Table of Contents

6.3.2 Medical standards for licensing

Requirements for unconditional and conditional licences are outlined in the standards table including standards for:

  • aneurysms (unruptured intracranial aneurysms) and other vascular malformations
  • cerebral palsy
  • head injury
  • intracranial surgery
  • multiple sclerosis
  • neuromuscular conditions
  • Parkinson’s disease
  • stroke
  • transient ischaemic attacks
  • space-occupying lesions including brain tumours
  • subarachnoid haemorrhage
  • other neurological conditions including developmental and intellectual disability.

It is important that health professionals familiarise themselves with both the general information above and the tabulated standards before making an assessment of a person’s fitness to drive.

Medical standards for licensing – Neurological conditions
Condition

Private standards

(Drivers of cars, light rigid vehicles or motorcycles unless carrying public passengers or requiring a dangerous goods driver licence – refer to definition)

Commercial standards

(Drivers of heavy vehicles, public passenger vehicles or requiring a dangerous goods driver licence – refer to definition)

Aneurysms (unruptured intracranial aneurysms) and other vascular malformations of the brain

Refer also to subarachnoid haemorrhage.

A person is not fit to hold an unconditional licence:

  • if the person has an unruptured intracranial aneurysm or other vascular malformation at high risk of major symptomatic haemorrhage.

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account the nature of the driving task and information provided by an appropriate specialist regarding:

  • the response to treatment.

If treated surgically, the intracranial surgery advice applies.

If the person has had a seizure, the seizure and epilepsy standards apply (refer to section 6.2 Seizures and epilepsy).

A person is not fit to hold an unconditional licence:

  • if the person has an unruptured intracranial aneurysm or other vascular malformation.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account the nature of the driving task and information provided by an appropriate specialist regarding:

  • the risk of major symptomatic haemorrhage; and
  • the response to treatment.

If treated surgically, the intracranial surgery advice applies.

If the person has had a seizure, the seizure and epilepsy standards apply (refer to section 6.2 Seizures and epilepsy).

Cerebral palsy

Refer also to neuromuscular and/or intellectual disability.

A person is not fit to hold an unconditional licence:

  • if the person has cerebral palsy producing significant impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, sensation, muscle power, coordination, vision (including visual fields).

A conditional licence may be considered by the driver licensing authority, taking into account:

  • the nature of the driving task;
  • information provided by the treating doctor regarding the likely impact of the neurological impairment on driving ability;
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments); and
  • the need for vehicle modifications.

Periodic review is not required if the condition is static.

A person is not fit to hold an unconditional licence:

  • if the person has cerebral palsy producing significant impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, sensation, muscle power, coordination, vision (including visual fields).

A conditional licence may be considered by the driver licensing authority, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist regarding the likely impact of the neurological impairment on driving ability;
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments); and
  • the need for vehicle modifications.

Periodic review is not required if the condition is static.

Head injury

Refer also to intracranial surgery, below.

A person is not fit to hold an unconditional licence:

  • if the person has had head injury producing significant impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, memory, sensation, muscle power, coordination, vision (including visual fields).

A conditional licence may be considered by the driver licensing authority, taking into account:

  • the nature of the driving task;
  • information provided by the treating doctor regarding the likely impact of the neurological impairment on driving ability and the presence of other disabilities that may impair driving as per this publication;
  • the results of neuropsychological testing if indicated; and
  • the results of a practical driver assessment if required.

Periodic review is not required if the condition is static.

If a seizure has occurred, refer to section 6.2 Seizures and epilepsy.

A person is not fit to hold an unconditional licence:

  • if the person has had head injury producing significant impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, memory, sensation, muscle power, coordination, vision (including visual fields).

A conditional licence may be considered by the driver licensing authority, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist regarding the likely impact of the neurological impairment on driving ability and the presence of other disabilities that may impair driving as per this publication;
  • the results of neuropsychological testing if indicated; and
  • the results of a practical driver assessment if required.

Periodic review is not required if the condition is static.

A person is not fit to hold an unconditional licence:

  • if they have a high risk of post-traumatic epilepsy (penetrating brain injury, brain contusion, subdural haematoma, loss of consciousness/ alteration of consciousness or post traumatic amnesia greater than 24 hours).

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account information provided by the treating doctor as to whether the following criteria are met:

  • the person has had no seizures for at least 12 months.

f a seizure has occurred, refer to section 6.2 Seizures and epilepsy.

Intracranial surgery (advisory only)

A person should not drive for six months following supratentorial surgery or retraction of the cerebral hemispheres.

If there are seizures or long-term neurological deficits, refer to section 6.2 Seizures and epilepsy.

A person should not drive for 12 months following supratentorial surgery or retraction of the cerebral hemispheres.

If there are seizures or long-term neurological deficits, refer to section 6.2 Seizures and epilepsy.

Ménière’s disease

Refer to text.

Refer to text.A person requires individualised assessment by an ENT specialist.
Multiple sclerosis

A person is not fit to hold an unconditional licence:

  • if the person has multiple sclerosis and significant impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, memory, sensation, muscle power, coordination, vision (including visual fields).

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account:

  • the nature of the driving task;
  • information provided by the treating doctor regarding the likely impact of the neurological impairment on driving ability;
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments); and
  • the need for vehicle modification.

A person is not fit to hold an unconditional licence:

  • if the person has multiple sclerosis.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist regarding the level of impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, memory, sensation, muscle power, coordination, vision (including visual fields), and the likely impact on driving ability;
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments); and
  • the need for vehicle modification.

Neuromuscular conditions

(peripheral neuropathy, muscular dystrophy, etc.)

A person is not fit to hold an unconditional licence:

  • if the person has peripheral neuropathy, muscular dystrophy or any other neuromuscular disorder that significantly impairs muscle power, sensation or coordination.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account:

  • the nature of the driving task;
  • information provided by the treating doctor regarding the likely impact of the impairment on driving ability;
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments); and
  • the need for vehicle modification.

A person is not fit to hold an unconditional licence:

  • if the person has peripheral neuropathy, muscular dystrophy or any other neuromuscular disorder that significantly impairs muscle power, sensation or coordination.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist regarding the likely impact of the impairment on driving ability;
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments); and
  • the need for vehicle modification.
Parkinson’s disease

A person is not fit to hold an unconditional licence:

  • if the person has Parkinson’s disease with significant impairment of movement or reaction time or the onset of dementia.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account:

  • the nature of the driving task;
  • information provided by the treating doctor regarding the likely impact of the neurological impairment on driving ability and the response to treatment; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

A person is not fit to hold an unconditional licence.

  • if the person has Parkinson’s disease.

A conditional licence may be considered by the driver licensing authority subject to at least annual review, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist regarding the likely impact of the neurological impairment on driving ability and the response to treatment; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

Stroke

(cerebral infarction or intracerebral haemorrhage)

A person should not drive for at least four weeks following a stroke.

Treatable causes of stroke should be identified and managed with reference to this standard.

The driver licensing authority may consider a return to driving on an unconditional licence, after at least four weeks, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist regarding the level of impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, memory, sensation, muscle power, coordination, vision (including visual fields); and the likely impact on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

The person does not require a conditional licence.

A person should not drive for at least three months following a stroke.

Treatable causes of stroke should be identified and managed with reference to this standard.

A person is not fit to hold an unconditional licence:

  • if the person has had a stroke.

A conditional licence may be considered by the driver licensing authority after at least three months and subject to at least annual review, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist regarding the level of impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, memory, sensation, muscle power, coordination, vision (including visual fields) and the likely impact on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

Transient ischaemic attack

(advisory only)

A person should not drive for at least two weeks following a TIA.

A conditional licence is not required.

A person should not drive for at least four weeks following a TIA.

A conditional licence is not required.

Space-occupying lesions (including brain tumours)

Refer also to intracranial surgery.

A person is not fit to hold an unconditional licence:

  • if the person has had a space-occupying lesion that results in significant impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, memory, sensation, muscle power, coordination and vision (including visual fields).

A conditional licence may be considered by the driver licensing authority subject to periodic review, taking into account:

  • the nature of the driving task;
  • information provided by the treating doctor about the likely impact of the neurological impairment on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

If seizures occur, the standards for seizures and epilepsy apply (refer to section 6.2 Seizures and epilepsy).

If surgically treated, the advice for intracranial surgery applies.

A person is not fit to hold an unconditional licence:

  • if the person has had a space-occupying lesion.

A conditional licence may be considered by the driver licensing authority subject to annual review, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist about the level of impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension,
  • reaction time, memory, sensation, muscle power, coordination and vision (including visual fields), and the likely impact on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

If seizures occur, the standards for seizures and epilepsy apply (refer to section 6.2 Seizures and epilepsy).

If surgically treated, the advice for intracranial surgery applies.

Subarachnoid haemorrhage

Refer also to aneurysms.

A person should not drive for at least three months after a subarachnoid haemorrhage.

A person is not fit to hold an unconditional licence:

  • if the person has had a subarachnoid haemorrhage.

A conditional licence may be considered by the driver licensing authority after three months and subject to periodic review, taking into account:

  • the nature of the driving task;
  • information provided by the treating doctor about the level of impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension, reaction time, memory, sensation, muscle power, coordination and vision (including visual fields), and the likely impact on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

A person should not drive for at least six months after a subarachnoid haemorrhage.

A person is not fit to hold an unconditional licence:

  • if the person has had a subarachnoid haemorrhage.

A conditional licence may be considered by the driver licensing authority, after six months and subject to periodic review, taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist about the level of impairment of any of the following: visuospatial perception, insight, judgement, attention, comprehension,
  • reaction time, memory, sensation, muscle power, coordination and vision (including visual fields), and the likely impact on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).
Other neurological conditions including developmental and intellectual disability

A person is not fit to hold an unconditional licence:

  • if the person has a neurological disorder that significantly impairs any of the following: visuospatial perception, insight, judgement, behaviour, attention, comprehension, reaction time, memory, sensation, muscle power, coordination and vision (including visual fields).

A conditional licence may be considered by the driver licensing authority subject to periodic review,* taking into account:

  • the nature of the driving task;
  • information provided by the treating doctor about the likely impact of the neurological impairment on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

* Periodic review may not be necessary if the condition is static.

A person is not fit to hold an unconditional licence:

  • if the person has a neurological disorder that significantly impairs any of the following: visuospatial perception, insight, judgement, behaviour, attention, comprehension, reaction time, memory, sensation, muscle power, coordination and vision (including visual fields).

A conditional licence may be considered by the driver licensing authority subject to periodic review,* taking into account:

  • the nature of the driving task;
  • information provided by an appropriate specialist about the likely impact of the neurological impairment on driving ability; and
  • the results of a practical driver assessment if required (refer to Part A section 2.3.1 Practical driver assessments).

* Periodic review may not be necessary if the condition is static.

IMPORTANT: The medical standards and management guidelines contained in this chapter should be read in conjunction with the general information contained in Part A of this publication. Practitioners should give consideration to the following:

Licensing responsibility

The responsibility for issuing, renewing, suspending or cancelling, or reinstating a person’s driver licence (including a conditional licence) lies ultimately with the driver licensing authority.

Licensing decisions are based on a full consideration of relevant factors relating to health and driving performance.

Conditional licences

For a conditional licence to be issued, the health professional must provide to the driver licensing authority details of the medical criteria not met, evidence of the medical criteria met, as well as the proposed conditions and monitoring requirements.

The nature of the driving task

The driver licensing authority will take into consideration the nature of the driving task as well as the medical condition, particularly when granting a conditional licence. For example, the licence status of a farmer requiring a commercial vehicle licence for the occasional use of a heavy vehicle may be quite different from that of an interstate multiple combination vehicle driver. The examining health professional should bear this in mind when examining a person and when providing advice to the driver licensing authority.

The presence of other medical conditions

While a person may meet individual disease criteria, concurrent medical conditions may combine to affect fitness to drive, for example, hearing, visual or cognitive impairment (refer to Part A section 2.2.7 Multiple medical conditions and age-related change).

Reporting responsibilities

Patients should be made aware of the effects of their condition on driving and should be advised of their legal obligation to notify the driver licensing authority where driving is likely to be affected. The health professional may themselves advise the driver licensing authority as the situation requires (refer to section 3.3.1 and step 6 of the assessment and reporting process).

References and further reading

  1. Monash University Accident Research Centre. Influence of chronic illness on crash involvement of motor vehicle drivers, 2nd edition, November 2010. Available: http://monashuniversity.mobi/muarc/reports/muarc300.html.
  2. Wood JM, Worringham C, Kerr G, Mallon K, Silburn P. Quantitative assessment of driving performance in Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry. 2005; 76:176–180.
  3. Hawley CA. Return to driving after head injury. Journal of Neurology, Neurosurgery and Psychiatry. 2001; 70(6): 761–766.
  4. Heikkila VM, Turkka J, Korpelainen J, Kallanranta T, Summala H. Decreased driving ability in people with Parkinson’s disease. Journal of Neurology, Neurosurgery and Psychiatry. 1998; 64(3): 325–330.
  5. VicRoads, Occupational Therapy Australia. Guidelines for occupational therapy (OT) driver assessors, 2008.
  6. Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke. 2011 May; 42(5): 1489–1494.
  7. Annegers JF, Hauser WA, Coan SP, Rocca WA. A population-based study of seizures after traumatic brain injuries. N Engl J Med. 1998 Jan 1;338(1):20-4.
  8. Englander J, Bushnik T, Duong TT, Cifu DX, Zafonte R, Wright J, Hughes R, Bergman W. Analyzing risk factors for late posttraumatic seizures: a prospective, multicenter investigation. Arch Phys Med Rehabil. 2003 Mar;84(3):365-73.
  9. Christensen J, Pedersen MG, Pedersen CB, Sidenius P, Olsen J, Vestergaard M. Long-term risk of epilepsy after traumatic brain injury in children and young adults: a population-based cohort study. Lancet. 2009 Mar 28;373(9669):1105-10.
  10. Ferguson PL, Smith GM, Wannamaker BB, Thurman DJ, Pickelsimer EE, Selassie AW. A population-based study of risk of epilepsy after hospitalization for traumatic brain injury. Epilepsia. 2010 May;51(5):891-8.