Parkinson’s

Driving Assessments for people with Parkinson’s Disease

1. A diagnosis of any Parkinson’s  disease (PD) does not necessarily prevent anyone from driving. It is, however, a condition which, once diagnosed, must be reported to the DVLA.
2. Nevertheless, is often progressive and at some point, there is a reasonable likelihood it will impact upon a person’s ability to drive
3. It is important that a driver’s ability to drive safely with Parkinson’s Disease is reviewd as required, both for the person with Parkinson’s Disease and the wider general public.
4. In an ideal world we need to be more proactive and prevent an accident from happening whilst at the same time facilitating safe driving for as long as possible!
5. Equally, driving is a very important part of life for many people and ceasing driving can have a huge impact upon domestic and social activities. Hopefully, having a regular assessment and advice will prevent people from ceasing driving before they need to.

The Assessment procedure

1. Physical assessment. PD is predominantly a condition with physical symptoms. These can include such things as slowed movements or “freezing”, stiffness and tremor.  Any of these can make driving with standard controls difficult, painful and/or dangerous.
2. Cognitive Assessment.  PD can unfortunately affect a person’s cognitive skills.  HAD normally uses a set of tests called the Rookwood Driving Battery to see if there is any indication to suggest that this is the case. This is a collection of 12 separate tests looking at mental skills relevant to driving. The battery does have a scoring system. This can indicate whether someone does have some cognitive difficulties which may interfere with their ability to drive.  However, this is not definitive and, regardless of the results of this testing, HAD will invariably enable the assessment to proceed to in-car.
3. Eyesight test. This is simply a requirement for the person being assessed to be able to read a number plate on a vehicle at 20 metres. This is the minimum legal distance. Glasses or contact lenses can be worn for this test if required. If someone is unable to do this then their eyesight is not of sufficient acuity to meet the legal requirement for driving and it would not be legal to drive, and the assessment would be terminated at that point.
4. In-car assessment. This is, perhaps, the most important aspect of the process and the upon which the Assessors’ recommendations are based. It involves the following components-:
5. A familiarisation period in a quiet area or car park. It can be very stressful for someone to be asked to drive a car with which they are unfamiliar.  For this reason, there is an “open-ended” familiarisation period allowed before the formal assessment begins. This hopefully allows the person being assessed to become more comfortable driving the assessment vehicle. Help can be given by the Assessors during this period to achieve this. Once this familiarity is achieved then the formal assessment can begin.
6. The assessment route is pre-determined. Depending upon the centre being used the length of the route will be between 11 and 14 miles. They all include a wide variety of road and traffic situations, including complex junctions and roundabouts and some faster roads and dual carriageways. Although people may only drive by choice on certain roads and in certain areas, it is important to cover any situations they may come across. Driving licences are not restricted to areas local to the holder and the DVLA understandably require anyone holding a licence to be able to manage to drive safely wherever they are.

The physical symptoms of PD can vary considerably during the day, often linked to the medication routine. If this is the case, HAD recommends that this be discussed with staff at the time of booking and also with the Assessors during the assessment. Please remember to bring along any medication you may need during the time spent at HAD.

Evaluation of Driving

When evaluating the drive, what the Assessors are trying to do is to determine if the medical condition (in this case, the PD and any resulting physical or cognitive difficulties) is having an impact upon the persons ability to drive safely. This is not the same as re-sitting a driving test and the Assessors appreciate that everyone develops their own driving style. They would prefer that the person being assessed does not try to alter the way they drive just for the assessment. The stress trying to do this can have the perverse effect of distracting the driver from the other aspects of driving and making the drive less safe. Rest assured, if there are any bad driving habits that the Driving Instructor feel can be improved, they will let the person being assessed know!

Rather, the Assessors are more concerned about the ability of the driver to make good observations and to react appropriately at junctions. It is quite common for people to be able to drive to a very safe standard in quiet, straightforward areas but have greater difficulty maintaining safety in more complex, busier situations. The following errors, normally related to difficulties with cognition and processing information, are some of those more frequently seen and which would cause concerns-

• Poor/unsafe gaps in the traffic flow in which to merge at junctions
• An inability to respond appropriately to road signage and instructions, such as trying to turn right at “no right turn” junctions or turning the wrong way into one-way streets
• Responding inappropriately at traffic lights (stopping at a green light or trying to drive through a red light)
• Not noticing or responding to give way signs
• Poor lane positioning (either too close to the kerb or parked cars or over centre white lines and “lane straddling”)
• Poor lane discipline and selection of approach lanes at roundabouts
• Signalling a left or right turn and then turning the other direction
• Turning the wrong way at roundabouts
• Driving excessively slowly and slowing dramatically to read directional road signs
• Driving excessively quickly and exceeding the speed limit
• Lack of awareness of surrounding vehicles and trying to change into lanes which are already occupied

This is not an exhaustive list. Some of these errors, depending upon the situation, may be of such profound severity that alone they may result in the Assessors deeming the drive to have been unsafe. It is more common, however, for a pattern of mistakes to be noted and the judgement of the Assessors to be based upon more than one incident.

The Assessors will also be checking that any physical disabilities are not adversely affecting the physical control of the car. They will check things such as the ability to move the right foot accurately between the accelerator and brake pedals, to steer quickly and accurately and to depress the pedals with the force required.

The feedback

After the assessment is completed, the Assessors will, after a short discussion between themselves, give some immediate feedback and recommendations. When assessing someone with dementia, the recommendation is likely to be one of the following-;

1. The driver is currently safe to remain driving.
2. The driver is currently safe, but a further assessment is recommended in 6 months or 1 years’ time
3. The driver is unfortunately unsafe to continue driving and is recommended to cease driving with immediate effect.

The Assessors always hope that they will be able to recommend that someone can continue driving. It is the very nature and purpose of the assessment, however, that there are times when they must recommend that the driver should give up driving. If the problems are caused by cognitive or physical difficulties or physical, unfortunately driving is very unlikely to improve with lessons. Such are the nature of the physical difficulties normally associated with PD (such as delayed reactions to road situations or difficulty steering quickly or accurately enough), then unfortunately it is the experience of HAD that adapted methods of control are often of little benefit. Changes in medication or symptom treatment are more likely to make a difference. However, if any alternative methods of control may help the Assessors will suggest trying them.