What does this 3-ring binder have to do with a person’s ability to drive?

Nothing, I would argue. But that’s the test that the ALS clinic uses to determine whether I need to have an official road test with a certified driving evaluator.

The test goes like this: An open 3-ring binder is placed flat on the floor and the occupational therapist times how long it takes me to move my right foot from side to side over the rings, tapping 10 times. This is supposed to simulate shifting between the gas and the brake.

Except that’s not how you are supposed to drive.

I looked for a definitive authority on this topic, and everyone from driver’s ed instructors to mechanics to WikiHow says that you should plant your heel between the brake and the accelerator and pivot your foot between the two, NOT move your foot back and forth:

“Most new drivers think they need to be pressing the pedal with their entire foot and that their foot should be inline or parallel with the pedal. As soon as they start using the pivot method, however, they’ll realize they have much more control over the amount of pressure they can exert over the pedals.” DriversEdGuru.com

But, like the cooperative patient I am, I agreed to do yet another driving evaluation – my third since diagnosis. We’ve now spent over $1,000 on driving evaluations.

So last Tuesday, the driving evaluator came to my house for an hour-long road trip in the Subaru.

While we we driving, I asked him if he moves his foot between the gas and the brake.

“No, I kind of rotate my foot back and forth,” he said.



Where does this test come from?

I discovered that the “Foot Tap Test” is frighteningly ubiquitous in scholarly literature for evaluating elderly drivers (and then applied to people with neurological conditions)…even though it has repeatedly been shown to have NO statistical validity.

Consider the Geriatric Evaluation Toolkit from the U of Missouri (whose language is replicated across multiple sources):

[No need to click on any of the following unless you really want to join me in the statistical weeds…]

Just as our NEALS CRLI training taught us to do, I dug into two referenced studies and realized that they just reinforce the highlighted conclusion. A 2006 follow up study to the first one confirmed no statistical link and the foot tap test was dropped as a measure for a third study. It is a misleading interpretation of the data to say that there is an “elevated” risk of moving violations (which may not have anything to do with braking) when the results are within the margin of error. I could only access the abstract for the (now-23-year-old) second study, but it concluded that a combination of factors related to mental capacity, blocks walked, and “foot abnormalities” led to a substantial higher risk of an accident (6% increase with only one factor present).

Ironically, it makes sense that there’s no correlation between the foot tap test and car crashes – because that’s not how you’re supposed to drive.

Driving a car comes with serious individual and civic responsibility. I get that. And there are provisions for the state DMV to take away the license of anyone who is medically unsafe to drive. As there should be.

All I’m saying is that the medical community shouldn’t hide behind a bogus test with bogus validity. It’s insulting.

I know people who are still driving with poor vision, heart conditions, diabetes, epilepsy, or on medications that make them drowsy. Why is it that people with ALS aren’t trusted to make the same decision as everyone else about when they can drive safely? Our judgment isn’t impaired.

(As for the argument that ALS is different because it can progress rapidly, well then, a once-a-year test isn’t really sufficient anyway.)

“Your driving hasn’t really changed from last year,” said the driving evaluator at the end of our road test. Yeah, I knew that. But it was still nice to hear.

The only issue I had was the quick stop. I was supposed to drive 10mph and slam on the brake when he told me to. Knowing what was coming and worried I wouldn’t stop quickly enough, I instinctively shifted my foot from the gas to the brake.

“Can you try it again without moving your foot?”


At least I get to re-post my favorite meme:

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