Learning to drive is an exciting rite of passage for young people. It can be the beginning of their life as a young adult, independence, trips with their friends – no more pick up and drops off for parents!
As exciting as it may be for the young person, it’s often a daunting prospect for parents.
Learning to drive requires a massive energy, time and monetary commitment. It takes time and practice to learn road law theory, courage to sit the exam (once or twice!) and even more courage to sit in the passenger seat as your child takes the wheel. Add to the mix, a learning disability, autism, ADHD, anxiety or physical impairment and it can seem an unclimbable mountain.
At Driving Well, we’re here to help you through this process.
Our Potential to Drive Program provides a starting point for learner drivers with additional needs who may be thinking of getting their learner’s permit or starting driving lessons. We provide comprehensive assessment to uncover the learner’s/your child’s learning needs based on their disability and work closely with specialised driving instructors to put together a learning package just for them.
We can also provide you with advice on what you can do in day-to-day life to build the skills they need to be a successful driver and support linking with formal therapies that may help. We also offer support for parents and caregivers to learn how to practice skills on-road skills with the individual and to learn the techniques used by their driving instructors to minimise lesson stress!
We can support you through the process of seeing if learning to drive can be supported by your NDIS Plan and walk you through the process form start to finish.
This is a huge undertaking and not a simple process. It is really important that we have a partnership between Driving Well OT and the client and their family.
Read more about the OT “potential to drive” process here.
Approval for driving training program
When a driving program (lessons) are recommended, the OT driver assessor will submit the OT driving assessment report and quote for the number of recommended lessons from the driving instructor provider, to the NDIA
“specialised driving training” is a quote required item, which needs to be approved by NDIA and added as a line item to your NDIA plan under Capacity Building: improved daily living (Specialised driver training 15_046_0129_1_3) this applies even if you have a goal regarding driving / community access, and even if you have sufficient budget in improved daily living.
Once you have written approval from the NDIA (and the line item is added to your NDIS plan), you are able to book your lessons directly with the driving instructor. (Note – as at February 2022, this is taking months to gain approval).
If you are with another insurer, a quote and report is provided, and the insurer must approve the quote to commence lessons.
Drive Focus is a tablet based app (ipad/android tablet) designed to develop visual search, reaction time/processing/decision and motor execution skills (the information processing model) required for driving.
Our learner drivers are recommended to practice the app three to four times per week for about 15 minutes each session; they can level up through the drives, and review their score and re-attempt to improve their score (number of critical items and average response time).
The app is a Finalist for Best Assistive Technology product at the upcoming Australian Disability Service Awards, and winner of the Technology Award for Australian Road Safety Foundation 2021!
Driving lessons are full-on – there is a lot to take in, especially in the early phases.
We know for conditions including ASD and ADHD that focusing on one task at a time and building this up (eg developing visual searching skills when outside of the car or when in the front passenger seat) will then make it easier to integrate skills when behind-the-wheel on driving lessons.
Driving Well has developed a therapy program (face to face clinic and passenger activities) and this online therapy toolkit for clients to purchase access at home with their parents / support workers, to work on fundamental skills needed for driving – and build these up so they will get more out of their driving lessons with the driving instructor.
We are renting a clinic space at Takes Care Specialist Centre, 11 Cleveland St, Stones Corner on Wednesdays, commencing 16th November. We are so excited to be able to provide “Get Driving” therapy programs to our learner driver clients at this beautiful and accessible clinic space. This will reduce costs to our clients, and allow us to be so much more efficient in providing services.
Need support with driving and vehicle modifications assessments? Email email@example.com to see if we can help you.
Article by Lauren Jackson OT Driver Assessor and Jenny Gribbin OT Driver Assessor
Blog by Zeta Griffiths, Practice Manager extraordinaire
Photo : Zeta and Jenny (Director of Driving Well)
From an intake perspective the best advice I could give to any client would be, be involved in the process.
Our OT team is amazing, but they aren’t mind readers. A lot of the important information will come from you. For example…. What are your capabilities and limitations? Do you really have 20/20 vision, or might the Optometrist have a different opinion of your eyesight. The information that you gather for us before you actually meet your OT for the first time is invaluable.
Be prepared, make that appointment with your GP (make sure it’s a long one) and don’t leave without the paperwork we’ve asked you to get. Sometimes the GP thinks they know the process and can be a little stubborn, be patient and insistent and it will save you a second trip back to see them if you don’t come away with what we need.
Sometimes there are other things holding people back from getting everything organised. You may need a family member to take you for the appointments or you have scanner or fax limitations. Don’t get too hung up on how I’m going to get the paperwork back, I’ve got a whole bag of tricks up my sleeve. Get the process started and we’ll help you with the returns policy 🙂
I was once told I was being a pest by a lovely young man (98 years young) who needed an assessment. He didn’t have his paperwork and his assessment was quickly approaching. I would call him every second day, and ask if he’s made his appointments with the GP and Optometrist. He knew he needed to get them, but something was holding him back. On my last call to him I asked him what was really stopping him? His answer, “it’s time to stop and I just didn’t want to admit it. Not to mention Zeta, I though about what you said about all the money I’ll save when I get rid of the car and insurances etc and you know what, that’s a lot of beer!” We had a laugh and he gracefully retired from driving.
Everyone’s situation is different and our team would like to help you find your destination.
Check out these 5 helpful tips for partnering with us.
Our website explains in detail the process and forms needed for an OT driving assessment:
Email your referral to firstname.lastname@example.org for support with driving assessments and vehicle modifications.
For experienced drivers, it is easy to forget just how complex driving is….. what do you think driving involves? Steering the steering wheel? Using the pedals? Indicating? Keep going, you’ll think about scanning, procedures, taking safe gaps, following the road rules… however, driving is much more than turning the steering wheel and pressing the pedals! To be a driver, we need to be able to read the traffic environment and make decisions VERY quickly, react, and plan ahead.
Michon’s model of driving performance outlines three areas of skill required for driving:
The Assessing Fitness to Drive Guidelines 2016 (the ‘bible’ used by medical and health professionals for driving and medical conditions) states:
Driving is a complex instrumental activity of daily living. It involves a complex and rapidly repeating cycle that requires a level of skill and the ability to interact with both the vehicle and the external environment at the same time. The demands of the driving task can vary considerably depending on a range of factors including those relating to the driver, the vehicle, the purpose of the driving task and the road environment. Information about the road environment is obtained via the visual and auditory senses. The information is operated on by many cognitive processes including short- and long-term memory and judgement, which leads to decisions being made about driving.
Decisions are put into effect via the musculoskeletal system, which acts on the steering, gears and brakes to alter the vehicle in relation to the road. This repeating sequence depends on:
Given these requirements, it follows that many body systems need to be functional in order to ensure safe and timely execution of the skills required for driving. The driver’s sensory, motor and cognitive skills may require detailed assessment to determine the potential impact on driving.
In simple terms, cognition is our memory and thinking skills – it allows us to read and make sense of the environment, to make decisions, to react in a timey manner, to have awareness of errors and correct these, to learn. Without sufficient cognitive functioning, driving is impossible.
Occupational therapy driver assessors include a thorough screen of cognitive functioning in the clinical or “off-road” part of the driving assessment, and then this is reviewed practically during the on-road driving assessment.
Clients may have impairment of cognition due to various reasons – eg stroke, brain injury, other neurological conditions such as Parkinson’s disease and Huntington’s disease, Alzheimer’s/Dementia, or a mild cognitive impairment which may be associated with age-related changes. For many people, getting older can lead things generally slowing down – including slowed speed of information processing – that is, taking longer than it used to, to read the situation, react and make decisions. This often doesn’t impact on day-to-day tasks – it doesn’t really matter if it takes a little longer to do the grocery shopping, cook a meal or do a puzzle – but it is a HUGE problem when it comes to driving. To be a safe driver, we need to be consistent and reliable with being able constantly observe the traffic environment (and not miss any signs or hazards), react and make decisions accordingly.
The table below outlines different aspects of cognition, and how these may impact on driving.
There are three possible outcomes from any occupational therapy driving assessment:
(Definition: A critical error is where the driving instructor has to intervene on the steering wheel / brake / accelerator for safety – this is only done when absolutely needed, and the client is given a chance to recognise and react themselves, prior to the instructor intervening).
“Pass”: medical condition is not impacting on driving and therefore safe to continue driving.
In practice, this would mean:
“Driving program: trial of lessons”: client has not yet passed – requires lessons / refresher sessions with the specialised Driving Instructor to attempt to address concerns seen in the initial on-road assessment or learn to drive with vehicle modifications. In practice this would mean:
“Fail”: medical condition is impacting on driving and no longer safe, and recommendation that the licence will be cancelled and the person is recommended to retire from driving.
Safety trumps everything…. most people can operate the car (steering and pedals), but if they are not reading the environment appropriately and not processing things quickly enough – this is not going to be safe, and this means that it is time to retire from driving.
#occupationaltherapydrivingassessment #cognition #olderdrivers #neurologicalconditions #retiringfromdriving
Michon, J. A. (1985). A critical view of driver behavior models: What do we know, what should we do. In L. Evans & R. C. Schwing (Eds.), Human behavior and traffic safety (pp. 485–520). New York: Plenum Press.
When a person can’t use their lower limbs for operating brake/accelerator anymore (eg due to an injury such as lower limb amputation, or medical condition such as diabetes or multiple sclerosis), they will often be able to return to driving by using hand controls – this is where they have a lever that comes out from the steering column for braking, and then various different options for accelerating.
Two main types of hand controls: mechanical and electronic:
How do they work: “push-pat” – push the brake lever forwards for braking (braking is ALWAYS push forwards – because as humans we tend to put our hands out in front of us to stop us from falling), and “pat” it down for accelerating. This style has two rods that run down through the steering column, that connect to the pedals, so when you push the hand control, they activate the pedals.
For steering, a spinner knob is required to be able to operate the steering wheel safely with one hand. This is a requirement of all State Licencing Authorities, and a requirement of the governing guidelines AS/NZS 3954:2019 Motor Vehicle Driver Controls: adaptive systems for people with disabilities.
From left to right below:
Young fellow had his precious (and old) Ford Falcon, so had push-pat hand controls installed; close-up of push-pat hand control with electronic indicator panel, and close up of push-pat hand control with green toggle switch indicator.
Suitable for: these are a basic hand control that work well for older vehicles.
Problem: cars with knee airbags
How do they work: the brake lever is still connected to the pedals, so push forward on the lever activates the brake. This is typically positioned on the right hand side but can be trialled in some driving instructor vehicles on the left side. We usually like the stronger hand to operate the brake – stopping the car is the most important function in driving!
Then there are multiple options for accelerating – it depends on the person’s abilities such as dexterity, strength, sensory issues, any pain/fatigue. Common types are:
From left to right below:
Female driver using the trigger accelerator; male driver using the satellite accelerator; female driver using the overring accelerator; close-up of the Fadiel FSK2005 brake lever/trigger accelerator; close-up of the Fadiel e-radial accelerator; close-up of the satellite accelerator; close up of the Carospeed hand control system (left side operated); male driver using the trigger accelerator.
Higher level needs
For people with higher level disabilities (eg quadriplegia) who need a little extra help, then the next level of hand controls are full electronic input systems – such as the mini-wheel or joystick, and “Freedom” brake/accelerator units. These are available from Problem Management Engineering and Total Ability and require very intensive assessment and trials, and intensive training.
Getting back on the road with hand controls is a bit of a process, but so worthwhile. These steps will guide you through the process (bearing in mind the licencing process may vary from state to state – this is the QLD flavour)
1. Referral / intake
2) OT driving assessment: clinical and practical assessment, to trial various hand controls.
At intake, your OT driver assessor should be able to work out with you which type of hand controls you will be most suited to, and book a specialised driving instructor with these type of controls in their vehicle.
If we haven’t nailed the hand control choice, we will do further drives in the same vehicle/hand controls to get a bit more practice and confirm, or we may do further drives with different hand controls (same instructor/vehicle or different instructor/vehicle).
If we’ve worked out the right hand controls for you, we’ll discuss the recommended number of lessons – this will vary between 5 to 10 lessons, right through to 15 to 20, or even 30 to 40 for high level electronic gear, dependent on previous driver experience (some clients are teens / learners and have never driven before) and your progress.
3) Recommendations and paperwork
Once a decision on the hand controls is made, the OT driver assessor completes report/s and obtains quote for driving lessons from the chosen driving instructor, which is submitted to the insurer for approval.
When lessons are recommended, the OTDA will submit the OT driving assessment report and quote for the number of recommended lessons from the driving instructor provider, to the NDIA – “specialised driving training” is a quote required item, which needs to be approved by NDIA and added as a line item to your NDIA plan under Capacity Building: improved daily living (Specialised driver training 15_046_0129_1_3).
Once you have written approval from the NDIA, you are able to book your lessons directly with the driving instructor. (Note – as at February 2022, this is taking months to gain approval).
4) On-road re-assessment to review progress
For some clients, an OT on-road re-assessment will be completed part-way through their lessons, to check that everything is progressing as it should be, and gain the evidence to confirm that the modifications will enable the person to be a safe driver in the long term.
5) OT Driver Assessor to submit vehicle mods application
A vehicle modifications application is then completed and submitted to the insurer. This will typically include a suite of documents including:
NB: insurers have varying criteria about age and kilometres of the vehicle, which is considered to be “suitable” to modify. NDIS require no older than 5 years and no more than 80,000km – however, when minor modifications are being completed (including hand controls) which can be transferred to the next vehicle, they will usually accept this as long as the Safety Certificate is also provided.
Await approval of the vehicle modifications. (again, there may be lengthy wait times for NDIS Participants).
7) Installation, lessons, license/medical certificate review
8) Handover assessment
Note: in QLD, a Transport driving test is not required, however this is a requirement in other states. In QLD, we need to be confident that the client is driving at the QLD Transport driving test standard, and that if they did have to complete a test, that they are at passing level.
9) Further lessons as needed
Some clients will have another few lessons in their own modified vehicle to gain experience and confidence.
OT driver assessor will complete final on-road report and post-modification evaluation report – these will be sent to QLD Transport and the insurer.
A celebration is definitely in order after all this! And for Driving Well, the handover days are the absolute highlight for us, our “WHY FACTOR” – this is why we do what we do!
Brisbane vehicle modifiers:
Specialised driving instructors in Greater Brisbane region:
Check out our website www.drivingwell.com.au and get in touch if you need support with driving and/or vehicle access with a medical condition or disability.
#drivingassessment #handcontrols #vehiclemodifications #transport #independence #safety #driving #NDIS #occupationaltherapy #brisbane
There is a wide range of vehicle modifications on the market which enable people with injury or disability to drive a vehicle and/or to access a vehicle.
Passenger / vehicle access modifications:
The general process with any vehicle modification is as follows:
1) Have an OT assessment and prescription from a qualified Occupational Therapist (must be a driving trained OT to prescribe driver mods). Prescription will usually require the team of client, OT, driving instructor and vehicle modifier to work together to determine the best option.
Clients returning to driving
2) Have lessons with the rehabilitation driving instructor to develop competence with the modifications
3) Have an OT on-road re-assessment if necessary
4) OT liaises with the driving instructor and informs GP/specialist that you have passed
5) Return to GP/specialist to gain new medical certificate,
6) Take updated medical certificate to QLD Transport to have licence endorsed with conditions “M” for medical condition and “V” for vehicle modification
7) Modifications must be installed and authorised by an approved officer
8) Modifications must also be reported to QLD Transport and a modification plate installed
Earlier in the year, Car Free Me was featured on Channel 9 News. This blog is shared from Car Free Me’s website – for information click here.
The reporters talked to the team about how to prepare for a car free life. Driving cessation is a big step for most people. But it doesn’t mean that it takes away your freedom and independence. In this two minute segment, Channel 9 introduces the Car Free Me program and how it can help senior drivers in Australia.
Watch the video: Older drivers in Queensland preparing for a car-free
Car Free Me is for people who are still driving and are considering stopping, and for those who have already stopped driving. It is an interactive and supportive program that runs for 6 weeks. Every week, a group of people gets together with their Car Free Me accredited coach. During each workshop we will give you with the building blocks to becoming car free.
“The important thing is that people take that time to plan for it, to think about stopping driving”, said Dr Theresa Scott, academic at The University of Queensland and member of the Car Free Me research team.
“We are here to support you in your decision and preparation for a car free life. We help you evaluate the options that suit your lifestyle so you can continue to do what you love, without needing a car.”
The participants so far have been very pleased with the program. A Brisbane workshop participant wrote: “I have learned about finding alternative means of transport, planning with more wisdom, the search for best retirement options. The information supplied, support and encouragement, professionalism of the program have all been very useful”.
Recommended reading: How does Car Free Me work?
Did you know that elderly drivers are the safest drivers? Age is not a factor determining whether or not one should stop driving. However when you start facing new health challenges (like mobility issues and vision impairment), this is when you need to start thinking about alternatives.
At 79, Ross McKinnon still drives everyday and has a clean bill of health. But he told Channel 9 that “it’s important to recognise that everybody will have to make that change.” Safe mobility is essential to healthy ageing.
“Don’t leave it to the last minute to start preparing for your car free life.”
Everyone should be able to have access to the help they need. Thanks to telehealth trials, the Car Free Me program will be trialled outside of urban, metropolitan areas.
What is telehealth? The Department of Health defines it as “the use of telecommunication technology for the purpose of providing health education over a distance”. That is, you will be able to chat and see your Car Free Me coach using video-conferencing. Easy and effective.
Please contact me at Driving Well Occupational Therapy if you have concerns about an elderly client’s / patient’s / loved one’s driving.
#olderdrivers #occupationaltherapy #practicaldrivingassessment #drivingcessation
My beautiful Great-Aunty Joanie (pictured here a few years ago with my son Henry, now 3) has travelled the world, loves going to the ballet and theatre, and has never driven. She has survived almost a century on planes, trains and bus tours, and more recently gets around with transport help from friends and family, and of course taxis.
Recently, at 97 years young, she told me that she asked her doctor to assist her with obtaining the Taxi Subsidy Scheme to help her with transport costs, and was told she wasn’t eligible. So, I decided to have a closer look.
The TSS looks like an ID card and has your photo – you present this to the driver and at the end of the journey you are charged half the fare, up to a maximum of $25.
The eligibility criteria are fairly straight forward – except for Category 2 – Mobility Impairment.
It says that the person “has a physical disability or a medical condition that restricts the person from walking, unassisted and without a rest, 50m or less” or “has a physical disability or other medical condition requiring the person to carry treatment equipment which restricts them from walking unassisted and without a rest 50m, or requires someone else to carry the equipment”.
In basic terms, the person applying for the taxi subsidy needs to have a medical condition that impacts on their mobility in one of the following ways:
A GP, occupational therapist or physiotherapist can complete the TSS application for people eligible for Categories 1 and 2 (severe mobility impairment). The form and details to submit the TSS application are on the website. You also need two passport-sized photographs, witnessed by a health professional / JP / lawyer / police officer / pharmacist.
“It’s the best thing!”
You’d think at 97 years of age it would be a no-brainer to be given access to the taxi subsidy!
I was able to demonstrate Aunty Joanie’s eligibility on Category 2: Mobility Impairment with the following information:
Aunty Joanie received her Taxi Subsidy Scheme card within 3 weeks of my visit to complete her application. She happily waved it at me and said it was “the best thing” and has used it successfully to go to her local shopping centre and favourite cafe. Love her.
I recently sat down with my Mum (Barbara) the other day, and had a chat about her experiences in supporting her mother (my dearly missed, late Nanny) in retiring from driving.
Thanks for sharing your insights Mum. What initially concerned you about Nanny’s driving?
She had been using a wheelie walker because of her bad hip and difficulty getting out of the car – I was concerned about her reflexes to brake quickly. She always passed the eye test – but there didn’t seem to be any other regulations at the time. I wasn’t aware of any assessment programs at the time.
How did you feel about this challenge
For me – it was hard, but it was the only way. She was fiercely independent and was always the one helping others, not the one being taken care of.
How did you approach the conversation with her – that it might be time for her to give up driving?
I told her, you’ve had a perfect driving record – “you’ve only ever had one accident 50 years ago which wasn’t your fault and you don’t want to be the old lady on the news who has crashed into a childcare centre.” At that time a number of elderly drivers were involved in some serious accidents as reported in the media. Mum understood the implications.
What strategies did you use to encourage her to stop driving?
Various family members would borrow her car for a few weeks at a time, to get used to not having a car around.
Did you do anything else to support her transition to non-driving?
I would take her shopping, then we had a family conference to try to organise rotations of transport assistance. One advantage for family members driving her places and taking her shopping was the social aspect, having coffees or lunch and chats, just getting out and seeing the world. She also had access to transport assistance through DVA. She was concerned about the costs of taxis, but I pointed out if she sold the car she would have heaps of money for taxis.
And what was the outcome?
She said she had liked having the car there “just in case” – she actually stopped driving about a year prior to selling the car. It took time, but she got used to not having the car around. In the end she was convinced, and her grandson (a mechanic) did up the car and sold it for her.
Please contact me at Driving Well Occupational Therapy if you have concerns about a client’s / patient’s / loved one’s driving.
#practicaldrivingassessment #driving #occupationaltherapy #drivingcessation #olderdrivers #disability #olderdriver
From early on in my career as an Occupational Therapist, I had an interest in pursuing driving assessment. I don’t know what it was exactly…. I don’t particularly enjoy driving that much myself – it tires me out… I’m not really into cars – just give me my reliable Toyota! My husband and I even got by with just one car for many years, and even for about six months after our first child came along.
I like that driving provides me independence and enables me to do the things I want to do.
It enables living. And for so many people, this is true.
In our uni training, OTs learn to develop a balance between independence and safety. In my first job at Blue Care in Brisbane, it became evident to me that many older adults were teetering on the edge of becoming unsafe with their driving (if they weren’t already over the edge).
It was around this time that with my family I personally went through the experience of navigating serious concerns regarding my beloved Nanny’s driving. My family were faced with the dilemma of balancing her independence with her (and the community’s) safety. Of course safety wins in this situation, and she eventually came to the decision to give up driving, and with the support and kindness of family she found other options that enabled her to keep some independence.
Changes in my career led me to managing serious injuries at WorkCover, where I was involved in funding purchase of a new vehicle for a lovely “Grey Nomad” who had sustained spinal injuries in a scooter accident. His main vehicle was a 70 foot caravan, so he needed to be supplied with a modified van that would enable him access in a powerdrive wheelchair, and possibly allow further modifications in the future if he were to progress to return to driving. This vehicle was no less than a full fit-out of a Mercedes Sprinter costing about $70K.
Worth. Every. Penny.
Shortly after this, I was working for a private return to work provider in Brisbane. I was asked to see a courier driver who had sustained a severe right hand injury during a car accident –
don’t worry, I don’t have a picture of his actual injury… in his words with Halloween approaching at the time, his hand looked like it could have been a party entree. It would take many surgeries and months of therapy to recover, and had a poor chance of regaining full function. I just remember talking to his case manager at WorkCover and saying, let’s organise a driving assessment – he will be able to drive an automatic car with a spinner knob and though he mightn’t be able to do his usual work duties, at least he can get to his hand therapy appointments and get some normality back into his life. Not to mention, get his confidence back after his accident. Sadly, I don’t know what ended up happening for this fellow.
Before long, I found myself sitting in the Driving Assessment role at Logan (without yet having done the training), so I took myself off to Sydney for 2 weeks in September 2012 and gained the OT driving assessor qualification. I loved every minute of the course, and then managed the Logan driving service. Staff changes and life have resulted in a break from driving assessment, but my passion for this speciality didn’t fade.
Finally, knee and foot injuries sustained by some men in my family – my husband, cousin and brother-in-law – have resulted in temporary, inconvenient periods of non-driving. My husband’s injured knee was the left one, so we were able to trade in our manual car for an automatic and he was able to drive, however my cousin and brother-in-law sustained right knee and foot injuries this year. I advised them that they can have a left-foot accelerator installed and have driving lessons, but with both fellows being ineligible for funding support, they have decided to wait things out. How great to have the option though! And certainly for someone sustaining a serious permanent injury – a quick modification and some driving lessons would be such a tiny price to pay to get your independence and freedom back.
I am so excited to be doing driving assessments again, and so excited for this new adventure in private practice, and to be “keeping you safe and well on the road”.
Please contact me at Driving Well Occupational Therapy if you or someone you know needs an OT driving assessment.
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