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Medical Conditions & Driving  

Age Related Medical Conditions
Autism
Brain Injury
Cerebral Palsy
Dementia
Hearing Loss
Mental Health Disorders
Multiple Sclerosis
Parkinson's Disease
Spinal Cord Injury
Stroke
Vision Deficits
Other

Age Related Conditions

Chronological age has little to do with driving safety. Some people are unsafe driving due to ill health in their late 50's and some people are perfectly safe to drive in their 90s. It is about function not age! Nevertheless aging is associated with the onset of many medical conditions which could affect driving skill, particularly those causing cognitive decline. In some states and countries age related driver testing is required and doctors are often called on to determining whether older patients are medically fit to drive. Doctors may request an occupational therapy driving assessment to determine this. The increasing age of populations in developed nations and increasing numbers of older people who want to retain driving contributes to a growing need to identify older drivers who are ‘at risk’. Follow this link to find out about older driver licensing rules in NSW: http://www.rta.nsw.gov.au/licensing/downloads/olderdriverguide.pdf

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Autism

Autism spectrum disorder (ASD) is a sensory processing disorder characterised by significant difficulties in social interaction and restricted and repetitive patterns of behaviour and interests. People with Autism often have an average or above average cognitive capacity and can use this to their advantage in compensating for their condition when learning to drive. Some people with Autism who are higher functioning (previously labelled as 'Aspergers') can learn to drive without special assistance. Some people require a specialised driving programme with a driver trained occupational therapist and driving instructor. Clinical experience indicates students with Autism often find it difficult to learn to drive from family members (such as Mum!) It is recommended that a driving instructor with special training in rehabilitation is used. It is important that the instructor uses consistent training methods, the same words for instructions (eg. 'gentle brake', 'off the gas'), step by step training, and does not advance until each stage is well learnt. If there are any difficulties the instructor should return to basic skills. It is important to stay in quiet traffic conditions until each stage is mastered and not to progress too quickly. Difficulties may occur with novel driving situations (such as a loud horn or other drivers not obeying traffic rules). Difficulties may also occur in road position and coordination of vehicle controls. A patient, consistent and gentle approach is required from the instructor. After obtaining a license a driver with Autism should be aware that stress and novel driving situations may still affect driving performance. Leave home in plenty of time, plan your trip, use a navigation device such as a navigation device, plan parking ahead, and avoid driving in conditions that you find challenging where possible. Below are some Sydney based instructors who have the specialised skills required to teach students with Autism (also see 'Links'):

Dean McMillian - 0423 007 550
Peter Karkoulas - 0417 469 849
Bill Karkoulas - 0411 727 233

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Brain Injury

A traumatic injury to the brain can result in a wide variety of deficits that may impact driving. This can include deficits in cognition (eg. initiative, memory, concentration, reaction time, planning, judgement and frustration tolerance etc.), vision and physical deficits. Most physical difficulties can be overcome with vehicle modifications or by learning new driving techniques. Vision should be checked to ensure it is still within license authority guidelines (particularly visual fields). Cognitive capacity and insight are the most important factors for determining who will return to driving following a brain injury. Research shows that around 50% of people return to driving after a brain injury. Common difficulties in returning to driving include reduced speed of information processing, road position errors, difficulty coping with novel traffic situations, reduced frustration tolerance, reduced awareness of own driving performance and reduced awareness of road signs and hazards. An occupational therapy driving assessment is usually required after a brain injury, even if mild, and a driver rehabilitation programme may be required.

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Cerebral Palsy

Cerebral Palsy (CP) is caused by injury to the developing brain before birth and is usually of unknown cause. The impact of the condition varies depending on the area of the brain affected. Symptoms can be very mild (eg. weakness in one limb) or significant (eg. affecting all limbs, cognitive function and speech). Common problems people diagnosed with CP have with driving are difficulty in operation and coordination of vehicle controls, vehicle position, complex decision making and vision. Even if cognitive function is not affected, people diagnosed with cerebral palsy often take longer to learn to drive. It is recommended that a vision assessment is conducted before attempting to drive to make sure vision is with license authority standards. An occupational therapy driving assessment is advised for prescription of appropriate modifications and a specialised driving programme where required.   

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Dementia

Dementia is a term used to describe progressive and irreversible loss of cognitive capacity over time. Dementia impacts 1 in 4 people over the age of 85 in Australia; thus 591,000 people are expected to be living with dementia in this country by 2030 (Access Economics, 2009). Many people continue to drive for a time after receiving a diagnosis of dementia (Alzheimer’s Australia, 2010). Alzheimer's disease is the most common type of dementia. It is often possible to continue driving for around 12 to 18 months after diagnosis but as soon as a person is diagnosed a plan should be made for retirement from driving. Too often people wait for a near miss or collision to tell them it is time to give up. It is not OK for a driver to continue driving if they need a co-pilot to be safe because at this stage there are global deficits affecting driving and the driver may not have the insight not to drive alone.  Drivers are usually be required to attend an occupational therapy driving assessment once they are diagnosed. The condition can cause slowed information processing, reduced reaction time, reduced insight and difficulty navigating (getting lost) when driving. Encouraging drivers with dementia to stop driving can be very difficult and stressful for family and they often need support from doctors and other health professionals in addressing this.

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Hearing Loss

People who are deaf are not required to report this to the licensing authority in NSW unless they are a commercial vehicle driver. There is no evidence that hearing loss affects driving safety. People who are deaf do need to compensate with their vision and increased caution / awareness. Due to the impact of hearing loss on communication there may be some additional challenges in the driver training process. Rehab trained driving instructors may have greater awareness of strategies for teaching people with communication difficulties (see driving instructor links on this site or contact the NRMA who have instructors trained in teaching students with hearing loss). If you have hearing loss or are deaf make sure you conduct safety scans at all intersections, be aware of emergency vehicles particularly when coming from the sides, and as for any driver keep your mobile phone off and other distractions to a minimum. You will need to be extra vigilant with your vision checks and scanning.

Information for driving instructors: The driving instructor and the student need to find a way to communicate that works - but this will be different for each student depending on the level of hearing loss and preferred method of communication. Find out the level of your student's hearing loss; keep the windows up and background noise to a minimum if some hearing is retained; make eye contact where possible; provide feedback when stopped; a light appropriate touch on the shoulder or a wave is fine for gaining attention; use a normal tone of voice rather than shouting or exaggerating lip movements; use diagrams, gestures and visual cues to help communicate. You can use your hands to represent cars when describing manoeuvres. In NSW book an RMS Disability Driving test and explain to the testing officer your student's special communication needs. You can use a signing interpreter for lessons and the test but this is usually not necessary (unless your student would like this). If your student has been deaf since birth they will already have developed compensation strategies / well developed vision skills. If the hearing loss or deafness is more recent you will need to teach strategies to compensate, such as safety scans at intersections and increased vigilance in observation skills.

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Mental Health Disorders

Driving is usually poorly address in the area of mental health as the focus is often on managing the acute phase of the condition and it can take years to obtain an accurate diagnosis and a stable medication regime. The difficulty with mental health disorders is that driving performance can fluctuate from hour to hour let alone day to day. A driving assessment may help but can only provide a picture of driving performance at one particular time period. Compliance with medication and ongoing medical management are important factors in retaining safe driving.  

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Multiple Sclerosis

Multiple sclerosis (MS) damages the central nervous system, which is made up of the brain, spinal cord, and optic nerves. The progress and severity of the disease varies greatly between individuals. Symptoms may include sensory loss, paralysis, loss of vision and in some cases, cognitive changes. It can be difficult to judge the point at which cognitive changes and reduced insight will impact driving safety. Most physical deficits can be compensated for to allow driving long after diagnosis. Common problems associated with driving for people with MS include reduced speed of information processing, reduced reaction time, diminished problem solving, fatigue, depression, weakness of limbs, incoordination, vision deficits and reduced insight. An occupational therapy driving assessment may be required to determine fitness for driving and to prescribe car modifications and a driver retraining programme.

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Parkinson's Disease

Parkinson's disease is a disorder of the central nervous system affecting the basal ganglia. Parkinson's disease affects speed of thinking, speech, physical movements, cognition and insight. The condition gets worse over time. These difficulties can affect driving, particularly in reaction time and ability to operate vehicle controls smoothly and in a coordinated way. People can usually continue driving for several years after diagnosis but there comes a time when it is necessary to retire from driving. Annual medical review of the medical condition for driving is required and the driver may be required to attend an occupational therapy driving assessment every 1 to 3 years (depending on the rate of progression of the disease). The main concern with driving is reaction time and speed of thinking. It can take longer to react to changing traffic conditions and reach the brake in time. Driving performance can vary throughout the day depending on the driver's medication cycle.  

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Spinal Cord Injury

Drivers with spinal cord injury can usually return to driving very successfully and a plan should be made for this early in their recovery. Most physical deficits can be overcome with vehicle modifications, even for people who have a high level spinal cord injury such as C5/6. Drivers with a spinal cord injury will need to attend an occupational therapy driving assessment to identify what vehicle modifications are needed and so a driving programme can be set up. Usually a rehabilitation driving instructor will conduct the retraining programme either in their own modified car or in the driver's vehicle where there are special needs. In NSW an RMS driving test is required at the conclusion of the driving programme. Rehab on Road aims to use the most simple and cost effective modifications first, while still meeting the client's needs. Electromechanical modifications are sometimes required for people with injuries at C5-C7. Most people diagnosed with quadriplegia aim to drive from their electric wheel chair to maximise independence. Individualised assessment is required.

Click here to see the Bancroft Driving Exerciser for drivers with high level spinal cord injury.

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Stroke

Damage is caused to the brain by blockage or leakage of blood vessels. Depending on the location of the damage there can be a wide range of physical, visual or cognitive difficulties. A person's ability to return to driving following a stroke often depends on the effect the stroke has had on their physical function and thinking ability. Most physical problems (such as hemiplegia) can be overcome through vehicle modifications. Cognitive problems such as poor memory, poor insight,  poor spatial awareness and neglect, can be more difficult to overcome. Sometimes a driver retraining programme is required. Research shows that around 30-40% of people return to driving following a stroke. Vision should be checked after a stroke to make sure there has been no loss of visual field (black spots or missing areas). Drivers are usually required to attend an occupational therapy driving assessment after a stroke, even if mild.  

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Vision Deficits

Please see 'Vision & Driving' for more information

Further Information

For further information on specific medical conditions & driving see 'Assessing Fitness to Drive' (2012): http://www.austroads.com.au/assessing-fitness-to-drive/

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