Medical Driving Evaluations

Driving After a Stroke

Posted by Joan Cramer on Mar 29, 2019 1:49:03 PM
Joan Cramer
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The road to recovery after a stroke is challenging, and different for each person. And when it comes to driving, your past medical history, age, medical conditions, and severity of the stroke can all play a role in understanding how to work towards healing and hopefully getting back on the road. 

In this article, I'll talk about my experience as a Certified Driving Rehab Specialist, or CDRS, and my work with stroke patients as they’ve worked to return to driving, or found alternative transportation plans, after recovering from a stroke.

Types of Strokes

There are two main types of strokes, each of which can have different long term effects on your body.

Ischemic Strokes

Ischemic strokes are associated with plaque buildup in your arteries. As a result of these buildups, which are usually made up of fat, cholesterol, calcium, or other compounds, blood flow is restricted to the brain, which causes ischemic stroke. 

Ischemic strokes comprise the majority of strokes and are usually the result of other cardiovascular risk factors like high cholesterol, high blood pressure, or heart disease. 

Hemorrhagic Strokes

Hemorrhagic strokes happen when there is damage to the arteries in your brain. When arteries are consistently subject to high blood pressure or weakened, they can burst, which allows blood to bleed into the brain or between the brain and skull. 

Hemorrhagic strokes are rarer and are typically caused by long-term damage to your arteries from aging, illness, or risk behaviors like high blood pressure or smoking.

The Differences in Driving Recovery

For many people, baseline functional skills can return quickly after a stroke. But even in cases where most functions return, you can experience subtle issues that may increase your risk behind the wheel

For this reason, it’s a good idea to discuss a plan with your doctor before returning to driving after a stroke.

 

Some Key Questions to Consider Before Driving After a Stroke

For many people, driving after a stroke can be scary, anxiety-inducing, and avoidable. Before you begin the path to recovery, ask a few key questions: 

  • Are there potential alternatives that would be preferable to driving?
  • Do you want to return to driving?
  • If you do want to return to driving, why? 

Understanding these key questions can help shape your path to recovery or finding alternative methods of transport.

 

Who Determines if You’re Safe to Drive After a Stroke? 

The State of Connecticut Department of Motor Vehicles does not have a mandatory reporting requirement for medical professionals when an individual experiences a stroke, or any other medical condition that may have a temporary or permanent influence on the ability to drive.  

There are documents to voluntarily recommend that the DMV suspend a license for people with disabilities due to medical conditions, but these are provided to the DMV at the discretion of the medical professional.

The DMV does, however, recommend that doctors submit these forms, and anyone who submits such a form is protected from any civil action as recourse.

Still, in many cases, it’s up to you and your family to do the due diligence required to make sure you’re safe to be back out on the road.  

Common Challenges That May Arise When Driving After a Stroke

Visual Challenges

These challenges can include:

  • Impaired Peripheral Vision
  • Neglect of either visual field
  • Poor depth perception
  • Delayed visual processing speed
  • Limited ocular motion
  • Change in acuity
  • Difficulty scanning
  • Divided Attention

Vision is the sense used most often to impact safety during driving. All of these factors, especially spatial relationships and perception, should be assessed by an optometrist or other eye professional before you get back on the road.  

Cognitive and/or Verbal Challenges

These challenges can include:

  • Impaired judgment
  • Expressive Aphasia
  • Receptive Aphasia
  • Impaired communication
  • Reduced right/Left discrimination
  • Difficulty learning new things
  • Limited memory
  • Reduced problem solving

Cognitive impairment is unique to each person depending on the severity of the stroke, the timeliness of the treatment after the stroke occurred, and any continuing medical issues. A trained professional, especially a CDRS, can help you understand how these factors affect your driving and adapt. 

 

Driving after a Stroke

Early Stages of Recovery

In the early stages of recovery from a stroke (after discharge from the hospital) you likely will not be safe to drive. In this case, it’s a very good idea to work with your doctor or a family member to come up with a transportation plan during the period of follow up appointments.

The best option is to work with family, as having family members around will also help with the emotional and mental aspects of recovery. If you’re unsure of how best to organize this transportation, you can reach out to us at The Next Street for guidance.

Returning to Driving | Some Factors to Be Aware of 

As we’ve mentioned above, there are many aspects of driving after a stroke to consider:

  • Reaction times can be slowed, limiting your reactions to unexpected situations caused by other drivers
  • Control of the wheel can be difficult with sensory loss or weakness in one hand
  • Trunk control and sitting posture can make it hard to remain comfortable and mobile in the driver’s seat
  • Slowed visual processing can make it difficult to attend to multiple mirrors and maintain your awareness on the road (like when changing lanes)
  • Limited vision or spatial perception can make it difficult to place your car correctly within the flow of traffic 
  • Having a harder time paying attention can make it far more difficult to pay attention to signs and visual instructions presented while the car is moving

Whether young or old, a person who experiences a stroke will have to relearn and train the safe habits and behaviors that make up good driving practices. We know that driving can be a key part of your freedom, which is why we recommend working with a CDRS professional to plot out your path to recovery. 

The Road to Recovery | Understanding the Facts

We recommend that you avoid trying to return to driving until you’ve reached a plateau in your recovery process (at the very earliest). Regaining full function and adapting to life after a stroke can be complicated enough without the additional challenges of driving. 

From here, we also heavily recommend working with the occupational therapy expertise of a Certified Driving Rehabilitation Specialist (CDRS). Even though you or your family member may feel like you’re back to full health, there may be risk factors that you won’t notice until you’re on the road or in stressful conditions.

Working with a driver rehabilitation specialist can provide you the confidence to know that you’re as safe as possible on the road, or offer the exact plan of adaptive devices you may need to recover.

Assessing Driving Skills

The two major tools a CDRS will use to help you plan your driver rehabilitation are a Comprehensive Clinical Driving Assessment and, if possible, an actual Driving Assessment. 

Remember, operating a motor vehicle involves many skills performed simultaneously, and a CDRS will be able to look at each of these building block skills individually and together during their Comprehensive Clinical Driving Assessment, which usually takes about 2 hours.

If your mental and physical capabilities are on track, your CDRS can work with you to schedule a follow up Driving Assessment to see how you actually perform on the road.

Possible Outcomes at Next Street

Based on the results of your assessments, your CDRS will likely recommend one of the following outcomes.

Drive On

It’s completely possible that you’ll be able to make a full recovery and return to driving exactly as you were before, with the confidence that you’re safe on the road. It may take some time, and some possible training to form new habits or learn new strategies, but in many cases, it’s possible to return fully to driving.

Restricted Driving Privilege

Another possible recommendation is to return to driving in certain conditions, but not others. For example, if you struggle with certain visual aspects of driving, you might return to driving during the day, but avoid night driving or driving in inclement weather. 

Adaptive Driving Devices

Another option is to return to driving, but with the added support of adaptive equipment and vehicle modifications that make it easier, more comfortable, or safer in the car. 

The cost can be a consideration here, though there are grants from adaptive driving programs and health/accident insurance that can often cover these costs, as well as DMV requirements to abide by. Most states require that drivers with adaptive driving devices like hand controls take follow-up driver evaluations to ensure their safety on the road before rewarding their driver’s license again.

Retirement from Driving

Finally, for some, it’s just not a safe option to continue driving after a stroke. In these cases, a CDRS can help you develop a transportation plan (through ride-sharing, taxis, public transport, friends and family, etc.) to provide an alternative to driving. 

At Next Street, our ultimate goal is to help you maintain freedom, mobility, and independence after your stroke in the safest way possible, and our CDRSs are experts at developing a plan that works for you.

Take the Next Step Today

If you or a loved one has suffered a stroke and is thinking about how to get back on the road or find alternative mobility resources, you can reach out to us for a free consultation.

Schedule a Free Consultation

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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