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Driving Rehabilitation After a Trauma

Orli Boni, Director of the National Occupational Therapy Service, Commissioner for Equality and Accessibility, Ministry of Health;  Dr. Maayan Katz, Deputy Director of the National Occupational Therapy Service
27 May 2026

Driving is much more than transportation. For older adults, driving is considered one of the most important instrumental activities of daily living (IADL). It affects many areas of life. Driving is key to independence, quality of life, and active participation in the community and family.

The ability to drive is essential for maintaining daily routines and living independently. This includes regular activities such as shopping, running errands, getting to work, and staying socially active.

The challenge: Returning to driving safely

When a person’s medical condition changes because of trauma, physical or brain injury (such as a head injury or stroke), cognitive decline, or diseases that worsen with age (such as Parkinson’s disease), their ability to drive safely may be affected. These conditions can create a real danger for the driver and others on the road.

When to seek a driving evaluation

A driving evaluation and rehabilitation process may be needed when there is a decline in function or a change in health status because of different medical conditions, including:

  • After a stroke, head injury, or neurological disease.
  • Because of age-related cognitive or physical decline.
  • When there are concerns about the ability to drive safely.

The process includes identifying challenges, finding solutions, and making adaptations that may allow safe driving to continue. In cases where driving is not recommended, guidance about other transportation options is also provided.

Important to know: The final decision about fitness to drive is made only by the authorized committees at the Medical Institute for Road Safety (MARVAD). Driving evaluations performed by occupational therapists may be used by MARVAD as a supporting tool in the decision-making process.

If you are a family member and notice a decline in your loved one’s driving ability, you can ask your family doctor to encourage them to get evaluated.

For most of us, driving is much more than just a way to get from place to place. For older adults, driving is considered one of the most important instrumental activities of daily living (IADL), and it affects many areas of life.

How driving supports daily life

The ability to drive has two main benefits:

  • Independence and quality of life

    Driving is key to living independently in the community. It directly affects quality of life, social participation, and a person’s active involvement in family life and daily routines.

  • Maintaining daily routines and managing daily life

    The ability to drive is essential for everyday activities such as shopping, running errands, getting to work, and maintaining a social life. In today’s world, it is hard to manage daily life without the ability to get around independently.

The impact of losing the ability to drive

When a person can no longer drive because of an injury or illness, it can seriously affect their independence. It may also lead to financial hardship and impact many areas of daily life.

The importance of being able to drive becomes even greater when a person does not have a reliable alternative for getting around independently in the community.

When to seek a driving evaluation

Changes in health status, such as vision changes, cognitive changes, physical injury, mental health disability, and aging-related changes, may affect mobility in general and driving ability in particular. Disabilities and conditions that affect driving ability and are not identified or treated may create a real danger for drivers and for others around them, including other drivers and pedestrians.

Who should consider a driving skills evaluation?

  • Older adults with medical or functional conditions that are acquired, congenital, or permanent
  • People who have experienced a physical or brain injury
  • People with diseases that have worsened
  • People with cognitive decline
  • Older adults whose driving ability should be assessed due to age-related changes
  • Older adults with congenital disabilities or disabilities from a young age who want to learn to drive
  • Older adults, including drivers, who have medical or functional conditions that are acquired, congenital, permanent, or that have worsened over time, which may affect their ability to drive.
  • People who have experienced a physical or brain injury that may affect driving ability. For example: stroke, head injury, spinal cord injury, and amputations (for example, due to diabetes).
  • People with diseases that have worsened over time and with aging, such as Parkinson’s disease, multiple sclerosis, and arthritis.
  • People with cognitive decline, for example due to a dementia process.
  • Older adults, drivers, or family members who want to assess driving ability due to age-related changes, or changing health or functional status, or when there is a concern about a possible issue that may affect driving safety.
  • Older adults with congenital disabilities or disabilities from a young age who want to learn to drive, when the driving learning process needs to be adapted to the disability from the beginning, including vehicle modifications and equipment adjustments.

Driving assessment and rehabilitation process

The driving skills assessment process is a dynamic process carried out by occupational therapists. It includes diagnosing the problem, with a focus on the source of difficulty in safe driving (for example: sensory-motor function, vision impairment, behavioral, cognitive, or perceptual difficulties). Based on this, solutions are identified, along with adjustments and modifications that can help the person continue driving safely.

For example: seating adjustments for driving, adaptation of assistive devices, and learning strategies to improve reaction time, visual focus, divided attention, and more.

This process is personalized and includes several stages:

Occupational therapists will assess visual function, sensory-motor abilities (such as reaction time and range of motion), and cognitive function (such as attention, memory, and judgment), all of which are essential for driving.

In some cases, an advanced driving simulator is used to replicate real driving conditions. It allows assessment, practice, and improvement of on-road responses in a safe and controlled environment.

A practical driving session with a specially trained driving instructor, in a dual-control vehicle, accompanied by an occupational therapist, to assess how the person manages in real time under changing road conditions.

If there is potential for rehabilitation, a referral will be made for practical driving practice. If needed, recommendations will be given for personalized vehicle adaptations for the individual’s disability, such as panoramic mirrors, relocating pedals to hand controls instead of foot controls, or steering assist devices.

If a medical and professional decision is made that it is not safe to return to driving, the team will advise and guide on alternative solutions to maintain safe mobility, such as using a mobility scooter, public transportation, transportation services, or guidance for safe mobility as a pedestrian.

Important to know

Important to know

Referral to assessment centers can be made through a referral from a medical professional or another treating provider as part of a rehabilitation process. Referral to an occupational therapy driving assessment and rehabilitation center outside of a rehabilitation process is not covered by the health basket. The service involves a fee that varies from one institute to another.

Learn more about occupational therapy intervention in the process

What to do when a change in driving ability is identified

Driving assessment and rehabilitation processes are handled with great sensitivity, as drivers are often not aware that there is a problem that may affect their ability to drive. In many cases, these are people who have driven for most of their adult lives and find it difficult to imagine daily life without a vehicle that supports their routine activities. Therefore, if you are a family member or someone close to the driver and you notice a decline in driving ability that may lead to unsafe driving, you can seek support from a family doctor and other professionals. They can help reflect the changes and their implications to the driver and encourage them to undergo an evaluation for their safety and the safety of those around them.

Mandatory reporting and determination of fitness to drive

In Israel, according to the Traffic Ordinance Section 12B, a change in medical condition that may affect a person’s driving ability must be reported to the authorities. The reporting requirement applies to the individual themselves, or to the treating physician who believes there has been a change in vision, physical condition, cognitive state, or mental health that may affect driving.

It is important to note that decisions regarding driving fitness and the granting of a driver’s license are made only by the authorized bodies — the medical committees for driving fitness at the Medical Institute for Road Safety (MARVAD). Occupational therapists in all treatment and rehabilitation settings serve only in an advisory role. They are not legally authorized to determine whether a person is fit or unfit to drive, and they cannot guarantee that their professional recommendations will be accepted by the authorities. This is explained to clients before the assessment or intervention begins. Therefore, if a person is referred to or chooses to undergo evaluation at an occupational therapy driving center, the occupational therapists will document their professional conclusions and send the report to the referring party.

Completion of the assessment process

In some cases, a person’s driver’s license is not revoked during the fitness evaluation process, but it may still be appropriate for the person not to drive until the evaluation is completed.

At the end of the assessment process, overall driving fitness will be determined. Based on the findings, a report will be provided to the individual and the referring party, which may include the following recommendations:

  • Whether the driver is fit or unfit to drive.
  • Special conditions for driving fitness.
  • Recommendations for physical and technical adaptations (such as driving strategies and vehicle modifications).

If necessary, the recommendation report may also be submitted to the committee at MARVAD.

Alternatives to driving

In cases where the professionals conclude that the person is not fit to drive, they will receive counseling and guidance about the available alternatives to their familiar and convenient use of a vehicle:

  • 1
    Public transport

    Guidance, practice, and training in the use of accessible and safe public transportation.

  • 2
    Mobility scooter

    The option of using a mobility scooter as an alternative to driving will be considered after assessing the driving environment and evaluating the person’s cognitive ability to use it safely.

  • 3
    Accompanied driver or supervised driving instructor

    This may be a caregiver, a hired driver, or sometimes a family member who volunteers to help with transportation.

  • 4
    Transportation services

    Various nonprofit organizations provide transportation services, either for a small fee or on a volunteer basis. It is recommended to contact the social services department in your local municipality to get accurate details.

  • 5
    Safe mobility in the community

    Personal counseling by an occupational therapist that includes a combination of guidance, practice, and real-life experience in safe road crossing and walking along roads, using simulators and community-based outings.

Important to remember

Important to remember

Referral to an occupational therapy driving assessment and rehabilitation center outside of a rehabilitation process is not included in the health basket. The service involves a fee that varies from one institute to another.