You are back to doing most things. Your speech is fine. Your walking is fine. But by mid-afternoon you are flat, and the drive home feels harder than it used to.

That tiredness is real, and it matters on the road. This article explains why, what we look for, and what may help.

Why does tiredness matter for driving?

Driving asks you to keep paying attention for a long time. You scan, judge speeds, watch mirrors and respond to what other drivers do. All of that uses energy.

When you are fatigued, attention slips first. You may miss a sign, drift in the lane or react more slowly. You may not notice it happening.

The national standard, Assessing Fitness to Drive, says: “It is common for a person to experience fatigue and impairments in concentration and attention after a stroke.” It adds that these effects are normally temporary. “Normally” is not “always”, and recovery varies from person to person.

What does it look like in the car?

You may notice it yourself. You drive well to the shops, then find the trip home harder. Or you feel fine until the second or third errand.

Family often see it first. Common signs include:

• Quiet or short-tempered after a drive.

• Needing to sleep after even a short trip.

• Missing a turn you would normally know.

• Drifting toward the line, or braking later than usual.

• A good morning and a poor afternoon.

If you recognise two or more of these, tell your doctor. It is useful information for them.

Is it only after a stroke?

No. Fatigue and poor concentration are also common after brain injury. The national standard says a head injury will only affect your licence if it leaves chronic impairment or seizures, and that some people who start out unfit may recover enough to drive again after many months. Your doctor works out which applies to you.

If you want the full picture on either condition, start with Driving After a Stroke in Queensland or Driving After a Brain Injury in Queensland.

Who decides if I can drive?

Your doctor decides when you are fit to drive and completes your Medical Certificate for Drivers. Transport and Main Roads (TMR) makes the licence decision. Queensland drivers have a duty to report a permanent or long-term condition that is likely to affect driving. We explain how in Reporting a Medical Condition to Queensland Transport.

An OT does not make the licence decision. We write a report that gives your doctor evidence about what we saw.

What do we look at in an assessment?

The assessment has two parts. In the off-road part, at your home, we check your vision, thinking skills such as attention and processing speed, and physical function. You can read how those skills link to driving in How Do Cognitive Skills Affect Driving?

In the on-road part, you drive about an hour in a driving instructor’s car, fitted with dual controls. We sit in the back and take notes.

That hour matters for fatigue. We do not only watch the first ten minutes. We watch whether your driving at the end looks like your driving at the start. If it changes, we describe exactly how.

What may help?

Some small habits can make a difference.

• Drive at the time of day you feel best.

• Keep trips short, and plan rest before and after.

• Stop if you feel tired. Do not push on to get home.

• Avoid driving at the end of a big day.

• Ask your doctor about sleep, mood and medicines. Each can add to tiredness, and your doctor is the right person to sort that out.

Sleep problems are a separate issue. If you snore heavily or wake unrefreshed, read Sleep Apnoea and Driving in Queensland.

Could my licence have conditions?

It may. The national standard says that for people with lasting effects after a stroke, conditions “can include requirements for vehicle modifications, local area driving only, no night driving, or no freeway driving.”

If fatigue is the main problem, a condition like local driving only or no night driving may let you keep driving while reducing the risk. We explain what these look like in What Do the Condition Codes on My Queensland Licence Actually Mean?

Conditions are set by TMR. Our report only describes what we observed and what we think would reduce the risk.

When you may not need an assessment

Many people do not. If your doctor is satisfied, the tiredness has settled, and you and your family are comfortable with your driving, an OT assessment may not add anything.

An assessment is worth considering if your doctor is unsure, if you are having near misses, or if your family is worried and you are not.

Ready to book an OT driving assessment on the Gold Coast? Steer Driving is a mobile assessment service covering the Gold Coast and surrounding areas. Whether you already have a referral or you’re just getting started, get in touch and we’ll guide you through the next steps.

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