DULUTH — Ann Forrest Clark is passionate about driver safety.
It shows in her custom traffic sign jewelry and driving-themed office decor, and it shows in how she’s worked to train drivers for decades, even starting her own business on the side to do behind-the-wheel training. The drivers Forrest Clark works with aren’t teenagers practicing to get their licenses — they’re patients at St. Luke’s and other area health care systems who need rehabilitation to keep their licenses.
At St. Luke’s, Forrest Clark is an occupational therapist who leads the driver rehabilitation program. The program involves several steps for most participants — many of whom are older patients with a spinal cord injury or cognitive impairment, such as from a stroke, dementia or a traumatic brain injury. Patients can be referred for an assessment by doctors or law enforcement to take a cognitive assessment.
“Oftentimes people come because the state has mandated that they have a driving assessment — that they have a statement of medical fitness from their physician,” Forrest Clark said. “Physicians are uncomfortable making that statement without first having some objective testing that backs that up.”
Patients are tested on physical, visual and cognitive skills. Can they get from point A to point B? Can they detect unexpected hazards? Are their reaction times fast enough? Depending on their score, patients may also be referred to take a behind-the-wheel assessment.
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From those assessments, it can be determined if patients are safe to drive, need occupational therapy to improve driving skills, need a restricted license, or if they should no longer drive themselves.
Forrest Clark has made those determinations easier for many occupational therapists and doctors in the region. She created the Driving Risk Calculator, which lays out each of the tests in the cognitive assessment and sorts the outcomes into three categories: low, moderate or high risk. If a patient has one high-risk result or four or more moderate-risk results from the 21 tests, they’re referred to a behind-the-wheel assessment.
“I didn’t design anything other than the framework for how to interpret all this information as a whole,” Forrest Clark said. “As I’m testing someone, I’m able to look at my Driving Risk Calculator. Say that someone was dizzy when we were doing the vestibular ocular reflex testing and they ranked a five out of 10, that’s considered a high risk and I would record it there.”
The Driving Risk Calculator is used at eight clinics in northern Minnesota, including St. Luke’s in Duluth, Two Harbors and Hibbing. It’s endorsed by the Association for Driver Rehabilitation Specialists and is used at the Minneapolis VA Hospital, in Canada, and has been translated into Hebrew to use in Israel. Forrest Clark is presenting the Driving Risk Calculator to a conference in India soon.
“It’s really amazing how it’s taken off. I never expected it to do that,” Forrest Clark said, noting she gets referrals for behind-the-wheel assessment from occupational therapists all over northern Minnesota. “They do the Driving Risk Calculator because I taught them how to use it, and if the person meets the criteria, they refer them to me for behind the wheel assessments.”
Forrest Clark said she’s the only person north of the Twin Cities who offers the behind-the-wheel assessment. She has her own personal business, called Safer Driver Medical Assessment and Driving Training School, where she can monitor patients’ driving. She opened the driving school in 2020 because she didn’t want to see the program dissolve. St. Luke’s chose not to offer behind-the-wheel training because of the high liability involved with it.
At Essentia Health, the Polinsky Medical Rehabilitation Center at the Miller Hill Mall has a driving simulator that patients can use for both assessment and therapy exercises. The simulator has three video screens that act as a windshield, and a chair, steering wheel and pedals for the patient to get the behind-the-wheel experience.
Also offered in Superior, patients can be referred to Essentia’s driving assessment program by a physician or can contact the facility directly to learn more. Essentia also uses the Driving Risk Calculator, and Forrest Clark said she’s grateful to St. Luke’s for supporting her sharing the calculator across health care systems to improve community safety.
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“It’s more important for people to be safe on the roads and getting the services that they need so we’re all safer,” Forrest Clark said.
Wendy Anderson was Forrest Clark’s patient last year. Anderson suffered a stroke in July and had lingering left-side weakness with double vision. After a few weeks in St. Luke’s inpatient rehabilitation unit, Anderson was referred to outpatient physical and occupational therapy. Anderson, who has worked at St. Luke’s for more than 40 years as a health unit coordinator, knew Forrest Clark could help her manage her double vision and get back behind the wheel.
Forrest Clark had Anderson work on several visual exercises, including a divided attention task where Anderson would tap circles as they appeared on a screen with a letter in the middle. If the letter changed, Anderson would change her attention to tap the letter, then return to tapping the circles. They did physical exercises including following a ball back and forth with both her eyes and body. She also used an eye patch and has a prism lens that helps her manage the double vision.
After a couple of months with twice-weekly occupational therapy sessions, Anderson was discharged from the program. With her driving ability restored, she was able to return to work last October.
“It’s enormous because I don't want to give up working,” Anderson said of her ability to drive independently. “I still have a few years left in me — I've been here for 43-plus, and I have a couple of goals to stick around a while longer. And I'm single, so I was dependent on sisters for bringing me to therapy and getting things done.”
When Forrest and other St. Luke's occupational therapists work with patients, there are several machines and exercises used to both test and strengthen skills. A reaction-time tester focuses on lower motor control. As a remote-controlled stoplight changes colors, patients must move their foot back and forth between the brake and gas pedal. This ensures a patient can feel when their foot is changing pedals and that they have the mobility to do the motion repeatedly. Depending on a patient’s needs, Forrest Clark can train people to use left-foot adapted pedals during her behind-the-wheel sessions.
A vision screener machine, similar to what the Department of Motor Vehicles uses for eye tests, can be used to check each eye’s abilities both independently and together. Exercises include reading numbers and letters, identifying road signs with and without words on them, and interpreting symbols on both the left and right sides.
If patients are able to pass some but not all tests, it may be recommended they have a restricted license, limiting them to only drive during daylight hours, only drive in a certain range near their home or limit their speeds to eliminate highway driving.
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Forrest Clark said a lot of patients she sees come in with a fear that they’re going to lose their license if they have to take the assessment.
“I only have my own statistics to go by, but at least 80% of the people that I see for driving assessments continue to drive,” she said. “There's a significant portion that I recommend driving retirement, but my goal is for everybody to be safe and successful.”
Forrest Clark said she won’t take anyone on the road that she doesn’t feel is safe, but if there’s a chance they can be a safe driver, she wants to work with them as much as she can.
“I know not driving is huge to many people because it causes isolation, it causes depression,” she said. “It’s taking away your access to possibly getting groceries, getting medications, visiting family and friends. This is a very important part of many people's lives. … I understand how emotionally charged this is. So I try to be really respectful of people and their identity with their driving, but only recommend continued driving if it's safe for all of us.”
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