DRIVING WITH MULTIPLE SCLEROSIS

Multiple Sclerosis Society of Queensland

December 2009

DOWNLOAD BROCHURE

Are you aware that as from 1 March, 2006 drivers are required to report medical conditions, including Multiple Sclerosis, to the Department of Transport and Main Roads.  (Drivers who fail to report such a condition as soon as it develops may receive a maximum A$6,000 penalty or be disqualified from driving for a certain period.)

The Austroads booklet titled “Assessing fitness to drive:  Guidelines and Standards for Health Professionals in Australia” is a publication adopted by every driving licensing authority in every State in Australia and endorsed by 25 of the relevant leading professional associations in Australia. www.austroads.com.au

The 2006 edition states the medical standards for people with Multiple Sclerosis are as follows:

“The criteria for an unconditional licence are NOT met:

If the person has Parkinsonism, Multiple Sclerosis, Degenerative Peripheral Neuropathy, Progressive Muscular Dystrophy ……..”

“Should not drive if has poor coordination, weakness, vertigo, memory loss, significant cognitive impairment or visual impairment.”

The driver licensing authority may issue a conditional licence, if safe to drive. Periodic reviews by your Health Practitioner, at least yearly, are recommended. Additional assessment by a specialist (eg Ophthalmologist) and or an OT driving assessor, may be recommended.

A range of additional factors and requirements are in place for drivers of commercial and heavy vehicles.

You will need to keep your licence and your medical certificate with you when driving.   

If you need any assistance with regard to this matter, please contact staff at the Department of Transport and Main Roads 13 23 80. www.transport.qld.gov.au  

DRIVING AND MS

Multiple Sclerosis may affect your ability to drive.  It can compromise your safety and the safety of others.  It is a legal requirement to notify the Department of Transport and Main Roads (DTMR) that you have a medical condition that could affect your driving ability.  Remember, driving is a privilege, not a right. Notifying to the DTMR is done via your Health Practitioner, who is required to fill out a specific medical certificate saying you are fit to drive. You are then required to take this certificate to the DTMR.   

Think about your answers to these questions:

•    Would I want my loved ones to be crossing the road on foot, or driving on the same road at the same time as me (or my partner with MS)?

•    Are others willing or reluctant to be your passengers?

•    Do others offer to drive you instead of you driving them?  

•    Do you rely on others in the car to help you see signs, pedestrians and other cars?  

•    Do you find that sometimes your legs are really so heavy from fatigue that you have trouble moving them from one pedal to another?  

Cognitive changes such a lack of insight or an inability to see the consequences of one’s actions, can make it very difficult for a person with MS to answer these questions honestly and accurately.

Remember, regardless of how MS has impacted on your life, you are legally required to inform the Department of Transport and Main Roads of your condition.

How can MS affect my driving ability?

MS can affect your driving ability in many different ways, such as:

•    Coordination between your two legs – important for brake, accelerator and clutch use

•    Coordination between your arms and legs, as when changing gears

•    Strength – to use the foot pedals, to turn the steering wheel

•    Controlled speed of movement – important if you need to get your foot off the accelerator onto the brake pedal quickly, if you need to swerve to avoid another car

•    Vision – ability to focus, to see the signs on the periphery of your vision, to judge distances, to see obstacles that have poor contrast with their surroundings, to cope with glare, changes in your visual field

•    Fatigue – can make all your MS symptoms worse

•    Heat fatigue – a major issue if the car doesn’t have air conditioning, or is parked in the sun, as your other symptoms will be magnified

•    Concentration – easily distracted by the radio, other cars etc

•    Reaction times – the time between something appearing in your visual field or when you hear something such as an emergency alarm, and your response

•    Judgement and planning – your ability to decide what action to take when driving (eg when to overtake, whether to stop or proceed through amber traffic lights

•    Memory - knowledge of road rules and signs, the way to get from point A to point B

•    Mood swings and personality changes – dealing with frustrations appropriately, managing other drivers road rage

•    Changes to your sensation – a problem if you can’t feel the pedals under your feet, or if you can’t feel the gear stick so have to look at it each time you change gears

•    Spasms – can make it impossible to move your foot from a pedal at the necessary time

•    Poor awareness of the position of your limbs (proprioception) – makes finding pedals and hand controls difficult

These changes do not have to be major ones to impact on your driving ability.  Often, as the person with MS, it is difficult to stand back from your driving and the independence it brings, to seriously consider your symptoms and the impact they may have on your driving ability.  This is why the Queensland Government insists that you gain medical clearance to enable you to drive.

If your doctor says you are fit to drive, he or she will complete the appropriate paperwork called “Medical Certificate for Motor Vehicle Driver Form (F3712)”.  However, your doctor may not be sure that you are safe to drive.  He or she may want an expert opinion before making this decision.  In this situation, it is advisable to have a comprehensive driving assessment carried out by an Occupational Therapist (OT) who has post-graduate training in this field.  Before the assessment, the OT needs a letter from your GP stating you are medically fit to undergo a driving assessment. 

How do I find an OT in my local area who can do these assessments?

Contact OT Australia (Qld) 33612444 or www.otqld.org.au. For contact details on Driver trained OT’s in Qld. People using the public health system are required to pay for the driving assessment with the qualified driving instructor, and for modifications/lessons if required.  There is usually a waiting list of between 4–6 months in the public health system.

What is involved in an Occupational Therapy driving assessment?

The assessment is made up of two parts.

1.    Off road driving assessment / pre-driving screen, which assesses your physical abilities, vision, reaction times, judgement and planning, knowledge of road rules and signs, and strategic thinking skills.  

    The results of the off-road assessment will assist your OT in determining your readiness for an on-road assessment, and any vehicle modifications that are required.

2.    On road assessment, which is with the Occupational Therapist and a driving instructor in a driving school car with dual controls.  The vehicle may be automatic or manual with additional modifications if required.  This part of the assessment takes about 45 minutes, with the OT observing from the rear seat to assess the potential effects your MS may have on your driving skills.  

What happens after the assessment?

After the drive, the driving instructor and the OT meet briefly and then sit down with you to give you feedback regarding the drive.  They may advise you of the following options.

1.    You are safe to drive with no further action required.  A report will be forwarded to your doctor who can provide you with official clearance stating you are fit to drive.

2.    You require a general brush-up on your driving skills, or a more detailed driving remediation program of several lessons, in order to improve your driving skills to a safe and competent level.  When you have completed the program and/or been reassessed, the OT will advise you of the procedures for medical clearance and license endorsement.

3.    Adaptations to your vehicle are required as well as a number of driving lessons so that you will become competent in using modified controls.  When it is considered that you are safe to drive a modified vehicle, your driving OT can then provide you with a medical certificate stating that you are medically fit to resume driving with a conditional license (i.e., with vehicle modifications only).  You will need to present this certificate to your local Department of Transport and Main Roads branch for a driving test and license endorsement.  Depending on the modifications you require, your vehicle may need to be inspected by the DTMR.

4.    & 5. You are not fit to drive or are unsafe to drive at the present time.  Your OT or MSQld 1800 177 591 can advise you on alternative transport options such as public transport, disabled parking permits and taxi subsidies.

Possible Recommendations

Remember that MS is a fluctuating, frequently progressive illness.  Your doctor may recommend that you have at least an annual review of your driving ability.  Because of the often-gradual progressive nature of MS, people with MS may not realise the gradual impact MS has on their driving.  Someone who has had a stroke, for example, has a sudden change in their abilities, so may be more aware of the impact of their disability on their driving ability, compared with a person who has MS.

Remember, the driver trained Occupational Therapist makes the recommendations.  However, it is your referring doctor who must make the final decision on remaining or resuming driving.

It is your responsibility to inform your insurance company that you have a medical condition, and the outcomes in terms of license conditions and any car modifications that may be required.  Otherwise your insurance may be null and void if you have an accident, even if you are not at fault.  

SUMMARY

?    As from 1 March, 2006, you can be fined or lose your licence, if you do not notify Queensland Transport of your diagnosis of Multiple Sclerosis. (Maximum penalty $6,000).

?    You MUST get medical clearance to drive once you have been diagnosed with Multiple Sclerosis.  This is a legal requirement.  

?    Your doctor MUST complete a medical certificate for you to give to Queensland Transport.

?    It is your responsibility to stop driving if you experience change in symptoms which may adversely affect your fitness to drive. See your Health Professional.

?    You MUST notify your car insurer that you have Multiple Sclerosis and have medical clearance to drive.

?    You or your doctor may want you to have an OT driver assessment to be sure that you have the necessary skills to drive safely.

?    Your medical clearance will need to be reviewed on a regular basis, as determined by your doctor.

?    MS may impair your ability to decide whether or not you are safe to drive.  Listen to the advice of health professionals & family members.

?    If you need to have your driving abilities assessed, you may feel quite stressed and worried about the possibility of giving up your licence.  Please utilise the support of the MS Society of Queensland, family and friends during this time to express your concerns.  Staff at the MS Society of Queensland can also provide advice about alternative transport options, such as taxi subsidies, if you have concerns now or for the future.