Abstract
Background
Stroke can advesely affect movements, sensations, alertness, awareness, coordination, and judgement, all of which may impair the ability to drive a car.
Discussion:
Many stroke patients consider driving to be essential to their quality of life and want to drive if at all possible. Thus, the physician may be challenged with a tough decision about whether a patient should be allowed to drive.
Conclusion:
Referral to an occupational therapist can be of great help.
Keywords: stroke, driving
Every year in the United States as many as 700,000 people suffer a stroke. Many of these people won’t survive, some may recover with no obvious impairments, and others may be left with a wide range of disabilities. Those with disabilities will definitely benefit from acute rehabilitation. However, once a patient is past the acute rehabilitation aspect of their recovery the question often arises as to whether or not they may resume driving.
Driving is very important to people and provides them independence. Many stroke victims would find it hard to give this up. How do you decide if it is safe for someone to get behind the wheel of a car again? There is no simple answer but there are many resources available now to aid in making an informed, responsible decision.
Factors that affect driving after a stroke
The first thing to consider is what kind of stroke the patient had. The brain is divided into many areas and almost all of them influence movement and sensation. In driving many of these areas are used simultaneously and the effects of a stroke in any part of the brain may affect someone’s ability to drive again. Driving is a very complex skill and may be greatly affected by any of the following deficits:
Weakness, paralysis or numbness
Neglect
Visual impairment
Diminished memory, judgment or concentration
Slow reaction time
Patients may or may not comprehend that they have these impairments. If possible it is helpful to discuss with close family and friends the changes they have noticed in the patient. Family and friends have more opportunities to observe effects that may not be easily observed by the practitioner in a short clinic visit.
Resources to assess driving skill
It is a good idea to be familiar with the requirements of your state’s department of motor vehicles for patients who have had a stroke. Each state has specific physical, sensory and cognitive requirements that each person must meet to be eligible for a driver’s license.
An occupational therapist can provide a valuable comprehensive screening of a patient’s current skills and deficits. From there a patient could be sent for further evaluation by a certified driver rehabilitation specialist (CDRS). They can assess driving skills in a controlled and safe environment. The patient is given a behind-the-wheel evaluation that will include testing for changes in vision, functional ability, reaction time, judgment and cognitive abilities. After this assessment the CDRS can determine if the patient is safe to drive, can not drive at all, or may drive with additional interventions. They may need to modify the car or use adaptive equipment. With or without special equipment, a patient may benefit from classroom training and simulation training. These are all services that a driver rehabilitation specialist can help with.
If your patient can not return to driving, be sure to encourage them to use public forms of transportation. This will increase their ability to be independent without the risk of driving themselves. Many communities also offer services to help patients that suffer from mobility problems.
For those who do return to driving, it is also important to understand the warning signs of stroke so that they are aware if any of them should occur again. This may help them get off the road and seek immediate medical help.
Conclusion
Whether or not to let your patient that has suffered a stroke drive is a decision not to be taken lightly. The patient is not only putting their safety at risk but the safety of those around them when they get behind the wheel. However, with careful, professional evaluation of specific skills, it is possible to make a well-informed decision about who can resume driving.