Family News and Views, A Monthly Publication of the Brain Injury Association
Vol. 5, No. 7 December 1998
By Carolyn Rocchio

Driving is considered a "rite of passage" in our society. Most teenagers look forward to and plan for the day when reaching the age of eligibility for a license to drive. After a brain injury, driving is often taken for granted and many families are unaware of the potential for danger if a family member returns to driving without first being evaluated to determine that skills necessary for operating a vehicle are in place.

Many persons with brain injuries and their families presume that once recovered from the initial and more medical aspects of a brain injury, an individual will gradually resume normal pre-injury activities, which may have included driving. Often the need to evaluate driving skills is overlooked in rehabilitation facilities, which creates a major power struggle for the family once the individual returns to the community. After sustaining a brain injury, individuals who were licensed drivers do not normally "forget" how to drive. However, there are more skills involved other than starting, steering and stopping, and these skills need careful evaluation to ensure the safety of the driver and others on the roadways.

Physical impairment can be more easily overcome with assistive devices than can be overcome when the residual impairments are cognitive and perceptual. Occupational therapists, physical therapists and neuropsychologists are the primary professionals evaluating driving skills through use of various assessments during rehabilitation. It can be extremely helpful for families to be aware of negative information as soon as possible, so the subject can be discussed while the client is still in rehabilitation where opinions are reinforced by the professional staff.

Even though the individual may not be capable of driving when discharged from rehabilitation, there should be some plan for revisiting the issue as progress warrants or determining once-and-for-all that driving may not be safely undertaken and alternate transportation arrangements discussed.

Some frequently asked questions about driving include:

Is a person’s license to drive revoked after sustaining a traumatic brain injury (TBI)?

Driving privileges are usually not suspended or revoked when an individual sustains a TBI. However, in cases in which the driver is charged with a traffic violation, e.g., driving under the influence or other traffic violations, the law may require revocation or suspension of the license as a consequence of the infraction. Some states require that physicians report to the Department of Motor Vehicles (Transportation Department in some states) the names of persons sustaining injuries that may impair driving skills. This may include such conditions as epilepsy, visual loss (functional blindness), spinal cord injury and TBI.

Following TBI, does an individual have a responsibility to report changes in medical status to the department governing driving licenses?

Some states require a change in medical status affecting driving skills be reported. When an individual has a legally valid license at the time of injury, at a future date it will be subject to renewal, and at that time questions may be asked about changes in medical or physical status. Most state renewal applications inquire about certain conditions that may have developed since the previous license was issued. Typical questions may be, "Do you ever have blackouts, have you had a stroke, diabetes, require glasses, or do you have any physical or mental impairments?" Although it is doubtful that any application will ask specifically about TBI, the questions should be answered honestly to avoid future consequences.

How does brain injury affect an individual’s ability to drive a car, boat, motorcycle or other vehicle?

Driving requires a myriad of skills and integration of complex information in very rapid order. In addition to the visual acuity needed, an individual must have intact perceptual skills, e.g., the ability to judge distances between cars, space in parking lots, interpret very complicated visual information and all this while operating a rapidly moving vehicle. When damage occurs in the frontal lobes of the brain (executive thinking), residual deficits can impair judgment, reasoning, reaction time, planning and organization skills, impulse control and decision making skills, all of which are essential to safely operate a moving vehicle.

How and where can an individual be evaluated for driving skills, subsequent to sustaining a brain injury?

Many rehabilitation centers have driver evaluation programs. In addition, there are professional driving evaluators in private practice in many communities. Driving schools (found under "Driving" in yellow pages) are not usually prepared to do more than teach the mechanics of driving and are unfamiliar with cognitive deficits that present major barriers to driving after brain injury. For further resource information, contact the nearest rehabilitation program that has spinal cord and/or brain injury rehabilitation. These facilities are most likely to have driving evaluation programs.

What would be included in a good driving evaluation program?

Assessment of the following skill areas:

Physical skills.

Can the individual physically handle the mechanics of driving? Does the individual require special adaptations to promote ease of handling or safety?

Visual skills.

Is peripheral vision within normal range? Does the individual scan the roadway well for hazards? Does the individual require corrective lenses?

Perceptual skills.

Does the individual judge depth and distance well? Does the individual use space on the roadway adequately? Can the individual recognize colors and shapes of traffic signs with relative ease? Is there evidence of right/left confusion? Can the individual follow verbal directions to get to a destination?

Speed of motor responses.

How quickly does the individual respond when the individual needs to brake quickly, change lanes or travel distances?

Judgment.

Is there evidence in the individual’s driving to indicate impulsivity or lack of quality control? In an emergency situation, how well does the individual exercise decision-making skills?

Are youngsters and previously unlicensed drivers eligible for driver’s licenses?

In many cases, youngsters upon reaching the age appropriate for issuance of a learners permit should be enrolled in driver’s education through school programs or privately operated driving schools to learn about the mechanics of operating a vehicle. They should further be evaluated by handicapped driving evaluators to assess the cognitive and perceptual abilities for safe driving.

Can individuals with epilepsy drive?

Epilepsy is a common consequence of brain injury and may prevent driving, possibly only temporarily. In addition to all of the skills noted above, state policies relative to epilepsy must be explored. Development of seizures does not routinely disqualify an individual from operating an automobile; however, each state has criteria for determining when and under what conditions persons with epilepsy may legally drive. You can obtain information about your state’s criteria for driving with epilepsy by contacting the Epilepsy Foundation of America at 1-800-332-1000.

In summary, many skills are required to safely operate a moving vehicle and, subsequent to a brain injury, care should be taken to ensure the safety of the individual as well as the well-being of others sharing the road.