Assessing Fitness to Drive

In this section

2.3.1. Practical driver assessments

2.3.2. Driver rehabilitation

2.3.3. Equal employment opportunity and discrimination

2.3.4. Information and assistance for drivers

The impact of a medical condition or multiple conditions or disability on driving is not always clear, so a practical driver assessment may be useful. Such assessments are different from the tests of competency to drive used with entry-level drivers that are routinely conducted by driver licensing authorities for licensing purposes. These practical driver assessments are suitable only for persistent impairments.

When is a practical driver assessment indicated?

A practical driver assessment is designed to assess the impact of injury, illness, disability or the ageing process on driving skills including judgement, decision-making skills, observation and vehicle handling. The assessment may also be helpful in determining the need for special training in compensatory techniques or vehicle modification to assist drivers with musculoskeletal or other disabilities.

A health professional may request a practical driver assessment to provide information to supplement the clinical assessment in some borderline cases and to assist in making recommendations about a person’s fitness to drive. However, practical assessments have limitations in that a patient’s condition may fluctuate (good days and bad days), and it is not possible to create emergency situations on the road to assess reaction time. Practical assessments are therefore intended to inform but not necessarily override the clinical opinion of the examining health professional. In addition, there are clinical situations that are clearly unsuitable for on-road assessments such as significant visual impairment or significant cognitive impairment.

What types of assessments are available?

There is a wide range of practical assessments available, including off-road, on-road and driving simulator assessments, each with strengths and limitations. Assessments for cars, motorcycles, buses or heavy vehicles may be conducted or overseen by occupational therapists trained in driver assessment or by others approved by the particular driver licensing authority, such as training providers for commercial vehicle drivers. Processes for initiating and conducting driver assessments vary between the states and territories, and the choice of assessment depends on resource availability, logistics, cost and individual requirements. Generally, the assessments may be initiated by the examining health professional, other referrers (e.g. police, self, family) or by the driver licensing authority.

It is not the intent of this publication to specify the assessment to be used in a particular situation. Health professionals should contact their local driver licensing authority (Appendix 9. Driver licensing authority contacts) for details of options or refer to Appendix 10. Specialist driver assessors.

What does a practical assessment involve?

Occupational therapy driver assessment usually involves two components: (a) an off- road screening and (b) an in-car practical driver assessment. The purpose of the off-road screening is to evaluate the nature, frequency and requirement for driving, underlying impairments, knowledge of road law, insight, medical history and requirements for the on-road test. Depending on the individual situation, the occupational therapy driver in-car assessment may involve evaluating:

• the need for specialised equipment or vehicle modifications
• the driver’s ability to control the motor vehicle truck, bus or motorcycle
• the driver’s functional status while driving including cognitive function, physical strength and skills, reaction time, insight level and ability to self-monitor their driving.

Recommendations following assessment may relate to licence status, licence conditions, the specific vehicle modifications, rehabilitation or retraining (refer to section 2.3.2. Driver rehabilitation), licence conditions or restrictions (refer to section 4.4. Conditional licences) and reassessment.

Where can I go to get more information?

More information about occupational therapy driver assessments can be found in the VicRoads publication Guidelines for occupational therapy driver assessors, 3^rd edition, March 2018.³² Refer also to Appendix 10. Specialist driver assessors.

A practical driver assessment may indicate a need for the person to participate in a rehabilitation or retraining program. A rehabilitation or retraining program will be developed based on the assessment results. It will be graded to increase the degree of difficulty or complexity in the task/environment and may include clinic-based activities, simulator or computer-based training, or on- road training with a driving instructor under the direction of an occupational therapist. It may also include training in the use of vehicle modifications or aids/adaptations as well as education to develop driver awareness and improve driving confidence. There is currently limited evidence to support the use of particular rehabilitation or retraining strategies. Designed and tested driving simulation activities may offer controlled and repeatable driving conditions for rehabilitation that are not available or limited in on-road driving situations, allowing practice and skills related to the behavioural, cognitive and physical skills related to driving.

On completing the rehabilitation program, a reassessment of the patient’s driving skills may be made and a report sent to the driver licensing authority with recommendations regarding driver competency and licensing.

See references 33,34,35

The purpose of the standards, particularly for commercial vehicle driving, is to protect public safety. They should not be used as a barrier to employment per se. The system of conditional licences aims to support employability without compromising road safety by providing for periodic medical review and driving conditions as appropriate.

Commonwealth and state/territory legislation exists to protect workers against unfair discrimination based on disability. If a patient suspects they are being unfairly discriminated against based on the disability outlined on their conditional licence, they may contact their union or the Human Rights and Equal Opportunity Commission, or the relevant commission in their state or territory.

Assessment by a health professional is one piece of information taken into account by the driver licensing authority in making a decision about the future licensing status of a person. The driver licensing authority may cancel, refuse or suspend a driver licence or place conditions on a licence. Because most people consider a driver licence critical to continued independence, employment and recreation, the risk of it being withdrawn can evoke strong emotions and reactions. Patients may become upset, anxious, frustrated or angry, especially if their livelihood or lifestyle is threatened (refer to section 3.3.2. Patient–health professional relationship).

In cases where licensing decisions may affect a patient’s ability to earn a living, the health professional should demonstrate some sensitivity in the interests of ongoing patient health. Timely provision of medical reports is important in this regard. Offering some direction in developing coping strategies may help alleviate some of the patient’s concerns or fears. Where appropriate, the health professional should consider direct referral rather than simply providing sources for further information. For example:

• Vocational assessors will assess a person’s ability to rehabilitate, retrain and reskill for another industry, or a new sector within the industry.
• There may be government-funded assistance programs to support work-based assessments and workplace modifications including vehicle modifications.
• Condition-specific support and advocacy agencies may also offer advice, support and services – for example, Diabetes Australia, Dementia Australia, MS Australia, Epilepsy Action Australia and the Epilepsy Foundation.

For older drivers, early advice will help them plan for the inevitable changes in their independence. Some driver licensing authorities have a range of dedicated fact sheets explaining the impacts of ageing and common medical conditions on driving safety: check the licensing authority website in your state or territory.