On the Road Again: Driving After Diagnosis
By Karen Ambrose OTR/L, Clinical Specialist for Inpatient Rehabilitation at WakeMed Health and Hospitals
As an occupational therapist in inpatient rehabilitation, I am fortunate to be able to work with an array of clients/patients with varying degrees of disability. When doing an intake interview I find it important to obtain accurate information about a person’s preadmission level of care. Did anyone assist you with dressing, meal preparation, getting into a shower? Did you drive? Most people, regardless of age or health, look at driving as one of the most important areas of independence. It is the one activity that allows a connection to work and leisure outside of the home. Even when we begin to lose our sense of autonomy in other areas, driving gives us the independence to put the key in the ignition and drive away.
When illness or injury affects a patient’s mobility, broaching the subject of driving can make a patient feel very defensive and even over protective. “You aren’t going to take my license away, are you?” “My license was just renewed. I have the right to drive!”
So let’s pose a question to ourselves. “Can I still drive safely or am I taking chances that will affect myself or others?”
Unfortunately there is not a simple black or white answer. There are many different levels of driving which create various demands on the driver. Many people can continue driving safely but within the limits of their deficits, such as not driving at night or using adaptive devices to assist them. Each person needs to be assessed individually and deficits addressed accordingly.
Multiple Sclerosis can have an effect on a multitude of different areas that can impinge on driving. These areas include but are not limited to:
Vision: Visual acuity, peripheral vision, double vision and glare can have a significant impact on a person’s ability to drive. Occasionally, medications can impact vision and one’s ability to see, including causing vision to “jump around”. It’s important to have your vision assessed and if possible, assessed by an ophthalmologist who has experience with MS or other neurologic conditions. Sometimes the adaptations are simple. For example, updating glasses, or limiting driving at night or when exacerbations occur can be simple changes that allow driving to continue.
There are regulations that stipulate a minimum requirement. The Federal Motor Carrier Safety Administration stipulates that a person should have a minimum uncorrected vision or corrected vision to 20/40 for both eyes and 70 degrees of horizontal peripheral vision. (North Carolina DMV handbook).
Physical/Motor changes: Driving assessments, for those with physical impairments include several areas; Motor involvement including muscle weakness, ROM limitations, coordination and sensory deficits in both arms and legs. Constraints in these areas can limit the ability to press gas or brake pedals or cause reaction times to slow down. There are many types of adaptive controls to allow people to drive with these deficits such as hand controls and steering knobs. These adaptations require a skilled professional to assess, educate and alter a vehicle.
Fatigue can have a huge impact on driving. There are some basic tips to keep in mind to help prevent fatigue from impacting one’s ability to drive. Spread chores and appointments out over a week. Always plan ahead. Keep a daily diary. What time of day is the worst? Scheduling appoints accordingly is one simple way to adapt your lifestyle.
Heat: Living in the South, we all know what an impact heat can have on us. If heat causes symptoms to flair, be aware of the time of day your appointments are scheduled. Look for parking areas that may be shaded such as parking garages. Other options that are available are remote car ignitions that allow you to start your car from inside your home giving your vehicle time to cool down prior to you going outside. Our northern counterparts use these frequently to warm cars during winter months!
Cognitive Changes: The task of driving already requires the ability to quickly process many pieces of information simultaneously. Then you add in all the different distractions that can impact your ability to absorb, digest, and sort out important information in order to make quick decisions. Keeping the radio and cell phones off are simple ways to decrease distractions.
Memory loss may also affect driving. It can be frustrating to forget where you are going or forget how to get to and from places that may have never been an issue before.
So how do you decide when you need assistance? For those with relapsing/remitting MS you may not necessarily have issues except during times of exacerbations. You may be able to set limitations for driving as the needs arrive. Making sure you have regular checkups for vision and motor changes help to keep you aware of impairments as they arise.
Luckily, for those with more significant deficits, there are people in the community that can assist you in making the right choices for driving. Assessments can be performed by neuropsychologists to make sure cognitive changes don’t impact driving. Neuro-opthalmologists are available to assess neurologic related vision changes. Occupational therapists, who specialize in driving assessments, can not only assess all areas of function for driving but can also make recommendations regarding adaptations to vehicles and addressing other areas such as fatigue. Some occupational therapists are even trained for on the road assessments.
So how do you find these specialists? Your neurologist may be able to refer you to appropriate ophthalmologists and neuropsychologists. For occupational therapists that are certified driving rehabilitation specialists you can check The Association for Driver Rehabilitation Specialist website at:
Unfortunately, there is no perfect answer for the “to drive or not to drive?” question. It has to be an individual, educated decision. Personally, I tell my patient’s that specialized testing does protect you in the long run. It gives sound, documented information attesting to your ability to drive safely. Or it will give black and white proof of why you shouldn’t drive. It can also simply give you restrictions that allow you to drive but on a limited basis. Being educated is the first step to keeping your independence sound!
Here is a list of several driving programs in the Eastern North Carolina Area:
Driver Rehabilitation Services
Cyndee Cromption OTR/L CDRS www.driver-rehab.com
Duke Health System
Fay J Tripp, Adult Outpatient www.ptot.dukehealth.org
PittCounty Memorial Hospital
Peggy Crisp www.uhseast.com/pittcounty