Driving with Parkinson's Disease: When You Need an OT Assessment

Parkinson's disease affects movement, coordination, and (over time) thinking skills. All of these matter for driving. But a diagnosis of Parkinson's doesn't mean you have to hand in your licence immediately.

Many people with Parkinson's continue to drive safely for years after diagnosis, particularly in the early stages. The key is getting properly assessed so you, your doctor, and Transport for NSW know where you stand.

Parkinson's must be reported to Transport for NSW

Like all medical conditions that can affect driving, Parkinson's disease must be declared to Transport for NSW. In most cases, your neurologist or GP will handle this by completing the Transport for NSW Fitness to Drive form.

The Austroads Guidelines classify Parkinson's as a condition that requires ongoing assessment, because it's progressive - meaning your driving ability may change over time, even if it's fine right now.

How Parkinson's can affect driving

Parkinson's disease can affect driving through several pathways, and the impact varies significantly from person to person.

Motor symptoms. Tremor, rigidity, and bradykinesia (slowness of movement) can affect your ability to steer smoothly, brake quickly, and operate vehicle controls. These tend to be the most visible symptoms, but they're not always the ones that cause the most problems on the road.

Reaction time. Parkinson's often slows reaction time - the gap between seeing a hazard and responding to it. In traffic, this can be the difference between stopping safely and not.

Cognitive changes. While Parkinson's is primarily known as a movement disorder, it can also affect executive function, attention, visuospatial skills, and processing speed. These cognitive changes may be subtle in the early stages but can significantly impact driving ability as the condition progresses.

Fatigue. Many people with Parkinson's experience significant fatigue, which affects concentration and reaction time. Driving when fatigued is a risk factor regardless of diagnosis - but Parkinson's-related fatigue can be particularly pronounced.

Medication effects. Some Parkinson's medications can cause drowsiness or sudden episodes of sleepiness ("sleep attacks"). Others may cause involuntary movements (dyskinesias) that can affect vehicle control. Your medication timing can also matter - you may drive better during "on" periods when your medication is working well than during "off" periods.

Vision changes. Parkinson's can affect eye movement, depth perception, and contrast sensitivity - all of which are important for driving.

When is an OT driving assessment required?

Your neurologist or GP may refer you for an OT driving assessment at any point, but it's most commonly triggered when:

• You've received a new diagnosis and your doctor wants a baseline assessment of your driving

• Your symptoms have progressed or changed

• Your medication has been adjusted

• Family members have raised concerns about your driving

• You're approaching your licence renewal and a medical review is required

The Austroads Guidelines recommend periodic reassessment for people with Parkinson's - typically annually, though the interval depends on how the condition is progressing.

What the OT driving assessment involves

Part 1: Off-road (clinical) assessment

This is conducted at your home and covers:

Medical and driving history. The OT will ask about your diagnosis, your symptoms, your medication regime and timing, and your current driving patterns. They'll also ask about any difficulties you've noticed - or that your family has noticed.

Vision screening. Visual acuity, visual fields, contrast sensitivity, and eye movement.

Cognitive assessment. Even in early Parkinson's, the OT will screen for cognitive changes that could affect driving. This includes attention, processing speed, decision-making, and spatial awareness.

Physical assessment. This is particularly important for Parkinson's. The OT will assess your upper and lower limb strength, range of motion, coordination, tremor, rigidity, and fine motor control. They'll look at how quickly you can move your foot from the accelerator to the brake, how smoothly you can turn a steering wheel, and whether tremor or rigidity affects your control.

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.

The OT will observe how your Parkinson's symptoms translate to real driving. Things they'll be looking for include:

• Smoothness of steering: whether tremor or rigidity affects your ability to hold a steady lane position

• Braking response: whether you can move your foot to the brake quickly and apply appropriate pressure

• Speed management: whether bradykinesia is causing you to react slowly to speed changes

• Multitasking: whether you can manage the competing demands of driving (mirrors, indicators, steering, traffic, signs) effectively

• Fatigue: whether your performance drops over the course of the drive

• Medication timing: how your current medication status affects your on-road performance

Possible outcomes

Fit to drive. Your Parkinson's is not currently affecting your driving. You'll likely be recommended for periodic reassessment.

Fit to drive with conditions. You can drive, but with restrictions - for example, automatic transmission only (if you aren't already driving an automatic), daytime driving only, or a limited driving radius.

Driving lessons recommended. If specific issues were identified that could improve with practice, the OT may recommend lessons with a rehabilitation driving instructor before a reassessment.

Vehicle modifications needed. If physical symptoms are affecting your ability to operate the car, modifications such as a steering knob or adapted controls may be recommended.

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

Planning ahead

One of the unique challenges of Parkinson's is its progressive nature. You might pass an OT driving assessment today and find that things have changed in 12 months.

Planning for this is important - not because stopping driving is inevitable in the near future, but because having a plan reduces the stress if and when that time comes. This might include:

• Talking with your family about how you'll manage transport if driving becomes unsafe

• Exploring community transport options in your area

• Getting familiar with rideshare and taxi apps while you're still comfortable with technology

• Arranging your medical appointments, shopping, and social activities in ways that are accessible without a car

Your neurologist and OT can help guide these conversations when the time is right.

How to get referred

Your neurologist or GP can refer you for an OT driving assessment by completing the Transport for NSW Fitness to Drive form. 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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