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. 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 you to drive after a brain injury (if driving independently is one of your 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. You 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, your rehabilitation team will have discussed this with you. But if not, you can contact the rehabilitation centre nearest to you to request a referral form. Ask if they require 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 you are scheduled for a driving evaluation, the OT/CDRS will determine:
- Your capacity/potential to drive
- The class of vehicle that will be most appropriate for your needs
- The equipment you will require to access your vehicle
- The adaptive driving controls that will best meet your needs
- The training that will be required to ensure you are able to drive your 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. You 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 your 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 your permit (i.e. left foot accelerator, automatic transmission, hand controls, etc.) to ensure you only drive a vehicle that is compatible with your abilities.
How long will the process take?
The process from beginning to end may require as little as 2 months. For those with more complex needs, this can be extended to 12-18 months. The time required will be dependent on many factors. You 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 you’re not ready. You can work with your rehabilitation specialists and a CDRS to determine when you 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 your capacity. If driving safely is one of your goals, remember to be patient with the process and don’t rush.
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.