Mary Looney loved getting behind the wheel of her '99 Honda. Pulling out of her New Jersey driveway, she'd take her sister Eileen on long drives to Florida, Virginia, Massachusetts.

But a stroke last April weakened the left side of her body and affected her vision. The New Jersey Motor Vehicle Commission informed Looney she'd need medical clearance to continue driving.

"I felt very bad when I got that letter," said Looney, who turned 70 in February. "My sister was living with me, but I did all the driving, more or less. It does one an injustice to take that ability away."

To give them more years in the driver's seat, seniors such as Looney are turning to a growing number of occupational therapists specializing in driver rehabilitation, once solely found at large hospitals. Other professionals are working to find alternatives for those who must stop driving.

At the same time, older-driver safety is fast becoming a major public health issue as people over 65 make up an ever-growing percentage of the American population — and 15 percent of New Jersey's licensed drivers.

According to government statistics, motor vehicle injuries are the leading cause of injury-related deaths among 65- to 74-year-olds, and the second leading cause in the 75-and-older group.

At the Palisades Rehabilitation Center of Cresskill, N.J., director Deborah Longest and her staff are working with many potentially unfit senior drivers.

"We do an assessment of range of motion of the head and neck, arms and legs; leg strength and mobility; and visual field, acuity and contrast sensitivity," Longest said. "Then we simply try to find solutions to particular problems."

Adaptive devices and specialized exercises can spell the difference between driving and being driven.

There are methods and devices to compensate for weak legs, limited shoulder or neck mobility, poor finger dexterity, even mild visual deficits. If night vision is a problem, "you can get a driver's license with modifications so it's not an all-or-nothing proposition," said Longest.

Looney, for one, is optimistic about her driving future, as Longest works with her on hand strength. But Longest first wants a neuro-optometrist to assess Looney's vision, which was damaged by the stroke.

Although there is value in assessment programs, sometimes on-paper skills differ from on-road skills. That's where certified driver rehab specialists like Beth Rolland come in.

Working out of Kessler Institute for Rehabilitation in Saddle Brook, N.J., Rolland gets on the road with clients — some as old as 94 — during her two-hour evaluations. She uses a car marked "Student Driver" with an emergency brake on her side.

One of her clients, an 85-year-old man coming off a long hospitalization, tested well cognitively. In the car, it was a different story.

"He couldn't keep his lane position, he drove over the curb twice, he missed a stop sign, he drove very slowly and he was unable to keep even that speed up without me cuing him," Rolland recalled. "And he didn't see brake lights of cars in front of him."

Rolland gently told him he could not keep his license.

She had better news for Durita Goodwin, 67, who suffered a mild stroke in January. Her discharge papers from Holy Name Hospital advised her to get evaluated by a driver rehab specialist before getting back in the driver's seat.

"I was glad I did it because it made me aware of my own abilities," said Goodwin, who got clearance to drive. "It turns out I had lost a little of my peripheral vision, and Beth explained that was a normal part of aging and what I could do with my mirrors to compensate."

Rolland often recommends AARP's two-day Driver Safety Program for people over 50. The course raises awareness of vision, hearing, flexibility and medication issues; teaches safety strategies; and reviews how to sit correctly and adjust mirrors.

Instructors also discuss how to know when it's time to retire from driving.

When adult children develop fears about an elderly parent's driving, experts recommend broaching the topic with understanding and patience.

"It's important for the adult child to show empathy," said Dr. Roberta Satow, author of "Doing the Right Thing: Taking Care of Your Elderly Parents Even if They Didn't Take Care of You." "This will maximize your chances of being able to negotiate with your parent, but you need to realize that it won't always work out."

Usually, the problem ends up in the lap of the family physician.

In New Jersey, hospitals and rehab centers must inform the Motor Vehicle Commission about patients who've had any neurological event, such as a stroke, said MVC spokeswoman Sandy Grossman. And any physician, family member or police officer can request a review based on general concerns.

The agency's medical review board requests details from the doctor and patient, then determines if the license should be restricted or suspended or if additional testing is warranted. Often the board refers the patient for a driver rehab evaluation.

But here's the catch: "The person in question does have the right to ask who requested the review," said Grossman, "and if they ask, they must be told."

That makes many doctors wary of reporting patients.

"Several eye doctors have told me they will not fill out that form because of doctor-patient privilege concerns," said Pat Davenport, statewide coordinator of AARP's Driver Safety Program.

"Doctors are legally liable if they think there will be a problem and don't say something," added Rolland. "But they don't want to take licenses away if a patient can still drive because that's not fair. So we help them make a determination."

Physicians sometimes prefer the occupational therapist or driver rehab specialist to be the bearer of the bad news "so they don't have an awkward situation with longtime patients," explained Longest.

She and others say it's best to discuss alternatives early on.

Studies have shown that over-65 drivers often have difficulty with attention-sharing, judging gaps in traffic, visual search, navigation and motor control. Left turns are particularly dangerous because attention must be divided between oncoming traffic and vehicles and pedestrians on the left.

Taking its cue from Detroit, where adding left-turn signals has reduced the rate of left-turn collisions involving senior drivers by 84 percent since 1997, the New Jersey Department of Transportation is identifying problem spots for modifications.

Altering road will be a slow process. In the meantime, New Jersey has some solutions to deal with the fact that most suburban communities were not planned for walking to shopping and services, and aren't equipped to offer neighborhood transportation, said Longest.

New Jersey Transit's Access Link program, for instance, provides eligible disabled participants with limited curb-to-curb van service, during the same hours as the local route and for the same fare. And all New Jersey counties offer by-appointment van transportation for seniors.

But that's not good enough, said Rolland. "What about just going to the movies with a friend? (Scheduled van transportation) is not spontaneous. And people would rather be in cars than vans."

Adds Davenport: "A lot of adult communities have shuttles, but they have rigid schedules so you have to plan ahead — and that can be difficult. There is just not enough transportation available."

That worries Mary Looney.

"For now, my sister Eileen drives me where I need to go, but if she — God forbid — gets sick, I'll have to contact Access Link," she said. "I don't think they should cut off (driving privileges) so abruptly until stroke victims are tested and given a chance to show their skills."