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Neurological Diseases: The importance of a fitness to drive assessment

24 de April, 2024

The global population is aging and the number of drivers with age-related declines in abilities or neurological diseases is increasing. Driving is a frequent concern for family members and caregivers, but also for medical specialists involved in decision-making regarding fitness to drive.

Driving is a complex activity that requires cognitive and motor skills and behavioral control. As we age or develop certain diseases, these skills can be affected and the risk of accidents increases. It is therefore recognized that it is necessary to assess drivers who are elderly or have neurological diseases such as Parkinson’s, Alzheimer’s, stroke, traumatic brain injury, multiple sclerosis, among others, as well as those with psychiatric disorders.

When there are doubts about fitness to drive, it is possible to request a specialized assessment, based on tests that examine skills such as attention, visual perception, coordination and motor speed. Based on objective results, an opinion is drawn up on driving, which may recommend driving without changes, indicate restrictions (e.g., on speed, driving radius) or adaptations to the vehicle, or even suspend driving.

When performances show significant impairment in capabilities and involve a potential risk to driving, suspension of driving is recommended. This result can have a negative psychological impact on the driver and requires increased sensitivity in communication. It is important to allow the expression and validation of the person’s emotions and to clarify why the decline in capabilities increases vulnerability and risk, and that stopping driving is a strategy to protect their safety. There are also situations in which the change in mental state is not evident to the person themselves, which makes it difficult to discuss the need to restrict driving. These patients require special attention because they may represent an increased risk to road safety, due to a lack of self-criticism about their limitations or excessive confidence in their capabilities.

This assessment consultation can be requested by any driver, family member, caregiver or health professional, allowing a specialized and independent assessment of driving fitness, supported by objective performances. It encourages the driver to become critically aware of their abilities and allows family members and caregivers to be relieved of the responsibility of confronting the driver with restrictive measures. Finally, it promotes joint reflection and decision-making to ensure safer mobility.

Driving aptitude training sessions can stimulate cognitive and psychomotor abilities.

When there is a compromise in abilities and potential for recovery, it is possible to carry out driving aptitude training sessions, which aim to stimulate cognitive and psychomotor abilities related to driving, and help in the acquisition of strategies for greater safety. The specific abilities that people must have to drive safely are differentiated into 3 domains: the cognitive domain, which includes attention, perception, movement estimation and memory; the psychomotor domain, which involves various types of coordination and motor reactions; and the psychosocial domain related to attitudes, behavior and emotions. In this way, it is possible to aspire to be able to resume or maintain driving independently and safely.

There are several situations in which driving aptitude training should be scheduled. In the presence of a neurological condition, neurosurgical intervention or physical injury that may affect driving; when a doctor or therapist has concerns related to functional changes and the ability to drive; when family members or caregivers express concerns about the patient’s driving, particularly due to reckless behavior and/or involvement in risky situations and/or accidents; and when a driver has experienced a traumatic event while driving, expresses fear of driving or after a significant period without driving practice. A driver may also benefit from this type of stimulation following recommendations for restrictions or adaptations, or to restrict or suspend driving after an assessment of fitness to drive.

This training consists of performing cognitive and psychomotor tasks with increasing difficulty, adapted to the situation in question. In specific cases, it will include practice in a real driving context. Sessions last 50 minutes, with the number of sessions being defined according to the capabilities and progress of the performances achieved. The vehicle used is the one presented by the driver with circulation requirements, including valid insurance.

Dr. Inês Ferreira, Psychologist at the CNS – Neurological Campus

Dr. Alberto Maurício, Psychologist at the CNS – Neurological Campus