Recommencing driving after a lower limb amputation

In today’s technological advanced environment, it is possible for a person who has had one or both lower limbs amputated to return to driving. This article will discuss what is involved in New South Wales to successfully regain your licence following this significant event.

What happens to my licence after a lower limb amputation?

All drivers in NSW are required to inform the Roads & Maritime Services (RMS) about any medical condition that potentially affects driving ability. By law, a driver is responsible for declaring their medical condition to the RMS, although many people are not aware of this. In an event of a lower limb amputation, the treating doctor commonly notifies the RMS by completing an RMS medical form. that indicates that the person requires an Occupational Therapy Driving Assessment to determine fitness to drive.

What affects my ability to return to driving following a lower limb amputation?

Driving requires the delicate coordination of a person’s physical, cognitive and visual functioning. After a lower limb amputation, ensuring that the person’s vision and cognition have not deteriorated, the main component that determines if the person will find driving difficult using standard equipment (nil modifications) depends on the site of the amputation (i.e. if it is above or below knee). If the amputation involves one lower limb, the main consideration is to observe how it impacts on the person’s ability to engage the vehicle’s foot controls; i.e. the accelerator and brake pedals. Drivers who have had both lower limbs amputated will generally not be able to utilise vehicle foot controls and will therefore require modifications that enable them to control all aspects of the vehicle with their upper limbs. Drivers with lower limb amputations are generally restricted to driving only automatic vehicles.

What is an Occupational Therapy (OT) driving assessment?

In NSW, any person with a diagnosed medical condition that may possibly impact on their driving capacity, maybe required by their doctor to complete  an OT driving assessment. An OT driving assessment is completed by an Occupational Therapist that has completed a specialised course to assess drivers with medical conditions. The focus of the assessment is to explore how the person’s condition or disability is affecting their driving, and if strategies may be put in place to mitigate the observed deficits (e.g. vehicle modifications, or the person may benefit from driving lessons with a rehabilitation driving instructor).

For a person with a lower limb amputation the role of the OT is to determine if they require the use of vehicle modifications. If the OT assess that the person does indeed require a vehicle modification, then the OT will trail various modifications with the person. Once a specific modification is selected that meets the needs of the person, the OT will write a report to the RMS and the referring doctor. The person will then be required to undertake several lessons with an instructor with the aim to learn how to use the prescribed modification safely. Once the person feels competent with the modification he or she will then complete an RMS disability test.  Once the person successfully completes this test they will then be able to drive independently. The purpose of the RMS disability test varies to the OT assessment. This is due to the RMS disability test assessing not the person’s physical control of the vehicle (if the amputation affects their ability to drive) but rather their ability to follow and drive to all RMS road rules.