Multiple sclerosis (MS) affects people in very different ways, and its impact on driving is just as variable. Some people with MS drive safely for decades with minimal impact on their driving. Others may need vehicle modifications, licence conditions, or, at some point, a conversation about whether driving is still safe.
An OT driving assessment helps work out where you sit, and what (if anything) needs to change.
Reporting to Transport for NSW
In NSW, any medical condition that may affect your ability to drive must be declared to Transport for NSW. This includes MS.
In practice, your neurologist or GP will usually handle this by completing the Transport for NSW Fitness to Drive form. On this form, your doctor will indicate whether you can continue driving, whether you need an OT driving assessment, or whether you should stop driving.
For many people with MS, particularly those in the earlier stages or with relapsing-remitting MS, the GP or neurologist may clear you to continue driving without an OT assessment, especially if your symptoms are well-managed.
An OT driving assessment is typically recommended when:
Your symptoms have progressed or changed significantly
You're experiencing new physical, cognitive, or visual symptoms that could affect driving
Your medication has changed in a way that may impact driving
Family members or your treating team have raised concerns
You've had a relapse that has affected your function
Transport for NSW has requested a formal assessment
How MS can affect driving
MS can affect driving through multiple pathways, and the impact depends on the type of MS, where the lesions are, and how the condition has progressed.
Physical effects. Weakness, spasticity (stiffness), reduced coordination, and fatigue in the arms and legs can affect your ability to steer, brake, and operate vehicle controls. Foot drop or reduced sensation in the feet can affect your ability to feel and control the pedals.
Fatigue. MS-related fatigue is one of the most common symptoms, and it's different from ordinary tiredness. It can come on unpredictably and significantly affect concentration, reaction time, and overall driving performance. Some people find they can drive well for 20 to 30 minutes but then their performance drops noticeably.
Cognitive effects. MS can affect processing speed, attention, working memory, and executive function. These are the thinking skills that underpin safe driving, particularly in complex traffic situations.
Visual effects. Optic neuritis (inflammation of the optic nerve) is common in MS and can cause temporary or lasting visual changes. MS can also affect eye movement (causing double vision or nystagmus) and visual processing.
Sensory changes. Numbness or altered sensation in the hands or feet can affect your awareness of vehicle controls.
Relapse-related changes. During a relapse, symptoms may worsen significantly. It's generally advisable to stop driving during an active relapse and only resume once symptoms have stabilised.
What the OT driving assessment involves
The assessment follows the same structure used for other medical conditions.
Part 1: Off-road (clinical) assessment
Conducted at your home, this takes approximately 60 minutes and covers:
Medical and driving history. A conversation about your MS diagnosis, your current symptoms, your medication, your relapse history, and your driving experience. The OT will also ask about fatigue patterns, which is particularly relevant for MS.
Vision screening. Visual acuity, visual fields, and eye movement.
Cognitive assessment. Attention, processing speed, decision-making, spatial awareness, and memory.
Physical assessment. Upper and lower limb strength, coordination, range of motion, sensation, and reaction time. For MS, the OT pays particular attention to grip strength (for steering), foot control (for braking and accelerating), and any spasticity or fatigue patterns.
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 MS specifically, the OT is watching for:
Physical control of the vehicle (smooth steering, adequate braking pressure, pedal management)
Signs of fatigue affecting performance over the course of the drive
Cognitive effects showing up in real-time driving (slower processing at intersections, difficulty managing multiple demands)
Visual effects (missed hazards, difficulty judging distances)
Overall consistency and endurance
Possible outcomes
Fit to drive with no restrictions. Your MS is not currently affecting your driving. Periodic reassessment will likely be recommended given the variable nature of the condition.
Fit to drive with conditions. You can drive, but with restrictions. Common conditions for MS include automatic transmission only (if leg strength or coordination is an issue), daytime driving only, or driving within a specified radius.
Vehicle modifications recommended. If physical symptoms affect your ability to operate the car, the OT may recommend modifications such as a steering knob (for reduced grip strength), a left-foot accelerator (if right-leg function is compromised), or hand controls (for more significant lower limb involvement). You'd then have lessons to learn to use the modifications before being reassessed.
Driving lessons recommended. If specific issues could improve with targeted practice, lessons with a rehabilitation driving instructor may be recommended.
Not fit to drive. If the combined effects of MS are too significant for safe driving, the OT will recommend that driving is no longer safe.
The relapsing-remitting pattern
One of the unique challenges with MS (particularly relapsing-remitting MS) is that your function can change significantly during a relapse and then improve during remission.
As a general rule:
During an active relapse, especially one that affects vision, cognition, or significant physical function, it's advisable to stop driving until symptoms stabilise.
After a relapse, your neurologist or GP can assess whether you can return to driving or whether a reassessment is needed.
If you've had a relapse that has left lasting changes to your function, an OT driving assessment may be appropriate to evaluate the impact.
The variable nature of MS means that reassessment may be needed at different points, not just on a fixed annual schedule. Your neurologist and OT will guide the timing based on your individual situation.
Fatigue management and driving
Because MS-related fatigue is such a common issue, managing it is often a key part of staying safe on the road. Some practical strategies:
Know your limits. If your fatigue tends to worsen after a certain amount of time driving, plan shorter trips and take breaks.
Plan your timing. If you have more energy in the morning than the afternoon, schedule your longer drives accordingly.
Avoid driving when fatigued. This sounds obvious, but it's worth stating. If you're having a high-fatigue day, don't drive. Arrange an alternative.
Air conditioning matters. Heat sensitivity (Uhthoff's phenomenon) is common in MS and can worsen fatigue. Keep the car cool.
Rest before driving. If you've had a physically or cognitively demanding morning, rest before getting behind the wheel.
How to start the process
If your neurologist or GP has referred you for an OT driving assessment, you can start the process at steerdriving.com.au/referral.
If you haven't been referred but you're noticing changes in your driving, the first step is to talk with your neurologist or GP. They can determine whether a referral is appropriate.
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.
FAQ Section
Can you drive with multiple sclerosis? Many people with MS continue to drive safely. The impact on driving depends on the type of MS, your symptoms, and how the condition has progressed. Your doctor will determine whether an OT driving assessment is needed.
Does MS automatically disqualify you from driving? No. A diagnosis of MS does not automatically mean you can't drive. Many people with MS drive safely for years. An OT driving assessment may be recommended if symptoms change or progress.
Can I drive during an MS relapse? It's generally advisable to stop driving during an active relapse, particularly if it affects your vision, cognition, or significant physical function. Your neurologist can advise when it's safe to resume.
What vehicle modifications are available for drivers with MS? Common modifications include steering knobs (for reduced grip strength), left-foot accelerators (if right-leg function is affected), hand controls (for more significant lower limb issues), and adapted indicators or secondary controls.
How often do I need an OT driving assessment with MS? There's no fixed schedule. Reassessment timing depends on how your condition is progressing, whether symptoms have changed, and your neurologist's recommendations. It's not always annual, but may be needed after a significant relapse or progression.
Can the NDIS fund an OT driving assessment for MS? For eligible NDIS participants, yes. If driving supports your independence and community access goals, the assessment may be funded through your plan. Your support coordinator can help confirm.