Timothy Williams, a principal occupational therapist, discusses the occupational therapy role in driving assessment and rehabilitation. Occupational therapists with additional postgraduate training can conduct on-road and in-office assessments to evaluate clients' medical fitness to drive. Referrals come from GPs unsure of a client's driving ability. Assessments examine biomechanical, cognitive, and perceptual skills, and identify if driving should be restricted, further training needed, or if the client is unfit to drive. Assessment outcomes help GPs determine the appropriate medical certification.

1. Driving Assessment and
Rehabilitation:
The Occupational Therapy Role
Timothy Williams
Principal Occupational Therapist
Evolution Occupational Therapy, Brisbane QLD
Presentation to RACGP 58th Clinical Update Weekend
Sunday May 3rd 2015

2. 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…

3. 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 status
3. 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 learner
6. When the activity of driving is aggravating the client's symptoms or the client's symptoms
are impacting on their ability to drive
7. Where they require ANY or ALL vehicle/driver modifications. Vehicle Mods are an
“Equipment Prescription”.
Indications for Referral for an
OT Assessment

4. ∗ 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

5. ∗ 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

6. 1. Review AFTD Guidelines
2. 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

7. 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 Screen
Physical and Neurological
Examination
Cognition and Perception
Assessment
Road 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

8. OT Driver Assessment
Outcomes
NB. Percentages do not total 100%, as there is some category overlap

9. 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

10. ∗ 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

11. Tim Williams – Director / Occupational Therapist
www.evolutionot.com.au
office@evolutionot.com.au
(07) 3103 3561 or 0407 561 012
Evolution Occupational Therapy

12. QUESTION ANSWER
How 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)

13. 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)

14. 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)

15. 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)