What to Expect With a Driving Rehab Specialist
For some, being able to drive yourself is crucial for staying independent. But patients with MS are three times more likely to have car accidents and more traffic violations. Enter the driving rehab specialist—specially trained occupational therapists who assess your driving abilities and recommend changes to your car. The key: Start the process early to get an idea of the big picture, says Elin Schold Davis, O.T.R./L, practice manager for community access and driver initiatives for the American Occupational Therapy Association (AOTA). Here’s how to stay safe on the road for longer.
Know How MS Can Affect Driving
MS affects every patient differently, but there are two aspects of the condition that can affect driving, says Marisa McGinley, D.O., a neurologist at the Cleveland Clinic’s Mellen Center for Multiple Sclerosis in Cleveland, OH. “One is weakness, primarily in people’s legs and their ability to use the foot pedals. And sometimes vision.” People with MS also may have problems with attention, processing information, and visual-motor coordination, researchers found.
Realize Some Setbacks May Be Temporary
All sorts of things can affect your driving, from lack of sleep to flares. For instance, really hot weather can often exacerbate symptoms like spasticity, says Dr. McGinley. If that’s the case, bring that up with your neurologist, who can recommend cooling vests or having a good A/C system in the car to stay comfortable while driving. Fatigue can also affect driving, says Dr. McGinley, so it’s worth talking to your doctor about strategies (like maybe not driving during flare-ups).
Work With Your Doctor Who Can Help Get a Team in Place
Some patients proactively ask about hand controls because they’ve noticed it’s become harder to push down on the pedals, says Dr. McGinley. But she’s also asked patients about driving if she notices more weakness during an exam. “More often than not, I've had patients say, ‘I just stopped because I was unsure of my abilities.’ And then we talk about other options for driving and rehab and things like that.” An occupational therapist can also connect you with a driving specialist (or they may be one themselves).
Figure Out How Important Driving Is to You
Specialized evaluations and adapting a car to your needs (or getting another model) can be pricey. So let your team know how important staying behind the wheel is to you, Davis explains. “If I want to get around independently longer, then I have to figure out how to fund this plan. And that might take some time. So the earlier you get information about it, the more you can start thinking ahead.”
Don’t Be Afraid of an Evaluation
Having your driving skills checked out by a pro can be nervewracking—especially during a 4-hour assessment. But the focus is less about what’s wrong with you and more “measuring what's wrong with you in the context of what’s possible,” explains Davis. “The OT is not in the business of taking over your license. The OT is in the business of doing everything they can to help you keep it.”
Click through to see what you can expect during an evaluation…
You’ll Start the Evaluation in a Clinic
Half the evaluation takes place indoors. A driving specialist has to get a good picture of your visual skills, strength, range of motion, and sensation, explains Terri Cassidy, O.T., a certified driving rehabilitation specialist in Colorado Springs, CO. “It’s just a very thorough OT evaluation. We have an eye chart but we’re also looking at visual tracking,” she says. There are also physical tasks, like how well you can move from one chair to another, she adds. The specialist also notes any spasticity or tremors or whether you have something like binocular vision (which can distort depth perception) or cognitive issues.
Then You Head Out on the Road
“What we did in the clinic informs our next step,” says Cassidy. So if, say, you have double vision the specialist wants to see how that affects your driving. You’ll drive in a car outfitted with a brake and gas pedal for the specialist and start in the parking lot. Then you’ll drive around the neighborhood. “We look at visual attention, processing speed, how well people are able to alternate between making decisions about what's important. So a lot of times there's really a cognitive piece that we're looking for too,” Cassidy explains.
You’ll Get Recommendations After the Eval
“The driving rehab specialist will tell you, ‘This was risky, this was risky, this was hard for you, this was exhausting for you,’” says Davis. But sometimes the advice is to get more physical therapy to build up strength or for prism glasses to fix double vision, says Cassidy. If you need hand controls because your foot is too weak to press the pedals, you’ll get training in that—first in the specialist's car with a mocked-up model and then in your car, Cassidy explains.
A Specialist Will Also Problem-Solve
Driving rehab specialists will suggest whatever new equipment you need—whether it’s hand controls or changing the gear shift from the right to the left or special mirrors. They’ll also give tips for planning your route to conserve energy or reducing the times you have to get in and out of the car, which can be exhausting, says Cassidy. Maybe it’s taking Ubers for trips downtown, finding routes that don’t demand too many entrances and exits on the highway, or doing curbside pickups for everything.
Keep Your Doctor in the Loop
“I tell all of my patients, ‘I need feedback of how you're doing,’” says Dr. McGinty. “And when patients give me clear examples it helps me better understand what the limitation might be.” So you might tell the doctor that you used to be able to drive two hours to visit family but can’t anymore because your leg spasms are worse. Your doctor might refer you for another driving evaluation to change up your car or to physical therapy for Botox injections (that can calm spasms), Dr. McGinty notes. The end goal is to make it easier and safer for you to drive.
MS and Accident Statistics: Acta Neurologica Scandanavica (2002). “Driving accident frequency increased in patients with multiple sclerosis.” pubmed.ncbi.nlm.nih.gov/11886359/
MS and Traffic Violations: Archives of Physical Medicine and Rehabilitation (2014). “Neuropsychological performance, brain imaging, and driving violations in multiple sclerosis.” pubmed.ncbi.nlm.nih.gov/24929025/
MS and Driving Problems: Journal of the International Neuropsycholgical Society (2014). “Driving competences and neuropsychological factors associated to driving counseling in multiple sclerosis.” pubmed.ncbi.nlm.nih.gov/24867442/