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:


 

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