Life with MS

 

Driving is an important activity of daily living and one that is needed to maintain a good quality of life. As of 2009, there were about 210 million licensed drivers (approximately 68 percent of the population) in the U.S. However, driving is risky and sometimes results in crashes. Driving can be more challenging for individuals with multiple sclerosis. One study showed an accident rate three times higher for individuals with MS than age-matched individuals with no diagnosis of MS.

 

Nevertheless, a diagnosis of MS does not automatically mean giving up one’s driving privileges. Many individuals with MS continue to drive safely and react to all traffic situations as well as any age-matched individuals with no diagnosis of MS.

 

The burning questions are “when is it advisable for an individual with MS to stop driving?” What are the common signs to look for? There is currently no specific guideline for when individuals with MS should stop driving.

 

MS is a progressive neurodegenerative disease. The Expanded Disability Status Scale is used to describe the progression of MS. As the EDSS rating increases from 0 to 10, the ability to continue with safe driving decreases. In a 2009 study led by Maria T. Schultheis of the Department of Psychology at Drexel University in Philadelphia, MS drivers reported driving less than those with no diagnosis of MS. Drivers with advanced disease severity (EDSS between 3.5-6.5) drove less than those with mild disease severity (EDSS between 1.5-3.0).

 

Reasonably safe conclusions that can be drawn from current research on the ability of individuals with MS to continue safe driving include:

 

• The ability to continue safe driving can be affected by MS.

 

• Each case is unique and should be treated individually.

 

• As the severity of MS increases, the likelihood for impaired/unsafe driving performance increases.

 

• In the early phase of MS, safe driving is usually not a major concern.

 

• As MS progresses and one starts to experience any of the signs listed below, it is necessary to start discussing continued driving with family members, caregivers, personal physician or any other healthcare provider.

 

• If one starts to experience two or more of the signs below, it is necessary to be officially evaluated for fitness to drive.

 

Common signs it is time to evaluate continued ability to drive safely include the following:

 

• When one starts to be very sensitive to what time of the day to drive because of difficulties with driving at certain times: for instance, when the preference is to avoid driving during rush hour or other heavy-traffic periods because of concerns of tiredness, slow reaction to traffic, and slow decision-making, or driving at night because of concerns of poor vision.

 

• When one starts to limit the frequency of driving because of concerns of general safety or doubt in the ability to react in a timely and accurate manner to hazardous traffic situations.

 

• When one prefers to drive alone because of concern of distraction by the other persons in the car or because of fear that one’s impaired driving performance has been observed.

 

• When driving remains difficult despite modifying the vehicle as much as possible.

 

• When family members, friends, caregivers, and/or healthcare providers start to express concern regarding the ability to drive.

 

For personal safety and that of other passengers in the vehicle and other road users, it is important for drivers with MS to discuss their driving concerns freely and, when necessary, perform a fitness to drive evaluation. Such evaluations are usually administered by a driving rehabilitation specialist. Information on the closest DRS can be found at www.aded.net. The evaluation typically involves the assessment of one’s reaction time, strength, and coordination. The abilities to see well and process visual information at the same time are also assessed during the evaluation.

 

The good news is that, if detected early, there are promising methods that can help with retraining the affected driving skills. Studies are ongoing to look at the best training methods and the potential benefits of training.

 

Dr. Abiodun Akinwuntan is a professor in the departments of Physical Therapy, Neurology, and Ophthalmology, as well as director of the Driving Simulation Laboratory, and associate dean for Research in the College of Allied Health Sciences at Georgia Regents University in Augusta, Ga.
 

Dr. Hannes Devos is currently Assistant Director of the Simulator Lab and Assistant Professor of Physical Therapy, Neurology, Ophthalmology, and Graduate Studies at Augusta University, Augusta, Ga.