Returning to Driving
April 2/2012
I have created a new page dedicated to returning to driving after stroke. I know this a contentious issue as driving means independence for a lot of us. The truth however is that we are all not neurologically or physically fit to drive after a stroke, as much as we like to think we are. You may be allowed to drive very soon after your stroke, or need a year or to to recuperate before you can attempt it, or you may never be able to drive again. It is a painful truth that some find hard to accept, but you have to ask yourself would you like to have your children or loved one driven by a person who is not cognitively fit to make the decisions and judgements that are constantly required to drive? Of course not, and neither do the doctors who care for you or the Ministry of Transportation in your district. They must consider the public good.So take a big breath and really think about this question and consider all sides of the equation before getting angry and frustrated. Driving is a privilege not a right.
Remember that cars kill.
Click on the driving tab found at the far right top of the blog for some information about navigating through this complex issue. Good luck in your pursuits and know that if you are told that you are unsafe to drive, there is probably a very good reason.
Marilyn
One of the most difficult and contentious issues following a stroke event is returning to driving. Patients are understandably upset when they have their license taken away by their doctors and often feel very angry; after all, driving is important for work, play, errands, and most importantly, independence. Cars are a part of our everyday life. For many it is the means by which they maintain social contact, and without it they may feel helpless and alone. For some men it is emasculating not be able to drive.
Your doctor is obligated by law to take your license away if there is any question about your safety to drive. You may be completely unaware that you are unsafe. Often only comprehensive neuro –testing and a visual exam, among other tests, can determine this. As well it is not the doctor but The MTO (Ministry of Transport) who makes the final decision as to whether or not a person’s license will be medically suspended. Remember it is not an inherent right to drive, it’s a privilege. Cars kill.
If the MTO decides to suspend your license, they will send a letter to the driver. The letter outlines the next steps to take in order to get your license back. They may require the following:
1. A medical report by a physician or a neurologist stating that all the residual deficits including physical, cognitive, visual and perceptual, have been addressed. This may include information from your rehab team.
2. An ophthalmology assessment report—if there has been a visual field loss.
The MTO will consider the information in these reports (this may take 6 weeks or more), make a decision about your driver’s license, and notify you in a letter. They may decide to reinstate your license, ask for further reports and information, require you to take an on-road driving test (at an MTO recognized Driver Assessment Centre), or continue the suspension. You may appeal their decision.
Studies suggest that about half of those who experience a stroke return to driving.
There are also rules about driving if you experience specific problems related to your stroke. For example, people with blindness on one side of both eyes that may occur after a stroke, are generally not
permitted to drive.
Driving is a complex skill.
• Research states that we make approximately 20 decisions during each mile.
The Canadian Medical Association has specific Guidelines in Determining
Medical Fitness to Operate Motor Vehicles:
Stroke
• Patients should not drive for at least one month. During this time an
assessment by their regular physician is required.
• Driving may resume if:
• No significant motor, cognitive, perceptual or visual deficit.
• Neurological assessment discloses no obvious risk of sudden recurrence.
• Underlying cause has been appropriately treated.
• No post stroke seizure has occurred.
Single or recurrent TIA (Transient Ischemic Attack)
• Patients who have experienced a single, or recurrent TIA, should not be allowed to drive any type of vehicle until a medical assessment and appropriate investigations are completed by the patient’s regular physician.
They may resume driving if a neurological assessment discloses no residual loss of functional ability, and any underlying cause has been addressed with appropriate measures (CMA, 2006).
A referral to a stroke prevention clinic in your area would be indicated.
Dr. David Gladstone and patient at the Sunnybrook Stroke Prevention Clinic.
Medications may affect your driving, especially when you first begin taking them.
*Try not to take your assessment if you have just started taking a new medication.
Specific problems you are experiencing from your stroke make driving
dangerous therefore professionals must evaluate vision, cognition, driving experience and functional ability.
• You may need to work on specific skills and learn new ways of driving before you take an on-road driving test or resume driving.
Driving After Stroke, some scenarios:
• You are able to drive safely but you need certain adaptations to your car and training on how to use them.
• You are able to drive safely but with certain restrictions, for example, no night driving.
• You are able to drive safely without modifications or restrictions.
Assessment in rehab
Neuro-testing is done to assess personality changes-ability to maintain attention-executive function (decision making) among others.
Preliminary testing for vision and reaction time can be done at the rehabilitation hospital.
The next step may be to have further testing and driver education at MTO approved Driver Assessment Centres specifically set up for comprehensive return to driving solutions. An example of one of these companies in Toronto
*The author does not endorse any one product or company.
Drive Again
A company that is “dedicated to helping people with injuries, disabilities or driving challenges regain driving independence”.
The Process at Drive Again:
An occupational therapist who has expertise in driving assessment. This individual is termed a driver rehabilitation specialist or driving evaluator.
Most often this person is an occupational therapist with special training in driving evaluation.
You may undergo a quick evaluation by a doctor or other health professional, typically an occupational therapist. Based on the result of the quick evaluation they will either consider you ready to return to driving, or indicate that you need to have a detailed driving evaluation. A detailed driving assessment usually consists of two parts—a pre-road
evaluation and an on-road evaluation.
Pre-road evaluation: The pre-road evaluation usually takes place in the driving evaluator's office. She will typically ask you about your medical history and your driving history and habits. She may assess your arm and leg movements, strength and sensation. You will also need to have a visual assessment (there are specific rules about vision and driving) and you will usually need to bring a report from a visual specialist such as an ophthalmologist.
The driving evaluator may decide to do a series of paper and pencil or computer tests to evaluate, amongst other things:
• How you are dealing with visual information.
• How quickly you respond to situations.
• How your memory is functioning.
• Your judgment and awareness about specific driving situations
On-road evaluation:
The on-road assessment may be done on the same day as the pre-road evaluation, or on another day. Usually you will be asked to drive a car that is
equipped with a passenger side brake for safety. There may be one or two people with you in the car. The person who sits in the front seat is usually a trained driving instructor who will give you directions on what route to take.
This person is usually trained to work with people who have had a stroke. They understand about the stroke and how it can affect you and your driving. The driving evaluator will typically sit in the back seat and
observe your driving while taking notes. The evaluation route may include driving on quiet and busy streets and may also include highway driving. You will be asked to perform specific driving maneuvers such as left turns. The evaluator will take notes on how you are doing - for example if you are keeping in your lane, driving at the correct speed, stopping at red lights and stop signs. You may also be asked to find a specific destination using road signs.
If you have a problem understanding spoken directions because of your stroke, the instructor can show you cards with pictures on them to explain what he wants you to do. Make sure that you take the time to understand what you need to do. For example, he may show you a card that has a car turning left that he uses to let you know he wants you to turn left.
A complete driving assessment usually takes about 2 hours (about 1 hour for the preload assessment and 1 hour on the road). This can vary depending on you and your driving evaluator. It is important to ask about the details before you start the assessment including:
• How many appointments will it take to complete the assessment?
• What do I need to bring with me when I come for my appointment? For
example, if you wear glasses make sure to bring them.
• What, if any, medical reports do I need to bring?
Depending on where you live and other circumstances related to the health care system in your area, you might have to pay for the assessment. The assessment may cost about $300 to $400. There is the cost of the driving evaluator's time and also of the driving instructor's time and the rental of the car you will use for the evaluation. Some driving evaluators will let you use your own car.
There are very few studies that have looked at the effects of retraining driving abilities after stroke. One study found that people who had a specific problem after the stroke—visual perception problems—benefited from a specialized computer training program when practiced for 6 weeks.
What are the possible outcomes of the driving evaluation?
The test might show that the specific problems caused by the stroke make driving dangerous and that it is unlikely that you will benefit from practice or retraining. The evaluator will then recommend that you do not continue driving.
The test might show that you have specific problems that you need to work on or new ways of driving that you must learn before you resume driving.
The evaluator may suggest that you take some lessons with a specialized driving instructor. This instructor is usually someone who works with people who have had a stroke.
You may need certain adaptations (for example, a special mirror) to your car and training on how to use the adaptations. If all goes well with the training you will be able to resume driving
The test may show that you drive safely in certain situations (light traffic).
The evaluator may then recommend that you have certain restrictions placed on your driver's license. These "restricted licenses" are available in some, but not all, places. You will need to check for the specific rules where you live.
The test may show that you drive safely. The recommendation from the evaluator will be that you are licensed to drive with no restrictions.
Drive again does all the paper work and communicates with MOT. You normally don’t need to test with them.
Insurance
The effect of a medical suspension on car insurance is dependent on the insurance company. Some companies will allow a medical suspension for up to a year after the MTO suspension date. If reinstated at the same
licensing level (G, G1 or G2) there is no penalty. Some companies have indefinite time limits as long as the reinstated license is at the same level as the license before suspension.
*taken form The Drive Again website
Tips For Driving After Stroke
You will be more easily tired at the wheel -try to drive early in the day or when you are most alert.
Limit your driving on the highways- lots of stimuli at high speed is hard to cope with no matter how experienced you are.
It’s difficult to contend with many stimuli especially in unfamiliar areas.
Drive for short periods.
Take frequent breaks.
Don’t drive if tired.
Monitor yourself honestly-if you think your driving skills have lessoned don’t drive-is your independence worth someone’s life?
Don’t drink and drive -even a very little.
Accept your limitations.
Consider a Global Tracking Device –it is somewhat distracting but so is getting lost.
Never use cell phone while driving.
*Taken from Heart and Stroke Foundation website www.heartandstroke.com Home > Stroke >health information> living with stroke > Daily living
And TRI website www.torontorehab.com/
And McGill’s StrokeEngine http://strokengine.ca/
I cannot stress enough that you, the stroke thriver, must be aware of the consequences of misjudging your own ability to drive. Do Not push yourself. Pay attention to your fatigue level. Pay attention period. Egos must be left behind in the name of safety. It is tragic that life has dealt you a hard blow, you know you have my complete sympathy; but you need to accept that you may not be entirely as you were before the stroke. You do not have the right to take anyone else’s life in your hands.
Marilyn
Return to Driving companies in Toronto
Drive Again
DriveAble Saint Elizabeth’s Health Care
The Ontario Ministry Of Transportation lists approved centres throughout Ontario
Other provinces will list similar sites.
For more information about returning to driving after a stroke, visit the Ontario
You made be asked to install devices in your car after your testing but before you regain your licence. For example, because I have no use of my right hand I have had a small knob, similar to the one below, installed on the steering wheel so that I can turn the car with one hand. *You cannot get an assistive device without approval from the driving centre.
Driving assessment is expensive, in the range of $500.00.This fee may or may not include your driving lessons. Your are paying for one or two assessments by an occupational therapist specially trained in return to driving assessments, as well as one or more lessons from an MOT driving instructor who will help you adjust to driving after your stroke and discern if you need an assistive device. These driving lessons are around $100.00 apiece.
The instructor will give you your final driving test. Usually you do not need to redo the written portion. The company will do all the appropriate correspondence with the MOT for you and on approval of your return to driving status the MOT will send you a temporary license to cover you until you can get to a Driving Licensing Office for your permanent license.
Assessible Parking Permit
For information about how to obtain your permit, visit the Government of Ontario’s Service Ontario website:
Good Luck!
April 5/2012
More driving news.
