WORK A Journ~1 of Prevention, Assessment .. Rehabilitation

ELSEVIER

Work 8 (1997) 271-280

Transport technology: New Zealand perspectives Carol J. Beatson Driver Assessment Service, 16 Raumati Road, Remuera, Auckland 1005, New Zealand Received 9 March 1996; accepted 7 April 1996

Abstract This article reviews the current driver and passenger assessment and rehabilitation in New Zealand with emphasis on those with an acquired disability. At the same time, heightened expectations by people with disabilities to achieve improved quality of life have also created a consumer driven demand for services. Established services have developed close team work between Occupational Therapists and Engineers, specialising in vehicle modifications for people with disabilities, who work together with the client to find the most ideal solution. Finally, this paper provides a description of a private practice in occupational therapy. As a case example, the Driver Assessment Service specialises wholly in assessing and meeting the transportation needs of people with disabilities and their funding agents. © 1997 Elsevier Science Ireland Ltd.

Keywords: Driving; Disability; Vehicle modifications; Passenger; Private practice

1. Introduction 1.1. Options for accessible transport in New Zealand

In New Zealand, there are few options for accessible transportation for people with disabilities. Public transport is limited to small networks of bus, train or ferry services in the major cities. Many of these services are still not accessible. As observed by the NZ Land Transport Safety Authority (1996), there is a 'high level of motorisa-

*Coresponding author. Tel.: +64 9 5200721 (home), +64 9 5767194 (work); fax: + 64 9 5200932; e-mail: [email protected]

tion in New Zealand which has widened debate because the holding of a driver's licence is interlinked with a person's right to mobility. The private car is the primary means of transport for employment, shopping and social occasions'. For people with disabilities, government subsidised 'mobility taxi' schemes, which are part of a standard taxi service, provide taxi vans with hoists or taxi cabs. These are available in cities and many small towns. However, the numbers of service providers are limited and they do not always operate in the evenings or weekends. In addition, the taxis are often pre-booked in peak times, such as pick up and delivery of school children with disabilities. This further limits the availability of

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services and spontaneity of outings for New Zealanders with disabilities. People with disabilities who want independence and freedom of mobility to go out and enjoy New Zealand's 'great outdoors' have no choice. Their own transport, or nothing at all. 1.2. Self help and empowerment for people with disabilities

Over the last decade in New Zealand, human rights and pro-disability legislation have helped to raise the profile of people with disabilities. As a result, practitioners have observed that their consumers of disability services are increasingly knowledgable and discerning. Although a Human Rights Act exists, disability rights were not specifically outlined (National Advisory Committee on Core Health and Disability Support Services, 1993). This omission was the main focus for feedback to government, at a consensus development conference on 'Self help and empowerment: people with disabilities challenging power, promoting change'. The conference forcefully requested that the Human Rights Legislation be 'resourced and implemented to cover all people with disabilities, minimising the exceptions'. Among the 17 high priority outcome~, the conference identified that people with disabilities must have the right 'to make individual choices about services we need, where we want to live, who we live with and how we live our lives', and also to be 'fully integrated into the community of our choosing'. The Health and Disability Commissioner Act was passed in 1994. In order to clarify issues relating to the provision of services to people with disabilities, the Code of Health and Disability Services Consumer's Rights Regulations (section 75 of the Health and Disability Act, 1994) was adopted by Parliament on July 1, 1996. These regulations cover 10 basic rights during the provision of health and disability services as follows: The right: 1. To be treated with respect. 2. To freedom from discrimination, coercion, harassment and exploitation.

3. 4. 5. 6. 7.

To dignity and independence. To services of an appropriate standard. To effective communication. To be fully informed. To make an informed choice and give informed consent. 8. To support. 9. Rights in respect of teaching or research. 10. To complain. In this legislation both aspects are covered, in that 'the consumers have rights and the providers have duties', and' The onus is on the provider to prove that it took reasonable actions'. 2. Social changes Until the 1960s, importation of vehicles to New Zealand was controlled and vehicle franchise dealers were able to maintain high prices within the country. At the same time, used vehicle prices were also relatively high, even for cars 10 years old or more (F. Hall, Licensed Motor Vehicle Dealer, personal communication). As successive government policies have loosened international trade agreements, New Zealanders have had the choice of an increasingly wide variety of imported products, not seen in New Zealand before. As a result, over the past decade, a new car industry has evolved. New Zealanders have seen an influx of literally thousands of reasonable quality used vehicles from Japan at prices lower than the traditional used car market could offer. These vehicles have more 'options' for people with disabilities, who could not have driven in the past. On smaller, more affordable cars there are more features to choose from: power steering, electrically powered window winders and external mirrors, better seating design and central locking have been notable improvements. 2.1. The information age

The ease of international communication is having its impact. Overseas television programmes, visiting celebrities with disabilities and international newsclips have contributed to a more highly knowledgeable and discerning disability consumer market. Although electronic me-

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dia such as the Internet is still 'young' in New Zealand, it is quickly catching on and the vast amount of knowledge about people with disabilities will soon be available to many. Along with the information age, practitioners have experienced a consistent but increasing demand for up to date professional and technical services which will advise people on their options and safety, whether they intend to travel as drivers or passengers. 3. The law and driving At the time of writing, the entire driver licensing and testing system is under review. New Zealand's Land Transport Safety Authority is concerned about the high road death rate, especially amongst the under 25 age group. The aim of the licence review is to (a) identify best practice in other countries, (b) evaluate improvements to the driver licensing system and (c) investigate how driver licensing procedures could reduce road deaths (Land Transport, 1996). Submissions have been called on the medical aspects of fitness to drive. Specific to this section, questions posed include 'are we on the right track with our current provisions for revoking driver licences on medical grounds?, Are we too stringent or too lax?, Where could we improve?, Should other provisions be added in or taken out?'. At present, New Zealanders under 25 years must pass a three tiered licensing process including: (i) knowledge of road law, to gain a Learner's Licence which allows them to get behind the wheel and learn how to drive, once they have passed a practical driving test; (ii) a restricted licence is issued for up to 18 months, permitting no passengers and limiting night driving, once this stage is reached, then a Full licence is issued. At this third stage; (iii) a 'lifetime licence' is issued, which expires on the month of their 71st birthday. From 71 onwards, a medical certificate is required on an increasingly frequent basis. After the age of 80, annual medical reviews are undertaken, in conjunction with a practical driving test. 3.1. Medical fitness to drive

In the event of disability or illness, there is no

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compulsion to notify any authority about a change in health. Instead it is left to the discretion of the person's physician or optometrist to advise against driving. Current guide-lines to physicians on medical fitness to drive are vague when it comes to screening for the severity of disabilities and their likely impact on driving. A physician's handbook (Land Transport, 1990) covers the following areas: coronary heart disease; diabetes; epilepsy; cerebrovascular disease; mental disorders; visual standards; hearing; locomotor disabilities; medication and drugs; fatigue; and finally aging. 3.2. Vision

Visual standards require a 'basic eyesight test' of visual acuity on first application for a license and no further tests are taken until the age of 71 years. Although it is noted that 'very careful assessment is necessary if resumption of driving is contemplated' after a stroke, head injury or brain damage, and some of the cognitive deficits are noted, the narrative style of the handbook makes it difficult to distinguish advice from mandatory ruling. However, the hand book is also under review. Homonymous hemianopia and lower quadrantanopia are contraindications for driving. Fatigue is discussed in relation to professional drivers. 3.3. Aging

For issues related to aging, medical fitness to drive is on a 'case by case basis' when the physician is left to decide the importance of various factors for him or herself. No adequate system is in place to support the families of those with progressive memory loss, who are maintaining a relative at home, in their effort to prevent their relative from continuing to drive, despite license revocation. A form of 'crisis support' as well as method of liaising with the local police station and a way of legally impounding or disabling a vehicle, as a function of the power of attorney, are measures which would go a long way to help families to resolve this undesirable situation. The informality of the process does not appear to be working. Practitioners frequently report feedback from families who say that their physi-

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cian had not mentioned the subject of driving and it is only the family's concern which has brought the person for an assessment. Hospital based clinicians find that, prior to a patient's discharge from hospital, doctors are frequently unaware of their obligation to give advice regarding driving safety (S. Gibson, personal communication). 4. Funding for driver assessment, vehicle purchase and modification Funding for driver and passenger assessment services is sourced from three statutory bodies, Accident Compensation and Rehabilitation (statutory no-fault insurance scheme), Equipment Management Services (health) and the Lottery Commission (from government for voluntary community services). 4.2. Accident compensation and rehabilitation (Ace)

For those with acquired disabilities, resulting from a personal injury, the Accident Compensation and Rehabilitation scheme is responsible for the costs of social rehabilitation, which encompasses personal transportation for drivers and passengers. In order to obtain a vehicle grant, the occupational therapist must establish that the client is 'permanently unable to drive a vehicle (or travel as a passenger) without modifications to that vehicle'. This means that if the client can drive an automatic vehicle, even with poor control, then a grant is not forthcoming. This one sentence often results in a direct conflict between the goals of the funding organisation and the ethical values of the assessing occupational therapist. On several occasions this narrow interpretation of the ACC Regulations has been challenged in court. 5. Equipment management services (EMS) For those whose disability was not caused by an accidental injury, ie medical condition, developmental or inherited defect, another source of funds is available to drivers who are studying, working full time or doing voluntary work for a

minimum of 20 h/week. Under this scheme, there is no funding for full time parents, high school students or children. These funds for vehicle purchase and modifications, were until recently, provided through the social welfare system, the NZ Income Support Service. Since 1 July 1995, funds for assessment, vehicle purchase and modification, along with housing modifications, aids to daily living and wheelchair prescription are now administered by two private companies (Equipment Management Services Ltd) who are contracted to the health service. One Equipment Management Service provides for a relatively small area, but with the largest population, in the northern part of the North Island (from Auckland, north). The other Equipment Management Service, which covers the remainder of the country is based in Palmerston North, at the NZ Disabilities Resource Centre, Palmerston North, which is in the lower third of New Zealand's North Island. 5.1. NZ lotteries commission

Drivers and passengers who are unable to work, may obtain funding from the NZ Lotteries Commission. Under this scheme, full time parents or children with disabilities are eligible. A proportion of the revenue from more than one government owned national lottery is redirected back into the community. One of over 20 committees who disseminate Lottery funds, the Lottery Welfare committee has the difficult task of allocating available funds for vehicles and outdoor mobility scooters to some, but not all, of those who apply for assistance. 5.2. Working within funding constraints

Of the three main funding agencies in New Zealand, all three have similar capped budgets for the purchase of vehicles and modifications. This means that, in order to manage the project effectively, assessment services are involved with the careful selection and modification of second hand vehicles. The Occupational Therapist can be involved throughout the entire process, from the time of assessment, to the choice of a vehicle

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right through to the fitting and completion of vehicle modifications. The modification budget is small, mostly only allowing for straightforward hand control and driving modifications or the installation of wheelchair hoists into a van with appropriate safety restraints. Consequently, the 'high-tech' modifications of joy stick steering and other low effort controls are not common place, because of funding constraints. However, one funding agency, ACC, is now acknowledging the need of people with high level spinal injuries to have appropriate transportation. Therefore in the past 2 years, we have seen many more people enquiring about the ability to drive a van from their wheelchair. Vans which allow wheelchair users to access the driver's seat have not been readily available until 12 months ago. Even then, the range of choice was small and the cost high. 6. The beginning: driver and passenger assessment The support and growth of a network of professional services in driver and passenger assessment and rehabilitation throughout NZ can be credited to one of the services offered by the NZ Disabilities Resource Centre, Palmerston North, known as NZDRC. This was established as a national specialist unit for disability products and services, providing expertise in complex seating, vocational aids, disability information and vehicle modifications. The NDZRC was originally funded by the Department of Health and administered from within the Palmers ton North Hospital Board. In the intervening years, following a series of changes within New Zealand towards privatisation of the health service, the NZDRC is now a 'stand alone' unit, and operates as a limited liability company. Over the past two decades, the NZDRC developed enviable technical expertise, gathered from other countries as well as from their own experience. Through regular courses and networking between services nationally, NZDRC established a vehicle modifications knowledge base for occupational therapists and engineers.

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During that time, continuing education of occupational therapists by NZDRC preached the point to seek out local expertise and to follow their example of working closely with engineers who specialise in vehicle modifications. As a result, many fledgling assessment services were supported during their early days and continue to develop and flourish today. Unfortunately one of the casualties of NZDRC's privatisation has been ongoing continuing education for occupational therapists and engineers and unless action is taken by the professional bodies of occupational therapists and engineers, we are now in danger of a fall in national standards.

6.1. Current services Today in New Zealand, assessment services have continued to be established and now exist in every major city and most smaller towns in New Zealand. Recent rationalisation of national heath services towards privatisation, and consequent competition for funds, has meant that 'core' service funding is not available for new assessment program development, such as driver assessment. Identification of core services (versus non-core services) are those services which receive public funds and which are seen to 'achieve the best results or outcomes for the patient, bearing in mind the interests of the whole population' (National Advisory Committee on Core Health and Disability Support Services, 1994). Driver assessment services which were already established as part of the health service, and which were traditional to that area, continue to exist. But, newly established driver assessment programs are now provided from within community based private practices in occupational therapy. One service has also been formed as a community trust. Because of the relatively small population in New Zealand (nearly 3.5 million in a country about the size of Japan), services cannot afford the luxury of specialising in one section of driver or passenger assessment. To offer an assessment service in New Zealand means that all ages and all types of disabilities are seen, whether they be passengers or drivers.

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6.2. Team work and vehicle modifications

6.4. Voluntary standards of practice

The following information reflects trends of established assessment services around New Zealand. It is important to note that each service is unique and has developed in response to the need of the local community. With the Occupational Therapist as service coordinator, an informal team is drawn from local health services and other expertise within the community, including Engineers, Driving Instructors, Psychologists, Optometrists and the clients own Physician. Because of the wide~spread, sparse population in country areas, and their difficulty in obtaining appropriate transportation, assessment services are increasingly offered on a mobile basis, at the client's home. This is necessary because clients are people whose identified problem is their inability to access personal transportation.

As a result of concern about lack of continuing education for occupational therapists in this specialty within New Zealand, a voluntary Standard of Practice guideline, including a Code of Ethics for Occupational Therapists who work in the field of driver and passenger assessment and rehabilitation has been developed for New Zealand (Beatson et aI., 1993). The Code of Ethics addresses many practice issues. It includes allowing the client to maintain control of their project, acknowledging their right to disagree with assessment findings, honouring physical safety needs as well as the client's need for emotional and cultural safety. Emotional safety relates to the manner in which a client's results are objectively discussed, especially in relation to driving skills which seem to be inextricably mixed with many people's self worth and independence. A distinction is made between the part of the person which is the body (which may be deteriorating) and the spirit (through which the person identifies themself). Cultural safety relates to the way in which the assessor honours the family ways or cultural customs of the person being assessed, by being aware of and avoiding actions or statements which may give offence. The Standard of Practice document is intended as a guideline for new and existing therapists and is based on the New Zealand Association of Occupational Therapists (Inc) Standards of Practice document (Abercrombie et aI., 1992). This is only the beginning. More contact is needed between occupational therapists who specialise in the field. Over the years, a special interest group existed informally. Now a formal special interest group has been established as a function of the New Zealand Association of Occupational Therapists to co-ordinate a national voice for continuing education and sharing information on common issues. If the specialty is to continue, we need to establish a nationally recognised post graduate qualification in driver and passenger assessment and rehabilitation. There is plenty of work yet to be done.

6.3. Professional association of engineers

Another role undertaken by NZDRC was to oversee the establishment of a professional organisation for engineers who carry out disability vehicle adaptations. The need for this was fuelled by the New Zealand Land Transport Safety Authority's introduction of safety regulations, the Road Transport Safety Regulations, 1990. This legislation addressed the need for safety inspections on small numbers of handcrafted vehicles for motor car racing, or modifications done as a hobby to 'hot up' car engines. These regulations, known as the Low Volume Vehicle Code, are now in force, for vehicles produced in small numbers. The section pertaining to disabilities is now monitored from within the industry by a national association of engineers experienced in the disability field. The Low Volume Vehicle Technical Association (Disabilities) approves and licenses inspectors to certify that vehicles adapted for drivers or passengers with disabilities have been completed to an approved safety standard.

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7. Case example The Driver Assessment Service is a service established in Auckland, New Zealand, as a private practice 12 years ago. No other occupational therapy service for driver and passenger assessment and rehabilitation existed in the Auckland region at that time. Initially, growth has been slow, starting with only 10 clients for the first year in 1985 and referrals grew to 45 in 1987. In 1990, 175 clients were assessed, and by 1995 there was a steady growth of referrals to 340, almost double the number, creating a busy, full time practice for one therapist.

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subjective criteria when judging the findings of a test'. Instead of a minimalist approach, the Driver Assessment Service is based on a who lis tic approach to the complex issue of driving. This service is based on the occupational therapy model, and encompasses the clients' quality of life, their ability to resume life roles, their support systems and their emotional state as well as functional ability and medically based data.

7.2. Community based seroice The range of services provided includes computerised cognitive evaluation of driving skill, on

7.1. Assessment approaches

Table 1 Driver Assessment Service: client range of disabilities

Literature on the subject of driver assessment cannot agree on the exact range of assessment tools which should be used (van Zomeren et aI., 1987; Sprigle et aI., 1995), probably because the task of driving is so complex and continuously interactive that the exact skills to be measured have not yet been clearly defined (Fox et aI., 1992; Galski et aI., 1992). Because the Driver Assessment Service's philosophy is to take the assessment to the client, the accent is on the need for compact and realistic assessment methods, as well as the effective use of community resources, particularly the client's physician and optometrist. Decisions on expenditure for assessment equipment are controlled by size and cost of the equipment. In private practice, where the client is paying by the hour, tests which have direct relevance to the field of driver assessment are considered essential. Computerised cognitive assessment is performed with the aid of a note book sized computer and portable hardware, a variety of functional assessments and recording forms have been developed by the practice but no standardised test is administered. This is consistent with the findings of Sprigle (1995) who surveyed 403 driver evaluators and educators throughout the USA, and found that 'characteristics were measured through observation or a functional test rather than by using equipment' and 'the overwhelming majority of evaluators used

Alzheimer's amputees Upper limbs Finger(s) Through wrist Above/below elbow Lower limbs Through ankle Above/below knee Bilateral/unilateral Ankylosing spondylitis Arthritis, (OA and RA), complicating other conditions Brachial plexus lesions Back and neck injury Cerebral palsy CVA Developmental delay Frail elderly: review for over 70s licence Head injury, including post concussion syndrome Multiple injuries/fractures (MVA and other causes) e.g. injury to ankle, knee, median nerve palsy, fractured wrists, bilateral foot drop, multiple fractures, whiplash, multiple fractures with head injury. Multiple Sclerosis Multi-handicapped: physical and mental disabilities moderate to severe. Muscular dystrophy Occupational overuse syndrome Osteogenesis imperfecta Post polio syndrome Short stature Spina bifid a Spinal injuries, complete and incomplete paraplegia and tetraplegia including: C2-3. C3-4, C5-6, C6-7, n, T7, T12. Spinal injuries with head injury

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road assessment of driving skill, functional assessment of driving modifications using a modified car with dual controls, assessment and prescription for wheelchair passengers in vans and advice on vehicle selection. Initial assessments are usually conducted in the client's own home, and also at their rehabilitation setting or place of work. This affords excellent opportunity for data gathering, understanding the terrain and driving conditions with which the client must cope as part of their transportation needs. Visiting the person's own surroundings allows informal interviews with family members, spouse, neighbours, workmates or rehabilitation personnel. The information gained by visiting the client in their own environment always adds a great deal of insight and depth to the assessment process.

8. Wheelchair passengers in vans

7.3. Cognitive evaluation of driving skill

If planning for a return to work does not consider driving safety, or the energy expended as a result of driving to and from work, then planning is flawed. Examining and recording the client's functional ability 'off road' and in the car for a 'static' assessment will tell a great deal about what modifications are likely to be used even before asking them to drive.

Before there was an affordable, portable, reliable method of off road cognitive assessment, the only method available was crudely known as the 'Sweat Test'. This alludes to how fast the assessor's heart was beating and how sweaty were their palms after a 'near miss'. Since her lecture tour of New Zealand, Dr Rosamund Gianutsos' computer programme, the 'Driving Advisement System' (Gianutsos, 1992) is now used in many assessment centres. As part of the Driving Advisement System was developed in recognition of research already carried out in Christchurch, New Zealand by Jones et al. (1983) with a later publication by Croft (1987), the use of this method of assessment in New Zealand was already attractive. In addition, the Driving Advisement System is interactive, makes effective use of time by producing immediate results and is a reasonable cost. Its portability allows us to choose not to go on the road if results are poor and, being portable, still enables us to offer assessment in the safety of the client's own home. An Optometrist's visual field assessment and opinion on the client's functional vision is requested prior to an appointment.

Recent years have seen a move to de-institutionalisation of multiply mentally and physically disabled people. As many more people care for their severely disabled children at home, there has been a growing demand for safe, appropriate transportation. Finding the right van and deciding on the most suitable modifications can be a complex process, because of safety regulations, the complexity of the disability as well as the family's coping skills. The Driver Assessment Service offers a 'project management' service, keeping in touch with the family, the car sales yard, the funding agent and the modification Engineers to ensure a satisfactory outcome. 8.1. Driving modifications

8.2. Vehicle selection

Besides prescribing the most appropriate range of modifications, it is vital that the correct design of vehicle is obtained. This may include a door that opens wide, the seat at a height which allows ease of entrance and exit, pedals within the person's range of motion and muscle strength, knobs and switches within easy reach and able to be operated without taking their eyes off the road. The Driver Assessment Service offers a prepurchase evaluation, with the client present, to check the design features of a car at the car sales yard. 8.3. Range of disabilities

Referrals come from a broad cross-section of the community, including the client themselves or

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their family, Social Workers, General Medical Practitioners, funding agents, licensing authorities and colleagues in hospitals and rehabilitation centres. The range of disabilities referred is extremely wide. So also is the age range of clients, from 3 years and up for passengers and between 15 and 92 years for drivers. There is an emphasis on those with multiple fractures, amputees, spinal injury, stroke, head injury and the older driver. A list of disabilities seen is given in Table 0).

B.4. Team work For the past 4 years, VAMCO (Vehicle Assessment and Modification Co. which works solely with disability modifications) has been operating successfully as a stand alone unit within an engineering workshop. As a result of close liaison, occupational therapy assessments are now more realistic, advice on vehicle selection is more specific, joint client assessments are regularly organised and communication about the progress of individual client progress is frequent. The best part is seeing the clients arrive to collect their newly modified vehicle, set up just as you have envisioned, and witnessing the joy on their face when they leave! 9. Summary Considering that New Zealand has a population of almost 3.5 million, which is less than the population of many major international cities, the state of the art is well advanced. A thriving industry of imported second hand cars and vans has meant affordable mobility for many more people with disabilities. New Zealanders frequently look overseas for ideas, which then have to be modified to meet local needs. This has resulted in an up to date mix of the most affordable ideas best suited to New Zealand conditions. New Zealand has a growing network of driver and passenger assessment and rehabilitation centres throughout the country, most having been established in the last 10 years. New centres continue to be established within Occupational Therapy private practices, using the latest technology to keep up to date and to make effective use of time and resources.

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The challenge ahead is to maintain standards by providing co-ordinated continuing education, promoting communication about issues of common concern and to establish a formal post graduate qualification in driver and passenger assessment and rehabilitation. Acknowledgements

The Author is keen to make contact with others in the field to share information and invites contact via E-mail (CompuServe 100400,674), (Internet [email protected]), fax (NZ 9-520 0932) or post (PO Box 51-056, Pakuranga, Auckland, New Zealand). References Abercrombie, L., Higgins, C, Pembroke, J., Smith, J. (1992) Standards of Practice for Occupational Therapy in New Zealand, The New Zealand Association of Occupational Therapists, PO Box 12 506, Wellington, New Zealand. Accident Compensation and Rehabilitation Act (1990) Social Rehabilitation (Vehicle Purchase and Modification). Beatson, C, Gibson, S., McCann, J., Morrison, B., Wilson, P. (1993) Professional Standards in Transport Technology, NZAOT Pre-conference Workshop Manual. Croft, D., Jones, R (1987) The Value of Off Road Tests in the Assessment of Driving Potential of Brain Damaged Drivers, BJOT 50(10), 357-361. Fox, G., Bashford, G., Caust, S. (1992) Identifying safe versus unsafe drivers following brain impairment: the Coorabel Programme. Dis. Rehabil. 14(3), 140-145. Galski, T., Bruno, R, Ehle, H. (1992) Driving After Cerebral Damage: a model for implications for evaluation, AJOT 46(4),324-332. Gianutsos, R, Campbell, A., Beattie, A., Mandriotta, F. (1992) The Driving Advisement System: a computer-augmented quasi-simulation of the cognitive prerequisites for resumption of driving after brain injury, Assist. Technol. 4, 70-86. Jones, R, Giddens, H., Croft, D. (1983) Assessment and Training of Brain Damaged Drivers, AJOT 37(3),754-760. Land Transport Safety Authority (May 1996) Medical Fitness: driver licence revocations and limitations on medical grounds, Driver Licensing Review Discussion Document, PO Box 2840, Wellington, New Zealand. Land Transport Safety Authority (1995) Driver Testing Criteria and Driver Education Discussion Document, PO Box 2840, Wellington, New Zealand. Land Transport Waka Whenua, (1990) Medical Aspects of Fitness to Drive: a guide for medical practitioners, Land Transport Division Ministry of Transport NZ, PO Box 2840, Wellington, New Zealand.

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National Advisory Committee on Core Health and Disability Services (] 994) Issue I, The Core Debater. National Advisory Committee on Core Health and Disability Services (] 993) Self Help and Empowerment: People with Disabilities Challenging Power, Promoting Change, A consensus development conference report. The Health and Disability Commissioner (J 996) Code of Health and Disability Services Consumer's Rights Regulations.

Springle, S., Morris, 8., Nowachek, G., Karg, P. (1995) Assessment of the Evaluation Procedures of Drivers with Disabilities. OTJR 15(3), 147-164. van Zomeren, A., Brouwer, W., Minderhoud, J. (J987) Acquired Brain Damage and Driving: a review. Arch. Phys. Med. Rehabii. 68, 697-705.

Transport technology: New Zealand perspectives.

This article reviews the current driver and passenger assessment and rehabilitation in New Zealand with emphasis on those with an acquired disability...
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