Motor and Praxis Skills*: ability to walk on uneven surfaces and inclines, walk around obstacles, turn head to check traffic and maintain the path on the sidewalk, step up and down from the curb safely, carry items while navigating with or without use of mobility aids, cross an intersection within the required time, and maintain sufficient endurance (c) *Sensory-perceptual Skills*: ability to identify traffic, judge spatial relationships at the curb and sidewalk, and maintain topographical orientation (d) *Emotional-regulation Skills*: ability to adapt to crowded versus empty environments, observe road safety precautions, and handle unexpected events (e) *Communication and Social Skills*: ability to multitask in maintaining social conversation and observing road safety, ask for directions, and observe social etiquette as a pedestrian *OT Evaluation and Intervention for Walking* (a) Assessment in the community setting (b) Intervention using both remedial and compensatory strategies to address deficits in each performance skill area (c) Family and caregiver education on use of compensatory strategies

*General Considerations* Public Transportation: *Fixed Route Transportation: Performance Skills Required, OT Evaluation and Intervention*

*Performance Skills Required* (a) *Cognitive Skills*: ability to consider transit options, read a schedule, figure out a route, calculate the time required to travel to a destination, determine the optimal departure time to arrive at the destination on time, remember which station to disembark at, and use the stop-request control at the appropriate time (b) *Motor and Praxis Skills*: ability to step on and off the vehicle, maintain balance while walking in a moving vehicle, and maintain postural control while standing or sitting in a moving vehicle (c) *Sensory-perceptual Skills*: ability to identify obstacles on a public vehicle and judge spatial relationships to identify seats, the stop-request control button, and the gap between the vehicle and the sidewalk or platform (d) *Emotional Regulation Skills*: ability to adjust to a crowded versus empty environment and to handle unexpected events (e) *Communication and Social Skills*: ability to ask for directions and obtain information (f) *Money Management Skills*: ability to obtain a monthly pass, have the correct fare ready, and use the change or ticket machines at the station *OT Evaluation and Intervention* (a) Assessment in the community setting (b) Intervention using both remedial and compensatory strategies to address deficits in each performance skill area (c) Family and caregiver education on use of compensatory strategies

*General Considerations* Legal and political issues related to community mobility: *SAFETEA-LU Act: Definition*

*The Safe, Accountable, Flexible, Efficient Transportation Equity Act: A Legacy for Users* This was legislation that funded the Safe Routes to School program from 2005 to 2012, providing 100% federal funding to facilitate states' initiatives to create safe environments surrounding schools and encourage children to bike and walk to school as part of developing a healthy lifestyle. In 2012 these initiatives were combined with others as part of the federal Transportation Alternatives Program.

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: *Older Adults Facing Driving Cessation*

--*Community mobility alternatives*: education, resources --Psychosocial support --Travel training

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: People with Specific Disabling Conditions: *Spinal Cord Injury*

--Analysis of the sensorimotor demands of community mobility that intersect with clients' functional presentation --Determination of community mobility options relative to performance capacities --Travel training --Collaboration with transit providers regarding wheelchair safety restraint

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: *Older Adults with Dementia*

--Driving cessation --Education regarding community mobility alternatives --Family and caregiver education and support regarding community mobility

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: *Well Elderly and Community-dwelling Older Adults*

--Education and resources regarding community mobility options --Maintenance of driving fitness --Personal safety during community mobility --Age-related changes in function and intersection with community mobility

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: People with Specific Disabling Conditions: *Mental Illness*

--Occupational analysis of community mobility activities and contexts relative to clients' abilities and performance deficits --Modification of the community mobility context to match clients' abilities --Travel training --Opportunities to practice social interactions associated with community mobility --Training and support for transportation entities serving clients with mental illness

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: People with Specific Disabling Conditions: *Cerebral Palsy*

--Occupational analysis of community mobility activities and contexts relative to clients' abilities and performance deficits --Modification of the community mobility context to match clients' abilities --Travel training --Passenger safety training --Training and support for transportation entities serving clients with cerebral palsy

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: People with Specific Disabling Conditions: *Developmental Disabilities (e.g., autism spectrum disorder, intellectual and developmental disabilities in both children and adults)*

--Occupational analysis of community mobility activities and contexts relative to clients' abilities and performance deficits --Modification of the community mobility context to match clients' abilities --Travel training --Passenger safety training --Training and support for transportation entities serving clients with developmental disabilities --Opportunities to practice social interactions associated with community mobility

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: People with Specific Disabling Conditions: *Stroke*

--Occupational analysis of community mobility activities and contexts relative to clients' abilities and performance deficits --Modification of the community mobility context to match clients' abilities --Travel training --Passenger safety training --Training and support for transportation entities serving clients with neurological disorders

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: People with Specific Disabling Conditions: *Muscular Dystrophy*

--Occupational analysis of community mobility activities and contexts relative to clients' abilities and performance deficits --Modification of the community mobility context to match clients' abilities --Travel training --Passenger safety training --Training and support for transportation entities serving clients with progressive neuromuscular conditions

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: People with Specific Disabling Conditions: *Rheumatoid Arthritis*

--Occupational analysis of community mobility activities and contexts relative to clients' abilities and performance deficits --Modification of the community mobility context to match clients' abilities --Travel training --Passenger safety training --Training and support for transportation entities serving clients with rheumatic conditions

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: *Children with Sensory Processing Disorders (SPD)*

--Occupational analysis of the intersection between community mobility and sensory processing issues --Education for transportation providers regarding SPD --Parent and caregiver education and support --Interventions to assist children with SPD to adapt to community mobility challenges

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: *Parents of Infants in the Neonatal Intensive Care Unit*

--Passenger safety education --Education and resources regarding infant car seats

*OT and Community Mobility* Community Mobility Challenges with Specific Populations: *Children who are Wheelchair Users*

--Safe school bus transportation --Education and support regarding vehicle restraints --Parent and caregiver education regarding safe community mobility --Passenger safety