Occupational Therapy Driving Assessment

Driver Trained Occupational Therapist

 

Occupational Therapy Driving Assessment

The Occupational Therapy driving assessment may be required if a driver has a diagnosed medical condition or disability that possibly changes their driving capacity. In NSW, it is the prime responsibility of the driver to let the RMS know of any changes in their medical status or condition. However, often, people are not aware of this, and their treating doctor (usually GP or Specialist) will inform the RMS of their medical condition and any concerns related to driving.

Once a driver has been diagnosed with a medical condition, their doctor should fill out the ‘RMS fitness to drive’ form, where they indicate whether the medical condition may be affecting the person’s driving ability. If the doctor indicates specifies that the person should have an Occupational therapy driving assessment, you will need to begin to organise this with your local Driver Trained Occupational Therapist.

Occupational Therapy Driving Assessments can be divided into 2 sections; the off-road section and the on-road section. All Driving Assessments, regardless of the person’s medical condition, follow the same format. The aim of this article is to focus on the process involved in the off-road component of the assessment.

The off-road assessment consists of three screens and assessments that aim to detect any deficits related to an individual’s vision, cognition and physical capacity. These are the three main areas that every driver needs to be able to drive safely, and driving involves the synchronization of these three areas. All Driver Trained Occupational Therapist follow the same therapeutic process to ensure consistency and validity with each assessment. Other additional information is also obtained e.g. need for driving, medication and medical history, as well as licence status/history.

Vision

One of the three screening areas is testing the person’s visual acuity. The Occupational Therapist will complete a functional screening test. The purpose of this screen is to ensure that the person’s visual acuity meets RMS standards, and determine if the person’s vision has the potential to impact their driving. It is to be noted that no formal diagnosis will be made from this screen. The aim is to detect any deficits. If deficits are detected, the Occupational Therapist will refer the client to an Optometrist, Ophthalmologist or appropriate specialist. The visual assessment consists of the following

  • Questions about vision history
  • Visual acuity test (using a Snellen vision chart)
  • Visual field test (testing peripheral vision)
  • Confrontation test
  • Cover test (to detect any presence of strabismus)

Physical and functional test

The physical function test assesses an individual’s entire body and physical capacity (in relation to driving). Again, the assessment remains the same regardless of the person’s medical condition. The aim of the assessment is to determine if the person has any deficits that may impact on their ability to physically control the vehicle; i.e. control the steering wheel, brake, accelerator and/or clutch. The entire assessment is completed with the person seated. The assessment focuses on the following areas:

  • Active range of motion
  • Passive range of motion
  • Muscle tone
  • Strength
  • Coordination
  • Sensation
  • Trunk stability
  • Proprioception
  • Kinaesthesia

Cognition

The third and final screen assesses a person’s cognitive functioning. Various or multiple assessments can be used for this section. The most commonly used and recommended test is the DriveSafe DriveAware (DSDA) assessment. This assessment is considered to be the gold standard for assessing a person’s cognitive fitness to drive. The assessment has high validity and is one of the few assessments that are specific to driving. The assessment can assess a person’s concentration, attention, ability to follow instructions and road knowledge. However, for clients who have cognitive specific conditions e.g. brain injury or dementia, the DSDA, as well as a second assessment, will often be used. Examples of other cognitive assessments that may be utilized include:

  • Mini Mental State Examination
  • Trail Making Test
  • Motor-free Visual Perception Test
  • Rey Osterreith

Complex Figure

  • Clock Drawing Test
  • Cognitive Behavioral Driver’s Inventory
  • Stroke Drivers Screening Assessment
  • Gross Impairment Screening Battery of General Physical and

Mental Abilities

  • DriveABLE
  • P-Drive
  • Computerized Sensory-Motor and Cognitive Test

Once these 3 assessments are completed, the Occupational Therapist will discuss the results with the person. Any deficits identified will be monitored during the on-road component of the occupational therapy driving assessment.