Driving after stroke: What you need to know
- Marian Engelbrecht
- Nov 4, 2024
- 5 min read
A question individuals recovering from a stroke often ask is, "When can I start driving again?" or "Will I be able to drive after my stroke?" Understanding how a stroke can impact your driving ability is essential to determine if and when you are ready for a safe return to the road.
How can a stroke affect your driving?
A stroke can lead to various impairments that can impact driving in several ways. These impairments may vary depending on which part of the brain was affected, and the severity of the stroke.
Every person is different and may be affected differently
Left Hemisphere (left side of the brain): May include apraxia (difficulty with motor tasks) and planning), aphasia (language impairment), and mathematical difficulties.
Right Hemisphere (right side of the brain): Often includes impulsivity and challenges with spatial awareness.
Motor Symptoms
Strokes affect individuals differently, but common symptoms include paralysis or weakness on one side of the body, which may affect coordination and control. This can include weakness in the face, arm, hand or leg and can differ in severity.
Sensation
Impaired sensation can hinder your ability to feel the pedal or judge the pressure of your foot needed while driving. This may include some numbness or total loss of sensation and position sensation (proprioception).
Vision
Strokes can cause visual impairments, such as:
Hemianopia (loss of half of the visual field)
Visual neglect (difficulty noticing one side)
Blurred vision
Double vision
Changes in eye muscle movements and coordination
This may affect visual search abilities, visual scanning and can also result in slower visual processing, which can significantly affect driving.
Visual perception and processing
Visual perception and processing refers to how the brain processes and makes sense of what you see.
Here are a few examples of how this can affect driving.
Spatial orientation: Keeping the car in the lane, also called lane maintenance, while driving straight,going around corners and parking.
Depth perception and perception of speed: E.g. judging safe gaps in traffic in order to turn right. Judging speed aand distance of uncoming cars.
Visual search: Difficulties can affect your ability to effectively scan the environment for hazards and other road users.
Slower visual processing: Taking longer to see and perceive in order to respond e.g. a pedestrian crossing the road, or brake lights of the car in front.
Cognition
Cognitive impairments can include slower information processing, attention deficits, executive functions like planning problem-solving, judgment and insight can significantly impact driving.
Returning to Driving
Returning to driving is typically one of the final goals in rehabilitation, alongside returning to work and independent living. The rehabilitation team can include occupational therapists, physiotherapists, and speech therapists who will work on improving the different skills needed for safe driving.
It is recommended that the person is referred to an occupational therapist trained in driving to do an independent assessment and return to driving rehabilitation. The occupational therapist will evaluate your readiness to return to driving and recommend any necessary vehicle adaptations or driving modifications.
People who recover well after a stroke may be able to return to driving without any further intervention or assessment. Your treating occupational therapist will guide you through the process. Others may need the services of an occupational therapist to assess the need for vehicle adaptations and driver training. For some, driving may not be a realistic goal, necessitating a shift to alternative modes of transportation and support.
Warning Signs that someone might not be ready to return to driving
When considering a return to driving after an illness or injury, it is crucial to assess whether you are truly ready to get back on the road.
Here are some important red flags that might indicate you're not quite prepared to resume driving:
Neglect of one side of the body or visual space: Difficulty in noticing or responding to objects or stimuli on one side of your body or in your field of vision could pose serious risks while driving.
Poor attention and impulsivity: Challenges with maintaining focus or controlling impulsive behaviors can impair your ability to drive safely and make sound decisions on the road.
Cognitive impairments affecting daily function: If you are experiencing memory problems, difficulties with problem-solving, or other cognitive issues that impact your daily activities, these may also affect your driving abilities.
Visual Perception impairments: Issues with interpreting visual information, such as depth perception or the ability to judge distances, can significantly affect driving performance and safety.
If you recognize any of these signs in yourself or a loved one, it may be wise to consult with a healthcare professional before resuming driving. Your safety, and the safety of others on the road, is paramount.
Vehicle Adaptations and Modifications
Depending on your specific needs, some adaptations may be required. The occupational therapist will guide you through this process to determine the best fit for you.
Manual Transmission: Driving a manual car requires good recovery of both arms and legs. Coordination for operating the clutch, brake, and accelerator, as well as managing the gear lever, is essential.
Automatic Transmission: For those with mobility impairments affecting your leg or arm, an automatic vehicle may be necessary.
Left-Foot Pedal Conversion: If the right side is affected but the left side is functional, a left-foot pedal conversion of an automatic car may be needed. This adaptation requires specialized training and strong cognitive skills to relearn driving techniques.
Secondary controls: Adaptations may be needed if the controls are out of reach or too difficult to manage. Consider the left or right position of the indicators.
Seating: Correct set-up for seating, steering wheel and mirrors may be needed. Practice getting in-and-out of the car, managing the seatbelt and walking aids may be needed.
For more information on vehicel adaptations
Driver training
Driver training can help individuals regain their driving skills through various methods. This will be provided by the driving occupational therapist.
Clinic or home based exercises: Improve cognitive, visual and motor skills for driving.
Passenger exercises: Practice driving-related tasks as a passenger with exercises provided by your occupational therapist. This can include visual scanning and hazard detection exercsises. and is a safe way to train before getting behind the wheel yourself.
Stationary vehicle: Before going on the road, motor skills like managing the pedals or basic steering can be practiced safely.
Behind-the-Wheel training: Practical driving sessions with a qualified instructor or occupational therapist.
Common Questions
How Long Should I Wait Before Driving After a Stroke?
The South African Society for Occupational Medicine (SASOM) recommends waiting at least one month post-stroke before resuming driving. It is recommended that a person may only resume driving after showing sufficient recovery (satisfactory clinical recovery) aand may need to be determined by the relevant health professional.
Do I Need to Change My License?
You may need to update your driver's license if:
You are only able to drive an automatic vehicle.
You use vehicle adaptations such as a left-foot pedal conversion or a steering knob.
Consulting with your healthcare provider and rehabilitation team will help determine the safest approach for returning to driving.
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