Transportation
Driving After Injury
Last Updated:
When can I drive again? Who decides? Why do I have to wait?
These questions are echoed by the unfortunate one whose driving has been stopped by illness, injury, license revocation or suspension. Each driver should be considered as an individual, when considering his/her potential to return to driving. The timetable for testing and training, if appropriate, varies according to DMV guidelines, the driver’s medical and driving history and at times physician involvement.
Driving is a privilege, and almost a necessity in our community. There are limited options for transport for those unable to return to driving. Mass transit is more accessible in urban settings, but still not practical in many communities. However, there is a growing awareness and support to provide the disabled, elderly and non-drivers with greater transportation alternatives.
A seasoned driver often does not appreciate the high level of skill required to safely operate a motor vehicle, even for short distances. With aging, illness or injury, one is often not aware when vision, cognition and motor skills fall to a dangerous level. DMV reassessment may not occur automatically without physician, family or driver self-report. Public safety is at risk, and often becomes an important topic when the headlines highlight the tragedy and aftermath of an unsafe driver, young or old. The process of regaining a driver’s license after revocation can be painfully long, confusing and frustrating. There are those who should not regain their driving license for the common good.
Signs of unsafe driving:
- Confusion with signs/signals or brake/gas pedal
- Coordination problems or delayed braking/acceleration
- Become confused in regard to signs/signals
- Stops abruptly in intersection, indecisive
- Misses details, does not see pedestrian
- Misjudges distance, other visual problems
- Have anxiety when driving/become lost easily and disoriented
- Looks straight ahead, but does not look right and left
- Unable to cope with busy setting, crowds
- Improper speed, does not adjust to flow of traffic
- Difficulty merging
Who can help advise and evaluate whether driving is attainable?
Consult your physician for guidance. Occupational Therapists are able to evaluate pre-driving skills and make recommendations. Some have additional specialized training in cognition, vision rehabilitation and certification as Driving Rehabilitation Specialists (CDRS). Occupational therapists are uniquely qualified to evaluate strength/flexibility, coordination, vision, judgment, and concentration. Reaction time can be measured against standards and help predict potential risk for accidents. If there is lack of skill in an area, often there are activities than can be initiated in the clinic and home that can improve areas of weakness. Loss of function such as weakness after a stroke or partial amputation of a leg due to neuropathy can be compensated for by use of adaptive equipment for driving.
A certified Rehabilitation Driving Specialist (CDRS) can determine if a candidate for adaptive equipment has the ability to benefit from training and return to driving. The CDRS can also go beyond the clinic setting, and train you in the car to improve driving habits and enhance your driving performance, especially if a road or written test is planned in the future to reinstate a driving license. In order for behind the wheel training to occur, the driver must have a valid permit or license to drive. If there are problems with loss of visual field, double vision, etc., the Occupational Therapist can help to remediate skills and refer to other resources. Services are often private pay, but at times medical insurance may cover therapy, if treatment will benefit other daily living tasks. Resources for other transport options are given if driving is not an option.
The older driver has special issues, and there is a growing need for the community at large to take a closer look. Declining skills require more regular monitoring and a way to direct appropriate drivers to education and training in order to maintain safe driving for as long as possible. In addition, there should be an established process to re-direct unsafe drivers to other transport means: to keep doctor’s appointments, to sop for groceries, go to work, etc., in an efficient manner. A change in vehicle or conditions may make the difference between safe and unsafe driving. The Occupational Therapist can help discuss the resources available.
Unsafe drivers may:
- Have trouble regulating speed with flow of traffic
- Drift out of lane, difficulty making turns
- Become confused in regard to signs/signals
- Have difficulty moving foot from brake to accelerator
- Have dents or scrapes on car, garage, mailbox
- Have difficulty backing up/ hits curb
- Have anxiety when driving/become lost easily and disoriented
- Have recent tickets or accidents
- Have difficulty reading street hazard signs
Your local DMV office can provide information on testing, and whether their special division, Driver Safety can assist you with the evaluation process. There are classes through the American Automobile Association for driver safety and driving schools with certified instructors than can help you improve driving habits.
Farrell Sheffield, OTR/L, HTC, CDRS is an Occupational Therapist, certified as a Driving Rehab Specialist, with advanced practice in hand therapy. A graduate from University of Southern California with a degree in Occupational Therapy, she has been a clinician for more than 25 years in hospital, outpatient, and home health settings, working with children and adults with physical disabilities. She has a passion for Visual Rehabilitation and is a member of the Neuro–Optometric Rehabilitation Association. Mrs. Sheffield is the founder and coordinator of a Driving Rehabilitation hospital based program in San Diego County, and received driving instructor training in 2002 from the California Driving School Inc. She was appointed 2004 Association of Occupational Therapy Driver/ Driving Network Coordinator.