Stroke is a medical condition that impacts people in various ways and differs in severity between individuals. A stroke occurs when an artery becomes blocked or bursts, preventing the brain from receiving its essential supply of blood. This then results in the death of brain cells, as the brain becomes starved of nutrients and oxygen. There are two sorts of stroke: haemorrhagic and ischaemic stroke.
- Haemorrhagic stroke: When bleeding occurs in the brain due to a burst blood vessel
- Ischaemic stroke: When an artery in the brain becomes blocked due to a blood clot
A stroke is a serious medical condition that can be life-threatening and requires urgent medical attention. After an individual has sustained a stroke, they are required by law to notify the RMS of their medical condition. Many drivers in NSW are unaware that they have a fundamental responsibility to inform the RMS of any medical condition or disability that may affect driving ability. For many people after a stroke, this notification is usually attended to by their treating specialist or GP, through the completion of the RMS medical ‘fitness to drive’ form. On this form, the doctor makes a clinical decision regarding the person’s functional capacity to return to driving. Once the RMS is made aware of the individual suffering a stroke, they notify the person (usually by post) of the requirement to have undergone an Occupational Therapy (OT) driving assessment, as recommended by their treating doctor. Usually, doctors allow for a 3–6 month time period after the stroke before recommending that the person completes the OT driving assessment.
A stroke can affect the person both cognitively and physically. While the person’s doctor performs various medical assessments and tests to monitor their recovery after a stroke, they do not witness the person drive. Thus, the OT driving assessment serves to make a determination about the ongoing effects (if any) that the stroke has had on the person’s driving skills.
The OT driving assessments examines the 3 areas that are required for driving a vehicle: vision, cognition and physical capacity. Unfortunately, stroke can affect all 3 of these areas, causing reductions in a person’s capacity to drive safely and to proper standards. The Occupational Therapists at Modified Driving Solutions will go to the individual’s home and assess all 3 of these areas. Any deficits that are detected are documented and discussed with the person (and their family). Once this is completed, the individual completes a 1-hour drive in their local area with the Occupational Therapist and a Driving Instructor. The driving instructor utilised has completed specific training to work with people with medical conditions. The focus of the driving assessment is to determine if any of the deficits that were detected earlier, or the symptoms of the stroke, impact on the person’s ability to drive competently. It is important to note that the assessment is primarily concerned about how the stroke has influenced driving ability, and is not majorly concerned about minor errors made due to poor driving habits, being unaccustomed to the car, or because of nervousness due to testing conditions. After the assessment, the OT will explain to the individual about the outcome of the test and their recommendations moving forward.
There are 4 potential outcomes of the Occupational Therapy Driving Assessment.
1. It is determined that the stroke does not impact the person’s ability to drive safely and to RMS standards. The Occupational Therapist will send a report to both the RMS and to the individual’s referring doctor. The individual will then be able to return to driving with an unrestricted licence.
2. It is determined that the person requires vehicle modifications, which the OT will prescribe. This generally occurs when the individual has sustained physical deficits due to the stroke e.g. weakness in a limb. In this case, the individual will require additional lessons with an instructor to learn how to drive with the modifications, then complete an RMS Disability Driving Assessment prior to resuming driving. The OT will outline a driving lesson plan to best assist the person to become proficient with using the modification. The specific modification will then be endorsed on the individual’s licence (meaning that they will not be legally able to drive without the modification).
3. It is determined that the stroke is impacting the person’s ability to drive and is resulting in some errors that require lessons with a driving instructor to rectify. With this outcome, the Occupational Therapist will state that the individual will require a certain number of lessons with a driving instructor to overcome the assessed deficits or errors. A lesson plan for the driving lessons will be developed, outlining specific goals that the person is expected to complete. The Occupational Therapist may also request that the individual completes another on-road driving assessment with the Occupational Therapist, depending on the severity of the identified errors. Once the individual completes the lessons and can drive safely, a report is sent to the RMS and to the individual’s doctor, and the person can continue to drive with an unrestricted licence.
4. It is determined that the person can no longer drive in a safe manner and their licence will be cancelled. This outcome generally occurs when an individual is unable to rectify or show improvement with any driving deficits noted, where further lessons or vehicle modifications will not help the individual to return to driving. This is generally when the effects of the stroke are cognitive in nature e.g. severe issues with concentration, attention or decision-making.