Driving after Stroke

Driving after stroke can be a daunting task. It is not only a major concern of individual safety, but, also public safety on the roads. Given the emotional, physical and financial burden of stroke on the stroke survivor's family, it is, but natural for the survivors to want to get back to work as soon as possible. Often survivors don't realize the difficulties that they might have when driving after a stroke. Some may not know all of the effects of their stroke. Driving against doctor's advice is not only dangerous, but also illegal.

How do I know if I can drive?

Many-a-time, the survivors are so keen to get back to normalcy that they ignore some of the signs and symptoms of unsafe driving. After all, they had been doing that for years before the stroke. 

Ask your family if they have noticed changes. Those around you may notice changes in your communication, thinking, judgment or behavior that should be evaluated before you drive again. They often have many more opportunities to observe changes than others do. 

What are the signs and symptoms of unsafe driving?

• Drives too fast or too slow for road conditions
• Needs help or instructions from passengers
• Doesn’t observe signs or signals
• Makes slow or poor distance decisions
• Gets easily frustrated or confused
• Often gets lost, even in familiar areas
• Has accidents or near misses
• Drifts across lane markings into other lanes

Where can I get help?

Talk to your doctor or occupational therapist. He or she can tell you about your stroke and whether it might change if you can drive. Unfortunately, there are no specific regulations for driving for stroke survivors in India. As such, there are no authorized driver rehabilitation specialists to evaluate driving ability. It would be of great help if the survivors enroll in an authorized driving school and receive instructions on how to modify your driving and the car to compensate for the disabilities. As more capable technologies and new advances in mobility equipment are made each day, wheelchair accessible vehicles have become more powerful than ever before. These modified vehicle solutions – such as hand controls, pedal extensions, seat bases, lifts and ramps – have changed the lives of countless stroke survivors and people with disabilities.

Guidelines in the UK
Driver and Vehicle Licensing Agency (DVLA)/Driver and Vehicle Agency (DVA) sets the rules. After a stroke or TIA you must stop driving immediately, but for many people this is temporary. It is possible to return to driving as long as it is safe to do so and the correct procedures are followed. The DVLA produce a factsheet, Car or motorcycle drivers who have had a stroke or transient ischaemic attack (TIA). This outlines when you have to inform them that you have had a stroke. This guide also applies in Northern Ireland and your medical practitioner may refer to these when advising you.

Cars or motorcycles

If you have a licence to drive a car or motorcycle (category B licence) you are not allowed to drive for at least one month after a stroke or TIA. After a month you may start driving again if your doctor is happy with your recovery. If you have had a number of TIAs over a short period of time you will need to wait until you have not had any TIAs for three months before returning to driving. You will also need to notify the DVLA/DVA.
If you have a licence to drive a large goods vehicle (LGV) or a passenger carrying vehicle (PCV) you must tell the DVLA immediately that you have had a stroke. You are not allowed to drive this type of vehicle for one year. After this time you may be able to resume driving, but this will depend on how well you have recovered and also on the results of medical reports and tests.

Specially adapted cars

Even if you have physical disabilities following your stroke, it may still be possible for you to drive. There are various vehicle adaptations and motoring accessories that can make driving possible and more comfortable. Specialist mobility centres can carry out assessments and provide advice about making adaptations to your vehicle which can enable you to return to driving. They can also provide assessments for passengers who have disabilities, and information on how to safely lift wheelchairs in and out of a car.

Pre-driving assessment tools

1. History to determine previous motor vehicle accidents, number of miles driven, psychosocial aspects, medical conditions and current level of psychological functioning
2. Physical examination to identify subtle physical conditions

• Assess joint mobility of neck, shoulders, wrists, hips, knees and ankles
• Assess upper and lower muscle strength manually
• Assess upper and lower coordination through finger-nose, heel to shin and rapid alternating motion
• Current medication
• Visual fitness
• Mental status

3. Neuropsychiatric testing
4. Off-road driving testing (simulator)

Impact of red tape on the healthcare in India

India is a great nation of over 1.2 billion people. It stands on a 11,000 year old strong culture that is probably matched only by the Mesopotamian culture. It has survived many invaders such as the Arabs and Europeans. After its independence in 1947, India was faced with many problems - poverty, poor healthcare, illiteracy, population explosion, security threats from neighboring countries, to name a few. Since 1980s, economic reforms have propelled India into a an era of rapid growth and development such that the GDP growth during January–March period of 2015 was at 7.5% compared to China's 7%, making it the fastest growing economy. Despite these developments, healthcare sector lagged behind in responding to the healthcare needs of the  nation. 

In a recent article in the New England Journal of Medicine, Dr. KS Reddy states "With weak regulatory systems failing to set and enforce quality and cost standards, some patients receive inadequate, inappropriate, or unethical care. 70% of health care expenditures consist of out-of-pocket spending". Today, the private sector accounts for about 80% of outpatient and 60% of inpatient care. The reasons behind this appalling state of affairs are many. Red tape and corruption are among the top causes leading to the current state of affairs. to state an example, the Supreme Court held the government and the Medical Council of India (MCI) guilty for the loss of 3,920 MBBS seats mainly because of lethargic inspection of infrastructure in medical colleges and non-grant of timely permission to colleges to admit students! Red tape swallows all walks of life from education to filling job vacancies to providing healthcare to the people. 

Failure on the part of any hospital to provide timely medical treatment to a person in need of such treatment results in a violation of the patient's "Right to Life,” which is guaranteed under Article 21 of the Constitution of India. This is the closest India has come to enacting laws similar to The EMTALA (Emergency Medical Treatment and Labor Act) and the COBRA (Consolidated Omnibus Budget Reconciliation Act), which are well recognized in the United States. In 1988, the Honorable Supreme Court of India had stated that every injured person be administered emergency medical care to preserve life and there should be no legal impediment to providing medical care. It is shameful to note that there has been no law to this effect and we, Indians, continue to not care for those in need of emergency medical aid.

How can we change the way we treat our people? Should there be a law enforcing people to care for fellow citizens? Should we punish people who see a person dying but, don't come forward to assist him/her? Should we enforce all the hospitals to provide emergency care? Unfortunately, the problem lies in the mindset of the people more than anything else. How can we get people to care for their fellow citizens? I do not know the answer to this question. But, one thing is sure, IF WE, THE PEOPLE, DO NOT CARE FOR OUR FELLOW CITIZENS, NO ONE ELSE WILL

Stroke Awareness

Please share this video with family and friends to spread stroke awareness