Road Safety Week 2022: ‘Caution! Risk zone ahead!’
Road Safety Week 2022: ‘Caution! Risk zone ahead!’ and other guiding signs for OTs steering clients through fitness-to-drive assessments.
Since a law change last summer, occupational therapists (OTs) and other healthcare specialists are now allowed, like doctors, to provide fitness-to-drive (FTD) assessments in Britain.
They are the assessments required by the Driver and Vehicle Licensing Agency (DVLA) that show how a medical condition affects a person’s ability to drive safely on the roads in England, Scotland and Wales.
So, to mark 2022 Road Safety Week this month [1], we followed the FTD route to discover the twists and turns neuro OTs may now find themselves navigating in order to keep their client safely in the driving seat…
Battery charging area
Fitness-to-drive assessments of people with medical conditions in England, Scotland and Wales are devised by the Driver and Vehicle Licensing Agency (DVLA).
However, occupational therapists charge up their FTD assessment skills by using the profession’s own evidence-based screens, such as the Rookwood driving battery.
The Rookwood battery is designed for use with people with neurological conditions and tests for the specific abilities needed to drive, such as executive functioning and praxis skills.
Many of Krysalis’s own neuro OTs turn to the Rockwood battery to support their clinical decision-making in FTD assessments of clients.
The results of driving battery tests can also help to shape an OT’s response when needed for the DVLA’s fitness-to-drive questionnaire for medical professionals.
More on that questionnaire and how to fill it out with help from the DVLA’s ‘Assessing fitness to drive’ [2] guide for medical professionals can be found below.
Construction ahead
Health professionals often do not feel sufficiently knowledgeable about the medical rules for driving. 
Watch out for reconstruction of some of the DVLA’s FTD assessments in the near future after the Road Safety Trust made its main research grants theme this year, ‘Fitness to drive’ [3].
The campaign focus was decided after a rapid scoping review carried out for the trust earlier this year identified gaping holes in road safety research, particularly around developments in:
- FTD self-assessment tools for older drivers
- Standardising FTD assessments after traumatic brain injury (TBI)
- Screening tests to identify patients in the early stages of dementia who are unfit to drive
And there were further evidence shortages found around links between FTD and:
- Diabetes
- Prescribed medications
- Sleep disorders and fatigue
- Impaired vision
More about the review’s results and recommendations here: [4]
Risk zone
A study from accident prevention charity RoSPA highlights some of the medical conditions that may cause a higher safety risk while driving.
Though the study found that medical conditions are “a relatively minor risk factor” in road traffic crashes, concern remained that a lack of evidence of drivers’ potential health conditions may be skewing crash statistics.
The health conditions posing particular fitness-to-drive challenges included:
- Epilepsy - rated as ‘high-risk’ for crash involvement
- Diabetes - a ‘higher crash risk’ than those without diabetes, and ‘even higher’ for diabetic drivers who are not taking medication for it
- Insomnia or obstructive sleep apnoea syndrome – ‘significantly increased’ crash risk
- Heart disease - the most common cause of sudden death at the wheel
- Multiple sclerosis – cognitive symptoms linked with increased crash risk
The evidence was ‘inconclusive’ around links between cardiovascular disease and crash risk and ‘inconsistent’ where it involved musculoskeletal conditions.
And there was ‘no significant association’ between crash risk and hearing impairments. More on that report here: [5]
Alternative routes
It’s not just OTs to whom doctors in England, Scotland and Wales can now refer DVLA medical questionnaires on fitness to drive.
Speech and language therapists, physiotherapists, some specialist nurses, and opticians can also complete the forms, depending on the area of expertise required.
It’s hoped the change to the Road Traffic Act 1988 [6] will speed up the fitness to drive licensing application and renewal process when a driver declares a medical condition.
Think Safety
The DVLA’s guide for medical professionals, Assessing Fitness to Drive, points to the specific skills needed for safe driving that OT assessors need to address, including:
- Vision and visuospatial perception
- Attention and memory
- Insight and judgement
- Reactive and adaptive strategies
- Planning and organization
- Self-monitoring ability
- Sensation
- Muscle strength, control, and coordination
The guide also suggests considering the following options when a health condition affects the fitness to drive:
- Medical treatment for the health condition
- Self-regulation – limiting driving depending on the effects of a health condition
- Driver education - to help the driver understand the effects of the condition
- Driver rehabilitation – such as driving simulators to help the driver manage the condition
- Vehicle adaptation – modifying a vehicle to meet the driver’s ability needs
- Restricted licences
- Stopping driving – temporarily or permanently
The DVLA’s fitness-to-drive guide for OTs and other healthcare professionals can be found here: [2]
Max headroom
And for neuro occupational therapists such as our Krysalis specialists, there is extra DVLA guidance relating to drivers with neurological conditions.
‘Neurological disorders: assessing fitness-to-drive’ lists 37 neuro condition categories and the criteria used to grant or refuse a licence.
The conditions include:
- Chronic neurological disorders, such as multiple sclerosis and motor neurone disease
- Parkinson’s Disease
- Stroke
- Traumatic brain injury
- Brain tumours
- Arteriovenous malformation (AVM)
Find the full list and focused guidance here: [7]
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Further reading
Fatigue and Traumatic Brain Injury (krysalisconsultancy.co.uk)
It is the most commonly reported symptom in the wake of brain injury, but what can be done to combat fatigue when it strikes without warning, lasts for so long and impacts so many daily activities? Neuro OT solutions here:
Nutrition and rehabilitation (krysalisconsultancy.co.uk)
Our mood, behaviour and brain function are all influenced by our diet, but scientists are discovering that diet can make a big difference to rehabilitation outcomes for brain injury survivors too..
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References