Professional Documents
Culture Documents
Community Mobility
I. General considerations (Eby et al., 2006; Stav & McGuire, 2012; Womack, 2012;
Womack & Silverstein, 2012)
A. Community mobility: “planning and 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” (American Occupational
Therapy Association [AOTA], 2020; Stav & McGuire, 2012)
B. Forms of community mobility
1. Public transportation: 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 (Womack &
Silverstein, 2012, p. 28)
a. Fixed-route transportation: transportation alternatives with a fixed route and schedule for
travel between destinations. Fixed-route transportation is most typically offered in the form
of bus, subway, train, and light rail services.
i. Performance skills required
• 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
• 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
• 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
• Emotional regulation skills: ability to adjust to a crowded versus empty environment and to
handle unexpected events
• Communication and social skills: ability to ask for directions and obtain information
• Money management skills: ability to obtain a monthly pass, have the correct fare ready, and
use the change or ticket machines at the station
ii. Occupational therapy evaluation and intervention
• Assessment in the community setting
• Intervention using both remedial and compensatory strategies to address deficits in each
performance skill area
• Family and caregiver education on use of compensatory strategies
b. 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 (Womack & Silverstein, 2012, pp. 28–29).
i. Performance skills required
• 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
• 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
• Sensory–perceptual skills: ability to judge spatial relationships in navigating between the
vehicle and the curb or sidewalk
• Emotional regulation skills: ability to handle unexpected events, such as a no show or late
ride, and longer rides
• 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
• Money management skills: ability to prepare fare or manage tickets
ii. Occupational therapy evaluation and intervention
• Familiarity with policies of the local transit company
• Orientation and assistance to the client in the application process for paratransit
• Assistance with planning for ride reservations and contingency and safety preparations for
longer rides
2. Personal transportation: means of moving about in the community using either one’s own
bodily capacity or vehicular or nonvehicular transportation technology (Womack, 2012, p. CE1;
Womack & Silverstein, 2012, p. 31)
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)
i. Performance skills required for walking
• 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
• 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
• Sensory–perceptual skills: ability to identify traffic, judge spatial relationships at the curb
and sidewalk, and maintain topographical orientation
• Emotional regulation skills: ability to adapt to crowded versus empty environments, observe
road safety precautions, and handle unexpected events
• 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
ii. Occupational therapy evaluation and intervention for walking
• Assessment in the community setting
• Intervention using both remedial and compensatory strategies to address deficits in each
performance skill area
• Family and caregiver education on use of compensatory strategies
3. Commercial transportation: transportation services operated as for-profit enterprises for which
people pay privately (Womack & Silverstein, 2012, p. 31)
a. Commercial carrier (e.g., airline, train)
b. Taxi service
c. Shuttle and van service (small-vehicle fleet)
4. 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 (Eby et al., 2006, p. 446; Womack
& Silverstein, 2012, pp. 29–31)
a. Senior-friendly supplemental transportation is ideally based on the “Five As”: availability,
acceptability, accessibility, adaptability, and affordability (Womack & Silverstein, 2012, p.
31).
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 (Stav, 2008; Womack & Silverstein, 2012).
5. Terms related to paratransit and supplemental transportation (Freund, 2002; ITNAmerica,
n.d.; Womack & Silverstein, 2012, pp. 32–33)
a. 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.
b. 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.
c. 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.
d. 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).
e. 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.
C. Legal and political issues related to community mobility
1. Americans With Disabilities Act of 1990 (ADA; Pub. L. 101-336; Bolding et al., 2018, pp. 260–
262; Koketsu, 2018, pp. 191–192)
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
(Bolding et al., 2018, p. 260)
c. Established a mandate for complementary paratransit services under Title II
(Transportation)—Part B (U.S. Department of Transportation, Federal Transit
Administration, 2020)
i. Paratransit eligibility criteria: 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 three 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
a. Older adults (AOTA, 2016; Andonian & McRae, 2011; Classen, 2010; Crabtree et al., 2009;
Stav, 2008; Womack, 2012)
i. Older adults with dementia
• Driving cessation
• Education regarding community mobility alternatives
• Family and caregiver education and support regarding community mobility
ii. 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
iii. Older adults facing driving cessation
• Community mobility alternatives: education, resources
• Psychosocial support
• Travel training
b. Infants and children (AOTA, n.d.; Case-Smith & Arbesman, 2008, p. 422; Heath, Case,
McGuire, & Law, 2007; Sharp, Dunford, & Seddon, 2012; Shutrump, Manary, & Buning,
2008; Stav & McGuire, 2012, pp. 4–5; Womack & Silverstein, 2012, pp. 32, 47)
i. 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
ii. 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
iii. Parents of infants in the neonatal intensive care unit
• Passenger safety education
• Education and resources regarding infant car seats
c. People with specific disabling conditions (AOTA, 2016; Atkins, 2014; Benson, 2009;
Crabtree et al., 2009; Eby et al., 2006, pp. 445–446; Hegberg, 2012; Lund et al., 2012;
Precin et al., 2012; U.S. Department of Transportation, Federal Transit Administration,
2020; Wendel et al., 2010)
i. 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
ii. Mental illness
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