Medical aspects of fitness to drive a guide for medical practitioners

1.8
Occupational therapists
If there is doubt regarding an individual’s fitness to drive, an assessment by an
occupational therapist may be appropriate.
Occupational therapists with specialist skills in driver assessment offer services in most
centres. Occupational therapists offer a thorough, independent, objective assessment
of driving ability, which is a valuable adjunct in determining fitness to drive.
Occupational therapists interpret how illness, trauma and subsequent disability
may impact on an individual’s ability to perform their usual functions. Driving is an
activity that requires a combination of sensory, motor, cognitive and perceptual skills.
Occupational therapists are aware of the high priority individuals give to their driving
independence and of the associated complexity in determining fitness to drive.
Occupational therapists are concerned that people with disabilities, including
age‐related disability, are assisted to be independent in the activity of driving where
technical and financial resources allow. Those with a disability that results in them
being unsafe are advised to relinquish driving privileges.
Assessments cover a wide range of skills required for the safe operation of a vehicle:
• Biomechanical problems are evaluated and recommendations made for the
acquisition of suitable vehicles and appropriate vehicle modifications, with
consideration given to lifestyle and mobility devices such as wheelchairs.
• Cognitive skills are assessed, including concentration, decision making, eye–hand
coordination and impulsivity, to ensure people are able to cope with the demands of
driving and traffic situations.
Details of occupational therapists’ driving assessment services can be obtained
from Enable New Zealand on 0800 171 981 or from the New Zealand Association of
Occupational Therapists on 04 473 6510.
1.9
Changes in medical treatments
Changes to medical treatments may make some of the information in this guide
become outdated. It is not possible to change the guidelines every time changes in
medical treatments are made.
If practitioners consider the advice in the guidelines is inappropriate for an individual
they are assessing for fitness to drive because of changes in medical treatment, they
can write to the Chief Medical Adviser and outline why the individual should not be
considered using the guidance in this guide.
2.
Summary table
Neurological and
related conditions
The table below summarises the information outlined in this section. It does not
describe any tests that may be necessary before some individuals can return to driving.
Practitioners should ensure that they are familiar with the guidance outlined in the
entire section rather than relying solely on the table.
The recommended minimum stand‐down periods from driving and guidelines only
apply where an individual’s medical condition has been adequately treated and
stability has been achieved so that road safety is unlikely to be compromised.
Medical condition
Severe disabling giddiness,
vertigo, or Meniére’s disease
Blackout or fainting of
known cause
Blackout or fainting of
unknown cause
Epilepsy – tonic clonic
Class 1 or class 6 licence and/or
a D, F, R, T or W endorsement
(see appendix 3)
Should not drive until sufficiently
treated.
Should not drive until cause of the
blackout has been identified and
treated appropriately to reduce the
risk of future blackouts. Any medical
condition(s) identified should be
treated having regard to the relevant
sections of these guidelines.
Same as tonic clonic epilepsy.
Should not drive for 12 months. This
may be reduced to a minimum of
six months by The Agency subject
to a supporting neurologist report
(see section 2.4.1). Individuals who
have more than one seizure‐related
crash should be seizure free for five
years, with or without medication,
before being considered fit to
resume driving.
Class 2, 3, 4 or 5 licence and/or a
P, V, I or O endorsement
Same as private classes.
Same as private classes.
Same as tonic clonic epilepsy.
Should not drive. However,
the Agency may consider granting
a licence to individuals who have
been seizure free for five years and
are not on any medication to control
seizures.
14 1. General matters | Medical aspects of fitness to drive | NZTA July 2009
July 2009 NZTA | Medical aspects of fitness to drive | 2. Neurological and related disorders 15