Driving After Traumatic Brain Injury

Thomas Novack, PhD and Eduardo Lopez, MD , Model Systems Knowledge Translation Center
Driving After Traumatic Brain Injury

Driving is an important part of a person’s independent lifestyle and integration into the community. Because we take our driving skills for granted, it is easy to forget that driving is the most dangerous thing we do in our everyday lives. A brain injury can affect the skills needed to drive safely. If and when an injured person may safely return to driving should be addressed early in recovery. The injured person, family members, and health professionals should all be included in this important decision. If anyone has concerns that that driving may put the injured person or others in danger, health professionals may recommend pre-driving testing.

How can a TBI affect driving ability?

A brain injury can disrupt and slow down skills that are essential for good driving, such as:

  • Ability to maintain a constant position in a lane.
  • Having accurate vision.
  • Maintaining concentration over long periods of time.
  • Memory functioning, such as recalling directions.
  • Figuring out solutions to problems.
  • Hand-eye coordination.
  • Reaction time.
  • Safety awareness and judgment.

Studies indicate that even mild thinking difficulties, which may not be recognized by the injured person, may add to increased risks while driving.

Warning signs of unsafe driving

  • Driving too fast/slow.
  • Not observing signs or signals.
  • Judging distance inaccurately when stopping or turning.
  • Slow to make decisions.
  • Becoming easily frustrated or confused.
  • Having accidents or near misses.
  • Drifting across lane markings into other lanes.
  • Getting lost easily, even in familiar areas.

How often do individuals with TBI return to driving?

Between 40 and 60 percent of people with moderate to severe brain injuries return to driving after their injury. To lessen the risk of crashes, people with TBI may place limitations on their driving habits. They may drive less frequently than they did before the injury or drive only at certain times (such as during daylight), on familiar routes, or when there is less traffic. Having experienced a seizure after the TBI may be a barrier to driving. States often require that a person be free of seizures for a period of time, such as 6 months, before resuming driving. People who want to return to driving need to check with the laws in their state.

Driving evaluations and training

A driving evaluation is a crucial step in determining a person’s ability to drive following recovery from a TBI. Research studies indicate that most TBI survivors are not thoroughly evaluated for driving skills before they begin driving after the injury, and this may put TBI survivors at risk for a crash.

While there is no standardized assessment test or process, a typical driving evaluation has two parts:

  • Preliminary Evaluation: A review of cognitive (thinking) abilities, including reaction time, judgment, reasoning and visual spatial skills. Recommendations regarding the need for adaptive equipment and additional skills training are based on the results of the evaluation.
  • On-the-Road: A test of the mechanical operation of a vehicle, either using a driving simulator or driving a vehicle on the roadway in the presence of the evaluator. This evaluation is used to assess safe driving skills in various traffic environments, as well as basic driving skills while a client uses the appropriate adaptive driving equipment.

Current research indicates that many individuals with TBI can become competent, safe drivers when given the proper training. Training serves to improve specific driving skills. Sometimes this involves practicing driving under the supervision of a driving evaluator. In some cases a training program might focus on specific skills such as rapid understanding of visual information.

Evaluations and training are often provided by professionals certified through the Association for Driver Rehabilitation (ADED). A list of certified professionals may be found on the ADED website, https://www.aded.net/.

Vehicle modifications

If an individual with TBI has physical disabilities but has well-preserved cognitive functions, the individual may be able to resume driving with adaptive equipment and/or other modifications to the vehicle.

Recommendations for adaptive equipment and modifications could include:

  • Hand-controlled gas and brake systems.
  • Spinner knobs for steering.
  • Left foot accelerator.
  • Lifts for entering and exiting the vehicle.

Legal and insurance considerations

A person who wishes to resume driving must have a valid driver’s license. In some states there must be a formal evaluation performed by a licensing bureau before resuming driving after a brain injury. Insurance may also be required. The person should check local regulations relating to licenses and insurance.

Other transportation options

Accessible and reliable transportation is the most critical part of community integration following a TBI. If a person is not able to drive, there may be other options for transportation. Family members can provide transportation, and public transportation such as buses can be used. Some communities provide public transportation specifically for disabled riders.

Step-by-Step: Should you be driving?

  1. Discuss your ability to drive with your doctor and/or health professionals, family members
  2. Get a professional evaluation to determine your driving ability
  3. Based on your evaluation you may be allowed to drive, need training or vehicle modification before returning to driving, or will need to use other transportation options

Recommended resources


Posted on BrainLine March 25, 2010.

Driving after TBI was developed by Thomas Novack, PhD and Eduardo Lopez, MD in collaboration with the Model System Knowledge Translation Center. Portions of this document were adapted from materials developed by the University of Alabama TBI MS and JFK Johnson Rehabilitation Institute TBI MS and from Driving After Brain Injury (reprinted with written permission from the Brain Injury Association of America, Inc. 2007). Copyright © 2010 by University of Washington/MSKTC. 

Please check the MSKTC site for any recent updates on this article.

Comments (26)

Please remember, we are not able to give medical or legal advice. If you have medical concerns, please consult your doctor. All posted comments are the views and opinions of the poster only.

Every brain injury is different. No two are the same. There are a lot of generalizations here. Primarily, it depends on what lobe(s) of your brain was damaged and how long you are in recovery in order too drive again.

Yes. The tests are a little crazy. I didn't have my license for three and a half years. On certain tests I did better than a person without a brain injury. So I know what you mean. It takes time but getting really good scores on a multitude of tests consistently will eventually get you there. The docs might see something negative cognitive wise that you don't notice. It's happened to me and only realized it later. I'm in NY and see Docs in NYC. Not because I live here, but 2 NYU hospitals here in New York (Manhattan) have the best cognitive doctors in the country. People from other countries come to see them. No bullshit. Seizures, cognitive functions. I went thru a Brain Injuy Program for 1 1/2 years to get back to approval from my docs to go driving finally. After the approval paperwork was filled out by the doctors it had to be sent to the New York State DMV medical review board before it was officially approved. Good luck, it's a super tough time I know.

For veterans and active duty, there are Defense and Veteran Brian Injury Centers, one in Richmond which did  lot for me after my severe TBI.  Still not driving, or drinking.....It's almost a year.

April 23, 2008, a DUI driver ran through a stop sign without stopping and knocked me across the road on my motorcycle, I was trauma hawked to Delray Medical Center Fl. and was in coma for 6-8 weeks, suffered a traumatic brain injury and many broken parts, when waking up didn't know my name or friends and family names, had 2 seizures after getting out of hospital. After my memory came back, I wanted my driver's license back just to drive my car again but they took my license away. I tried and tried, then I took an evaluation and passed 9 out of 10 on the test but they said my reaction time wasn't good enough. I asked them to put five people around me and throw punches at me and I will block every one of them.  It was a ridiculous test. They had me look at a computer with 1,500 numbers, five on each line, in no order at all. They called out 1 and I had to look through 1,500 numbers and find the one and mark it with a marker then say 2 and had to go back up and find the 2, then draw a line from 1 to 2 and it kept going. In a couple minutes, they said, "stop, you didn't finish in time." "You failed." I said you've got to be kidding me, right? They said "no." I said, "I couldn't have done what you want me to do before I had a brain injury!" I discussed it with 185 people and 184 people told me they couldn't do that either with no brain injury. I called Florida DMV they said call county clerks office. I called them they said call DMV. I tried it over and over and got the same results. Over 8 years and I still can't drive.  Does anyone know what the method would be for getting my license returned? Thanks for listening and Merry Christmas to all and God Bless.  Earl H

I was told I “should probably not drive” by my first neurologist. That was 10 yrs ago when both kids were in middle school with all kinds of activities. So I got a new neurologist and took a driving skills course offered by AAA for seniors.
If you haven’t been driving since 2008, a driver training course would give you a skills “tuneup” and some clarity whether it’s realistic for YOU to drive again given your physical condition, vision, reaction time, transportation needs etc. Good luck!

Just gave up my car 10 years after mTBI. Driving has been a huge stress because of visual perception issues. Finally decided I will only drive rarely in the future, if at all, and will only drive during daylight, on familiar roads, in dry weather with good visibility, AND with a GPS with audio, so I don't have the distraction of looking out for road signs. Such a relief to hear others talk about this -- I have felt very alone in this decision to give up my car. 

My visual perception issues have prevented me from driving. I misinterpret motion in my peripheral vision. For example I tend to misinterpret a bird flying in the corner of my eye as a car approaching; a leaf blowing on the ground as a small animal approaching; a shadow of another vehicle as a pedestrian I need to avoid. Even as a passenger this is very disorienting. As a passenger I tend to keep my eyes closed. But even then I’ll sense motion incorrectly… e.g. I think we are in reverse when we are going forward or I think we are stopped when in motion. I had what at the time appeared to be a moderate concussion 6 months ago (I did not lose consciousness). I have tried driving twice since then and found I ran red lights, over reacted to the movement of traffic around me, and entered the highway with a feeling that I was not safely considering the traffic around me. Wondering if anyone else has experienced similar issues.

Same here mate, i had 15 percent n everything was identical to what you just wrote

This is a rather generalized and untrue statement. I received a 'severe' traumatic brain injury. I was given a 5% chance to live and loved ones were warned that seizures would be likely and that I may be 'different' or need to relearn to eat, walk, speak, etc. none of that happened. I popped up from the coma like nothing happened. I have passed every test doctors have thrown at me to prove my brain still functions quite well. I can drive just fine. I could walk normally and steadily as soon as their drugs wore off. Perhaps many who have had brain injuries are left somewhat disabled. Not all are. Or perhaps I should be a case study to remove this stigma. Everyone is different and all brains heal differently. Mine healed completely. And it wasn't just a bump on the noggin. My skull was shattered and a portion of my brain about the size of a golfball was removed in surgery. And I still have a higher IQ than most. 'Only ten percent of severe traumatic brain injury victims survive. If they do survive, they have severe cognitive disabilities' Completely untrue. At least in my case.

Only 10 percent of people with severe TBI / Diffuse Axonal Injury survive.  Those that survive have severe cognitive disabilities.  Anyone driving soon after their "severe TBI" is either gravely misinformed about their actual diagnosis or putting us all at risk for harm.

was not diagnosed until 14 months later.  Was driving a loaner 5 days out of the hospital because my car was totaled.  Probably should not have been driving for the first 3 years after TBI.  Near misses are scary.  Had one today.  Was backing out of parking spot and a woman drove right behind me.  Said she didn't see me but she got out of her car and yelled at me.

After a DUI driver ran a stop sign and hit me, my drivers license was taken away from me because of a tramatic brain injury, 3 years after I took a test and 9 of 10 issues were 100 % correct, the reaction time test was not fair with 1500 numbers not in any order and had to look through all 1500 numbers each time one was asked for, they stopped me after about a minute and said I didn't go fast enough, 99.9 percent of people with no injury said they couldn't do it that may either ! There must be another way, could I take a drivers test like it was when I was 16 years old ? Help me Governers !

I am 10 yrs post injury, and do nott drive, because of visual perception issues. It took 8 years to get them diagnosed, and even longer to see these diagnoses documented in medical guidelines. They are Post Trauma Vision Syndrome and Visual Midline Shift Syndrome. They affect my ability to understand where I am in my environment, know where my visual "centre" is, and to be able to process movement (mine and others) properly. Up to 60% of TBI survivors can have these issues.

Yes there are so many things that are over looked after a Tbi . I never got help with alot of problems. Doctors don't get it and people don't understand its so bard. Thank you for Brainline. I would love to talk to a doctor that understands.

After my son's TBI, I became his legal guardian.  In OK, he took the driver's test five times before passing.  I was always his co-pilot because I didn't feel he could see well enough alone (optic nerve damage right eye).  I was another set of eyes.  When we moved to NY, he was given a NY license due to his OK one being active.  I felt even more concerned with his driving in NY and knew how he would feel about losing more of his independence.  I took him to a neurologist and an ophthalmologist for their opinions.  Both said he should not be driving.  He still feels his eyesight is getting better as time goes by, although it is not.  Wishful thinking.

For the person who said coma was required for a severe TBI...this is simply not true and unfortunately, many MDs still believe this. I had a severe TBI, was not in a coma and didn't even loose consciousness. It was actually 8 months before I was diagnosed. However, as I tried to work during that time, I had lost my ability to function if interrupted, I couldn't make sense of material I had written if I was interrupted & returned to it, I had taste and hearing issues, severe tinnitus, short term memory and working memory deficits that were quite severe.

Grading of TBI and treatment for it should NOT be based on whether someone lost consciousness. It should be based on symptoms and abilities.

Oh, btw, I was never sent to rehab...what I have regained, I did on my own. It was excruciating. I suffered depression for two years and didn't drive at all for over three. I was concerned RE my ability to react quickly and I was also extremely nervous. 

However, six years after my injury, I am driving. I don't drive at night and I'd prefer not to be on the Interstate. (But I hated THAT BEFORE my TBI!)

This is a frightening issue my husband suffers from a trip just the other day smashed our jeep because he didn't see the other car when he was turning the car is totaled and we only had it 6 months every car we have had, he has had an accident with. And nothing I can do to have his license taken away that's scary . I'm sick about this something needs to be done

Scary the lack of state to state consistency.  I was discharged from acute rehab for my severe TBI to home.  Six weeks after my discharge,  the MRI showed my broken neck (C-2 fracture) had healed and the neurosurgeon said I could drive and resume all activities.  My processing speed was slow and my double vision had not cleared up as they said.  My husband taught me to drive the Suburban I insisted on when my van was totaled.  Petrified, I drove with double vision for 2 years when it was determined that only surgery would resolve the 4th optic nerve palsy a result of the TBI.  Ohio has no process to resume driving after a TBI.  13 years later, I still drive that white Surburban that now has 241,000 miles on it.  It is the family(6) car and makes me feel safe.  My disability paycheck doesn't provide enough for me to afford to replace it.

Not true I have a mild tbi and did not experience a coma not that I was aware of

You didn't have severe tbi if you drove months after your accident. If you had severe tbi youd have been in a coma for months and then rehab for a few more months.

That is a lie. I had a severe TBI and I was not in a coma at all. So that is not true about severe TBI.

here in washington I have to have my doctor sign a paper and give it to motor vehicles and then take the permit test like we did while we were 15yrs old . It is hard cause how its worded compared to how it is taught or read in the book. I have to retake and retake . I feel thats wrong. As adult who have drove for years and taken the test then explained the new laws our states have then ok Let see how you do in the driving test. If you cant do that then restart it all. Some thing is not catching and Yes, we will have a fit due to loss of our independence and desire to have that back. Yes, we hate the bus and assistance bus. I sure do I accept who i am , but want some Independence to go here to there in less then 1/2hr.
My husband went to a driver retraining class at HealthSouth Hospital in Virginia. Check with HealthSouth in your state to see if they have a supervised driver retraining program near you. They did a great job and he has now been driving safely for nearly nine years!

My son had rehab at Health South in Evansville Indianna. Wonderful place for rehab.

Where do we, people who have TBI's re-learn driving and obtain a new drivers liscence?
No restrictions in Florida... I waited a couple of months after I got out of the hospital to drive. I have severe TBI - was hit on my motorcycle going to work and no helmet... and what do you do if you fall off the horse? You get back on and ride again... so 6 months later - I got another bike and when I can't remember stuff and having problems - I go for a ride and it comes back... Nobody really understands what works on our scrambled brains....