Driving Following a Brain Injury

Rehabilitation Institute of Chicago-Brain Injury Team
Driving Following a Brain Injury

Questions about being able to drive can arise during recovery from a brain injury. The rehabilitation physician and team can help in finding the answer. Since driving involves many skills that may be affected by a brain injury, testing is often recommended. Specialized driver rehabilitation programs offer this testing to determine driving potential.

Four types of professionals are usually involved in a driver rehabilitation program.

  • A physician makes the referral and gives medical approval for driving. A physician's referral does not mean that an individual is able to drive; it means that the person is medically stable and can be evaluated to determine the potential to drive. The physician's referral is essential, since the physician is responsible, and in some states liable, for the client's care. Every state has different requirements that physicians must follow.
  • An occupational therapist (OT) performs the clinical evaluation, assesses equipment needs and informs the physician and client on progress made throughout the program.
  • A driving instructor performs the actual driving evaluation and provides training as indicated.
  • A rehabilitation engineer develops seating systems, performs wheelchair modifications and recommends or constructs equipment.

Participation in a driver rehabilitation program requires: a physician's referral, a valid driver's license or instruction permit; and a payment method. The physician’s referral includes medical history, reason for referral, and list of medications with possible side effects that may affect driving.

A valid license or instruction permit is also necessary. Some people may need to renew a driver's license at the Secretary of State’s office. The rules may differ from state to state; contact the local Secretary of State to find out procedures. A Rules of the Road book can also be obtained at the Secretary of State’s office or at the driver rehabilitation program. For individuals under age 18, the driving program works with the high school to help with obtaining an instruction permit.

A few medical insurance plans cover the evaluation, but most do not. Check with your insurance representative to find out. Local state Departments of Vocational Rehabilitation, worker's compensation and high schools have occasionally assisted with funding.

The general evaluation consists of a clinical and behind-the-wheel evaluation. The clinical evaluation includes a medical history, vision screening, cognitive evaluation, physical evaluation and discussion of adaptive equipment. The cognitive portion of the evaluation assesses memory, judgment, problem solving, safety awareness, emotional stability and ability to follow directions. If communication is difficult, an aphasic card (below) may be indicated.

Front:

Driving After Brain Injury: Exapmle Aphasic Card Front
 

Back:

Driving After Brain Injury: Exapmle Aphasic Card Back
 

Following the clinic evaluation, if a behind-the-wheel evaluation is not appropriate, the obstacles and possible solutions will be discussed. Usually, a repeat evaluation can be done in six to 12 months.

If a behind-the-wheel evaluation is indicated, this is done in a vehicle equipped with an instructor brake and any necessary adaptive equipment. The drive begins in a low-stimulation environment such as a parking lot, then progresses to low traffic residential streets, on to commercial traffic areas and finally to highway driving.

One of three possible responses is given following the behind-the-wheel evaluation:

  • No problems; driving approved.
  • Some problems; more training is recommended.
  • More complicated problems; possible solutions are discussed. These may include continued occupational, physical or speech therapy; consultation with an eye doctor; or just allowing more time for the brain to heal. A re-evaluation in six months to a year can be performed if the physician and client feel the issues have improved. Occasionally, adaptive equipment is needed due to physical issues. If the primary mode of transportation is a wheelchair, then a mini-van or full-sized van may be appropriate, especially if transferring and loading the wheelchair into the car is difficult. Consultation with a professional in a driving program to discuss the need for ramps, lifts, transfer seats and other adaptive driving equipment is recommended before purchasing a vehicle.

The freedom of going out and enjoying life with family and friends is very important. A driver rehabilitation program can assist with understanding driving potential and regaining the ability to drive safely after a brain injury.

The content of this handout is for informational purposes only. It does not replace the advice of a physician or other health care professionals. Copyright 2007 Rehabilitation Institute of Chicago

Posted on BrainLine November 19, 2008.

Copyright 2008 Rehabilitation Institute of Chicago, LIFE Center. Reprinted with permission. www.ric.org.

Comments (9)

It's really annoying, the one thing I want to do is drive but because of my brain injury it's the one thing I can't do. Every plan I've ever made for the future consisted of me getting my license but I can't. :(

I was in a coma for 7 weeks in 2012 , have not driven anything since was at a Veterans hospital for ploy-Trauma transitional center They wrote a letter to DMV having my CDL class A suspended I just want a regular drivers license. Still trying to get it red tape and all

I had severe TBI 1.5 years ago. I was 3 months in coma. Right now I have a diplopia. Can I drive now?

i have absolutely no confidence in driving :(

I has a severe TBI on 7/11/07.  I was in the hospital or six months. My license had expired 2 months before my TBI. 

Basically no one told me specifically that I could not drive.  When I got home I called to find out what I needed to do to get my license renewed.  They said an eye exam.  That sounded good but then I realized I still had double vision.  I wen rand took the eye exam.  Since I was looking in a viewfinder for the test it was easy to cheat with both eyes, I simply closed one.   

I did pass.  I started driving all by myself about the 5th month post TBI.  I thought I was fine but I know that I wasn't.  lots of cars were honking at me.

bottom line, no one officially restricted me.   I wanted to drive.  I did take an evaluation test and then moved on.

I was unable to drive following my TBI because I had double vision. Once the double vision was corrected, I had to wait to get my post-traumatic epilepsy under control with medications to be able to get my drivers license. There are many things that need to be taken into consideration with someone being able to go back behind the wheel following a TBI.

I drove five months after a TBI at a family member's urging. I had no desire to drive. A sense of obligation put me behind a wheel. I got in a wreck that month that  totaled my vehicle. I was safe. While I think the wreck would have happened regardless of my TBI a few months earlier, that didn't change how jarring, scary, confusing and insecurity-heightening it was to experience a car wreck shortly after a TBI. Do NOT have people driving until they express readiness, if you're the loved one of a TBIer. And TBIers, remember that even if you feel ready, you can't control cars around you even if you feel in control of your own driving. Think about how it would impact you if something went awry.  

It would be helpful if this article listed the difficulties that TBI patients may experience. I had to stop driving because of limitations in my visual memory. I can look at an oncoming car's position and look away and not remember if I just saw a car coming. I am also very easily distracted from the task of driving. I can get my feet mixed up, Brake, clutch, gas pedal, especially during stressful times. I can also become visually overwhelmed easily. A brain injury Occupational Therapist driving evaluator tried to tell me that I was fit to drive, even though I had an over-stimulation melt down while trying to drive through a busy intersection. Luckily, I pulled to the curb until I could recover. If she could have been a fly on the wall in my brain, she would likely have had a different opinion. I have learned many adaptive skills but the over-stimulation and distractability still make driving risky. Be very careful and honest with yourself regarding choosing to drive. It is miserable to not drive but the memory of hurting or killing someone would be much worse. I do a little driving on uncontested country or small town roads. No highways where I can forget I am driving at 60 or 70 mph.
We are in the middle of this process for my 20 year old. Its difficult to explain to him why he can't drive right now. Hopefully it will get better. Doctor requires a neuro-psych test before she will give her ok.