Life with MS

In my job as an occupational therapist and a certified driver rehabilitation specialist, the number one concern my clients report is that they want the ability to drive or continue driving. CDRSs complete comprehensive driving evaluations with clients to determine if they are safe driving, determine if and what equipment may be needed to continue driving, and provide driving training. Driving is a privilege that allows people to be independent and to come and go freely. Driving also allows people to get to and from their place of employment, run errands, and transport themselves and loved ones. Now, imagine not being able to do these things. Multiple sclerosis, unfortunately, can alter clients’ ability to drive safely. So, how do these clients, their families, and their medical team know if they are safe to drive?

What are some changes to look for?

MS can affect vision, cognition, and physical abilities. These can affect the client's ability to operate a vehicle and drive safely. During driving evaluations with MS clients, many report vision issues such as light sensitivity, blurriness, double vision, and vision fatigue. Some cognitive deficits observed are memory changes, decreased reaction time, slower ability to process information, poor attention, decreased coordination, and decreased insight.

Some physical changes are difficulty lifting their legs and feet. This can cause difficulty moving feet from side to side to reach each pedal, pushing pedals down, or lifting feet from pedals. Clients may also experience decreased sensation, causing their foot to slip off the pedals, increased weakness or decreased ability to get in or out of a vehicle. Many have had falls and can no longer tolerate walking independently in the community. Some clients may have recently had to change their mobility device and have no way to bring the device with them in the community.

When should you consider adaptive options for driving?

Adaptive options are determined based on individual needs. Many clients may have to transition to using their hands for accelerating, braking, and steering because of increased weakness or loss of sensation in their legs and feet. To operate a vehicle using hands, a client will need to be trained to drive with hand controls. These controls are usually operated with one hand completing gas and brake. The stronger hand completes steering with a steering device mounted on the steering wheel. Many clients are receptive to driving with hand controls because they are reassured that they are able to stop the vehicle in a timely manner. Hand controls can also help with energy conservation and allow them to continue driving safely.

Other adaptive options may include different types of vehicles or lifts that can accommodate a client's mobility device such as a power wheelchair or scooter. Clients may also need equipment to help them get in and out of the driver's area. Recommendations may also be given to limit when, where, and how far clients drive. CDRSs may also recommend that clients follow up with other medical professionals such as an occupational therapist, physical therapist, speech therapist, vision specialist, and their medical doctor to help address their deficits.

When should clients stop driving?

Some examples of when clients should stop driving are if they can no longer operate gas, brake, and steering with or without equipment, they are having accidents, getting lost in familiar areas, or they are unable to be alone in the community. Other examples are if vision deficits get worse, weakness increases, they cannot get in or out of the vehicle, or manage their mobility device with or without equipment. If they display poor coordination, reaction time, decision-making, attention, or they are no longer able to follow the rules of the road then they should stop driving.

MS can be a progressive disease. Deficits can increase and driving, unfortunately, may no longer be safe at all. Having to give up the privilege to drive is a difficult fact to accept. It is not taken lightly by CDRSs when this is determined. These conversations can be difficult and hard to accept by clients and their families. However, the most important thing is to keep clients and others on the road safe. If clients, their medical team, or family notice changes in their function, cognition, vision, or in their ability to operate the vehicle, then an evaluation with a CDRS should be scheduled. A search for a CDRS in your area can be completed at ADED.net.