Medical Driving Evaluations

Driving With Cerebral Palsy

Posted by Joan Cramer on Sep 24, 2019, 7:23:10 AM
Joan Cramer
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Growing up is a natural part of life. For those of us with special needs children, the thought of letting them become independent adults can be both frightening and relieving. If your child has cerebral palsy, you have already struggled through years of coping with physical, sensory, or cognitive disabilities. You may wonder if it is even possible for your son or daughter to drive a car. In most cases, with the help of special techniques or adaptive driving equipment, your child can compensate for any impairments and safely get behind the wheel.

What is cerebral palsy?

Cerebral palsy (CP) is a non-progressive motor disorder usually caused by damage to the brain during pregnancy, childbirth, or early childhood development. This damage may be caused by trauma, infection, or an interruption in oxygen supply to the brain. It is fairly common, affecting one out of every 323 children, and can range from mild to severe.

Depending on the area of the brain that is damaged, CP can present with a number of symptoms. The most common part of the brain to be damaged is the cerebral cortex, which controls sensation, thought, and motor functions, among other things. When this area is damaged, the child can have weakness, muscle stiffness, involuntary muscle movements, and difficulty with controlling and coordinating movement.  This form of CP is known as spastic CP.

The second most common form of CP is ataxic CP, which is caused when the cerebellum is damaged. When this occurs, the person’s muscles become too flexible, which can lead to weakness and floppiness in the limbs. They may also suffer from balance and coordination problems.

Dystonic CP (also known as dyskinetic CP), is responsible for around 15% of all CP cases. It is caused when the basal ganglia are damaged, which interferes with the brain’s ability to communicate with muscles. This can lead to jerky, slow, or uncoordinated movement.

With each of these forms, it is also possible for the person to have visual, auditory or cognitive deficits.

Someone with CP may have one or multiple forms of CP at the same time. The result is that each person has unique symptoms that can affect any part of the body and mind, and these effects can be anywhere on a broad spectrum of severity.

How can cerebral palsy affect my child’s ability to drive?

Since CP can have such wide-reaching effects, the exact way it will impact their driving is unique to them. That being said, CP has many typical physical, visual, and cognitive effects that can interfere with driving.

How CP affects cognitive abilities

Around half of all people with cerebral palsy have some form of intellectual disability, with one in five experiencing moderate to severe deficits. This is most common in those who also have severe physical deficits as well. They may have problems with memory, which may make learning the rules of the road a challenge or interfere with recalling where they are and where they are driving. A person with CP might struggle with decision making and problem solving, which could make it dangerous for them to drive in heavy traffic or other situations where they will need to respond quickly or suddenly adjust what they are doing, such as when there are construction detours. It is also possible that they may have a hard time recognizing objects and processing visual stimuli to determine its relevance. This makes reading and reacting to signs and traffic lights difficult.

How CP affects physical abilities

CP can have profound physical ramifications. Improper communication between the brain and the muscles results in inappropriate, uncoordinated movements or paralysis of limbs. If the legs are affected, this can make using the gas, brakes or clutch difficult. If the arms are affected, it can be challenging to operate the steering wheel or other controls. Sometimes, those with CP have the problem that when they start to make one movement, it results in a different, undesired movement. This could pose a danger behind the wheel if reaching to change radio stations with one hand causes the other to move and turn the steering wheel, for example.

Those with ataxic CP may also have problems with balance and coordination. They may need additional support to stay upright in the driver’s seat, especially during turns, or may struggle with reacting quickly and appropriately to stimuli such as changing lights or merging traffic.

Nearly a third of people with cerebral palsy will also have epilepsy. Having seizures behind the wheel can lead to car accidents, and it is very important that these are controlled with proper medication before pursuing a driver’s license.

How CP affects visual abilities

Vision is a complex neurological process involving multiple areas of the brain. Since CP can affect any area of the brain, there are several types of visual problems that it may cause.

One common visual problem is amblyopia, which results from improper function in nerve pathways to the eyes and causes strabismus, a problem where the eyes look in different directions. This, in turn, can lead to poor hand-eye coordination. This can make steering and reacting to vehicles and obstacles on the road more challenging.

A person with CP may also have problems with refractive errors, which take the form of nearsightedness or farsightedness. This can make seeing the road difficult but is easily remedied with corrective lenses.

Around 10% of people with cerebral palsy will have such severe vision problems that they are legally blind. This often occurs with other severe mental and physical disabilities, leaving them incapable of driving.

How can my child prepare for driving with cerebral palsy?

Cerebral palsy is a life-long condition. Because it is rooted in damage to the brain, it is irreversible. However, there are things that can be done to improve general health, which will, in turn, help your child be in better shape for driving.

Operating a vehicle can be both physically and mentally taxing at times, so make sure they are getting enough sleep and eating a healthy diet. Exercise is also very beneficial. The right exercises and stretches can help improve their strength, control, and range of motion. Healthier muscles make it easier to minimize uncontrolled and jerky movements, which will help them maintain better control of their car. They don’t need to rush into these exercises too quickly, as this could cause injury. A gradual increase in the difficulty of their workouts will help them build their strength and stamina. Talk to their physician or physical therapist to determine which exercises are best for their unique symptoms.

Who determines if my child can drive with cerebral palsy?

One of the first steps is for you to have a conversation with your child about their driving goals. Some people with CP may not have the desire to take on driving, whereas others may be itching to get going as soon as possible. Keep in mind that just because they have physical limitations does not mean that they will be unable to safely operate a vehicle. This is a decision that is best made with the help of a Certified Driver Rehab Specialist (CDRS), who can objectively measure their abilities and make recommendations to your child’s physician and to the DMV about their ability to drive.

From a legal standpoint, there are no laws in Connecticut that prohibit someone with cerebral palsy from driving, but they will still need to pass state driving tests, including any special tests needed for any necessary adaptive driving equipment.  This adaptive equipment can be tailored to suit their unique situation, but it can also be very expensive. Speaking with a CDRS will help you determine the best course of action.

What does Next Street look for when assessing patients with cerebral palsy?

Whenever possible, we try to meet with our patients in the comfort of their own homes to carry out an assessment of your abilities. All your child needs to do to prepare is to get a good night’s sleep and eat normal meals so they have the strength and energy to get through the visit, which can take up to two hours. They don’t need to worry about memorizing anything, this isn’t a test of their knowledge, it is an assessment of their motor skills and cognitive and visual abilities.

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

Possible driving outcomes

After our evaluation, we will prescribe a recommended course of action.

Drive on

Some may be able to drive a regular car with no adaptations, but it would be best to use a car with an automatic transmission and safety features like backup sensors and collision detection braking systems. It still may take more time to master driving than for a typical student, but once they have their license, they are free to hit the road as they please.

Adaptive driving devices

For those with more severely affected muscles, adaptive equipment may be necessary. If the legs are affected, they may need customized footrests for the pedals. They may need to have the gas and brake pedals switched around to accommodate right-leg weakness. In some circumstances, it may be best to install hand controls to operate the gas and brakes.

If your child uses a wheelchair, we will also determine if they are able to transfer to the driver’s seat, and if so, what sort of equipment would help them get in and stow their wheelchair. If not, they will need a wheelchair lockdown system in place of the driver’s seat.

Driving with restrictions

In some circumstances, a person may be able to drive, but with limitations. Their reaction time, decision-making skills, or other deficits may make it unsafe for them to drive in some situations, such as at night, on freeways, or for long distances. If it is still decided that they are safe for simpler tasks, like driving to work or the store, they will be allowed to drive, but with restrictions.

Prohibited from driving

There are some times when a person simply cannot safely operate a vehicle. If this is the case, we will work with them to create a transportation plan to help them live an independent life. This may involve rides with loved ones, ride services like Uber, Lyft and Metro Taxi, or other forms of specialty and public transit. No matter where you are, we will work with you to reach your transportation mobility goals. 

 

Topics: driver rehab, medical driving, Cerebral Palsy, CP

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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