Driving Challenges with ALS

driving challenges with ALS

By Cynthia Knoche

For most people, driving provides independent mobility to commute to work, access to the community and travel.  As teenagers, most people anticipate the opportunity to master the skills required to drive an automobile.  However, few adults give much thought to assessing their ability to safely operate a vehicle.

Advancing age, illness, and medications can impair one’s ability to drive.  For those diagnosed with ALS, progressive loss of motor function resulting in weakness and decreased reaction times eventually take its toll.  Minor cognitive changes, such as having to “think twice” about a process or taking extra time to evaluate a familiar situation can lead to decreased ability to drive safely.

Progressive loss of muscle control can occur so slowly the person doesn’t recognize the change.  Comments from family members or other drivers’ comments may be the first indication that a person’s driving performance is deteriorating.  Broaching the subject of safe driving can be challenging for family members; the loss of independence afforded by driving is one of the most significant events a person can face.  Here are some tips for approaching this sensitive subject with a loved one:

  • Initiate a conversation outside of the car or actual driving situation
  • In a respectful manner, voice your concern about your loved one’s driving skills
  • Discuss specific symptoms that may impair driving; such as near misses, slow response time, sleepiness or weakness.
  • Expect loved ones to avoid a conversation or discount symptoms

Those facing progressive loss of motor function or cognitive challenges can take proactive action by regularly asking their physician or occupational therapist to evaluate the potential impact of symptoms on their driving skills.  Any occupational therapists can provide basic screening for driving safety. 

The ALS Association affiliates offer assessments through clinics such as the Duke University ALS Certified Treatment Center of Excellence, where Francesa Monchino, O.T.R./L., M.ED, M.O.T., regularly provides driver screening evaluations, which include assessing abilities related to cognition, strength, stamina and flexibility.  In addition, people can be referred to a Driving Rehabilitation Specialists.  Comprehensive evaluations can also include detailed measurement of braking time, neck movement, endurance and cognitive abilities.  Screenings or evaluations can result in recommended changes to allow continued safe driving, referrals for community mobility access, or recommendations to discontinue driving in the face of overt safety challenges. 

A neutral authority figure outside of the family, such a physician can initiate the discussion related to increased risk associated with driving and highlight the value of a transition plan for safe community mobility.  Occupational therapist Melissa Uhl, O.T.R./L., O.T.D. shares that many driving evaluations result in a proactive plan to access safe alternate transportation methods.  A plan may include a steering wheel knob or hand controls, using alternate sources for transportation such as family and friends, or community transportation.  Many communities provide alternate transportation services through an office of disability, special needs, or Agency on Aging.

While technology continues to provide equipment to maintain quality of life in many arenas, it is clear that addressing the challenging issue of driving will require team effort.  Additional information related to safe driving evaluations and alternate transportation options can be found from these resources:

Transportation Solutions for Caregivers
http://www.seniortransportation.net/ResourcesPublications/Caregivers.aspx

National Association of Agencies on Aging
http://www.n4a.org/programs/ncst/

American Occupational Therapy Association
http://www.aota.org/en/About-Occupational-Therapy/Professionals/PA/Facts/Driving-Community-Mobility.aspx

ALS Association Nationwide Chapter Locator
http://www.alsa.org/community/services.html?service_type=chapters

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