Welcome to Part 3/3
The outcome of an Occupational Therapy Driving Assessment
This is the third instalment of our series of articles explaining the entire process of an Occupational Therapy Driving Assessment. Before reading this article, it is recommended that the following articles are read in order to obtain a detailed understanding of what is involved when there is concern that a medical condition is affecting one’s driving ability:
P1. The Off-Road Occupational Therapy Driving Assessment explained
P2. The On-Road Occupational Therapy Driving Assessment explained
There are four main potential outcomes of an Occupational Therapy (OT) Driving Assessment. Each outcome depends on a combination of the client’s medical condition and the results of the off-road and on-road Driving Assessments. While each individual has unique needs and people’s personal situations are different, the OT driving assessment is the standard process in NSW to determine a person’s medical fitness to drive.
The first potential outcome
The “pass” outcome is when the Occupational Therapist assesses that the person’s medical condition does not impact on their ability to drive safely and according to RMS standards. This decision is made when the Occupational Therapist assesses during the on-road assessment that the person’s medical condition and/or any deficits noted during the off-road assessment do not impact significantly on their driving ability. Generally, to achieve this favourable outcome, the person must not commit any critical errors during the on-road assessment. A critical error occurs when the driving instructor must physically intervene (by either utilising the dual control brake or taking control of the steering wheel) to prevent an accident or collision.
When this outcome occurs, the Occupational Therapist will document this in their report and forward a copy of the report to the Roads and Maritime Service (RMS) and the person’s referring Doctor. Notification is usually made within 24 hours to the RMS and the person should be able to promptly return to driving, depending on their licence status.
The second possible outcome
Another possible result of the OT driving assessment is when the Driver Trained OT prescribes vehicle modifications for the person. This is necessary when the person’s physical ability to control the vehicle does not meet legal standards. Specifically, the person’s capacity to operate the following vehicle controls are focused on in the on-road assessment:
- Vehicle foot controls (brake, accelerator, clutch)
- Steering wheel
- Indicator use
- Complete blind spot checks and utilise vehicle mirrors (internal and external)
When a person has a physical condition or disability impacting on their skills to safely manoeuvre a motor vehicle, the OT will send the report to the RMS and to the person’s referring Doctor. The report will clearly specify the vehicle modifications the person requires. The person’s licence is temporarily downgraded to a leaner licence, and they need to undertake driving lessons with a driving instructor. The aim of the lessons is for the person to become proficient with using the modifications. Once the person feels confident with the modification in all driving environments, they will undertake an RMS Disability Driving Test. This test is carried out by RMS staff, not the Driver Trained OT. The test takes the form of a Provisional licence test (P’s test), with the primary difference being that the person drives with the prescribed modification. Once they pass this assessment, their licence is reinstated to its previous status, with the endorsement of the vehicle modification. From that point on, the person must always drive with the prescribed modification. The person can also be supported by the Occupational Therapist to have their own vehicle modified with the prescribed modifications.
The third outcome
Another potential outcome is that the OT determines the “need for further specialised driving lessons”. This option occurs when the person makes errors due to their medical condition and requires additional lessons to improve their driving performance and reduce their errors. The Occupational Therapist will recommend that they undertake a specific number of lessons with a rehabilitation driving instructor, with the specific aim to rectify the observed errors. The OT may formulate a specific lesson plan for the driver. After the lessons, the person will then undertake an Occupational Therapy Re-assessment to determine if their driving skills has improved. If the person can demonstrate that they have rectified the errors and can drive safely, the Occupational Therapist will be able to ‘pass’ the person and they can continue to drive as they were previously.
The final outcome
The last potential (and most unfortunate) outcome is a “fail” of the assessment. This is established when the person makes ongoing errors that he or she is unable to show improvement in. A fail also occurs when a person makes a critical error. A critical error is any error where the driving instructor must physically intervene and take physical control of the vehicle to prevent a motor vehicle accident that is the result of errors or action from the driver. If the person has a condition that is degenerative in nature causing the person to have poor insight into their driving errors or impact on their ability to take in feedback and modify their errors, the Occupational Therapist may be required to cancel that person’s licence. This occurs when the Occupational Therapist is of the clinical opinion that lessons will not improve the person’s driving performance and there is nil potential for improvement. Usually, this extreme result occurs with severe cognitive conditions or deficits, as the person’s medical condition will not improve.
