Driving After Traumatic Brain Injury

Driving can be an important part of feeling independent. It can improve mental well-being and self-esteem. It also helps you to feel like you are part of a community. It supports activities of daily living such as working and shopping. It also supports access to health care. Driving is a big part of our daily lives, but it is easy to forget that driving is dangerous.

Most people with a traumatic brain injury (TBI) want to return to driving after their TBI, and most do return to driving safely in time. But a TBI can affect the skills you need to drive safely. This makes it important for people with TBI to learn the facts as soon after their TBI as possible.

• Many people learn the steps needed to return to driving in rehabilitation. You can ask your care team questions during rehab and go back to them if you have more questions later.
• Many people with TBI may not be able to recognize their impaired driving skills. This makes it important to include family, friends, and health care providers in the choice to return to driving.
• Your care team may recommend testing before you return to driving.

Do People With TBI Return to Driving?

Research suggests that between 60% and 70% of people return to driving after a TBI. But some people may have to adjust their driving habits. Here are some examples of changes that a person with TBI might make to improve their ability to drive safely.

• Drive less than before their TBI.
• Drive only at certain times (such as during daylight).
• Drive only on familiar roads.
• Drive when there is less traffic.
• Drive only in good weather.
• Drive with less distractions (turn off the radio, do not use your phone).

What Driving Abilities Can a TBI Affect?

• Vision.
• Hand-eye coordination.
• Reaction time.
• Ability to do multiple tasks at one time.
• Ability to focus.
• Memory. This may include forgetting a destination or how to get there.
• Staying in the proper lane.
• Safety awareness and judgment.
• Problem solving.

What Are the Warning Signs of Unsafe Driving?

• Driving too fast or too slowly.
• Not spotting traffic signs or signals.
• Having trouble judging the distance between cars and when stopping or turning.
• Being slow to make decisions. This may include being slow to react in time to stop or avoid an accident.
• Getting frustrated, angry, or confused easily.
• Having accidents or near misses.
• Drifting across lane markings into other lanes.
• Getting lost easily, even in familiar places.

Driving Evaluations and Training

Many people do not have their driving skills evaluated before they return to driving after TBI. This may place them and others at risk. A driving evaluation can help you to understand your ability to return to driving after TBI.

There may be two parts to a driving evaluation:

1. Preliminary evaluation. This is a review of physical and cognitive abilities. It includes reaction time, attention, judgment, reasoning, and visual spatial skills. Recommendations about the need for adaptive equipment and skills training are based on the results of this review. This part may involve a doctor familiar with the person, a neuropsychologist, or an occupational therapist.
2. Road test. This is a driving test. An evaluator grades a person’s ability to drive a car safely in various traffic conditions and to follow state driving laws. The person might use a driving simulator or drive a car on the road.

Some people need training to become a safe driver after having a TBI. Training can often improve specific driving skills. For example, training may focus on response time, judgment, or finding where you are going.

• A certified driver rehabilitation specialist (CDRS) is a trained expert who helps drivers with unique needs. They work with people of all ages and abilities to explore services and alternative solutions for a safe return to driving. Search for a certified professional at https://www.aded.net.

Car Modifications

People with a physical disability may benefit from adaptive driving aids. You can search for adaptive driving aids through the National Mobility Equipment Dealers Association at www.nmeda.org.

Here are a few adaptive options:

• Hand controls for the gas and brake.
• Spinner grips or knobs for steering.
• An added foot pedal.
• Grips for getting in and out of the car.

Are There Laws About Driving After a TBI?

People who want to return to driving need to check the laws in their state. Laws are different for each state.

• Many states restrict driving within 6 months of a significant neurological event, such as a TBI.
• Many states require that people who had a seizure after TBI are seizure-free for some time (usually 6 months) before they return to driving.
• Some states require you to have an evaluation by the Department of Motor Vehicles or a certified driver rehabilitation specialist before you can return to driving. This requirement may apply even if you already have a valid driver's license.

Should You Be Driving?

Step-by-Step:

1. Talk to your doctor or health care provider and family members about your ability to drive.
2. Get an evaluation by a professional to determine your ability to drive.
3. Based on your evaluation, you may be able to return to driving. You may need retraining or modifications to your car before you can return to driving. You may need to use other transportation options.

What Are My Options if I Cannot Drive?

There may be other transportation options to consider for people who can’t drive.

• Family.
• Friends.
• Public transportation and ride sharing, depending on where you live.

Authorship

Driving After Traumatic Brain Injury was originally developed by Tom Novack, PhD, ABPP-CN, and Eduardo Lopez, MD in collaboration with the Model Systems Knowledge Translation Center (MSKTC). Driving After Traumatic Brain Injury was revised in 2024 by Tom Novack, PhD, ABPP-CN, Jenny Marwitz, MA Sean Hollis, PhD, Lisa Rapport, PhD, and Phil Klebine, MA, in collaboration with the MSKTC.

Source: The content in this factsheet is based on research and/or professional consensus. This content has been reviewed and approved by experts from the Traumatic Brain Injury Model System (TBIMS) centers, funded by the National Institute on Disability, Independent Living, and Rehabilitation Research, as well as experts from the Polytrauma Rehabilitation Centers (PRCs), with funding from the U.S. Department of Veterans Affairs. The content of the factsheet has also been reviewed by individuals with TBI and/or their family members.

Disclaimer: This information is not meant to replace the advice of a medical professional. You should consult your health care provider regarding specific medical concerns or treatment. This publication was originally developed with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education, grant no. H133A060070. It was updated with funding from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant numbers 90DPTB0029, 90DPTB0030, and 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this factsheet do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the federal government.

Recommended Citation: Novack, T., Marwitz, J., Hollis, S. Rapport, L., & Klebine, P. (2024). Driving after traumatic brain injury. Model Systems Knowledge Translation Center (MSKTC). https://msktc.org/tbi/factsheets/driving-after-traumatic-brain-injury.

Copyright © 2024 Model Systems Knowledge Translation Center (MSKTC). May be reproduced and distributed freely with appropriate attribution. Prior permission must be obtained for inclusion in fee-based materials.