Return to Driving after Traumatic Brain Injury

In March, Pam Ross (Grade 4 Senior Occupational Therapist, Driving and Vocational Rehabilitation Coordinator, Epworth Rehabilitation) delivered the first Breakfast Club Lecture of the year on Return to Driving after Traumatic Brain Injury – Processes, Outcomes and Driver Rehabilitation Interventions. The following is Pam’s summary of the lecture. If you would like to listen to the full lecture, the podcast is now available on iTunes.

According to Austroads, determining fitness to drive is based on a balance between minimising any driving-related road safety risks for the individual and the community posed by the driver’s permanent, or long term injury or illness, and maintaining the driver’s lifestyle and employment-related mobility independence.

Who is responsible for determining fitness to drive?

Responsibility for determining if a driver can safely return to the road is held by:

• The Driver Licensing Authority (DLA)
• Medical professionals including doctors, Occupational Therapists (OTs) and neuropsychologists
• The driver himself/herself

How is it assessed?

Assessing whether a driver is safe to return to the road is complex, and assessment depends on the physical and cognitive abilities of the driver.

• Medical: A doctor’s assessment is the first step in the process. The doctor is responsible for advising of any co-morbid conditions such as diabetes
• Specialist Medical: Sometimes a GP may need to refer to a specialist (e.g. psychiatrist, endocrinologist or neuropsychologist) in order to further assess the driver
• Eye Specialist: May be required to assess whether the driver has conditions such as double vision (diplopia), visual field deficits or diseases such as cataracts
• Occupational Therapy: Once the medical assessment has been completed, an OT can assess the driver’s motor, cognitive and behavioural function. A practical “on-road” test remains the gold standard of assessment, but assessment may also include neuropsychology tests and evaluation of medical history, medication, vision, insight, driving experience and cognitive ability.

Driver Outcomes:

After assessment, recommendations to the DLA may include:

• Return to driving
• Lessons then reassessment
• Suspension or cancellation of licence
• Conditional/restricted licence including area restriction, automatic vehicle restriction and time of day restriction

The effects of injuries or illnesses may affect a driver’s ability by impairing their cognitive or physical function or behaviour, and may result in reduced insight. The driver’s prospects of returning to the road may be influenced by whether their condition is progressive (conditions such as dementia, Parkinson’s disease and multiple sclerosis) or whether they are likely to improve (following stroke or traumatic brain injury). For more detail regarding how different conditions and injuries can affect a driver’s ability, see my lecture slides [LINK].

Is It Safe For Older People to Drive?

The requirement for older drivers to provide medical and eyesight clearances or to have a practical on-road assessment varies between states. Victoria, Northern Territory and Tasmania don’t have any requirements however, the following states require assessments:

QLD and ACT: Require an annual medical certificate once over 75

WA: Require a medical certificate once over 80, practical driver assessment annually once over 85

NSW: Require an annual medical certificate once over 75, practical driver assessment every two years once over 85

SA: Require an annual medical and eyesight assessment once over 70, practical driver assessment for licences other than cars once over 85

Research has shown that age itself is not a good indicator of driving ability; functional ability should be the criterion used in assessing whether older people are fit to drive.

Questions for family members and carers:

If you are unsure as to whether an older driver is safe to drive, the following questions may indicate that a driver assessment may be required:

• Does the driver get lost while driving in familiar areas?
• Do they forget the purpose of the trip?
• Have they had any crashes/near misses? Are there unexplained scrapes on the car?
• Do they drive too fast or too slow?
• Do they get easily confused?
• Do they get easily frustrated?
• Are they slow to make decisions at intersections?
• Do they drive through stop signs or give way signs?
• Do they find it difficult to stay in their lane?
• Can they tell left from right?
• Do they fail to see other vehicles, pedestrians or cyclists?
• Have they been pulled over by the police?
• Do they have difficulty parking?

Awarded a Churchill Fellowship in 2015, Pam Ross is currently investigating how driving simulators are being used overseas to assess and retrain older drivers and those with medical impairments and learner drivers with a disability, in order to develop guidelines for their use in Australia.

To listen to Pam’s full lecture and hear more about her research regarding return to driving after traumatic brain injury, download the podcast. 

[row]
[one_fourth][/one_fourth]
[three_fourth]

About the author

Pam Ross is a registered occupational therapist and has worked in the area of neurological rehabilitation for the past 30 years. She has specialized in the areas of driver assessment and rehabilitation and vocational rehabilitation. She is currently employed as the Grade 4 senior clinician at Epworth Rehabilitation where she coordinates both driver rehabilitation and return to work programs.

[/three_fourth][/row]