Medical Driving Evaluations

Driving After a Spinal Cord Injury

Posted by Joan Cramer on Aug 29, 2019, 8:14:56 AM
Joan Cramer
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If you have suffered paralysis as the result of a spinal cord injury (SCI), you may be struggling with feeling trapped and helpless. Having such a sudden loss of function and independence can be terrifying, and it can take a long time to adjust to the new reality. Some find that they want to push themselves to their new limits, whereas others feel defeated. They may see something like driving as a part of their old life that they must give up. Just because you are paraplegic or quadriplegic, doesn’t necessarily mean you need to surrender driving. Thousands of people with SCIs have been able to relearn how to drive with the help of adaptive equipment and take back some of their freedom.

What is a spinal cord injury?

The spinal cord is a bundle of nerve fibers that runs from your brain to your body through the hollow spaces inside your vertebrae. The nerves branch out between each set of vertebrae to reach adjacent parts of the body. Every time your brain commands a muscle to move, or any time you feel a sensation like temperature or pain, these impulses travel up and down the spinal cord.

When someone suffers an injury to their neck or back, the spinal cord can be injured, and these nerve fibers can be damaged. Just like a downed telephone wire, the two sides that were communicating are suddenly cut off, and the conversation ends. No more messages go back and forth. The brain doesn’t know what the body is feeling, and the body doesn’t know what the brain is telling it to do.

The effects of a spinal cord injury depend on where in the spine the injury occurred, and whether the injury was complete (cutting off all communication below the injury site) or incomplete (only cutting off some communication below the injury site).

Your spine is divided into five regions. The uppermost is the cervical spine, which is comprised of the seven bones of your neck. Injury to the first two bones in this section can often be fatal, as the nerves that branch out from them control breathing. Injury to the five bones below that is not necessarily as life-threatening but can result in quadriplegia, or full paralysis of the arms and legs.

The next 12 vertebrae in your upper back are known as the thoracic spine. When this region is injured, it can lead to paralysis of the chest, back, and abdominal muscles, though usually there is little to no deficit in the arms and hands. A thoracic spine injury cuts off communication down the line to the legs, which results in paraplegia.

Below the thoracic spine is the lumbar spine, which is made up of five vertebrae. Injuries to this section of the spine do not affect the upper body but can result in full paraplegia or weakened function in the legs requiring braces or other devices to assist with walking. The spinal cord itself stops at L2, the second lumbar vertebra, though nerve bundles do exit at the spaces between the remaining lower vertebrae.

The sacral and coccygeal spine make up the last six bones of the spinal column. Injuries at this level are less common and less serious as they do not involve the spinal cord. An injury here may still cause nerve damage. While it won’t result in full paralysis, it may cause some deficits in the hips and legs or may affect bowel and bladder control.

How can a spinal cord injury affect my ability to drive?

The answer to this question depends on where in the spine the injury occurred and how severe it is.

An injury in the lumbar spine can result in little to no function in the legs but will leave the arms and core muscles fully functioning. This means that a driver can still operate a steering wheel, horn, turn signal, and most of the other buttons and knobs in their car. They will probably still be able to turn their head to look at mirrors and over their shoulder as needed. Most likely, however, they will no longer be able to operate foot pedals and will have difficulty getting in and out of a vehicle. Adaptive devices may be needed, such as hand controls to use the gas and brakes, and it will take some time to relearn how to drive with them. The driver will also need to learn how to get themselves and their chair into and out of the vehicle.

Injuries in the thoracic spine, along with causing loss of leg function, can also lead to balance problems and sometimes decreased function in the hands. A driver may need additional straps across their chest to hold them up in a safe position while driving, especially while going around turns. They may also need adaptive devices such as joysticks or video game style controllers to operate a vehicle. This will take some time for them to relearn how to drive. It is also less likely that they will be able to transfer themselves and their chair in and out of the vehicle easily, so they will probably need to remain in their wheelchair while they drive. This means they will need a vehicle with more space to accommodate a ramp and an automatic wheelchair lockdown system.

If an injury happens below C4 (the 4th bone in the cervical spine), it is possible that the victim may still be able to drive using adaptive devices. Injuries at or above C4, especially if they are complete injuries, will render a person’s arms inert to the point that they are no longer able to carry out the minimum function needed to use adaptive devices in most cases.

There are some semi-autonomous vehicles with extensive modifications that allow quadriplegic drivers to control a vehicle using a combination of puffing and sucking on tubes, head movement, and voice commands, but these are not widely available at this point in time and can run with million-dollar price tags, so they are not very practical options for most people.    

What can I do at home to prepare for driving after a spinal cord injury?

If you or a loved one have suffered a spinal cord injury, you have most likely already begun working with a physical therapist. Discuss with them the goals you have for driving, and they will be able to help you determine what you can do to prepare physically.

Be sure that you take the time to properly heal from your injury and regain as much strength and function as possible. This puts you in the best position possible to be able to get behind the wheel with your SCI.

It can also be helpful to find blogs or YouTube videos about drivers with spinal cord injuries. You can hear directly from fellow para- and quadriplegics about their transition to driving after their injury. This can give you a sense of what the journey will look like for you.

You may want to start thinking about what sort of vehicle you may need to accommodate your needs, but we wouldn’t recommend making any purchases until after you have spoken with a Certified Driver Rehab Specialist (CDRS). There are many things to take into consideration when getting a vehicle, including whether you will be able to transfer yourself into the driver’s seat or if you will need to remain in your wheelchair, what sort of adaptive devices you will need, if the vehicle can accommodate how tall you are, and how much clearance your garage or other regular parking locations have.

How do I know if I can drive again with a spinal cord injury?

One of the big factors in determining if you can drive with a spinal cord injury is whether you have any use of your arms. As mentioned above, if your SCI is located below C4, you will possibly still have the arm motion needed to operate a vehicle with some sort of adaptive devices. If the SCI is at C4 or higher, your chances of driving are much smaller, but in some cases with incomplete SCIs, there is enough minimal hand movement to be able to operate a joystick or game controller style device.

If your break is below C4 or is incomplete and still allows you some arm function, you need to consider whether your body has had time to recover from the SCI. It is possible that with more time and rehab, you could improve your functionality a bit more. It is important that you have some degree of muscle control, especially in your arms and hands. You may also suffer from muscle spasms after an SCI. If these are severe enough that they could affect your ability to operate vehicle controls, this may need to be addressed before driving can be a safe option.

You may also have other issues related to your spinal cord injury that need to be addressed. If you received your injury in a car accident, there may be secondary injuries that still need time to heal. You may also be on medications, such as narcotic pain killers, that can alter your judgment and reaction time and render you temporarily unsafe to drive. Or you may have developed pressure sores during recovery that would prevent you from sitting properly in a vehicle. These may need to be dealt with before you can get behind the wheel.

There are no state or federal laws prohibiting people with SCIs from driving, but you may need to be placed under restrictions. A CDRS can help determine what you are capable of doing and which DMV regulations may apply in your situation. 

What Next Street looks for when they assess spinal cord injury patients for driving

At Next Street, we come to you. In many cases, we meet with you in the comfort of your own home and carry out an assessment of your abilities. All you need to do to prepare is to get a good night’s sleep and eat normal meals so you have the strength and energy to get through the visit, which can take up to two hours. Don’t worry about needing to memorize anything, this isn’t a test of your knowledge, it is an assessment of your motor skills and your cognitive and visual abilities. 

During your appointment with our CDRS, we check your range of motion, flexibility, strength, and coordination to see if you can handle operating a vehicle. We test your vision, reflexes and judgment skills. We also take the time to evaluate you for adaptive devices to see which equipment would work best for you. Depending on how this first appointment goes, we will schedule you for a behind-the-wheel evaluation at a later date. 

Possible driving outcomes

Adaptive driving devices

If you have an SCI but are still fit enough to get behind the wheel, you will nevertheless need to make some adjustments how you drive. You will need some sort of adaptive equipment, ranging from simple mechanical hand devices for operating the gas and brakes to more highly automated devices and vehicles with specialized lifts and lockdowns for your wheelchair. Once we have determined which equipment is best for you, the next step is to learn how to use it. It will take time to relearn to drive, or learn to drive for the first time, but once all is said and done, you can get out on the road.

Driving with restrictions

In some circumstances, drivers may be restricted from operating their vehicles at certain times of the day, or in certain locations for their own safety. It may be decided that you are fine driving around between home and work, but that you should not drive on the freeway.

Retirement from driving

Sometimes, a person’s disability after an SCI is so severe that it is not possible for them to safely drive on their own. If we determine that this is the case, we can help you plan alternative means of transportation. This may involve making use of specialty transportation companies or having loved ones modify or purchase a vehicle that can accommodate your wheelchair and any other equipment you require.  

Regardless of your situation, Next Street will work with you to help you maximize your independence and mobility. 

 

 

Topics: driver rehab, driving evaluations, medical, medical driving, spinal cord, spine injury

Driving is Important

We Are Here to Keep You Safe Behind the Wheel

Our Driver Rehabilitation program works with patients whose change in health may affect their ability to safely drive. We have a team of Certified Driving Rehab Specialists that will work with patients on evaluating your driving abilities. We also have a team of professional instructors to help you gain or regain the skills you need to drive. We created this blog to talk about the various diagnoses we experience and how they may affect your experience behind the wheel. 

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