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, it’s natural to wonder or even worry if driving is still a safe transportation option. Not to mention if you were injured in a car accident, one of the leading causes of TBI. 

On the other hand, the ability to drive can be very important to your mobility and freedom, especially if you have dependents who rely on you for transportation or require a vehicle to get to and from work. 

The good news is that for nearly 3 out of 5 people with moderate to severe traumatic brain injuries, it is eventually possible to get back on the road through rehabilitation and adaptive driving devices, and for others, there are a growing number of available alternative transportation options.

What is a Traumatic Brain Injury?

Traumatic brain injuries are the result of some sort of force causing damage to the brain, often caused by car accidents, sports injuries, blunt force impacts, and falls. Direct impact to the head or sudden changes in direction can cause the brain to impact the inside of the skull with varying severity. 

A traumatic brain injury, or TBI, can be categorized into one of three levels.

Mild TBI

The first is a mild TBI, which usually includes a brief loss of consciousness or no loss of consciousness at all, as well as short-term confusion or a struggle to recall the events of the injury.

More commonly known as a concussion, a mild TBI can lead to problems like headaches, poor balance, dizziness, fatigue, and difficulty concentrating for a week or two, with mild symptoms potentially lingering for longer. 

Still, a mild TBI rarely constitutes any lasting brain damage, and with rest, a good diet, and plenty of fluids, there are rarely any long-term effects.

Moderate TBI

A moderate TBI is classified as when you lose consciousness from fifteen minutes to several hours, with confusion continuing for days or weeks afterward. 

The same follow-on symptoms occur here, but over a much longer period of time, and with a moderate TBI there is a higher risk of permanent mental or physical deficits.

Severe TBI

A severe TBI is classified as when you lose consciousness for more than six hours following an impact. This loss of consciousness, known more commonly as a coma, can last for days to weeks, and in some extreme cases even years.

These injuries often coincide with fractures of the skull, and victims require extensive, long-term hospital care to recover. The risk of severe permanent disabilities is much higher in severe TBI cases, and complete recovery is rare.

How Can a TBI Affect My Ability to Drive?

Every TBI is unique, and so are the ensuing symptoms, especially because traumatic brain injuries can often coincide with spinal cord injuries, broken bones, internal organ damage, and other traumas. 

However, specifically from TBI, individuals can often suffer from cognitive, physical, and visual deficits that may affect their driving in the long term. A general rule is that driving with a brain injury is inadvisable until all of your symptoms have subsided.

How a TBI Affects a Driver’s Cognitive Abilities

Since a TBI results in damage to the brain, it can cause significant neurological changes both in the short term and long term. 

With a mild TBI, this confusion and disorientation that occur for the first few hours to weeks afterward make it unsafe to drive until these symptoms have subsided. 

In a moderate or severe TBI, it’s possible to have permanent problems with memory, decision making, judgment, communication, planning, problem-solving, concentration, and impulse control, all of which can affect your safety on the road. 

How a TBI Affects a Driver’s Physical Abilities

Since the brain is the body’s control center, there is a wide range of potential physical challenges that can come from a TBI. These can include a reduced sense of balance, poor muscle and hand-eye coordination, tight muscles or discomfort, and even low energy or difficulties with bladder and bowel control. 

Whether your TBI affects your comfort or your control in the car, physical problems are definitely worth addressing before getting back out onto the road.

How a TBI Affects a Driver’s Visual Abilities

Nearly nine out of ten TBI victims experience some sort of visual problems after their injury, which can include blurry vision, double vision, difficulty controlling eye movement, as well as a loss of peripheral vision, and difficulty processing visual signals. 

All of these problems can significantly increase your risk on the road, and if you notice any of these problems we definitely recommend staying off of the road until they subside.

At-Home Therapies for Drivers with Traumatic Brain Injuries

One of the best things you can do to heal is to stick to the physical and occupational therapy prescribed by your physician, which might include rest, a healthy diet, and exercises to help you regain strength, coordination, and any forgotten skills. 

Activities that stimulate the brain can like puzzles, painting, and board games can all help with memory, decision making, and coordination. Visual exercises can help your body improve its focus at different distances, object tracking, or peripheral vision. 

Remember, it takes time to recover from a TBI. For mild injuries, patients may only need to take 24 hours before driving, but for more severe injuries some medical driving experts can recommend at least six to twelve months off of the road, along with corrective lenses or hearing aids depending on the effects of your TBI.

The important thing here is to work with your doctor to find what works best for you.  

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. However, the DMV does encourage anyone concerned about a driver’s abilities — a family member, medical professional, or concerned friend —  to submit a document indicating medical concern for their safety on the road

These submissions are anonymous and protected by law, and can ultimately result in the revocation of someone’s license until they are medically cleared to return to the road.

For a simpler solution, we recommend working with your doctor to find a Certified Driver Rehabilitation Specialist (CDRS). These driving experts can help you understand your current mental and physical capacity, and help lay out a plan to get back on to safe driving or find alternate transportation options.

The Next Street Process | Assessing TBI Victims Before Driving

Our goal is to work with you to understand your unique situation and come up with a personal, tailored plan, which starts with an initial assessment. We can come to you in your own home or meet you at another location, and the only requirement here is a good night’s sleep and energy for the two-hour assessment. 

These assessments start by understanding you and your situation, then evaluation your visual, physical, and cognitive abilities, and how they work together. Each of these elements is important to drive safely and effectively on the road, and by testing each component of your driving skills we can start to develop a plan with you. 

Based on the results of your initial driving assessment, we’ll look to schedule a behind-the-wheel evaluation at a later date, or recommend one of a few courses of action. 

Possible Driving Outcomes

Drive On

In some cases, especially after a mild TBI, you may be able to fully return to driving completely normally. 

It’s possible that you may need some driving rehab or training to resharpen your skills, or might want to invest in additional safety features, but overall you’ll be fit to drive and able to confidently return to the safe operation of a motor vehicle on the road. 

Restricted Driving Privilege

Another possibility is that you’ll have the physical abilities to operate a vehicle, but might have some lingering mental and cognitive deficits that present challenges in certain conditions. For example, you might struggle to see in low light, and might avoid driving at night or in inclement weather. 

You can strategize all of these changes with your driver rehab specialist.

Adaptive Driving Devices

If you have suffered more serious physical deficits as a result of your TBI, you may be able to effectively drive with the assistance of adaptive driving devices. 

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 are all possible, but usually require guidance from a CDRS or other occupational therapist, as well as the approval of the DMV before you can return to driving. 

Retirement from Driving

In the case that your TBI has caused severe enough long-term effects that you’re unable to safely return to driving, your CDRS can help you plan an alternative transportation strategy to keep you mobile and independent. 

Recent years have significantly increased the availability of services like Uber and Lyft, adding to options like metro transit, taxis, or riding with loved ones.

Taking the Next Step

If you or a loved one has suffered from a TBI, and you’re starting to plan a strategy to get back on the road, you can reach out to us for a free consultation. Ultimately, our goal is to help get you back as mobile as possible as safely as possible.


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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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