For many people, driving is one of the keys to remaining independent. It’s a means to get to the grocery store or the doctor’s office and to stay connected to family, friends and the community.
But for people with multiple sclerosis, the autoimmune disease that damages nerves and can lead to problems with muscles, cognition and vision, driving can become a challenge. That’s reflected in research, like a 2014 study that suggested people with MS get more motor vehicle violations than people without MS. “I get a lot of phone calls from people with MS asking what they can do and if driving is even possible,” says Lisa McLemore, driving program coordinator at Siskin Hospital for Physical Rehabilitation in Chattanooga, Tennessee.
How MS Affects Driving
With MS, the body mistakenly attacks the covering of the nerves (called myelin) and the nerve fibers themselves in the spinal cord, brain and optic nerves. That damage and subsequent scar tissue (the body’s attempt at repairs) keep the nerves from communicating properly. The result is that patients can experience many physical, emotional and cognitive problems, such as stiff, weak, spastic or painful muscles; loss of sensation in the hands and feet; extreme fatigue; and problems with coordination, balance, cognition, vision and mood.
Those issues have a big impact when you’re behind the wheel. For example, problems with muscles, sensation and coordination may make it hard to open or close a car door, push the gas pedal or grip or turn the steering wheel. Fatigue may make it hard to stay awake on the road.
Thinking skills tend to slow as well when you have MS, and this slowed cognition can affect reaction time and one’s ability to focus on driving. Memory loss and disorientation when driving may lead to getting lost or confused.
Medications for various MS-related problems may also affect concentration, coordination or reaction time.
But the No. 1 MS driving issue is vision trouble, says Dr. Steven Galetta, a neurologist and neurophthalmologist at NYU Langone Health in New York. “Coordination and strength play a role in driving, but it’s predominantly a visual task,” Galetta says.
MS-related vision issues that affect driving include:
— Left or right field vision loss. “In the brain, the visual information from each optic nerve splits, so that the right half of the visual world is represented in the left brain and vice versa,” Galetta says.
— Blurred or double vision.
— Loss of visual acuity (clarity of vision, which is needed to see other cars, road signs or hazards on the road).
— Loss of contrast sensitivity. “When people have MS, they may have difficulty seeing shades of gray letters on a white background,” Galetta explains. This can make it harder to read road signs.
— Lack of gaze stabilization: “I was just speaking to a young woman who doesn’t have problems seeing, but her eyes wiggle up and down, and she can’t see or drive because her visual world jumps up and down,” he says.
— Visual processing issues. Visual processing takes all the elements of what you see — motion, color, object configuration — and puts them into a picture of the world.
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
A Driving Assessment
Report any driving difficulties you may be experiencing to your MS health care providers. You’ll likely be referred to a driving rehabilitation program, with a team that can assess your driving strengths and weaknesses and suggest ways to correct them if possible.
You’ll find these programs at both large and small community hospitals. A large program may have many people contributing to the assessment, including a neuropsychologist, an ophthalmologist, a social worker, an occupational therapist, a physical therapist and driving instructors. Smaller programs, like the one McLemore oversees, include an occupational therapist or an occupational therapy assistant and a driving instructor.
A referral for an assessment isn’t covered by medical insurance. “The costs can range from a few hundred dollars at a small program to a few thousand dollars at a large program,” McLemore says.
What’s Included?
A thorough driving evaluation assesses all aspects of your driving ability. It comes in two parts: a clinical evaluation and a road test.
The clinical component evaluates many aspects of health, including MS-related vision problems. For example:
— Visual spatial relations. “We are looking at how someone can recognize a whole object when only part of it is in view,” McLemore says.
— Visual search and divided attention. “Can the client rapidly scan the roadway environment for traffic information, navigation cues and potential conflicts with other vehicles or pedestrians?” McLemore asks.
— Visual reaction time, or the time it takes to react after you’ve seen something, like a car veering into your lane.
The clinical evaluation will also assess your thinking skills. This may be done with a computer program, a psychological exam or both. “We’re evaluating memory processing, visual processing and executive function,” McLemore explains. “Do you know you should wait for the car to pass before you pull out into the intersection? Can you plan how to get to the store if there’s a road you don’t typically use?”
After the clinical evaluation, you can expect a road test with a driving instructor who assesses your reaction time, your ability to follow the rules of the road and your ability to transfer in and out of the car safely.
[See: 11 Ways Rural Life Is Hazardous to Your Health.]
After the Evaluation
When the evaluation is complete, the driving assessment team makes recommendations to your health care providers about driving weaknesses and how to address them.
Fixes for MS-related driving problems may be as simple as getting any of the following :
— A new pair of eyeglasses to correct vision problems.
— Physical therapy to improve your leg strength and balance.
— Occupational therapy to improve upper body strength and the way you function at the wheel.
— Medication to treat fatigue or some vision problems.
— Hand controls that are installed in your car, allowing you to brake or accelerate.
— A new steering wheel that’s easier to turn.
— Convex mirrors (also known as blind spot mirrors) for someone with decreased peripheral vision or decreased head and neck mobility.
To keep MS patients driving longer, it’s also helpful to use these strategies:
— Drive in the morning if you know you’re usually tired in the afternoon.
— Avoid nighttime driving if you have trouble seeing in the dark.
— Avoid driving during rush hour when the roads are crowded.
— Stay off the road if your MS symptoms are flaring.
More complicated conditions (like field of vision problems) may require that you work with a specialist, like a low vision expert. Your ophthalmologist can make the referral.
Sometimes, advanced vision, physical or cognitive problems can’t be corrected and make it unsafe for you to stay on the road. In that case, you may need to consider giving up the keys. “This is a conversation that the physician has with the patient. And then we talk about alternative transportation — relying on public transportation or friends and family,” McLemore says.
But take heart: “The vast majority of the time, we have good news and good options to offer,” McLemore says. And that’s not just true at her facility. “Most people with MS will be able to continue to drive,” says Kathy Costello, associate vice president of healthcare access with the National Multiple Sclerosis Society.
[See: 10 Lessons From Empowered Patients.]
The important message, stress the experts, is that you seek help for MS-related driving problems as soon as possible — for your own safety and for the safety of others on the road.
More from U.S. News
Which Practitioner Do I See, and When?
8 Unexpected Signs You’re Stressed
10 Questions Doctors Wish Their Patients Would Ask
Can You Drive If You Have MS? originally appeared on usnews.com
