ASSESSING FITNESS TO DRIVE

ASSESSING FITNESS TO DRIVE
A matter of risk ?

Why Do Occupational Therapists Undertake
Driving Assessments
In a nutshell
• Occupational Therapists are interested in how people function
and interact with their environment on a day to day basis
especially those mundane everyday activities we all take for
granted and do without a second thought
• Driving for the majority of people is a routine daily activity.
• The objective is if at all possible to keep people driving rather
than reduce their independence.

The purely medical issues
related to fitness to driving
are the responsibility of the
Physicians not the Occupational
Therapists

Occupational Therapists become involved with driving primarily
related to three issues:
1) An individual’s ability to drive and the need for vehicle modifications
2) An individual's cognitive function related to driving
3) To a lesser extent some vision problems especially related to grey areas around
visual fields
Driving related to physical ability and cognitive function
is all about risk

The chance of bad consequences
Exposure
To the
risk of injury

What’s Up Officer ?

Valet Parking

What our Office Manager does off duty

Was the head not screwed on the right way
round ?

Driving Assessment is an exercise in risk
assessment and management
Are They Safe To Drive
Yes
No
A range of well, sort of depending…

Physical Driving Ability
Where an individual has a physical
deficit (excluding vision) in many
cases the technology exists to
compensate for that deficit.
These include a range of
modifications from the simple to
the technologically advanced.
Arms and legs are not required to
drive.

Modifications range from a simple knob on the steering wheel through to EMC joystick
steering
Steering and Indicator Extension
Left Hinged Accelerator Pedal

Menox Hand Control
Cullen Hand Control

Cognitive Function Related to Driving
Cognitive function related to driving is the most difficult area to assess
and the one with the greatest potential for disaster.

What Does The Assessment Involve
A two part assessment involving
An Off Road Driving Assessment
An On Road Driving Assessment

The Off Road Assessment
The Off Road Assessment is designed to assess a
number of areas:
We need to know:
• Where the client normally drives?
• What type of car they drive?
• Is their Driver’s Licence current?
• Are there any residual physical
problems which may affect driving?
- Hemiparesis
- Tone
- Functional movement
- Co-ordination
- Sensation etc
Vision – Visual Field Deficits
If present then a referral is made to
an Optometrist for visual field
testing, that is does the individual
have the required 140 of
horizontal visual field to drive. If
not then no driving.

Cognitive Function
A computer based assessment called the CanDAT
(the Canterbury Driving Assessment Tool)

What Does The CanDAT Assess ?
• Visuomotor Skills/Visuoperceptual Skills
• Reaction Time
• Speed of Information Processing
• Movement Speed
• Visual Spatial Ability
• Divided Attention
• Complex Attention
• Planning

What Do The Results Mean ?
In addition to the overall impaired pass/fail/no clear result the
individual sub tests can be indicative of potential problems
related to in terms of driving in familiar areas versus unfamiliar
and low complexity versus high complexity

The On Road Assessment
Lets go for a drive…..
The On Road drive is undertaken in the
individual’s own car or one of the
assessment cars if required.
The assessment is undertaken by a Driving
Instructor and the Occupational Therapist.
The Driving Instructor’s job is to give
directions and “risk manage”, that is
intervene in the driving if required.
The Occupational Therapist marks the
assessment sheet

The drive begins in the individual’s own area and covers places where they would
normally drive.
Part of the assessment drive will be in less familiar areas and will involve
different driving situations such as the local shopping area, suburban and
back streets, and the motorway or highway if appropriate.

The On Road Assessment is NOT a driving test of the type required to sit or
retain a Driver’s Licence.
The assessment focus is on a range of behaviours which can be associated with
cognitive function.
These include
• The ability to apply priority rules
•The ability to make a decision in a reasonable time acting appropriately
•Observe and recognise signs (includes knowing you are at a give way or stop sign).
•Reacting in time to hazards, i.e. late braking for other vehicles, intersections, bends in
the road, pedestrians, including inappropriate stopping for empty pedestrian crossings
and intersections
•Selecting correct lanes
•The ability to self navigate from point to point selecting an appropriate route

The assessment also looks for pre-existing habits such as:
•Failure to blind spot check when moving off and with lane changes.
•Stopping too close to the car in front.
•Following too close – two second rule.
•Minor speed limit infringements.
•Failure to consistently indicate.
•If a manual car
– clutch coasting
- neutral coasting
- occasional incorrect gear selection
- riding the clutch
The Assessor looks at the range of negative driving behaviours and makes some
judgments about how that affects overall driving safety. What are the patterns of
behaviours occurring and are they just bad habits or is it behaviours associated with
cognitive impairment.

The bottom line is:
1) Does the Driving Instructor physically intervene in the
individual’s driving to prevent a crash or near miss?
2) Are the behaviours/errors:
- Bad habits but not unsafe
- Less safe
- Unsafe
- Potentially dangerous
- Overtly dangerous.
This is taken in context of where the individual lives, wishes to drive and the
complexity of the driving situation the individual is likely to drive in,
physical status and insight into difficulties.
The outcome can be expressed in terms of high or low risk.

LICENCE ISSUES
• Occupational Therapists have no power to grant or revoke a Driver’s
Licence
• Current NZ Transport Agency rules allow the Medical Section of the
NZ Transport Agency to act upon the recommendations contained in a
formal Driving Assessment report
• The Occupational Therapist recommendations may include:
1) Resume/continue unrestricted driving
2) Resume /continue driving, but with limitations
a) Time of day
b) Distance from home
3) Revocation of a Driver’s Licence
4) Essential vehicle features
a) Automatic only
b) With vehicle modifications
Whatever the limitation placed on a licence it must be realistic and
enforceable

COSTS
• The Occupational Therapy Driving Assessment is highly
specialised
• The full assessment takes up to four hours with a
comprehensive report which is legally defensible
• A Driving Instructor is required for risk management
• The On Road Assessment is often undertaken in the
client’s own environment which often involves travel
Depending on where the person lives and the travel involved a full
assessment can cost between $350.00 and $550.00

Thank
You