Driving After a Stroke: What You Need to Know About the OT Assessment in NSW

If you've had a stroke, one of the first questions you're likely asking is: can I still drive?

The short answer is, not straight away. But for many people, getting back behind the wheel is absolutely possible. It depends on how the stroke has affected you, and the only way to find out for certain is through a formal assessment process.

Here's how it works in NSW, step by step.

You can't drive for at least 4 weeks after a stroke

This isn't optional. Under the Austroads Guidelines (the national medical standards used across Australia), you must not drive for a minimum of 4 weeks following a stroke. This applies regardless of how well you feel.

The waiting period exists because your condition needs time to stabilise. Some effects of a stroke (particularly cognitive ones) can be subtle and may not be immediately obvious to you.

During this time, your neurologist, rehabilitation physician, or GP will monitor your recovery and determine the next steps for getting you back on the road.

Your doctor decides what happens next

After the initial non-driving period, your treating doctor assesses your fitness to drive. In NSW, this is done by completing the Transport for NSW Fitness to Drive form.

On this form, your doctor will generally choose one of three options:

1. Your stroke hasn't affected your ability to drive, and you can return to driving. This is more common when the stroke was minor and you were shortly discharged from hospital with no significant impairments.

2. It's unclear whether the stroke is affecting your driving ability, and you need an OT driving assessment. This is the most common outcome, because driving is a practical skill, your doctor can assess your medical status, but they can't observe you behind the wheel.

3. The stroke has significantly affected your capacity to drive, and your licence should be cancelled. This usually only applies in cases of severe impairment.

Most people end up with option two: a referral for an OT driving assessment.

What is an OT driving assessment?

An OT driving assessment is a two-part evaluation conducted by a driver-trained occupational therapist (an OT who has completed specific postgraduate training in assessing fitness to drive). In NSW, these OTs are registered with Transport for NSW.

The assessment looks at how your stroke has affected the specific skills needed for safe driving: your vision, physical ability, thinking skills, and how all of these translate to actual on-road performance.

It's not a standard driving test. The focus isn't on whether you're a perfect driver, it's on whether the effects of your stroke are making driving unsafe.

Part 1: The off-road (clinical) assessment

This is usually done at your home. The OT will sit down with you and work through a series of assessments covering:

Your medical and driving history. The OT will ask about your stroke, your recovery so far, your medications, and your usual driving patterns. If family members are present, they're welcome to contribute.

Vision screening. This checks your visual acuity (how clearly you see), your visual fields (your peripheral vision), and other visual skills relevant to driving. Stroke can affect vision in ways that aren't always obvious - for example, you might have lost part of your visual field on one side without realising it.

Cognitive assessment. This is often the most important part for stroke survivors. The OT uses validated screening tools to assess your attention, concentration, processing speed, memory, decision-making, and spatial awareness. These are the thinking skills that underpin safe driving (things like noticing a pedestrian stepping off the kerb while you're also checking your mirrors and approaching a roundabout).

Physical assessment. The OT checks your strength, range of motion, coordination, and reaction time (particularly in your arms and legs). If your stroke has affected one side of your body, the OT will assess whether this impacts your ability to steer, brake, and operate vehicle controls.

After the off-road assessment, the OT will discuss the results with you before moving on to the practical component.

Part 2: The on-road assessment

You'll drive for approximately one hour in a dual-controlled vehicle with the OT and a specialist driving instructor. The drive happens in your local area, so you're on roads you know.

During the drive, the OT is specifically watching for how the effects of your stroke show up behind the wheel. This might include:

• Slower reaction times at intersections

• Difficulty scanning for hazards, especially on the affected side

• Trouble managing multiple things at once (e.g., merging while checking mirrors)

• Difficulty judging gaps in traffic

• Reduced awareness of road signs or changing conditions

The OT isn't concerned about minor errors that come from nervousness or unfamiliarity with the car. Everyone makes small mistakes in a test situation. What matters is whether the stroke is causing consistent, safety-relevant issues.

What are the possible outcomes?

After the drive, the OT will explain the results and what happens next. The possible outcomes are:

Fit to drive. The stroke is not currently affecting your driving, and the OT will recommend that Transport for NSW allow you to keep (or regain) your licence.

Fit to drive with conditions. You may be able to drive, but with restrictions (for example, automatic transmission only, daytime driving only, or within a limited radius of your home)

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

Vehicle modifications needed. If your stroke has affected your physical ability to operate the car (for example, reduced strength or movement on one side) the OT may recommend equipment such as a steering knob or a left-foot accelerator. You'd then have lessons to learn to use the modifications, followed by a reassessment.

Not fit to drive. If the effects of the stroke are too significant for safe driving, the OT will recommend licence cancellation.

The OT sends a formal report to Transport for NSW, your referring doctor, and you. Transport for NSW makes the final decision about your licence based on this report.

What about driving again in the future?

If your licence is cancelled or you're told to stop driving, that's not necessarily permanent. Stroke recovery can continue for months or even years, and if your condition improves, your doctor can refer you for another OT driving assessment down the track.

For people with conditions on their licence, periodic reassessments are usually required to check that you're still driving safely.

How to prepare for your assessment

A few practical things that can help:

Bring your glasses, hearing aids, or any mobility aids you use. Take your usual medications as normal. Eat beforehand and stay hydrated - the assessment takes 2–3 hours and you want to be at your best. Bring your licence and any relevant medical documents. Try to get a reasonable night's sleep.

And most importantly, try not to worry. The assessment is designed to find out what you can do, not to catch you out.

How to get referred

Your GP, neurologist, or rehabilitation specialist can refer you for an OT driving assessment. They'll need to complete the Transport for NSW Fitness to Drive form.

If you've already received your referral and you're looking for a mobile OT driving assessment in Sydney, you can start a referral with Steer Driving.

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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