Driving Assessments for people following a stroke
- Driving is not allowed for anyone for a minimum of 1-month post-stroke.
- One month is often too early to consider driving and a much longer recovery period is required. Obviously, this does depend upon the severity of the stroke.
- There is normally a way to adapt the controls of a car to compensate for the physical disabilities commonly caused by a stroke. This includes such things as left foot accelerator pedals and steering aids.
- Unfortunately, anyone with perceptual inattention or neglect will not be permitted to drive. This is a debarring condition and the DVLA will revoke the driving licence.
- Similarly, some visual field defects are also debarring, and their presence will also result in the revocation of the driving licence by the DVLA. HAD is unable to assess anyone with a visual field deficit without the approval of the DVLA.
- If there are seizures associated with the stroke, again driving will not be permitted until these are controlled and there has been at least 1 year seizure free.
- Strokes can cause cognitive difficulties which can also cause difficulties when driving. This is why cognitive tests are normally part of the assessment process.
The Assessment procedure.
- Physical assessment. When there is a physical impairment (including loss of sensation, strength, reduced range of movement, reduced coordination etc) we conduct a brief assessment in the office to establish if adapted control systems are indicated.
- Cognitive Assessment. The main assessment tool used at HAD is the Rookwood Driving Battery. 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 or not someone is likely to have difficulty driving which can give an indication regarding potential difficulty with driving. However, this is not definitive and, regardless of the results of this testing, HAD will invariably enable the assessment to proceed to in-car.
- 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.
- In-car assessment. This is, perhaps, the most important aspect of the process and the one upron which the Assessors’ recommendations are based. It involves the following components-:
- 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. This is particularly true with people who have not driven for an extended period because of their stroke. 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 and any new controls they are using. Help can be given by the Assessors during this period to achieve this. Once this familiarity is achieved then the formal assessment can begin.
- 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 evaluation of the driving.
When evaluating the drive, what the Assessors are trying to do is to determine if the medical condition (in this case, the stroke and any resulting cognitive or physical difficulties) is having an impact upon the person’s 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!
This said, if someone does have physical disabilities and is using adapted control systems for the first time, the Assessors are aware that these will take some acclimatising to. There is no expectation that this will be achieved during the first assessment to the point that it is possible to complete anything other than a short drive on quiet public roads.
If the stroke has caused mainly cognitive difficulties, 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 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.
After the assessment is completed, the Assessors will, after a short discussion between themselves, give some immediate feedback and recommendations. When assessing someone following a stroke, the recommendation is likely to be one of the following-;
- The driver is safe to return to driving.
- The driver requires the use of adapted controls which may help them to return to driving once they have been mastered. In these cases, a reassessment will be recommended once the driver has undertaken a series of familiarisation lessons in a suitably adapted vehicle.
- The driver is unfortunately unsafe to continue driving and is recommended not to return to driving. Sometimes, a further assessment is suggested at some point in the future to allow more time for rehabilitation and recovery.
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 not return to driving. As previously stated, sometimes HAD finds that people are understandably very keen to get back to driving and try too early in their recovery period. Sometimes a further recuperation period is required so that their cognitive abilities are given further recovery time. There are some people, however, who are unfortunately never able to recover their abilities sufficiently to drive safely.