By Patricia M. Niewoehner, OTR/L, CDR and Florian P. Thomas, MD, PhD,
Neurologist Ms. Niewoehner is an occupational therapist and certified driver rehabilitation specialist. She works in the Physical Medicine and Rehabilitation Department at the VA Medical Center in St. Louis, MO.
Dr. Thomas is board certified in neurology, spinal cord medicine, and neural repair and rehabilitation, and completed a neuroimmunology fellowship. He is the chair of the Neuroscience Institute and the director of the MS Center at Hackensack University Medical Center. He has served in various functions including as a member of the board, the clinical advisory committee and the government relations committee of the Gateway Area Chapter of the National MS Society, which awarded him its 2006 Pathlighter Award.
Introduction Driving — one of the many ways we maintain our independence — is also one of the most complex activities in our daily lives. Although symptoms associated with MS can affect the skills necessary for safe driving, adaptive automobile equipment may be an option to help you drive safely. Here we review the skills necessary for safe driving, information about driving evaluations, types of adaptive auto equipment, and Department of Motor Vehicle policies. Lastly, to help maintain your independence if driving is no longer possible, other transportation options are reviewed. Ways in which MS symptoms may affect your driving ability and safety A person’s driving performance may be negatively affected by symptoms associated with MS. For example, cognitive changes (memory loss, decreased information processing speed and impaired visual spatial skills) and spasticity (muscle stiffness or spasms) affect driving performance, putting the person at an increased risk for an automobile crash. In addition, your ability to drive safely may be affected if you experience any of the following:
Even if your MS symptoms seem to be mild and manageable, other indications that your driving safety may already be compromised include automobile crashes or near misses, moving violations, and the unwillingness of others to be a passenger while you are driving.
Most people with MS experience exacerbations (also called attacks or relapses). During exacerbations driving may be difficult or unsafe, but may return to normal as the exacerbation ends and symptoms improve. However, people with progressive forms of MS may experience a slow worsening of abilities that can permanently affect driving. When your body is under increased stress, such as having the flu, your MS symptoms may be worse. In addition, symptoms can fluctuate significantly during the course of a day. Planning daily activities around these fluctuations in energy is critical to optimizing your personal safety and that of others while you are driving. It is important to talk with your healthcare provider about the best strategies for managing your fatigue effectively. Driving evaluations If you or others are concerned about your ability to drive, you may consider obtaining a driving evaluation. Driving evaluations help identify any challenges you may be experiencing, and the appropriate adaptive equipment to keep you safely on the road. Driver rehabilitation clinics are located in medical centers and community based clinics. A driving evaluation is performed by a driver rehabilitation specialist (DRS). A DRS is typically an occupational therapist with specialized training in driver rehabilitation. Since the driving evaluation is usually performed by a therapist using specialized equipment, it is more comprehensive than a typical Department of Motor Vehicle (DMV) road test. While the length of the evaluation varies, you should expect it to last about two hours; it includes an office-based assessment and a behind-the-wheel evaluation. The office-based assessment includes a review of your medical and driving history, and a look at how MS affects your ability to perform other activities of daily living such as bathing, dressing or medication management. You will be asked about specific problems you may have with driving, any citations you have received while driving, and accidents or near misses. In addition the following will be assessed:
If you demonstrate adequate vision, cognition and motor function during the office-based assessment, a behind-the-wheel road test will be performed, usually in the facility vehicle. The road test will generally begin in low traffic areas and proceed to more complex or higher traffic areas. Your ability to safely operate the car will be evaluated, including:
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