Driving After a Stroke Or Another Severe Illness

Summarized by Robert W. Griffith, MD
October 25, 2005

Introduction

Crashes involving elderly drivers hitting pedestrians are increasing at an alarming rate. With the graying of America, the impact of driving impairment is being reported more commonly. In the year 2000 (according to US Census data), people over the age of 65 equaled 13% of the United States population yet were involved in 18% of all traffic fatalities. Many medical conditions may lead to problems with driving, including the process of normal aging. These may include conditions that affect the brain and its connections, the heart, eyes, ears, muscles, and even bones. But what can be done to ensure that people with these conditions can drive safely?

New research from Belgium recently published in Neurology suggests that people who have had a recent stroke may benefit from special training in a car modified with a driving simulator.

The study

The investigators used a full-sized Ford Fiesta car which remained stationary. It was equipped with adaptive aids, as well as a steering wheel coupled to a simulator. The stimulator projected life-sized computer-generated images that portrayed a driving scenario lasting about 25 minutes.

Eighty-three patients under 75 who had had a stroke within the past 3 months were divided randomly into two groups for the study. In one group, 42 people used the driving simulator. The other group of 41 people acted as controls, and received standardized training by performing driving-related thinking tasks such as finding a route on a road map. Each potential driver spent 1 hour, 3 days a week for 5 weeks, either in the driving simulation program or in the mental driving skills course.

Results

Each participant was tested before and after the driving training. Those with higher levels of education and smaller strokes tended to do better on overall driving performance. Those who received training in the driving simulation tended to do better on tasks practiced during the simulation than those who just participated in the thinking skills program. More of those who took the simulated training did well on an actual on-road test taken about 3 months later than those in the control group. The authors concluded that motor learning skills are better learned in a similar situation to where they will be required, i.e. in a simulation program.

It should be noted that people with large strokes and those over 75 were excluded. More research will be needed to see if this approach could help potential drivers with other neurological disorders, such as early dementia.

What happens when you give up your driver's license?

The ability to drive is a symbol of American independence. When there is a threat of losing the privilege to drive, older people or those with medical problems are faced with serious emotions. They may rightfully feel they are losing their independence and mobility in our society. If the retired driver does not have a strong social network. he or she may feel socially isolated. This may lead to depression, anger, and loss of control. In addition, necessary trips, such as grocery shopping or going to the doctor, may become difficult.

What medical conditions may impair driving?

Each state has different restrictions on an individual's ability to drive given his or her medical condition. Some require that physicians report specific conditions. These may include loss of visual sharpness or peripheral vision, seizure disorders, problems with heart rhythm, severe breathing difficulties, and even severe arthritis. Medical problems that may interfere with an individual's ability to drive may be grouped into the following categories.

• Mental impairment
  This may include any condition that affects an individual's ability to think, remember, or pay attention. Examples are strokes, dementias, loss of sleep, alcohol use, and use of various recreational drugs or medications (both prescribed and over the counter).

• Problems with sensation or movement
  These include loss of feeling in the feet from diabetes or other nerve problems, loss of muscle power because of a stroke, or weakness with sciatica. Poor range of motion may also limit safe driving, especially in turning the head or ability to step on the brake quickly.

• Loss of consciousness
  This includes conditions where an individual faints, passes out, or is otherwise not aware of his or her surroundings. Examples include seizures, strokes, heart rhythm problems, low blood sugar, and alcoholic intoxication.

• Vision problems
  These are problems affecting the eyes, such as cataracts, macular degeneration (a common cause of partial blindness), and diabetic retinopathy, which affects the blood vessels of the eye. In addition, brain lesions in areas that involve the processing of visual information may affect vision. There may be partial loss of the visual field from a stroke, tumor, or even a brain injury caused by head trauma.

What should you do if you wonder whether your loved one is able to drive safely?

Some people with medical problems such as visual impairment, hearing loss, or slowed reflexes often limit their driving to local roads, shorter distances, daytime hours, and fair weather during non-rush hour traffic. Others with limited insight into their abilities may not restrict themselves, which puts themselves and others at risk.

Family members or caregivers may consider driving in a car behind an older driver or consider riding as a passenger with the driver from time to time. This will help the caregiver to watch the driving habits and skills of the individual. Particularly important areas of concern are the following:

• Incorrectly making a left-hand turn
• Driving too fast or too slowly for the road conditions
• Making sudden turns
• Not using the turn indicator or forgetting to turn it off
• Getting lost or seeming disoriented

Unexplained dents on a car or recent fender-benders may be a sign of frequent accidents or near misses. When there is any question about an individual's ability to drive, the best place to start is with the person's physician. The physician can make recommendations about specialists to see and treatment that may help the driver resume or continue driving.

As discussed above, specialized driving training using simulated driving scenarios in a stationary, specially equipped vehicle may be a way to improve driving performance. Although this study focused on individuals who had had strokes, similar training may be helpful to people with other neurological impairments such as brain injury, mild dementia, or Parkinson disease, or perhaps even healthy elderly drivers.

Source

• Effect of simulator training on driving after stroke: A randomized controlled trial. AAE. Akinwuntan , DW. De Weerdt W, FH. Feys ,  et al., Neurology , 2005, vol. 65, pp. 843--850

Related Links
AMA Guidebook "Assessing and counseling older drivers"
AARP 55 Alive Mature Driving Program
AAA Safe Driving for Mature Operators Program