Medical Conditions and Driving: A Review of the Literature (1960 – 2000)

Section 11: Musculoskeletal Disabilities

Conclusions

As with many chronic diseases, the issue regarding licensing of individuals with musculoskeletal impairments concerns the effects of the impairment on functional ability with respect to driving. It should therefore not be surprising that guidelines regarding evaluation of fitness-to-drive recommend that, for many musculoskeletal disorders, assessments at the individual level be conducted (Austroads, 1998; Canadian Medical Association, 2000). In the absence of cognitive impairment, fitness-to-drive evaluations of individuals with musculoskeletal disabilities need to be directed toward assessing physical functioning. Those assessments are, for the most part, conducted by occupational therapists. However, as noted by Korner-Bitensky, Sofer, Kaizer, Gelinas, and Talbot (1994), survey results of occupational therapists across Canada reveal that "there is no well defined procedure for the assessment of drivers with, not only motor involvement, but also perceptual-cognitive disorders such as those seen following a stroke or head injury" (p. 142). The authors call for the development of a standardized driving evaluation battery to "ensure a thorough and comprehensive evaluation of the individual, to provide consistent evaluations across centres and regions of the country and to strengthen the scientific justification for revoking the license" (p. 147).

A similar call has been made by Springle, Morris, Nowachek, and Karg (1995) following an assessment of the evaluation procedures of drivers with disabilities. In their investigation, the authors sent surveys to 403 driver evaluators and trainers throughout the United States whose clientele included persons with disabilities. One hundred and thirty eight responses (38 percent) were received from 44 states. The authors state that most of the respondents were experienced evaluators (criteria not defined) and 62 percent were occupational therapists. Survey responses revealed that measurement of specific driving characteristics (e.g., brake reaction time, steering force) was thought to be more important than measuring non-specific physical characteristics (e.g., range of motion, grip strength). However, only half the respondents reported measuring those characteristics deemed most important. Most of the characteristics were measured through observation or by using a functional test but the overwhelming majority of evaluators used subjective criteria or no criteria in assessing the results of the test. The authors conclude that research is needed to assist in developing a standardized evaluation procedure.

Many musculoskeletal disabilities may be accommodated through the use of vehicle modifications (see Shipp, 1989 for an overview). These modifications may allow individuals with physical disabilities to drive competently and safely. However, individuals with musculoskeletal disabilities may need to be restricted to driving only those vehicles with the appropriate modifications.

A summary of the current fitness-to-drive guidelines (Musculoskeletal Impairments) for medical practitioners from Australia (1998) and Canada (2000) is presented in Table 31.

Table 31 Guidelines for Musculoskeletal Disabilities

(Reproduced with permission )

Guidelines for Musculoskeletal Disabilities (Drivers of Private Vehicles)
Disability/ Illness	Austroads (1998)	CMA (2000)
Disability of Cervical Region	Some loss of movement of head and neck allowable if vehicle fitted with adequate outside mirrors.	Some degree of loss of movement of head and neck permitted but driver restricted to driving vehicles equipped with right and left outside mirrors, and must have the ability to shoulder check. People wearing a neck brace or cast should not be approved for driving until pain and restriction of movement are minimal, and external support is no longer required.
Disability of Thoracic Region	Persons with interscapular pain, which prevents free movement of shoulder joints, should not drive. Persons wearing braces or body casts should not drive without specialist recommendation.	Persons with marked deformity or painfully restricted motion in thoracic vertebrae can best be determined to drive by a driver examiner. Persons wearing braces or body casts must be evaluated on the basis of their ability to move free of pain, operate the controls, and observe approaching vehicles.
Disability of Lumbar Region	Persons with severe pain, reduced mobility, or neurological impairment should not drive. Persons with moderate lumbar pain should use vehicle with power brakes, steering, and automatic transmission.	May need to be restricted to driving vehicles with power-assisted brakes.
Inflammatory Arthritis	Should not drive if permanent damage of joints has occurred which limits ability to drive. Conditional license may be issued. DLA should be notified.	Not addressed.
Joint Replacement	Driving assessor opinion recommended.	Not addressed.
Loss of Limbs	Should not drive if both upper limbs are missing. All cases need to be individually assessed. Conditional license may be issued. License should be restricted to modified vehicle. DLA should be notified.	May drive provided they demonstrate their ability to drive to the satisfaction of the driver examiner.
Loss of Thumbs and Fingers	Digit losses to be assessed with regard to spinner knobs. Driving assessor opinion recommended.	Can drive any type of motor vehicle provided they demonstrate ability to the satisfaction of the driver examiner.
Paraplegia or Quadriplegia	Not addressed.	May receive a learner’s license on the basis of favorable recommendation from medical consultant in physical medicine and rehabilitation. With permit, may then take driving lessons in specially modified vehicle.
Painful Joints	Should not drive if condition directly affects ability to drive. May drive once condition stabilized. Driving assessor opinion may be needed.	Not addressed.
Muscle and Movement Disorders	See specific impairments.	See specific impairments.
Post surgery	Should not drive for 6 weeks post major orthopedic surgery. Specialist opinion recommended.	Not addressed.
Prostheses	Driving assessor opinion required.* Driving test may be necessary.	Persons with amputations of arms or legs and who have been fitted with an adequate prosthesis may drive any class of motor vehicle provided they have demonstrated their ability to the satisfaction of a driver examiner.

* Defined as a professional who assesses fitness-to-drive of those with a medical condition.
DLA = Driver Licensing Authority

Back

Top

Next