Driving Assessment and Rehabilitation:

The Occupational Therapy Role

Timothy WilliamsPrincipal Occupational Therapist

Evolution Occupational Therapy, Brisbane QLD

Presentation to RACGP 58th Clinical Update WeekendSunday May 3rd 2015

Referral Indications: Spectrum of all patients

Medically Unfit :Do not issue Medical Certificate or clearance to drive. Recommend to cease driving(According to AFTD Guidelines or results of GP examination)

Medically Fit:Can easily and justifiably issue clearance to

drive(According to AFTD Guidelines or results of GP

examination)

Borderline Clients:Unsure of fitness. Need further information. Consider referring to a

specialist or OT for further examination.(According to AFTD Guidelines or results of GP examination)

Maintenance of GP – Patient is relationship is key here…

1. Any medical condition which could affect the person’s ability to drive. Concerns regarding a client's suitability include functional capacity and medical status

2. Deteriorating visual, physical and/or cognitive status3. Self-reported driving difficulties (rare!)4. Family report drive difficulties (common, sometimes groundless)5. If your client stopped driving due to an injury or disease, and they wish to explore the

possibility of returning to driving, or starting driving as a new learner6. When the activity of driving is aggravating the client's symptoms or the client's symptoms

are impacting on their ability to drive7. Where they require ANY or ALL vehicle/driver modifications. Vehicle Mods are an

“Equipment Prescription”.

Indications for Referral for an OT Assessment

Not all OTs work in Driver Rehabilitation: Additional Postgraduate OT Training Required to practice in this area Are experienced practitioners, and hold a minimum of two years experience in a relevant field of occupational

therapy practice Have established networks of GPs, Specialists, QLD Dept. of Transport, Driving Instructors, Vehicle Modifiers

Driver Trained OTs

Biomechanical, sensorimotor, cognitive and psychosocial aspects of driving Defensive driving in both manual and automatic vehicles Road craft theory and application Vehicle prescription Modification appreciation and application Off road assessment methodology On road assessment methodology including evaluation, analysis and interpretation Models of practical driver assessment (eg. Michon) Driver remediation program design Medico-legal issues including indemnity, report writing and duty of care Licensing Authority policy and procedures

Additional Postgraduate OT Training Required to practice in this area

1. Review AFTD Guidelines2. Contact therapist via fax, phone or letter.

Request assessment, indicating any specific concerns if relevant

3. Usually need to supply temporary QLD Medical Certificate specifically clearing patient as ‘Fit to Drive for Occupational Therapy Assessment*’

4. In some states of Australia – referrals may be initiated by the licencing authority

Simple Referral Process for all OT’s

Standard Driving Assessment

‘On Road’ Practical Assessment (~55 minutes) has good accuracy in identifying safe road users, and identifying one of 4 outcomes

In office or Clinical evaluation (1.5hrs) compared to age relevant norms, expected presentation / behaviors. Full Physical and Cognitive Ax completed

Tests indicate safe to proceed to on-road driving assessment

Driving Assessment Process Flowchart

Vision and Visual Field Assessment

Hearing ScreenPhysical and Neurological

ExaminationCognition and Perception

AssessmentRoad Rules and General

Road Craft Review

Advanced clinical testing of an experienced driver!

Operational, tactical and strategic control of vehicle

Self-Navigation and sign following

Standardised route where possible, encompassing all 24 required elements, allowing good re-test reliability and interpersonal comparison

OT Driver Assessment Outcomes

NB. Percentages do not total 100%, as there is some category overlap

Conditional Licences Need to be able to justify the restriction placed on the licence with evidence and risk assessment

If not able to justify – refer to a driver trained OT See section 6.1.3, page 72 of AFTD

For Example: Corrective lenses Automatic transmission Hand controls Time of day Specific distance radius (e.g. 5km from home address. Not ‘Local/Familiar area’)

May be used to aid in driving cessation Do not give conditional licences to those with suspected compliance / insight problems

OTs work very closely with Driving Instructors: Experts in Driver Training and Car Control

Instructors are not health trained therefore unable to provide health / functional/ medical opinions

Instructors are an excellent choice when a patient does not have any active or long term health complaint – used simply when a practical “refresher” is required.

Support OTs insight into on-road impact of clinical conditions

Some driving instructors also have additional disability modifications: spinner knobs, hand controls, left foot accelerator, etc.

Working in Partnership with Instructors

Assessment by a driving instructor alone does not support medical clearance

to drive

Tim Williams – Director / Occupational Therapist

www.evolutionot.com.auoffice@evolutionot.com.au

(07) 3103 3561 or 0407 561 012

Evolution Occupational Therapy

QUESTION ANSWERHow long to I have to wait for an appointment? 10 days to 2 weeks.  If you need vehicle modifications such

as a spinner knob or hand controls it may take longer, up to 6 weeks to make a booking.  If you are eligible for a public hospital driver assessment in Brisbane/Logan/Ipswich/Townsville, the wait time is up to 9 months. 

Why is it so expensive? The entire assessment may take up to 3 hours of the therapist’s time, plus cost of reporting and QLD Transport liaison if necessary.  It is a long and thorough with a specialist therapist/ AHP. 

It there a cheaper option? You may be eligible for a public assessment through QLD Health at the PA hospital, Logan community health and Ipswich community health.  There is a 8-9 month waiting list, and you may need to meet the inclusion criteria.  Some appointments can be fast tracked to 2-3 months wait.  There is a smaller charge of approximately $130.00.  Obviously, Evolution OT is a private clinic offering fast availability and excellent service. 

FAQ (1 of 4)

Do you have a pensioner discount? $390 is the discount rate. We charge a lower rate equally for all clients regardless of disability or age.  We may charge upwards of $700 for a commercial or insurance assessment.

Can I go in my own car? No.  For safety and legal reasons we must go in a driving school car with dual controls.  All therapists will follow this process, due to a fatality a number of years ago.

What sort of cars do you have? Modern, easy to drive automatics and manuals.  Even though it is a different car, we give you a nice period of time to get used to the different vehicle and get used to driving again if you have been away from driving for some time

I’ve been driving for 40+ years, why do I need this test now?

We work on the referral of your GP, doctor or specialist, acting as a second opinion or specialist opinion.  It is our role to determine 2 main things, 1. Are you safe, and 2. Does your health impact on your capacity to drive.  The therapist is aware that you hold a drivers licence, and may drive with your own “style” or habits.  The therapist is considerate to those habits, and will not score you badly if your habits are safe and suitable.  This assessment is not like a learner drivers assessment, where you must be perfect!  We are more “real world” than that. 

FAQ (2 of 4)

How long does it take for the report to be completed?

Up to 10 working days for a formal report.  The therapist may provide you with a handwritten summary to take to the doctor during the consultation, which may speed up your return to driving 

Can I drive now? You can only drive if you hold a medical certificate that clears you to drive independently.  Your OT will provide a report for the doctor, which will assist him to fill out a new medical certificate 

How often do I have to come back? You must return to your GP for medical certificate reviews at least each 12 months, sometimes more frequently for progressive or fluctuating health conditions.  You may need to return for an OT driver assessment if you have a functional change or decline in health.

How much does it cost? $390 for OT fee, $75 -110, for instructor, $45 for travel in Brisbane, $90 outside of Brisbane

Are there any rebates available? If you have private health insurance there may be a rebate between $40 and $100, depending on your level of cover. If you hold a Medicare EPC (Enhanced Primary Care) referral from your GP, you may be eligible for a rebate of $51.90 per consultation. (Max rebate of $102.80 for the Driving Assessment, if completed on separate days) 

FAQ (3 of 4)

Is there a cancellation fee? Yes.  A cancellation fee of $75 applies for driving instructor fees if the appointment is cancelled within 24 hrs of the appointment, or if the client does not attend.  The OT may also charge up to 80.91 for a cancellation. Please let us know at least 2 days before if you need to cancel, or on the Friday for a Monday appointment.

Where will we drive We may drive in your local area, or outside of this area.  We need to cover a range of driving situations and challenges.

Do I have to learn anything before the appointment? Not really.  Some clients like to refresh their knowledge of road rules, however this is not essential.  The therapist is looking at your current capacity, and practice is unlikely to affect the result.

Can I go with QLD transport instead? No.  QLD Transport does not get involved in the medical licencing process or older driver assessments.  They however will check your medical certificate to ensure that it seems acceptable, and may request a clarification if you are submitting multiple certificates from different doctors (“Doctor Shopping”)

When can I drive afterwards? Your OT will provide a report for the doctor, which will assist him to fill out a new medical certificate.  We recommend making an appointment approx. 1 week after the OT appointment to discuss the outcome with your GP.

FAQ (4 of 4)