cognitive issues

Safety, Driving, and Multiple Sclerosis

Lisa Emrich Health Guide November 28, 2012
  • Studies indicate that automobile accidents involving drivers diagnosed with MS occur at a higher rate than those involving healthy drivers of the same age.  About three times higher, according to early research studies on the subject from Denmark (Lings, 2002) and New Jersey (Schultheis, 2002).  

    Although the majority of people with MS can drive safely, there are symptoms, such as vision problems, muscle weakness, or spasticity, which can make driving more difficult.  During an exacerbation, some people with MS may temporarily give up driving.  Others may lose their license if involved in a serious accident.


    According to Dr. Akinwuntan in Augusta, Georgia, patients whose level of disability is low, scoring less than 2.5 on the Expanded Disability Status Scale (EDSS), “are relatively good drivers and those above 7 are not fit to drive.”  Of course, this is a wide generalization which may not apply to your personal situation.  

    The EDSS is designed to provide a standardized measurement of global neurological impairment in MS, but is heavily weighted to account for mobility and walking ability.  The EDSS is not a good measure of cognitive ability or impairment.  Other research has shown that cognitive skills which may be negatively affected in MS can greatly hamper driving ability (Schultheis, 2010).  

    Common MS symptoms which may affect driving include:

    • Sensory (touch) problems such as tingling or numbness in hands and feet
    • Visual problems such as blurred or double vision, changes in your visual field or contrast sensitivity, or a temporary loss of sight caused by optic neuritis (inflammation of the optic nerve)
    • Fatigue which can make MS symptoms worse
    • Loss of muscle strength, control and dexterity
    • Problems with walking, balance and coordination
    • Muscle spasms and stiffness (spasticity), or paralysis
    • Bladder and bowel problems
    • Difficulty with memory, concentration, and thinking

    The Association for Driver Rehabilitation Specialists offers recommendations to help people with MS stay behind the wheel.  Adaptations and changes in habit may be necessary.  But first, it is necessary to check the driver’s functional, visual, and cognitive statuses as impairments in each of these areas can make a driver less safe behind the wheel.  

    Conserving energy is vital for patients who experience decreased energy levels.  Energy conservation may require a car lift system to help with storing a wheelchair, or a ramp or mechanical lift for use in a van, truck or SUV.  Air conditioning is recommended to help manage cabin temperature for those who are heat sensitive.  

    Talk to your doctor about the medications you take, especially noting any potential side-effects which could affect your driving.  Don’t drive when you are sleepy, drowsy, or just before/after taking medication.

    Visual changes may be severe enough for the MS patient to avoid night driving.  Sun glasses may be helpful in dimming the glare from the sun.  Special mirrors and head turning can compensate for loss of peripheral vision.  Know the order of traffic signals so that if your color vision becomes impaired, you will know when to go, stop, or yield.  If double vision is a problem, glasses with prisms may be helpful.


  • A number of cognitive issues can interfere with driving including slowed information processing speeds or the loss of visuospatial awareness.  Emotional changes or anxiety may be problems and one may need to regulate emotions and avoid driving when angry or overly emotional.  A patient with MS might need to limit driving to familiar routes due to memory impairment or the diminished ability to problem solve.

    Limited concentration skills can make you more easily distracted by the radio, other cars or passengers, or make it difficult to multitask.  Reaction times are affected by the speed you can process information, changing situations such as the sudden appearance of something in your field of vision, or the sound of emergency sirens.  Some people with MS can become overwhelmed with too much information or stimulus coming at them all at once.


    Based on behind-the-wheel driving assessment, a person with MS may be approved for unrestricted driving (no complications and/or drives without the need of adaptive aids), restricted driving (some medical complications, but cleared to drive with adaptive aid or under specific conditions), or may be denied driving privileges entirely.
     

    The MS Society in UK with the Research Institute for Consumer Affairs (RICA) offers an excellent brochure, Motoring with Multiple Sclerosis, which discusses adaptations, products, and strategies to keep one behind the wheel when physical abilities become limited.  

    In Georgia, Drs. Abiodun Akinwuntan and Miriam Cortez-Cooper are conducting research to determine the psychometric (cognitive) tests which most accurately predict one’s ability to pass or fail a driving test.  Prior research has identified five tests which were able to predict driving ability with 91% accuracy and can be given in less than 45 minutes at a cost of approximately $150 (Akinwuntan, 2012).  Driving simulation training will be compared with Wii-based exercise training to determine which is the more effective treatment for people with MS.


    SOURCES:

    Driving with Multiple Sclerosis: Can I? Should I?” by David Orange, NARCOMS Staff Writer with contributions from John Brockington, MD, Associate Professor and Director, Division of General Neurology at the University of Alabama at Birmingham. Accessed November 26, 2012.

    Driving with Multiple Sclerosis.” John Vaughter, certified driver rehabilitation specialist.  Accessed November 26, 2012.

    Motoring with Multiple Sclerosis.”  MS Society UK.  Accessed November 26, 2012.

    Akinwuntan AE, Devos H, et al. Predictors of driving in individuals with relapsing-remitting multiple sclerosis. Mult Scler 2012 Jul 3.  [Epub ahead of print]  doi: 10.1177/1352458512451944 

    Lincoln NB, Radford KA. Cognitive abilities as predictors of safety to drive in people with multiple sclerosis. Mult Scler 2008;14;123-128. Originally published online Sep 24, 2007; DOI: 10.1177/1352458507080467

    Lings S. Driving accident frequency increased in patients with multiple sclerosis. Acta Neurol Scand 2002; 105: 169–173.


  • Schultheis MT, Weisser V, et al. Examining the Relationship Between Cognition and Driving Performance in Multiple SclerosisArch Phys Med Rehab 2010;91(3):465-473.

    Schultheis MT, Garay E, Millis SR, et al. Motor vehicle crashes and violations among drivers with multiple sclerosis. Arch Phys Med Rehab 2002;83:1175–1178.  

     

    Lisa Emrich is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers.