Driving is a freedom that many of us take for granted, but it can be an integral part of an individual’s sense of autonomy and independence. Survivors of traumatic brain injury (TBI) are no different; in fact, the ability to drive can be a critical piece of a TBI survivor’s re-integration into the community and re-engagement in activities of daily living. Between 40 and 60 percent of TBI survivors return to driving. But for many folks who have suffered a TBI, getting behind the wheel may not be so simple.
Brain injuries are not alike from one person to the next. Whether the TBI is categorized or labeled as “mild,” “moderate” or “severe” by the treating health professionals, some TBI survivors battle residual difficulties with headaches, visual disturbance, balance dysfunction, spatial reasoning and motor deficits that can significantly affect that person’s ability to operate a motor vehicle. In order to safely return to the road, the person’s vision (central, peripheral, spatial), reaction time, and judgment must be functioning adequately so as not to endanger themselves or others.
The decision of whether or when a TBI survivor who has suffered such impairments should return to driving is an important one, and should be discussed by the injured person, family members, and the treating provider team. If you have concerns about your patient getting behind the wheel but you do not raise the issue, the patient and family members may assume that this means the person can drive safely and without concern. As a result, if you do have concerns about your patient returning to the road prematurely, it is important to communicate this to your patient and the patient’s family and encourage them to wait until further recovery is achieved.
If you are unsure about your patient’s safety on the road, it may be prudent to suggest a driving evaluation. Research shows that many TBI survivors are not thoroughly evaluated before returning to the road, putting them and others on the roadway at higher risk to crash. A professional driving evaluation reduces that risk tremendously. Driving evaluations are often two-tiered. The first part examines a driver’s cognitive function, such as decision-making skills and reaction time. The second part involves an on-the-road test that simulates various driving situations and assesses a driver’s operation of the vehicle in real time. A driving evaluation can also determine whether the patient’s driving impairment is episodic or persistent, and whether your patient merely needs some re-training, or adaptive equipment to add to the vehicle, such as hand-controlled gas and brake systems, spinner knobs for steering, a left foot accelerator, or lifts for entering or exiting the vehicle.
A comprehensive driver re-training program specifically geared to helping folks that have suffered a neurocognitive injury is available if necessary through the University of Washington.
Also, driving evaluations by certified professionals are widely available through national organizations such as Association for Driver Rehabilitation Specialists, or local organizations such as Harbor Speech Pathology.
Having this discussion with your patient is crucial to their safety, as well as the safety of others on the road. The attorneys at Adler Giersch ps are recognized as strong advocates for those with traumatic injuries with an emphasis on and the necessity for access to health care and full recovery. The health and safety of our clients/your patients is the highest priority.
 UW Traumatic Brain Injury Model Systems Program.