Medical Driving Evaluations

Driving with Arthritis

Posted by Joan Cramer on Sep 4, 2019, 4:55:29 PM
Joan Cramer
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Sore, aching, throbbing joints are no fun. For almost 40 million Americans with some form of arthritis, this can be a torturous daily occurrence.  Pain in your hands, wrists, knees, hips, neck, back, or feet can make simple tasks like driving seem daunting. As operating a vehicle becomes too uncomfortable to do, you may feel your independence slipping away, and you may worry that you won’t be able to get to work, care for your family, or keep participating in life with others. Fortunately, in most cases, there are ways you can modify your lifestyle and your car to take the pain out of driving and get you back on the road.

What is arthritis?

Arthritis is a broad term encompassing over 100 different disorders that cause pain and swelling in the joints. Osteoarthritis is the most common form, accounting for more than half of all cases in the United States. It is most common in older adults and occurs when the cartilage that forms a cushion between bones is slowly worn away, leaving the bone ends to grind against each other during movement. This causes pain, stiffness, swelling, and a reduction in flexibility in the joint. There may be popping sounds as the joints move, and sometimes small extra pieces of bone called bone spurs begin to grow around the joint.

The second most common form of arthritis is gout, with more than 8 million sufferers in the U.S. It happens when crystals of uric acid begin to deposit in joints (typically the big toe, but it can occur anywhere in the body), and can lead to periods of intense pain lasting several hours, followed by days to weeks of discomfort. Over time, these attacks can increase in their duration and spread to other parts of the body, resulting in damage to your joints and a decrease in their range of motion.

Rheumatoid arthritis affects nearly 1.5 million Americans. It is caused by an autoimmune disorder in which the immune system mistakenly attacks the synovium. These membranes form a protective layer around the joints, and when they are inflamed, they can cause damage to underlying bone and cartilage. Joints become warm, swollen, and tender, and are often stiffer in the mornings or after periods of rest.

Arthritis can also develop as the result of psoriasis, lupus, Lyme disease, joint injury, obesity, and as a side effect of many other diseases.

How can arthritis affect my ability to drive?

The primary way that arthritis can impact your driving is by making it painful to move your joints and thus limiting your strength and range of motion. If your arthritis is in your hands, it can be difficult to open the car door, put on your seat belt, turn the key, or operate the steering wheel. If it is in your knees or ankles, getting in and out of the car and operating the pedals can be a challenge. Some people experience arthritis in their spine, which can make maintaining a safe driving posture painful, and it can be difficult to turn your head to look for passing cars.

You may be able to bear the pain well enough to drive on short trips, but this can be more difficult over longer distances, which can cause you to become fatigued.

For those with rheumatoid arthritis, sometimes the eyes can also be impacted by the autoimmune response, which can cause eye pain and vision problems. This can make it difficult to focus on the road and see other vehicles. This form of arthritis may also affect the brain and cause people to have a hard time thinking clearly.

Arthritis caused by other diseases can come with a host of additional issues that can also impact you physically, visually, and cognitively. On top of all of this, certain arthritis medications can cause drowsiness which can make driving hazardous.

At-home therapies for drivers with arthritis

You should always consult your primary doctor to determine the exact cause of your arthritis and follow their recommendations on how to treat it. That being said, there are several things you can do in general to relieve arthritis symptoms and make driving more tolerable. As with most health issues, a healthy diet and exercise can make a huge difference. Make sure to include stretching to help improve your range of motion, as well as strength training to improve joint stability. If you are overweight, losing a few pounds will lessen the load on your joints and ease your pain.

It is also often possible to relieve arthritis pain by alternating heat and cold therapy. Heat can help to loosen and relax joints and muscles in the morning or before exercise, whereas cold can help to reduce swelling and relieve pain after exercise.

Who determines if I can still drive with arthritis?

There are no laws in Connecticut that prevent someone with arthritis from driving. The State does, however, encourage law enforcement, doctors, and others who are concerned about someone’s driving ability to file a report with the DMV that can lead to the suspension of the individual’s driver’s license until they are medically cleared to drive. The forms for this can be found at https://www.ct.gov/dmv/cwp/view.asp?a=818&q=245036, and the law states that you are protected from civil actions against you if the forms were filed in good faith.

Whether or not your license is suspended, if you are concerned about your driving, you should meet with a Certified Driver Rehab Specialist (CDRS). They will assess you to determine if you are still fit to drive. They do not hold the authority to suspend or reinstate your driver’s license, but they can make recommendations to your physician and the DMV to help decide what would be best for you.

What Next Street looks for when assessing arthritis patients for driving

In cases where it is possible, 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, reaction time, and ability to follow directions. If this all goes well, at a later date we will recommend you for a behind-the-wheel evaluation.

Possible driving outcomes

After your evaluation, we will be able to determine what the best course of action is for you.

Drive on

We may find that you have little to no serious deficits from your arthritis and you will be able to continue driving as normal. It might still be a good idea to make some lifestyle changes to better manage your arthritis and improve your driving experience.

Restricted driving privilege

In some cases, you may be physically able to continue driving, but for various reasons, including problems with vision, cognition, and range of motion, you may be restricted from driving at night, on the freeway, or in other circumstances that are deemed hazardous.

Adaptive driving devices

It may be possible to continue driving with the help of some modifications to your vehicle. If gripping the steering wheel is a challenge, you may be prescribed a steering wheel knob to ease turning. If you have limited mobility in your neck, it may be possible to add panoramic mirrors to improve your field of vision. If your legs are no longer able to operate the gas and brakes, it may be possible to install hand controls. 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. Once you are prescribed these or other adaptive devices, you will also need to learn how to use them and then undergo a driver’s test with the DMV in order to regain your license. 

Retirement from driving

Unfortunately, there are some circumstances where your mobility is so severely restricted by your arthritis that it is no longer possible to get in and out of the driver’s seat or operate the controls. When this happens, it is time to say goodbye to driving. This doesn’t mean an end to independence and mobility, however. We will work with you to develop a transportation plan, which may involve the use of public transit, specialty transit companies, or riding with loved ones. Regardless of our findings during our assessment, we will work with you to find the best solution for you.

 

Topics: driver rehab, medical, medical driving, arthritis

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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