Driving After a Brain Injury: Returning to the Road Safely

A brain injury can change a lot of things, including your ability to drive. But for many people, returning to the road is possible. It just takes time, the right assessment, and sometimes a period of rehabilitation.

This article explains how driving is managed after a brain injury in NSW, what the OT driving assessment looks for, and what to expect.

What counts as a brain injury?

The term "brain injury" covers a wide range of conditions, including:

Traumatic brain injury (TBI), which can result from a fall, car accident, assault, or sporting injury. TBIs range from mild (concussion) to severe.

Acquired brain injury (ABI), which includes conditions that affect the brain from within, such as stroke, tumour, infection (for example, encephalitis or meningitis), oxygen deprivation, or complications of surgery.

The effects of a brain injury vary enormously depending on the type, severity, and which parts of the brain are affected. Some people recover quickly with few lasting effects. Others experience long-term changes in physical function, cognition, emotion, or behaviour.

You can't drive immediately after a brain injury

Australian driving standards (the Austroads Guidelines) require a period of not driving after a brain injury. The length of this period depends on the nature and severity of the injury, and is determined by your treating doctor.

For more significant brain injuries, the non-driving period may last months or longer, and will usually involve rehabilitation before any return-to-driving process begins.

How a brain injury can affect driving

Brain injuries can affect driving in ways that are sometimes obvious, and sometimes subtle. Common areas of impact include:

Cognitive changes. Attention, processing speed, memory, decision-making, and problem-solving can all be affected. These are the skills that underpin safe driving, particularly in busy traffic or unexpected situations.

Physical effects. Depending on where the injury is, you may experience weakness on one side of the body, reduced coordination, slower movement, or changes in reflexes. These can affect your ability to operate the vehicle.

Visual changes. Brain injuries can affect visual fields (you may have lost part of your peripheral vision without realising), visual processing, depth perception, and eye movement.

Fatigue. Post-injury fatigue is very common and can dramatically affect driving performance. You may feel fine at the start of a drive but become significantly impaired within 20 to 30 minutes.

Emotional and behavioural changes. Some brain injuries cause changes in mood regulation, impulsivity, or insight. These can affect judgement on the road, particularly in frustrating situations (for example, heavy traffic or aggressive drivers).

Insight. This is a particularly important one. Some people with brain injuries lose some awareness of their own deficits. You may feel like you're driving fine when you're actually not. This is one of the key reasons why an independent OT assessment is important.

How the OT assessment works

The assessment has two parts, and is the same structure used for other medical conditions, but with particular attention to the effects of brain injury.

Part 1: Off-road (clinical) assessment

This is conducted at your home. The OT will work through:

Medical and driving history. A detailed conversation about your injury, your recovery so far, your current symptoms, medications, and any rehabilitation you've had or are currently doing.

Vision screening. Visual acuity, visual fields, and other visual skills. Visual field deficits after a brain injury are common, and sometimes the person doesn't know they have one.

Cognitive assessment. The OT uses validated tools to assess the cognitive skills relevant to driving: attention, processing speed, decision-making, spatial awareness, memory, and executive function.

Physical assessment. Strength, range of motion, coordination, and reaction time, with particular attention to any side of the body affected by the injury.

Part 2: On-road assessment

You'll drive for approximately one hour with the OT and a specialist driving instructor in a dual-controlled vehicle, in your local area.

For brain injury, the OT is particularly watching for:

• Hazard perception (can you notice and respond to risks in good time?)

• Divided attention (can you manage multiple things at once, like checking mirrors while indicating and watching traffic?)

• Consistency (does your performance drop over the course of the drive?)

• Response to unexpected situations (how do you handle something outside your plan?)

• Judgement (are your decisions about speed, gaps in traffic, and risk-taking appropriate?)

• Insight (do you notice and correct your own errors?)

The on-road assessment often provides information that isn't visible in the clinical assessment. Someone can perform well on cognitive testing in a quiet room and still struggle with the real-time demands of driving.

Possible outcomes

Fit to drive with no restrictions. Your brain injury is not affecting your driving, and you can return to driving as normal.

Fit to drive with conditions. You can drive, but with restrictions such as daytime driving only, automatic transmission only, a limited radius from home, or time-limited drives (for example, no more than 30 minutes at a time if fatigue is an issue).

Driving lessons recommended. If the OT identified issues that could improve with targeted rehabilitation driving lessons, they may recommend a set number of lessons followed by a reassessment.

Vehicle modifications needed. If your brain injury has caused physical changes that affect vehicle operation (for example, weakness on one side), modifications such as a steering knob or left-foot accelerator may be recommended.

Not fit to drive. If the effects of the brain injury are too significant for safe driving, the OT will recommend licence cancellation. This doesn't have to be permanent. Brain injury recovery can continue for years, and your doctor may refer you for a reassessment in the future if your condition improves.

Funding your assessment

Several funding pathways are available, depending on how your brain injury occurred:

iCare often funds assessments for brain injuries resulting from workplace accidents or motor vehicle accidents in NSW. If your injury is covered by iCare, your assessment cost is typically included.

NDIS may fund assessments for eligible participants where driving supports independence and community access.

Medicare (CDM plans) may provide a rebate if your GP includes the assessment in a care plan.

Private payment is available if none of the above apply.

Your referrer (rehabilitation specialist, GP, or case manager) can usually help work out which funding pathway applies to you.

A note on rehabilitation driving

For many people with brain injuries, the return to driving isn't a single assessment. It's a process that may involve:

1. An initial OT driving assessment to identify strengths and difficulties

2. A period of driving lessons with a rehabilitation driving instructor

3. A reassessment to evaluate progress

4. Sometimes further lessons and further reassessment

This staged approach works well because brain injury recovery happens over time. Someone who isn't ready to drive safely today may be ready in six or twelve months, particularly with the right rehabilitation.

How to start the process

Your treating doctor (rehabilitation specialist, neurologist, or GP) can refer you for an OT driving assessment when they consider it appropriate. They'll complete the Transport for NSW Fitness to Drive form and provide a referral.

If you already have a referral and you're looking for a mobile OT driving assessment in Sydney, you can start the process at steerdriving.com.au/referral.

This article was written by Elise, an AHPRA-registered Occupational Therapist and Transport for NSW-registered driver assessor. Elise is the founder of Steer Driving, a mobile OT driving assessment practice in Sydney.

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