Multiple Sclerosis Centers of Excellence
Things to Consider About Driving
Pat Niewoehner, OTR/L, CDRS and Florian Thomas, MD, MA, PhD
MS can affect the ability to perform activities of daily living. Driving is the most complex activity of daily living performed every day. It is important not to minimize the complexities of driving or overestimate one’s abilities. Driving requires adequate vision, motor, memory, and thinking skills. MS can affect all these areas. As MS evolves, required driving skills may diminish in several domains:
- Blurred vision, poor night-time vision, blind spots, double vision, loss of color vision, impaired visual searching, scanning, and attention.
- Short-term memory loss, confusion about vehicle operation or one’s location or destination, stress intolerance, impaired motor planning, multi-tasking, and reaction time, fatigue, and heat intolerance.
- Impaired sensorimotor function may manifest as difficulty with car transfers, muscle weakness or stiffness/spasms/cramps, poor light touch and joint position sensation, pain, and impaired coordination, particularly in the arms or feet.
A cardinal feature of MS is its variability and unpredictability. Symptoms often fluctuate during the course of a day and from one day to the next. Most people with MS have a relapsing course and during exacerbations (attacks, relapses, or flare-ups), driving may be unsafe but may return to normal upon recovery. However, with disease progression, driving can become permanently affected.
If you, your loved ones, or your health care provider are concerned about your driving ability a driving evaluation performed by a driver rehabilitation specialist can help identify challenges you experience and the need for appropriate adaptive auto equipment to keep you safely on the road. The purpose of a driving evaluation is to assess driving skills, recommend adapted auto equipment if indicated to meet specific functional needs, and train the driver and family in its use, ensuring safety of entering/exiting the vehicle and proper storage of wheelchair and assistive devices.
The VA maintains 50 driver rehabilitation clinics nationwide. An evaluation takes up to two hours and includes a cognitive assessment, vision examination, tests for muscle strength, movement, coordination, sensation, and reaction time, as well as a behind-the-wheel evaluation using a VA-owned vehicle. Upon completion of the evaluation the driver rehabilitation specialist makes recommendations on driving safety. Adapted equipment may be recommended. Examples include hand controls to operate the gas and brake, a spinner knob to help turn the steering wheel, power transfer seats, digital driving rings, and hi-tech driving equipment for reduced effort and zero effort steering and braking.
Keen awareness of the fluctuating nature of MS symptoms can help you avoid the risk of unsafe driving. Here are some tips:
- Don’t drive if you are having a bad day.
- Avoid driving when you have another illness because MS symptoms are often worse when the “system” is under increased stress.
- Keep trips short if you suffer fatigue and don’t drive when fatigue is severe.
- Avoid distractions like cell phone calls/texting, eating, listening to the radio, and arguing with passengers.
- If you are heat intolerant, carry a cooling vest.
- Strategically plan out errands and appointments so that you can avoid heavy traffic times or areas that get congested.
- Avoid driving in bad weather.
What if you decide to stop driving or are told it’s no longer safe to drive?
Just as you plan for other circumstances associated with your disease (e.g. making your home more accessible), planning for the day when driving becomes impossible can ease the transition from driver to passenger. When transitioning from driver to passenger, explore transportation options in your community.
- Ask a friend, neighbor, or family member if they could give you a ride.
- Inquire about volunteer drivers at your local community center, place of worship, or Veteran service organization.
- Contact your city and state public transportation agencies about transportation options.
- Talk to your VA social worker or health care provider about transportation options in your area.
Driving can be seen as a sign of independence, and it can be scary to think about limiting or giving up that freedom. A professional evaluation and the use of adaptive auto equipment can increase your safety on the road and promote independence for as long as it’s safe for you to drive. If you feel like you can no longer safely drive, there are a variety of transportation alternatives and your family members, friends, and health care professionals are here to help and support you with this transition.
Change can be hard and if you are having difficulty accepting or adjusting to changes in your ability to drive, you might consider talking with a VA health care provider. Talking about how you feel may help you better understand and address the grief felt over these changes.