Category: Advancing Modules

It is now 18 months since Flora had her stroke and there have been some very difficult times for her and her husband.

However, she is now an independent driver with her adapted Mini Cooper which she is thrilled to be able to drive again. She regularly collects her grandchildren from school and assists with the child care. Her husband unfortunately had to give up driving as his condition has progressed but their social life continues to be very active.

Flora discusses her concerns with her GP at her next visit. The GP feels she has made considerable improvement. With Flora’s agreement, she is referred to an occupational therapist for further assessment with regard to return to driving.

The occupational therapist completes a functional assessment to determine Flora’s physical, cognitive and perceptual abilities.

Summary of Occupational Therapy assessment

• Flora is independently mobile within the house and uses her walking stick for outdoor mobility.
• She is able to use her left arm and hand for gross motor tasks but does not have fine motor functional return.
• However Flora is able to complete the majority of personal and household tasks using adaptive strategies e.g. using belly clamp and one touch tin opener when preparing food.
• She demonstrated cognitive and perceptual skills for complex domestic tasks i.e.
  • Able to divide attention
  • Able to adapt and improvise in unfamiliar situations
• There is now no evidence of residual visual inattention.

You continue to see Flora over the next few months.

She has continued to make progress and compensates well for her residual deficits which include reduced function in her left upper limb. Her cognitive functioning and visuospatial inattention have also improved.

She wonders if she will ever return to driving and worries about her husband’s driving abilities as his reactions have become much slower, he has had a few “near misses” and one minor accident. She feels that they will have to increasingly depend on others for transport and this has resulted in lowering of her mood. In light of this information, you advise Flora’s husband to discuss his ability to drive with his GP and advise him to inform DVLA of his progressive condition.

The topic of a driving assessment service is raised but she worries about having to sit a test as she passed her original driving test over 40 years ago. You reassure Flora that a driving assessment is not a driving test. It is used to clarify whether or not you are ready to go back to driving.

Flora is reviewed after 3 months. Flora tells you that she is seeing her GP again later this week and as she is now feeling fine she is going to ask her GP if she can return to driving.

You discuss her residual problems and her continuing lack of awareness into her problems. You discuss the legal position in relation to DVLA and clinically apparent visual inattention. Flora is reminded that it is still very early in her stroke recovery and allowing further time for ongoing recovery: physical, cognitive and perceptual, would be beneficial.  With her level of impairment a 1 year post stroke recovery period is likely to be more realistic for considering her medical fitness for a return to driving, with a referral to a specialist driving assessment service being recommended.