Driving after brain injury

An acquired brain injury impacts cognitive abilities (such as attention, memory, and reaction time), vision and depth perception, and physical abilities such as strength and range of motion. This means that a return to driving isn’t always possible right away – or at all. This is a challenge for people who are used to being independent. It can also pose a challenge for people who need to travel for errands, visits or rehabilitation appointments. It can also be challenging for caregivers who become responsible for transportation, and the errands that need to be done out of the house.

Although adapted transport services may be available, for many people following a brain injury, the convenience and independence that comes with driving makes it a common goal for those in rehabilitation.

A comprehensive driving evaluation will be required to determine if it is possible for your friend or family member to drive after a brain injury (if driving independently is one of their rehabilitation goals). This service is provided by occupational therapists (OT) who specialize in driver rehabilitation or Certified Driver Rehabilitation Specialists (CDRS). They can either be in the private sector or working in a public rehabilitation centre. The person with a brain injury will need to be referred to a driver rehabilitation program or to an occupational therapist/Certified Driver Rehabilitation Specialist in private practice offering comprehensive driving evaluations. Ideally, their rehabilitation team will have discussed this with them. But if not, they can contact the nearest rehabilitation centre to request a referral form. Make sure the person asks if the rehabilitation centre  requires any other documentation; they will likely require a form filled out by a physician regarding driving and may require documentation from a vision specialist.

What is involved in the driving evaluation?

Once the person is scheduled for a driving evaluation, the OT/CDRS will determine:

  1. Their capacity/potential to drive
  2. The class of vehicle that will be most appropriate for their needs
  3. The equipment they will require to access their vehicle
  4. The adaptive driving controls that will best meet their needs
  5. The training that will be required to ensure they are able to drive their adapted vehicle safely

A physical assessment, a cognitive/perceptual screening, and a visit with a specialized garage/dealer are all likely components of the comprehensive evaluation. They will also need to complete trials in an adapted vehicle and using adaptive driving equipment both in a controlled environment and then on the road. Once the adaptive driving controls that best meet their needs are determined, a report will be sent to the provincial driver’s licensing body regarding your driver’s license. Specific conditions will be placed on their permit (i.e. left foot accelerator, automatic transmission, hand controls, etc.) to ensure they only drive a vehicle that is compatible with their abilities.

How long will the process take?

The process from beginning to end may require as little as 2 months depending on the person’s injuries. For those with more complex needs, this can be extended to 12-18 months. The time required will be dependent on many factors. The person may require adaptive driving equipment/techniques or training may take longer than expected. The timeline of returning to driving is difficult to predict. It’s important not to rush to drive again if they are not ready. They can work with their rehabilitation specialists and a CDRS to determine when they are ready.

Since there are so many factors involved in returning to driving, the costs of the process can vary. A typical assessment with a CDRS will require at least 2-6 appointments. Learning to drive with adaptive equipment (such as hand controls, a left foot accelerator or relocated turn-signals and windshield wipers) may be another 4-8 hours of on-road training with a specialized driving instructor, while learning techniques to compensate for a visual field loss or decreased information processing speeds may require 10-15 hours of training.

This is a general timeline: it can vary depending on available services, scheduling, and their capacity. If driving safely is one of your friend or family member’s goals, remember to be patient with the process and don’t rush.

Adaptive vehicles

If the person can drive after a brain injury, their current vehicle may not work depending on any adaptations they need. They may need to get a specially-made vehicle or have their vehicle outfitted with adaptive technology (such as hand controls, etc.) If they don’t require adaptive technology and they can access their vehicle and safely load the mobility devices they need (i.e. walker, cane, manual wheelchair), almost any model of vehicle will work. If they have difficulty transferring themselves, or they use a motorized wheelchair/scooter for mobility, they will need a larger vehicle such as a van, truck or a sports utility vehicle (SUV). It is strongly advised that they do not purchase any vehicle until they have consulted with an OT/CDRS specializing in driver rehabilitation.

The costs associated with any vehicle modifications or adapted driving equipment required to make a personal vehicle accessible (for a driver or a passenger) can vary. There are programs available across the provinces and territories  that can help minimize the cost.

The actual vehicle modification and installation of adaptive equipment will be carried out by a specialized garage or a mobility dealer.  Ideally, the dealer is a member of the National Mobility Equipment Dealer’s Association (NMEDA) which ensures that the garage follows current guidelines within the industry and is governed by a quality assurance program. Information about NMEDA and the accredited specialized garages across Canada can be found at their website: https://www.nmedacanada.ca/

Once the driver’s license has been updated, the subsidy/payment has been received, the vehicle has been adapted and the driver training has been completed, the person will be able to drive their own vehicle. They will however need to repeat the process either when it is time to change vehicles, or if their vehicle no longer meets their needs.

Whether it is via public adapted transportation services or by modifying their own personal vehicle to meet their current abilities (as a driver or a passenger), having a mobility solution that enables them to get out into the community independently is an important part of creating a high quality of life.