Clinical Guidelines for Acute Stroke Management - Living on the EDge

8.8 Return to driving after stroke or TIA
Section 8 Discharge Planning, Transfer of Care and Integrated Community Care
The issue of returning to driving can be confusing and
the topic is often raised by the patient or their
family/carer, especially <strong>for</strong> patients with minor stroke or
TIA. Currently there are National <strong>Guidelines</strong> <strong>for</strong> Driving
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as well as state or local guidelines. The current
National <strong>Guidelines</strong> describe conditions <strong>for</strong>
unconditional licences and where conditional licences
exist. Patients with stroke automatically have a
conditional licence and are not to return to driving
<strong>for</strong> a minimum of 1 month if there are significant
neurological, perceptual or cognitive deficits.
A physician assessment should be undertaken be<strong>for</strong>e
returning to drive and where necessary (where stroke
deficits are deemed to potentially impact on driving)
a driver assessment. There is currently no restriction
in place <strong>for</strong> those with first TIA, however, restrictions
apply when the person has had two or more TIAs.
In such cases a conditional licence may be granted
taking into account the opinion of the treating
doctor/GP, and the nature of the driving task, and
subject to periodic review if the aetiology of the TIAs
has been identified, the underlying cause removed,
and the person has had a 6 month period free of
attacks. 472
State based guidelines describe the responsibilities of
the patient, the treating doctor or both. In general they
recommend a period without driving. The ABCD 2 tool
may assist to screen those at high risk after TIA and to
in<strong>for</strong>m the decision and advice provided to patients
and their families. Those with a high risk should clearly
be advised to avoid driving given the higher risk of
stroke within the first few weeks.
In all cases, people with stroke who held a driving
licence pre-stroke should be provided with written
in<strong>for</strong>mation about returning to drive including legal
obligations and necessary assessments. This
in<strong>for</strong>mation should be provided prior to discharge from
hospital or preferably within the first visit in the case of
those not admitted to hospital.
Further discussion about assessment and
management of driving after stroke is found in the
<strong>Clinical</strong> <strong>Guidelines</strong> <strong>for</strong> <strong>Stroke</strong> Rehabilitation and
Recovery.
CONSUMER
8.8 RETURN TO DRIVING GRADE LEVEL RATING
The National <strong>Guidelines</strong> <strong>for</strong> Driving and relevant state guidelines should ✓ – 9.7/10
be followed when assessing fitness to drive following a stroke or TIA.
In general, patients with TIA or minor stroke, especially those found to
be at high risk, should be advised to delay returning to driving <strong>for</strong> at
least 1- 4 weeks.
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