Strokes and head injuries result in very similar clinical features, depending on the density of the damage, which areas of the brain were damaged and how large the area of damage was. These include partial or complete paralysis down one side of the body, sometimes with sensory loss resulting in a difficulty knowing where the limb is, or difficulty coordinating movements on that side of the body. Damage to the visual cortex may result in a loss of visual fields. It is very common for people who are affected on the left side of the body to have a blind area on the left and to suffer ‘left neglect’. On visual testing they may be able to see in this area, but in functional activity their brain ‘forgets’ about this area and may not notice objects or activity that is happening on their left. This can be extremely dangerous when driving, so any form of left neglect excludes a person from driving. Even a very mild left neglect becomes exaggerated when they are driving at speed on the road.
Higher cortical functions are frequently affected. These include reduced attention, difficulty with concentrating, poor memory resulting in a tendency to get lost, visuospatial problems, poor planning judgement and decision making skills and difficulty with multitasking. They frequently have difficulty processing a lot of information which results in slow reaction speeds.
Frontal lobe head injuries may result in aggressive and irrational behaviour which may result in road rage. Often people with this type of injury lose their insight and understanding of the effects of their behaviour as well as their reasoning ability. They are not able to rationally judge the impact that a decision that they make may have on another driver. When told that they should not be driving they demonstrate an inability to understand why. People with this type of injury can be extremely dangerous behind a steering wheel.
It is very common for a person to suffer from fits, particularly after a head injury. Any form of epileptic fit excludes them from driving until they are stable and there is minimal risk of another fit. The decision as to whether a person is still capable of driving after a stroke or head injury can be extremely difficult. Research has shown that the best way to assess this is by an on-road driving test, done by an experienced driving instructor. It is important that they work with a therapist who is able to first identify the potential risk areas, before they go onto the road.
The majority of people who are able to return to driving after a stroke or head injury require minimal adaptations. The most common is the use of a steering wheel spinner click here to go to spinners, and an automatic gearbox – this simplifies the driving task and eliminates the need to use the left leg . Depending on the amount of function in the right leg, either the right foot can be used on the accelerator and the left foot on the brake, or a left foot accelerator pedal can be fitted click here to go to accelerator pedals. Should there be any risk of uncontrolled movement in the right leg it is important that the original accelerator pedal is either covered or removed to prevent inadvertent actuation. It is strongly recommended that the individual should undergo driving lessons to master this new driving technique. Any adaptations to the vehicle mean that they must redo their license.