Factsheet 36 – April 2009

Head injuries and driving

Many people who've had a brain injury resulting from a blow to the head can regain or relearn a lot of the activities they performed before they sustained the injury. Driving is one of these activities.

Being able to drive can allow people to be more independent, which is important for people who have suffered an injury.

Driving is an activity that requires the co-ordination of both mental and physical skills. Even if a person is confident that their driving skills have remained intact after an injury, it's still important to take the necessary steps to ensure safe driving.

This factsheet looks at how a head injury can affect someone's driving ability, the steps to help someone return to safe driving and some possible transport alternatives.

Factors affecting driving ability

Every driver should have the following skills to ensure they can safely operate a vehicle:

• Good vision in front and out of the corners of the eyes
• Quick reactions and reflexes (to be able to brake or turn to avoid crashes)
• Good coordination between eyes, hands and legs
• The ability to make decisions quickly
• The ability to make judgements about what is happening on the road.

It's important to remember that certain medications can affect coordination and reaction times while driving.

A head injury may affect people in different ways. Listed below are some of the consequences of a head injury that could affect someone's driving.

Altered vision

• Missing signs or traffic hazards on one side.
• Misjudging distance and speed.

Altered thinking patterns

• Thinking may be slowed and it may be difficult to make decisions at busy intersections.
• Trouble coping with too much sensory information at once.
• Loss of concentration resulting in a decrease in driving skills.
• Short-term memory loss.

Epilepsy

Head injuries severe enough to have caused unconsciousness or loss of memory may result in epilepsy. (This doesn't include seizures immediately after the injury, which are considered part of the injury process). See Factsheet 17, Epilepsy and driving for more information.

Physical challenges

• Reaction time may be slowed.
• Trouble coordinating hand and feet movements.
• Ability to steer may be reduced due to muscle weakness.
• Problems using foot pedals.

Returning to driving

When a person can return to driving depends on the type of licence and any endorsements they hold, and the nature and extent of the head injury. Higher criteria apply where commercial classes and endorsements are concerned.

With serious head injuries, the NZ Transport Agency (NZTA) usually requires a neurologist's report and an occupational therapist's assessment before a person will be allowed to start driving again.

If you have an Accident Compensation Corporation (ACC) case manager, check whether funding is available for driving assessments and/or specialist medical assessments (if required).

Medical assessment

The first step before a return to driving is to consult a doctor, who can determine if the person is fit enough to drive. The doctor may recommend or require an additional assessment with an occupational therapist.

An assessment with an occupational therapist can:

• give someone advice about licence issues following an injury or crash
• look at how any physical or cognitive changes might affect driving abilities
• ensure the person is likely to satisfy driving standards
• determine if lessons are required to improve confidence or to become a better driver
• help a learner driver develop the skills needed for driving.

The person with the head injury should ask these questions before seeing an occupational therapist:

• What does the assessment involve?
• Who will be assessing me?
• What do I need to take with me?
• When will the results be given?

See Factsheet 51, OT assessments: occupational therapist and driver licensing for more information.

Covered by insurance?

Insurance companies usually require that any condition likely to affect a driver's ability be disclosed or the company has the right to exclude cover. After notification of a medical condition, whether the company will continue to provide insurance cover depends on the recommendation of a doctor and consultation with the insured parties. The insurance company should be asked whether, in the event of a crash, the injured person will receive insurance cover.

Checklist before you start driving

• Get written medical clearance to drive from a doctor or specialist.
• Contact the insurance company to ensure the vehicle insurance is valid.
• Avoid drinking and driving.
• Check that medications won't affect driving.
• Keep in mind that fatigue can reduce concentration.

If you have a mobility disability, you may be eligible for a mobility parking permit card (mobility card). Forms are available from your local CCS office and must be completed by a doctor.

Alternatives to driving

Some changes that occur after sustaining a head injury can't be overcome and may prevent a person from ever driving again. Giving up driving privileges can mean a loss of self-esteem and freedom, which may in turn cause frustration and anger.

Here are some alternatives to driving:

• Total mobility vouchers. These give a reduction in taxi fares for people unable to use public transport. They're available from the Field Officers of your local Head Injury Society.
• A disability allowance may be available through the Accident Compensation Corporation (ACC) to cover travel costs.
• Make arrangements for someone to drive you (eg through a church or community group).

Where you can find out more

• Email us: info@nzta.govt.nz.
• Phone our driver licensing contact centre on 0800 822 422.
• Write to us: NZ Transport Agency, Private Bag 6995, Wellington 6141.