By Dr Lynne Hutton*, Consultant in Rehabilitation Medicine, Astley Ainslie Hospital
Driving might not be the first thing on anyone’s mind following a brain injury, but as recovery and rehabilitation progress it often becomes an important part of an individual’s goals.
What are the first steps?
In the UK it is a legal obligation of every licence holder to inform DVLA of any medical condition that could, or does impact on their ability to drive safely, and this includes brain injury.
What happens after I have told DVLA?
The DVLA will send you forms to complete so you can let them know how your brain injury has affected you. You will also be asked to nominate doctors involved in your care who can provide more detailed medical information. The DVLA’s own doctors will then decide whether to allow you to keep your licence, revoke it, or arrange further assessment. There are some medical complications after brain injury which prevent licence holding, such as seizures, uncontrolled double vision or visual field loss.
What further assessments might be required?
The DVLA might look to arrange further assessments such as an eyesight check, a review with a local doctor chosen by DVLA, or a driving assessment.
If you meet the basic medical requirements to hold a licence (including being able to read a car number plate from 20m), the physical and psychological impacts of your brain injury then need to be considered. A driving assessment undertaken by the Scottish Driving Assessment Service (SDAS) can provide this. The DVLA may arrange this for you, or your doctor can refer you directly. It is therefore important that you talk with your GP / Specialist if you are considering a return to driving so they can offer advice and referral to SDAS if required.
What will a driving assessment consider?
The goal of a driving assessment is to support you to return to safe driving, but unfortunately this isn’t always possible due to the nature and complexity of the difficulties caused by brain injury.
Physical changes such as limb weakness do not always mean you will no longer be able to drive. There are adaptations that can be made to a car to allow control to be achieved. For example, if your left arm and leg are weak, driving an automatic car with a steering wheel spinner and integral secondary control unit (see picture below) can allow you to control the car with your right arm and leg only.
There are lots of different control methods for cars, and the team at SDAS can help identify the best method to suit you as an individual. Sources of funding for adaptations can also be discussed, and advice offered.
However, after a brain injury there can be psychological or cognitive changes such as problems with memory, attention or concentration, which are important skills required to drive safely.
A cognitive assessment of attention, speed of thinking and decision-making is undertaken to understand any difficulties the brain injury may have created, followed by an on road / in-car assessment to determine if safe driving can be achieved. Sometimes the assessor will suggest changing from a manual geared car to one with automatic transmission to allow all “thinking” to be targeted at interpretation of the road situation and making good decisions, without attention being distracted by gear changing.
If driving is not recommended, an assessor will always explain the reasons for this and whether there is any possibility of the recommendation changing in the future.
If driving is recommended, then the advice may include undertaking a short course of driving tuition, particularly if a new control method has been recommended.
The importance of driving in 2021 cannot be underestimated for our independence and feeling of self-worth, and the Scottish Driving Assessment Service would always want to work with you to try and achieve the goal of safe driving within the structure provided by DVLA.
Dr Lynne Hutton*
Consultant in Rehabilitation Medicine
Scottish Driving Assessment Service
SMART Centre, Astley Ainslie Hospital
Edinburgh EH9 2HL
(Tel. 0131 537 9192)
* With input from Marlene Mackenzie, SDAS Manager