 What I thought I'd start by doing is just let you know where the OT assessment fits in the context of all of the other available driving assessments. So there's three main avenues that people may be assessed. And the first one is a driving instructor assessment. So these assessments are typically sought by family or by people after they've had a temporary medical condition from which they've fully recovered. But they might have lost their confidence a bit in the period of time that they've been in hospital. So for example, if they've been non-weight bearing on a leg and just haven't driven for four months and then they're getting back in the car, they're really nervous. It's a great way of getting people back on the road safely. They're in a dual-controlled vehicle. The driving instructor can give really good informal feedback to the client and their families about how this person's driving. But driving instructors don't report to VicRoads. So it's not a formal assessment of driving skills. Next is the VicRoads review driving test scheme that some of you may have heard of. So this is an assessment that's conducted by a specially trained VicRoads assessor and they'll go out to the person's home and conduct a local area assessment. So it's primarily an on-road assessment that lasts between 15 and 45 minutes and that's free of charge to the client. They can have up to three attempts to pass that assessment. But as the assessors don't necessarily have a medical background, these are for people that don't have a significant physical or cognitive impairment that's been diagnosed. So that third bunch of people come to an OT for a specialist driver assessment and what I wanna talk about today is really the nuts and bolts of that assessment. So when you're referring someone to an OT, what is it that they're going to do? That's what I'd like to let you know. So OT driver assessments are conducted by OTs that have undergone some postgraduate training. So we need to be experienced for at least two years in a related field of OT and then we go off and do an extra postgraduate course and in Victoria they run at La Trobe University. We're very tightly bound by legislation, by competency standards and by the VicRoads guidelines for OT driver assessors. So I've actually got all of those documents for you. So if you wanna have a look at those later on you certainly can flip through them but all in all it leads to a pretty tight restriction around what we should do and also what we're able to do with clients. So the benefit of that is that it means that any assessment conducted in Victoria should really be very similar in structure no matter which OT driving assessor performs the assessment. They really should be pretty identical. They should include an off-road and an on-road assessment and that's what we'll be talking about today. The requirements before someone does an OT assessment is that they're deemed medically fit to drive and also that they've been approved by VicRoads. So we need a clearance certificate from VicRoads that says that this person is right to continue through to an OT driving assessment. So there's approximately 65 practicing driving assessors in the state of Victoria at the moment which is better resourced than most states in Australia. However, in the Grand Pines region we've got four part-time driving assessors. It doesn't give us many options for getting people assessed. In the off-road assessment form, once someone's, we go through a consent form first and then we go through a pretty thorough driving history which includes all of the things that Chris Kite talked about earlier. We need to know where the person wants to be able to drive and how they want to be able to drive so that we can tailor the on-road assessment to meet the demands that they are going to encounter when they return to their normal driving behaviour. With the medical history, it's really critical that we've got a good understanding of all of the conditions that this person has that could impact on their driving. Often as we've said, it's not so much the one individual diagnosis and the relationship that bears to driving, but how all of their co-morbidities add together to accumulate, to create issues that either contribute to driving capacity or imperish. So common conditions that seem to be left off the VicRoads medical report form are things like treated hypertension, visual or hearing impairments and musculoskeletal conditions like osteoarthritis which again, when added into the mix can cause increased issues. In the off-road assessment, we'll then proceed to a hearing assessment and a vision assessment. So some of these criteria have set guidelines by VicRoads like acuity that has to be six on 12 at a minimum. And we'll test fields in the clinic to confrontation using a light wand, but if we've got any questions at all about peripheral vision or field loss, certainly send the person straight to an optometrist before we go on the road. I suppose tracking and fixation are things that may not routinely be assessed in rehab. So those skills are really important for being able to do your mirror checks. So glancing up to your rear mirror, looking back to the road, looking out to the side, looking back to the road, that fixation needs to happen quite quickly. The longer it takes someone to fixate on the image in the mirror and then fixate back on the road, the more time they've lost and the more distance they've traveled in that intervening period of time. Physical assessments pretty straightforward. I suppose what we're interested in is primarily the things that are going to affect driving. So we test all of these domains in driving related positions. So you stand a steering wheel type position and pedal control and we cross the midline when we do our proprioception and kind of seizure assessments. Cognition is probably the key factor that everybody has spoken about this morning. And I think the reason for that is that it does have a significant impact on driving and whilst we can do lots of things to overcome physical deficits, it's much, much more challenging to overcome some of these cognitive impairments. And what I thought I'd do is, I guess explain in a practical sense how these things play out on the road. So if you think about a very simple example of changing lanes, just gonna look at some of the cognitive domains that are required in order to make one single lane change. So your divided attention is really critical. You need to be able to adequately monitor everything that's happening around you, both in front, behind, adjacent to you. You need to be able to control your speed. You need to be able to control your steering. You need to be able to flick your indicators on and off pretty much all at the same time. You also need to be able to maintain your concentration on driving, not be distracted by the radio or something else happening and another car veering around. You need to be able to take in and process enormous amounts of information, but things like the speed that other vehicles are traveling at beside you. And you need to be able to respond quite quickly when you get a safe gap in traffic because it's likely that that safe gap isn't gonna remain safe for very long. So you need to make sure that you're processing information quickly. You also need to be able to remember how to change lanes. So the procedural types of memories, mirror, signal, head check, indicator, lane change, over you go. You need to be able to remember where you're going and how you're gonna get there and why this lane change is important in the whole context of your journey. Spatial and perceptual skills are obviously important and crucial for maintaining your lane position and to accurately gauge what the other vehicles are doing around you as well. Planning is really crucial, but it's quite time limited, particularly with changing lanes and things happen very quickly when you're traveling at speed. If you're doing a lane change at 110 kph, you've traveled 36 meters in a second. So you're traveling long distances in a very short space of time. So because of that, you need to be able to solve problems quite quickly and you need to be able to implement your solutions to that problem almost immediately to maintain your safety. But you have to have adequate control over your impulses. So you can't rush into the first thing. You have to actually be able to plan that out, implement an appropriate strategy to maintain your safety. You have to be able to monitor how you're performing the task and make quick adjustments if things aren't going right. And you need to have accurate insight into your performance in order to be able to reflect on your driving and then correct any errors that are occurring. And all of this needs to happen in the space of just a few seconds for that one lane change to be effective. And that's the kind of dynamic process that we're talking about with all of the individual components of making up a drive. So to add to the equation, a person's attitude and behaviour will also impact their performance. I think Simon gave a really good example this morning of how concentration is important in his attitude and behaviour and being angry in the impact that that had on his driving. And the task also becomes considerably more complex when there's other people in the car, if there's drugs or alcohol on board, and that includes the raft of prescription medications that many of our patients are on when the driver is fatigued or if they've got limited on-road driving experience, things get a lot harder. So the off-road assessment gives us the opportunity to have a look at each of these cognitive domains in isolation. But none of the tests that we have available off-road are able to accurately reflect what happens when all of these things come together. And it's often not until the on-road assessment that we really see the functional cognition. So after the cognitive screen, we'll move through to a road law test. So the road law test, people are often amazingly anxious about performing the road law test, and it's because for the majority of the people that we see, they've never, ever taken a road law test in their life. It wasn't part of the requirements for them when they first got their licence. So find the road law test really daunting. We try very hard to allay people's fears and let them know that there's a few reasons that we get them to take the test. We obviously want to know what their road law knowledge and understanding is, but we also want to give them a chance to be able to go back to the books and have a look through if there are things that we identify that they clearly don't know in the off-road assessment. So it gives them that week or so between the off-road and on-road assessment to be able to brush up on things that they're not certain about. And it gives us a chance to talk through the answers, and often that's really what people need is just some instruction through it. So there's some multiple choice questions like that. There's also some short answer questions. So this is really helpful for looking at people's idea generation. What are they thinking? Are they able to imagine themselves in a shopping centre and imagine the types of hazards that they might encounter? And some people really struggle with this. And then finally, we've got some diagram questions which is more about giving way. Can the person recognise that this is an intersection, that there's stop signs there, and can they implement appropriate road rules to get all of these cars through safely? So then we have what we call a slide test, which is a bit of a hazard identification, visual perceptual test, and road law knowledge kind of combined in one. So we'll show them pictures like this and say, what does this slide mean, and what should you do when you see this sign? And I've had some really interesting responses to this question. I've had people say, oh, never seen that sign before in my life. That's not a Ballarat thing. That must be a Melbourne thing. Never seen it. Doesn't exist. I've had one person describe a really elaborate series of intersections with two roundabouts and major intersecting roads, and she said, oh my God, I have no idea what to do there. But that's okay, because I'd never drive somewhere like that. It's all good. I know my street's here, and I've never seen that sign. So they're quite surprised when we trip around on the on-road and say, oh, just have a peek over there. See that sign there? Oh, what's it doing way over there? How am I meant to see it off the road? And then we'll show some photographs as well. So for this question, we ask people, you're the driver of the car proceeding down the street towards the roundabout. What hazards do you need to consider as you pass through the roundabout and travel further down the street? So I'm gonna use my laser light because I'm very excited that there's a laser light here. So what we're looking for is for them to identify this white car that's already in the roundabout that they should be giving way to, to identify the pedestrian crossing that's on the other side of the roundabout there to identify that cars may pull out, including this white car here. And there's also some traffic lights further ahead. And I'm sure you're all saying, oh my goodness, they're so little, they're little things. People get lots of time to have a look and talk through, but it's very interesting to hear what kinds of hazards people can or can't identify in that picture. Let's say when we go through it. So the final step for the off-road assessment is to really plan out our on-road assessment quite carefully. So that's taking into account all of the information that we've gathered during the off-road assessment and primarily the client's report about where they want to be able to drive. So the route that we select depends very much on the type of driving that they wanna continue to do. So if they ever need to or want to be able to drive on the freeway, if they want an open license that lets them trip up to Queensland, then we perform our standard route assessment. So that has give ways, stop signs, traffic lights. It's got a mixture of standard and complex intersections. We do lane changing, parking, freeway travel, roundabouts, railway crossing, school zones, and also a simulated emergency break, which is probably the only component that you wouldn't find in normal everyday driving. So what we ask the instructor to do in a safe place is to shout out stop and get the driver to stop as quickly as they can. So we're just having a look at their response speed in the car. We've also got a modified version that includes all of Ballarat, but without the freeway, if people are adamant that they never ever drive on the freeway. And then we have options to do a local area or a self-directed route, which is usually smaller again when people are looking at quite a restricted license just to get to the shops and back or the doctors and back, that sort of thing. We think very much about the time of day that we're going to take people out. Obviously the vehicle transmission, we select to be the same as the client's main car that they drive, and any likely modifications that we're going to recommend, we make sure are available in the vehicle as well. So after 90 minutes or so of gathering all of that information and putting it all together, we've got a really good understanding of the person, what's led them to this assessment, their physical and cognitive strengths and weaknesses, and their road-law knowledge and understanding. But what we don't know with certainty is how they're going to perform when they actually get behind the wheel. So one question we're frequently asked is, what happens if I fail the off-road assessment? But the reality is that very few people fail the off-road assessment. The only people that we wouldn't take through on-road are people that have medical conditions that preclude them from driving. So they might be things that weren't identified prior to our assessment, but if we found a quadrant anopia and we send them off the fields tested and they don't meet the visual criteria to drive, then we can't proceed to the assessment. Everybody else goes on-road. And the reason for that is that despite our hefty off-road assessment, there isn't always a correlation between that and performance on-road. So the only way that we can assess if people are safe to drive is to observe them driving safely and legally. So the on-road assessment is obviously a key component of that. So our on-road assessments are all graded from low-demand to high-demand environments which are safer for us and the client, obviously. No matter what route we select, it has to last 45 minutes. So that gives us a really good amount of data on which to base our decision. It gives the driver a chance to reduce their nerves. It allows us to see the effect of fatigue or complacency over the course of the drive. And probably the biggest question we get asked is, can I take my own car? And the answer is a categorical no, but it is a question. So this is an example of a bit of a snippet from our on-road assessment form. So what I wanted to show is really the breadth of information that we're collecting as the person is driving. So we've got a chance to write some nice comments in the middle. These boxes on the right stand for driving instructor intervention, people making observations, that's mirror checks and looking around them at the intersection, signalling speed control, brake and clutch control, lane position, gap selection and road law. So you can see in this case, they're turning right onto Ghillie Street. And we've marked out some key features along Ghillie Street where errors typically happen or complex parts of that drive. And that's what we're documenting each of those things at each of those points. So over the course of a drive, we'll make several hundred observations of a person's performance while they're driving. We have to do it quite quickly, obviously. And we get our own little codes shorthand. That makes sense to us so that we can do that quite quickly while still watching what's happening at the same time. So at the end of that assessment, we've got a lot of rich data on which to base our recommendations. And it's helpful that the driving instructor usually stays and helps us with the first part of our feedback. So the person's able to ask both of us questions about what happened during the assessment. So following all of that, we make a recommendation to VicRoads. And it's really important for you to remember that our assessment results in a recommendation only to the driver licensing authority and it's VicRoads who determine with all of the information that they have what's going to happen ultimately to this person's license. Our three main options, I suppose, are either to recommend that the person retains a license, that they do some remediation or rehabilitation that can be both off and on-road. And then they usually would have a reassessment after that or that their license is suspended. So those are the three main categories. We can also recommend a number of conditions be placed on the license and there's a whole variety of those. And we can also make suggestions about when medical or future OT reviews might be appropriate. We'll then send a letter to the client and the referrer if the client's given a consent to. And then after that, the VicRoads letter will follow. So there is a gap between the OT assessment and the VicRoads determination. And as Janet spoke earlier, that is often a time of intense anxiety while they wait to hear what's happening from VicRoads because for some people it will mean that they can't drive for that interim period until they get that confirmation from VicRoads. So if you're looking to refer someone to an OT, VicRoads maintain a list of all of the practicing driving assessors in the state. And some of them can be found on the OT Australia website as well. So in summary, suppose there's three main options for on-road assessment. And OT is getting involved when the person's got significant physical or cognitive impairment that could impact on their capacity to drive. It involves a comprehensive off-and-on-road assessment that's time consuming and it's expensive. And OT driver assessments at the end of that assessment will make recommendations to the DLA and they'll implement those. So thanks. Thank you. Thank you.