Medical Driving Evaluations

Driving After a Traumatic Brain Injury (TBI)

Posted by Joan Cramer on Sep 4, 2019, 4:31:47 PM
Joan Cramer
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If you or a loved one are among the 2.8 million Americans who sustained a traumatic brain injury (TBI) this year, you may be wondering if driving is still a safe option. If you were injured in a car accident, which is one of the leading causes of TBI, you may be even more uneasy with getting back behind the wheel.  At the same time, you may be concerned about losing your independence, or even about losing your ability to care for loved ones. Many drivers not only have themselves to think of but dependents as well. Driving can seem less like a convenience and more like a necessity.

As the stress of this weighs on you, keep in mind that for nearly 3 out of 5 people with moderate to severe traumatic brain injuries, it is eventually possible with rehab and adaptive driving devices to get back on the road. For those who can’t, there are still many transportation options out there.

What is a traumatic brain injury?

Traumatic brain injuries are the result of some sort of force causing damage to the brain. They are often caused by car accidents, sports injuries, acts of violence (including combat), and falls. When these incidents occur, they can either cause direct injury to the head or can make it change direction suddenly, which results in the brain impacting the inside of the skull.

Depending on the severity of the injury, a TBI can be categorized into one of three levels.

Mild TBI

If the victim does not lose consciousness or loses consciousness for less than fifteen minutes, exhibits short-term confusion, and possibly struggles to recall the events of the injury, they likely have a mild TBI, also known as a concussion. They may continue to experience problems such as headaches, poor balance, dizziness, fatigue and difficulty concentrating for a week or two after the injury. Brain scans often come back normal. With rest, a good diet, plenty of fluids, and a healthy lifestyle, a mild TBI usually resolves within a week or two, but sometimes symptoms can linger for a year or more.

Moderate TBI

When a loss of consciousness lasts from fifteen minutes to several hours and the victim’s confusion continues for days or weeks, they are diagnosed with a moderate TBI. Recovery from a moderate TBI can be a much longer process, though frequently a full recovery is possible. At other times, however, the damage can lead to permanent mental or physical deficits.

Severe TBI

In the event that the victim does not regain consciousness for more than six hours, they have a severe TBI. This loss of consciousness, known as a coma, often lasts for days to weeks. The most severe cases may see unconsciousness continue for over five weeks, and it may even last for years.  These injuries are often the result of such extreme violence that the skull is fractured or penetrated. Victims require extensive, long-term hospital care and are likely to have severe, permanent disabilities when they do wake up. Complete recovery is rare.

How can a TBI affect my ability to drive?

Every TBI is unique. The exact symptoms experienced depend on the severity of the injury, the area of the brain affected, and any other injuries sustained in the same incident. Because traumatic brain injuries are caused by such high energy impacts, it is not uncommon to also have spinal cord injuries (HYPERLINK), broken bones, damaged internal organs, and other traumas. Full recovery is not always possible, and the victim may face lasting physical, visual, and cognitive deficits that can interfere with normal driving.

How a TBI affects a driver’s cognitive abilities

Since a TBI results in damage to the brain, it causes significant neurological changes. Even with a mild TBI, the victim can experience confusion and disorientation for a period of time which would temporarily render them unsafe to drive. In a moderate or severe TBI, the victim may have permanent problems with memory, decision making, judgment, communication, planning, problem-solving and impulse control. This means that they may have a hard time remembering the processes needed to operate the vehicle, the rules of the road, or even directions from point A to point B. They may have difficulty knowing how to react when cut off by another vehicle, at stoplights, or when a deer runs in front of them. It may be difficult to cope with unexpected events, such as construction detours or inclement weather. Victims of TBI  may be more easily distracted and have a hard time concentrating on the road or sticking to a route.

How a TBI affects a driver’s physical abilities

The brain is the body’s control center. Depending on the location of a TBI, any part of the body can be affected, and any of the victim’s senses may be impacted. This can include their sense of balance, which may leave them feeling like they are falling over while turning and can lead to overreaction and difficulty steering. They may also suffer hearing loss and be unable to hear car horns, passing vehicles or police sirens. They may struggle with muscle coordination and hand-eye coordination. This means that it may be difficult for them to operate the vehicle’s controls or to respond to other vehicles on the road. Difficulties with bladder and bowel control may also occur, which can distract drivers as they focus more on their dignity than on the road.

How a TBI affects a driver’s visual abilities

Nearly nine out of ten TBI victims experience some sort of visual problems. Blurry vision, double vision, and difficulty controlling eye movement can all make it difficult to see the road. Victims may also experience a loss in peripheral vision, which would make it hard to notice vehicles coming up beside them. The brain may have problems processing visual stimuli and assigning meaning to it, which means that they might have a hard time reading road signs or recognizing potential hazards.

At-home therapies for drivers with traumatic brain injuries

One of the best things you can do is to stick to the physical and occupational therapy prescribed by your physician. They will generally give you a variety of activities that can be done at home to help improve strength and coordination and relearn forgotten skills. It takes time to recover from a TBI. For mild brain injuries, patients may only need to take 24 hours off from driving and may have no need for rehab. For moderate to severe TBIs, some doctors recommend taking at least six to twelve months off from driving to allow your brain adequate time to heal before taking on such a serious task. It is worth taking this time to find your new normal before adding the stress of relearning to drive into the mix.

As you prepare to relearn to drive, engage in activities that help stimulate the brain and encourage its function. Activities like puzzles, painting, and board games can help with memory, decision making, and muscle coordination. Practice eye exercises where you follow an object around the room, focus on objects at different distances, or have to pay attention to what is going on in your periphery. If you have suffered vision or hearing loss, get evaluated for corrective lenses or a hearing aid, and be sure to use them.

Who determines if someone with a TBI can continue to drive?

There are no laws in Connecticut that specify that a driver must stop driving if they have a traumatic brain injury. There are also no laws requiring physicians, law enforcement, or others to report drivers with traumatic brain injuries. The DMV does, however, encourage anyone concerned about a driver’s abilities to submit documents to them that can lead to the revocation of someone’s license until such a point as they are medically cleared to return to the road. These forms can be found on the State of Connecticut DMV website at https://www.ct.gov/dmv/cwp/view.asp?a=818&q=245036. Forms can be submitted anonymously or with the doctor, police officer or concerned loved one identified, and the documents state that “No civil action may be brought against someone who provides such a report in good faith.”

The best course of action is for your doctor to refer you to a Certified Driver Rehab Specialist (CDRS) who can evaluate you and help you determine if you are able to drive. The CDRS will make recommendations to your physician based on their findings on whether you should continue driving. If so, they will prescribe you a course of action to get back behind the wheel. If not, they will work with you to develop a transportation plan that maximizes your independence. 

What Next Street looks for when assessing TBI victims 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.

We start out by taking the time to get to know you and your unique situation. Then we evaluate your visual, physical, and cognitive abilities. We check your visual acuity, peripheral vision, and your ability to move your eyes about and scan your environment. We check your physical flexibility, strength, and coordination. This includes both muscle coordination and hand-eye coordination. There will also be several exercises we do to evaluate your memory, awareness, judgment, and ability to follow directions. If this all goes well, we will recommend you for a behind-the-wheel evaluation at a later date.

Possible driving outcomes

Drive on

In some cases, we may determine that your deficits are minor enough that you will be able to drive normally. You may still need to undergo occupational therapy to relearn certain aspects of driving, or attend driving courses to resharpen your skills. It may also be worth investing in a vehicle with added safety features, such as a collision avoidance braking system, backup cameras and sensors, and self-parking systems. An automatic transmission will also be easier to operate than a manual transmission and decrease the mental and physical workload needed to drive.

Restricted driving privilege

Sometimes, you may be physically able to operate a vehicle but still face cognitive or visual difficulties. It may no longer be safe for you to operate your car at night or in busy environments such as freeways.

Adaptive driving devices

If you have suffered serious physical deficits as the result of your TBI, the CDRS may prescribe certain adaptive driving devices to help you operate your vehicle. There are many adaptive devices available to help with various physical needs. Depending on your situation, you may need help gripping the steering wheel, operating the gas and brakes, securing a wheelchair into a vehicle, or a number of other tasks. These vehicle modifications can be expensive and require not only a prescription from a CDRS but also the approval of the DMV and the Connecticut Bureau of Rehabilitation Services, which can take months to obtain.  

Retirement from driving

Unfortunately, there are times when continuing to drive is no longer an option. This does not mean an end to mobility and independence, however. We will still work with you to develop a transportation plan, which may involve ride services like Lyft, Uber, and Metro transit, other specialty transit companies, public transportation, or riding with loved ones.

 



Topics: driver rehab, medical driving, brain injury

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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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