Daniel was referred to Driving Well Occupational Therapy to obtain a wheelchair accessible vehicle in May  2023.  Daniel had outgrown his specialised car seat where he needed to be physically lifted in and out of his wheelchair and also lifted in and out of his car seat.  He needed a wheelchair accessible vehicle to transport him as a passenger in his wheelchair, due to his postural support needs.  The vehicle modification was required now, and needed to be suitable in the future as well as he continues grow and develop. 

Daniel lives with his parents and three brothers.  Previously, they were unable to travel together as a family, as there was insufficient space in their car to transport the whole family of 6 and Daniel’s mobility aid.  This restricted Daniel and his family’s ability to access the community together, and limited Daniel’s opportunities for social connection and community participation to home, school and therapy/medical appointments.   

Daniel and his family successfully trialled and submitted a NDIS application for vehicle modifications (lowered floor conversion for wheelchair occupant) to their Hyundai Staria, which was subsequently approved by NDIS.  This is a mutually beneficial investment long term, as this modified vehicle will be used frequently to facilitate Daniel’s access to his community and is a more cost effective and client-centred support than an additional transportation budget to access Maxi-Taxis where short/ frequent trips are required. 

Retirement from driving is an inevitable part of aging for many people. However, this transition often brings emotional and practical challenges that can be difficult to navigate. As an occupational therapy driving assessor, I see firsthand the complexity of this life change, which not only affects an individual’s mobility but also their sense of independence and quality of life.

For many, driving isn’t just a way to get from one place to another—it’s a symbol of freedom, autonomy, and connection to the community. When it’s no longer safe to drive due to age-related conditions, health concerns, or cognitive changes, the impact can be profound. The loss of the ability to drive often leads to feelings of frustration, loss of control, and even isolation, particularly for those who live in areas with limited access to public transport.

When it becomes clear that a person’s ability to drive has been compromised, part of the challenge is helping them come to terms with this reality. This is often the most difficult part of the process for individuals and their families. The next hurdle is finding alternative transportation options.

AustRoads Assessing Fitness to Drive Guidelines Definition of Driving:

Driving a motor vehicle is a complex task involved perception, appropriate judgement, adequate response time and appropriate physical capability. A range of medical conditions, disabilities and treatments may influence these driving prerequisites. Such impairment may adversely affect driving ability, possibly resulting in a crash causing injury or death. 

There are many conditions that may impact on driving such as blackouts/seizures, diabetes, eye/vision problems, heart disease, neurological —dementia, stroke, or epilepsy, psychiatric disorders, sleep disorders and alcohol or drug dependency.

Anyone who has a medical condition that could impact on driving must have their treating doctor complete a Queensland Transport Medical Certificate for Motor Vehicle Driver (F3712) to continue driving.  This also includes individuals over the age of 75, who must have an annual medical certificate form their treating doctor.  Some conditions may require a medical specialist to complete this form.  Once your doctor has completed the medical certificate form, you must submit this to Queensland Transport either in person, or scan and email the completed form to mcr@tmr.qld.gov.au.  Under the conditions section on your licence, there will be an M. 

Problems encountered with driving instructors who do not hold additional qualifications:

It has been our experience that standard driving instructors may have a basic understanding of Autism, ADHD and intellectual impairment/executive functioning difficulties, however their day-to-day skill is working with neuro-typical students and they have less understanding of the cognitive, sensory, visual and information processing challenges faced by individuals with these diagnoses.

• They are less able to identify skill deficits specific to neurodivergent learners and plan a remediation program to target and develop these skill areas.
• Learning to drive is a highly verbal and non-verbal process and it’s essential that the driving instructor can adapt their teaching and communication style to meet the communication needs of the individual with Autism/ADHD/II. Neurotypical teens will learn to drive by verbal repetition, but this does not work for learners with Autism/ADHD – where they have challenges with verbal/auditory processing and literally often have no idea what the driving instructor is saying – “in one ear and straight out the other”.
• A consequence of a neurotypical driving instructor teaching style of constant verbalisation and commentary (in an overloaded way) – is that we don’t know if the learner driver is actually able to recognise critical items and plan themselves. This has significant safety implications – the client may pass the test, especially if they have been practicing the TMR routes with the instructor, however they may lack the ability to recognise hazards and plan and problem solve effectively. I have seen this first hand in a client:
• Mr M: 3 weeks prior to his test, an on-road review with a regular driving instructor indicated that the instructor was still providing constant verbal commentary – so I didn’t know what the client was seeing/planning for himself, and then when I asked the instructor to be quiet, the learner driver had these problems:
  • did NOT plan a lane change safely
  • was frazzled with a red light ahead, did not see a merging lane or complete that lane change safely, and needed prompting to notice signs at a slip lane turn. The safety implications are huge and we cannot afford to be putting our teens in this situation.
• It has been our experience that individuals who participate in standard lessons with instructors who are not skilled in tailoring communication and lessons to their needs can lead to reduce understanding of what is being asked of them, reduced generalisation of skills, reduced self-esteem and increased anxiety. This may also lead to young people who may be capable of learning to drive, to be too scared to continue.
• It is of our opinion, that instructors who are not on this list above and not known to or engaging with the driving OT community, most likely lack the skills required to work with these populations effectively.

1. Get Enough Sleep Before the Trip

One of the simplest yet most effective ways to prevent fatigue is to ensure you’re well-rested before hitting the road. Aim for 7-8 hours of quality sleep the night before your journey. Starting your trip refreshed can make a significant difference in your alertness and overall driving performance.

2. Plan Frequent Breaks

Long drives can quickly become exhausting if you don’t take breaks. Before you start your journey, map out rest stops along your route. Aim to take a 15-minute break every two hours. During these stops:

• Step out of the car.

• Stretch your legs.

• Walk around and breathe in fresh air to reinvigorate your body and mind.

3. Share Driving Duties

If you’re traveling with another licensed driver, take turns behind the wheel. Switching drivers every few hours gives each person time to rest and significantly reduces fatigue. Teamwork makes the journey smoother and safer for everyone.

Chris said at the time of the accident, he was a delivery driver and felt really stressed by needing to make the delivery within a set timeframe and his workplace tracking his location. He said he was driving at night, stressed about making the delivery, trying to navigate to the location using maps; and whilst driving up a hill, he ran into the back of another car. Chris said he’d been anxious, overwhelmed and distracted.

Fortunately, our client had a manual wheelchair, that was suitable for wheelchair occupant travel as it had been crash tested and had appropriate postural support including backrest and headrest. 

We were able to successfully trial a lowered floor conversion Kia Carnival through KM Kite, an experienced vehicle modifier with a tried and tested engineering certification with this type of vehicle modification for wheelchair occupant travel.  Our client was able to be positioned in the second row, behind the front seats with his carers or family being able to sit on either side beside him. 

Applying for the award

The application process for the award included writing a personal statement, which I am going to share with you here, as it beautifully sums up my story about how I came to be working and teaching OTs in this Potential to Drive approach.

“In 2019 I advised a 22 year old woman that despite her efforts, she would likely never drive because the challenges of her disability were too severe. She was devastated. It was an awful conversation and I thought “there has to be a better way” to assess and support clients with neurodivergence and psychosocial disabilities wanting to learn to drive.

My curiosity and drive for improvement lead me to finding Dr Monahan in 2020, and with her guidance I pioneered implementation of the “Potential to Drive” approach in Australia. More than 160 driver-trained OTs and rehabilitation driving instructors have attended more than seven workshops transforming clinical practice across the country.

I also collaborated with Dr Monahan to adapt the ‘Drive Focus’ app and bring it to Australia, to date supporting hundreds of young Australians with a disability with their driving goal. I took a leap to then facilitate Drive Focus’ worldwide OT conference debut at OT Exchange in Melbourne 2022 and featured live on the Communities of Practice Facebook group, bringing the app to the attention of thousands of non-driver and driver trained occupational therapists. My work was recognised nationally winning the Australian Road Safety Foundation awards in 2021 and Finalist at Australian Disability Services Awards in 2022.

Innovation never ends: I have also developed a driving therapy program, online toolkit and webinars to support OTs and families. I’m sought after for clinical supervision, inservices, OTA Hot Topic and podcasts, and was recently featured in ABC news stories highlighting updates in licencing guidelines for autism and driving.

My contribution has indeed been outstanding and impactful to the practice of occupational therapy: Australia’s OTs are better prepared to address the question of potential to drive because of my curiosity, leadership and innovation.”

Driving a motor vehicle is a complex task involved perception, appropriate judgement, adequate response time and appropriate physical capability (Austroads, 2022). As an occupational therapy driving assessor, there are many components to our assessment:

• The Person
  Individual performance component skill level, the type of amputation (below or above knee), co-morbidities, their functional capacity in daily life as well as their mobility (prosthesis and/or wheelchair user).
• The Environment
  Where do they live, work, etc, as well as the social environment/context. Goals for driving and does the environment support this?
• The Occupation (Driving)
  Individual driving history, habits, where they would like to drive to, any specific vehicle modifications or preferences they have looked into?

  There are a range of vehicle modifications options that could be considered – left foot accelerator is common for people who have a right lower limb amputation, hand controls (hand accelerator and brake, of which there are several types) are also common, and many people report they have found this easier to learn to drive with compared to a left foot accelerator. 

  There are a small number of people who have a well-fitting and tolerated prosthesis (usually with a below knee amputation) and have good sensation (superficial and proprioception) who can drive with their prosthesis.  

  This and other vehicle modifications can be trialled in an on-road assessment with the occupational therapy driving and specialist driving instructor.  This is undertaken in dual controlled vehicle to ensure safety for everyone involved in the assessment process.