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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Adapting to life after a spinal cord injury (SCI) can be a scary and difficult process for many reasons. Tasks that were simple before may be challenging or impossible now, which can lead to some very understandable feelings like you’ve lost independence or freedom. 

One major area that affects people recovering from an SCI is driving, which to many people represents a fundamental part of mobility and independence. However, thanks to adaptive driving equipment and training, thousands of people with SCIs have been able to relearn to drive and safely get back on the road, even with paraplegic or quadriplegic injuries.

What is a Spinal Cord Injury?

The spinal cord is a bundle of nerve fibers that run through the “spinal canal”, hollow spaces inside your vertebrae, and serves as a fundamental connector between your brain and body. Every time your brain sends a signal to a muscle to move, or your body receives information from its nerves like temperature or pain, these impulses travel up and down the spinal cord.

When you suffer an injury to your neck or back, your spinal cord can be injured, and these nerve fibers can be damaged. Like a downed telephone wire, damage to the spinal cord has the ability to cut off connections and communications between your brain and parts of your body. 

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

Types of Spinal Cord Injuries

Your spine is divided into five regions. The uppermost is the cervical spine, which is comprised of the seven bones of your neck. Injuries to the sections of the spinal cord in the first two vertebrae are often fatal, as the nerves in these two vertebrae control breathing. 

Injuries to the lower five bones of the cervical spine are not as immediately life-threatening but can result in quadriplegia, 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 also cuts off communication to your legs, which results in paraplegia, full paralysis of the legs.

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, which often require braces or other devices to assist with walking. 

The spinal cord itself stops at the L2, the second lumbar vertebra, though nerve bundles do continue to connect through the spaces of the remaining lower vertebrae.

The last six bones of the spinal column are the sacral and coccygeal spine. Injuries to these lower vertebrae are less common and less serious as they do not involve the spinal cord. However, an injury here can still cause nerve damage, which can damage hip and leg mobility, as well as bowel and bladder control. 

How Can a Spinal Cord Injury Affect My Ability to Drive?

The answer to this question depends on which section in the spine (cervical, thoracic, or lumbar) the injury occurred and how severe it is.

Lumbar Spine (Lower Spine Injury)

In the worst case, a lower spine injury can result in little to no leg function, but generally leaves the arms, core, and upper body muscles fully functioning. 

In this case, the main areas that drivers need support are with the foot pedals, as well as during entry and exit of the car. Fortunately, there are adaptive devices that provide hand-control of the gas and brakes, and car adjustments modeled to help drivers and wheelchairs into their car.

Thoracic Spine (Middle Spine Injury)

Injuries in the thoracic spine, along with the loss of leg function from a lumbar spine injury, can also lead to problems with balance and decreased function in the hands. 

In addition to the same adaptive devices used with a lumbar spine injury (hand control of gas and brakes and adjusted access), drivers with a thoracic spine injury may also need additional straps across their chest to hold them up in a safe position while driving, especially while going around turns. 

Depending on the height of a thoracic spine injury, a driver may also need further adaptive controls to the car similar to video game controllers depending on their level of hand and arm function, and a vehicle with more space to accommodate a ramp or wheelchair lockdown system. 

 

Upper Thoracic and Cervical Spine (Upper Spine Injury, C4 and Above)

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. Injury to the spinal cord at or above C4, especially if they are complete injuries, will render a person’s arms inert. At this point, they will no longer be able to carry out the minimum function needed to use adaptive devices in most cases.

In recent years, there have been prototype models for semi-autonomous vehicles with extensive modifications that allow quadriplegic drivers to control a vehicle with their breath, head movement, and voice commands, but these are not widely available at this point in time and can be very, very expensive.

What Can I Do at Home to Prepare for Driving After a Spinal Cord Injury?

First, 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 in the long term to be able to get behind the wheel with your SCI.

You’ll most likely have already begun working with a physical therapist. If so, discuss with them the goals you have for driving, and they will be able to set out a roadmap to help you prepare physically.

The next step that we recommend is to meet with a Certified Driver Rehabilitation Specialist (CDRS). These occupational therapists can help you with the many considerations of getting back in the driver’s seat, tailoring an approach based on your physical ability and current driving skills.

These recommendations may include suggesting adaptive devices to add to your vehicle to continue driving, information about if such modifications work with your current vehicle, and how to begin preparing to once again get out on the road and navigate freely and safely. 

How Do I Know if I Can Drive Again with a Spinal Cord Injury?

One of the major determining factors for driving after a spinal cord injury is the 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, you’ll have enough minimal hand movement to be able to operate a joystick or game controller style device. We recommend working with a CDRS to determine your safety if you have an upper spine injury.

With a mid or lower spine injury, the most important consideration is the consistency and strength of your body, especially your arms and hands. Temporary loss of function, weakness, or muscle spasms can all be common after an SCI and can affect your ability to drive again safely. 

Other issues related to recovery, like medications that may cause slow reaction time or nagging health issues like pressure sores or brain injury that can affect your comfort and control in the car, are also warning signs that it might not be time to head back out on the road yet. 

In the United States, there are no state or federal laws that prohibit people with SCIs from driving, but some states place restrictions on these drivers, like not driving at night, or in inclement weather. This is another area where a CDRS can help tailor a plan to keep you safe and cleared by your local regulations.

SCI Driver Rehab | The Next Street Criteria and Recommendations

At Next Street, our goal is to help you understand exactly where you are at physically and mentally, and provide the best possible solution to help keep you mobile and independent. 

We’ll start by having one of our CDRSs meet with you in the comfort of your own home for an initial driving evaluation, which usually takes about two hours. We recommend you get a good night’s sleep and eat well prior, but don’t worry about studying or memorization. This is a test of your motor skills and current cognitive and visual abilities. 

We’ll also check your range of motion, flexibility, strength, and coordination, as well as your vision, reflexes, and judgment skills. 

Based on this initial assessment, we can start to understand which adaptive devices might be right for you, and potentially schedule a follow-up, 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 to how you drive. 

Adaptive equipment can range 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, all of which you can discuss with your CRDS. 

Once you have a plan, the next step is to get comfortable with your new equipment, which we recommend doing with a CRDS instructor. Under their guidance, you’ll be confidently able to relearn to drive and return to the road. 

Driving with Restrictions

Another result of a specialist assessment is recommended (or in some cases required) restrictions to driving. For example, if you struggle with quick reactions, it may be safe to drive between home and work, but inadvisable to drive on the freeway, or late at night. 

You can work with your instructor or specialist to figure out exactly when and where it’s safe for you to drive. 

Retirement from Driving

Sometimes, an SCI can limit your body function enough that it’s not safe to be out on the road. However, if this is the case, our CRDSs can help you come up with a custom-tailored alternative transportation plan. Whether this includes ride-sharing, public transport, or support from friends and family, our specialists will work to find a plan that works for you. 

Take the Next Step

Regardless of your situation, Next Street’s goal is to help you maximize your independence and mobility after an SCI. If you’d like to learn more about how our team can help you continue to move about safely, you can reach out to us for a free consultation.

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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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