Driving Challenges with ALS
By Cynthia Knoche
Driving an automobile is an economic, social, and recreational necessity for most Americans. A privilege most teens seek, driving soon occupies a central role in the lives of most adults. For people with medical problems, such as ALS, conflicts may arise in balancing self-reliant driving privileges and society's need to protect public safety.
An additional challenge is recognizing the potential loss of safe-driving skills in one’s self, or that of a spouse or loved one dealing with the symptoms of illness or disease that impairs safe-driving ability. A 2010 Practice Parameter Update published in Neurology indicates a person’s self-rating of driving ability is not useful in accessing unsafe driving issues. However, a caregiver’s rating of a driver as marginal or unsafe was considered useful. Often, persons dealing with cognitive issues or executive thought processing may not recognize changes in their driving skills. Even episodes of a “near miss,” or slow reaction time, may not be apparent to the driver. Loss of function related to upper or lower extremities may be more visible yet still not acknowledged by drivers.
Those facing progressive, cognitive or motor function challenges can take progressive action by asking their physician or occupational therapist to evaluate the potential impact of symptoms on their driving skills regularly. Thoughtful planning with regard to amended or alternate transportation is the key to a smooth transition for mobility and transportation needs.
Broaching the subject of safe driving can be challenging. The loss of the 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, caring manner, voice your concern about your loved ones’ 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
- Discuss symptoms and how they might affect driving during clinic visits
- Schedule an evaluation by an occupational therapist or driver rehabilitation specialist
Many adults with physical or cognitive challenges are reluctant to stop driving. A neutral authority figure outside the family, such as a physician or therapist, could be helpful in making the case for the need for a transition plan. Neurologists often make a point of discussing symptoms that may be serious enough to impair driving ability, including warning patients about the possible effects of prescribed medications on alertness and coordination. However, physicians’ reporting of medical status that may impair driving to authorities varies; some states require it, while others accept reports on a voluntary basis.
A report published by the National Center for Senior Transportation revealed that 83 percent of caregivers are responsible for arranging transportation for their loved ones. Creating a transition plan provides a path for accessing alternate transportation options. Investigate alternate sources for transportation, such as family and friends, community transportation, including disabled or special needs services, and local Agency of Aging offices.
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 a team effort. Additional information related to safe-driving evaluations and alternate transportation options can be found from these resources:
Transportation Solutions for Caregivers
National Association of Agencies on Aging
ALS Association Nationwide Chapter Locator