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Hi, I'm Karl TBI survivor and member of BIND.
And Hi I'm Carrie a stroke survivor and a member of BIND as well and today we have Christine Nelson with us. She's a licensed occupational therapist and also a certified driver specialist certified Driver Rehab Specialist. Trying to say it without reading. Um, with a background in neurorehabilitations. She has an MBA in strategic management and oversees the operations across all the PATE locations. So, Christine, welcome. We're happy to have you here today.
Thank you so much for having me. Absolutely. Pleasure to be here.
Welcome to BINDWAVES, the official podcast of the Brain Injury Network of Dallas. I'm Brian White, BIND's Executive Director. On each episode, we'll be providing insight into the brain injury community. We'll be talking to members and professionals regarding their stories and the important role of BIND's Clubhouse. We work as a team to inspire hope, community, and a sense of purpose to survivors, caregivers, and the public. Thank you for tuning into BINDWAVES.
BINDWAVES Let's get on with the show.
Great. Well, and we know, like, independence is key for brain injury survivors, and one of the biggest ways to get our independence back is driving. I know that's one of the questions that every new brain injury survivor Asks me. So that brings us to our first question is who decides when someone's ready to go back to driving?
That's a really great question. It's actually a, it's a team decision, really. I mean, the families, um, you know, the, the brain injury survivor, um, ultimately it's the decision of the department of public safety, the DPS, and there's a medical advisory board within that department. So, um, they have the ultimate decision making capacity, but really, um, uh, the doctor weighs in on the decision. A lot of times the treatment team, um, the family, the survivor themselves.
So, but the ultimate say is the DPS.
So, ultimately, what exactly is the process for someone with a brain injury to get back to driving?
So, there's a lot of different ways you can go about getting back to driving. But the first thing to do is usually to talk with your doctor. Um, the doctor can, um, can let you know if you're medically, um, you know, fit to drive if you're medically at that point. And then a lot of people choose to go through a driver rehab program. Um, and it's a really good idea because you get an assessment of all the different skills related to driving in that kind of a program.
Um, if you go through a driver rehab program, you'll know if you're, if you have the physical capacity or whether you might need some adaptive equipment. Um, you'll get, um, cognitive testing, vision screening, those kinds of things. So, um, If you go through a driver rehab program, um, you'll know when it's time to get out on the road and start doing maybe some driving training.
Um, with a, um, driver rehab specialist or even a driving school if, if maybe you don't have a lot of, um, um, therapy needs, maybe you just go to a driving school and get some time out on the road to see if you're, you know, ready to take the, the driving test again and then when you get kind of through that program, you'll go to the DPS and you'll, you'll retake the test with them and you'll be, you should be ready to go at that point.
Are there any additional steps that a brain injury survivor needs to take to, um, get their license renewed after having a brain injury?
Yeah, so it's because in Texas the doctors are not, it's not a mandatory report state. So doctors don't have to, you know, report to the medical advisory board if, um, if there's a brain injury. So it's really, um, the individual driver's responsibility to disclose their brain injury to the DPS. And with that, um, being said, once you've disclosed that, um, that injury, they'll usually have you retake the test.
Um, sometimes I will say there are some DPS offices that we've been to that, um, that they'll take like a, a driver eval from, you know, um, from us or that kind of thing. But if you go through a driving program that is a driving school, a lot of times you can take the test with them. Um, but extra steps, you have to have a valid license when you go to take the test. So a drive, either, either a valid permit or a valid license.
So if your license has expired, Um, in, you know, during your injury, you have to get it renewed first before you can retake the test. Okay.
Is there anything that, uh, has to be done differently for visual motor, uh, problems?
Yeah, so a lot of people with brain injuries do, um, experience maybe some, um, impaired reaction time, visual motor reaction time, that kind of thing. So we do some of the testing, um, for that in these driver rehab programs. There's almost always some way to assess. You know, are people able to process visual information and react to it in a timely manner? So there's a lot of different ways we can do that.
We can use, um, computer, you know, type tests where a, you know, a stimulation is put on the, stimuli is put on the screen and then you have to react as quickly as you can. Um, sometimes it's like a DynaVision. Sometimes it's a, um, a pedal that you have to hit, like a brake pedal you have to hit once you see, So we do have a way to test it, and depending on what method you're using, there are some, like, protocols.
If it's below this visual reaction time, it's probably not a good idea to get on the road at this time. So, yeah, there are some ways we can test that and work on those things.
Okay, and then kind of going back with the license, I know a lot of people with brain injuries end up with seizures. Mmhmm. Are there different guidelines if you have seizure problems? As opposed to just brain injury?
Yes, so in the state of Texas, it's different. Every state kind of determines their own rules, but in the state of Texas, if you have ongoing and persistent seizures, you are not permitted to drive. However, if you don't, if you just have intermittent or it's been a while, you've had a seizure there for a Class C license, you have to be three months Seizure free.
There are different guidelines for, um, like more commercial licenses or like, you know, um, Class A, AB, you know, you have different, um, guidelines, but for Class C, which most of us are, uh, have, that would be at least three months seizure free. And that's, that's for, you know, someone that isn't, hasn't experienced pervasive ongoing seizures. So it's, it's definitely, there are some guidelines and then that's something to talk to the doctor about.
As some certain medications, um, And certain, you know, there are certain things that increase seizure risk, and so you'd want to talk to your doctor about those things. Because even if it's been three months, you don't want to increase your seizure risk and then, you know, be driving, so.
Are there any basically common reasons for brain injuries to be denied from getting their license back?
Sure. Some of the kind of more pervasive things that happen to be the case with brain injury survivors is sometimes, um, like attention, um, working memory. A lot of the executive function stuff, stuff that goes on in your frontal lobe, those are the kinds of things that sometimes make it hard to return to driving or to be fit to drive.
As you can imagine, um, you know, your distractibility, you know, your ability to attend to the things that you're supposed to and not get distracted by something that's not important, like a noise in the back seat or the radio or those kinds of things. So attention and memory are kind of some of the big ones. Um, there are other things that can sometimes happen where someone can get, um, Um, you know, maybe quickly, like you're, uh, maybe quick, quick to anger, those kinds of things.
Obviously that would put you at risk for driving. But other things, you know, sometimes, um, you know, having some visual spatial issues, like if you, if you have a, like, maybe a right parietal brain injury and you have visual spatial issues, sometimes it's hard to, you know, detect distance or gap, you know, like, is there a large enough gap for me to pull out in front of that car?
You know, so the visual spatial stuff, um, also, um, um, You know, sometimes people with brain injuries have field cuts. And there are some restrictions on field cuts if they're not compensated, if you're not able to compensate for them, like, um, and then also things like left neglect, those kinds of things.
Yeah, I know that. I worried about that a lot.
Right. So you probably had to work, you know, hard to overcome and to compensate for some of these visual spatial things.
Yeah, I did. And I still drive in the middle lane just to be safe.
So you have a strategy. Yeah, exactly. So learning strategies, learning to compensate for what you know is going on. And that's where, A comprehensive driver rehab program can really help, um, because you, you can, you can figure out what your issue is and work on that specific thing, so.
And I know, like, some people have memory issues and, like, remembering where to go. We have GPS, which is great now, but how does, like, aphasia or memory affect, Being able to drive.
So, people with aphasia, you know, generally, that doesn't, you know, preclude people from being able to drive, um, because, you know, especially in familiar environments, you are going to have trouble, like, reading signs, potentially, communicating with other people out on the road, like, if you get pulled over, those kinds of things.
So, there, there are things that if you have aphasia, you kind of need to do differently, but usually, aphasia doesn't, it doesn't, just because somebody has aphasia, even if it's fairly severe, it doesn't mean they can't drive. The other thing that usually goes along with aphasia, though, is, you know, difficulty with movement of the right side of the body, right?
So you might need some physical, if you had a left hemisphere stroke, you might need some accommodations for your physical impairments as well. But aphasia alone doesn't, you know, doesn't preclude you from, or, you know, doesn't exclude you from being able to drive. There might be some strategies that you have to use.
Speaking of that, what other modifications to vehicles are available for the brain injured?
Yeah, so there's a lot of things. Um, like I already kind of mentioned the right, you know, movement problems on the right side. Well, think about all the things you do or you need to be able to do on the right side. And the same thing if you have, you know, a left sided, you know, a left hemiparesis, you might not be able to do the turn signals and things like that as the car is made. But there are some items like crossover turn signals. You can move the turn signal to the right side.
Or you can use a left foot accelerator so that you're not having to use your right leg to push on the gas. You could actually use a left foot accelerator. So you can drive primarily with the left foot. It takes some, takes some practice. You don't want to just go out on the road and do that. But with, with a therapist working with you and you know, there's a lot of adaptive equipment.
There's spinner knob on your, on your steering wheel so that you don't, you know, so you can drive one handed better. There's a lot of different things. There's mirrors that you can have, um, placed in certain places to help you, um, to help you see if you have difficulty with like neck mobility or, or that kind of thing. So there's quite a bit that can be done. Nice.
Yeah, that's cool. I have a, my mother has a friend who has a PT Cruiser that was modified so that she could, you know, Can roll her wheelchair up into it from the back and exactly and then drive that way which I think isn't
Yeah so when you start looking at other, you know other Types of injuries like spinal cord injuries things like that, which I know isn't the topic of this conversation But it's amazing. You can drive from your wheelchair. You can drive with completely adapted equipment like a lot of basically what we consider high tech equipment where you don't have to have a lot of movement to be able to drive. It's pretty neat.
It sounds like it. Um, what, I guess what that goes along, all those modifications cost a lot of money. Are there any programs or companies or grants that help fund that kind of stuff?
So, there, I'm not aware of a lot of grants. Um, there are some, depending on the diagnosis, sometimes like the, like, um, associations, um, like, I'll just give you an example even though it's not brain injury related, but like the ALS foundation might have some money for somebody for driving equipment. But what, what we see a lot of times in brain injury is that the, um, if you're returning to drive will help you get back to work.
The Texas Workforce Commission, the voc rehab program will a lot of times pay for adaptive equipment in vehicles or driving programs because it helps that brain injury survivor get back to work. And so they buy it, um, the equipment for you, um, if you qualify. And then if you got hurt on the job, um, Workers Comp is a funding source that a lot of times will pay for driving equipment. So there are a few things out there.
For the most part, a lot of the driving equipment is private pay and so some, a lot of people will do like a GoFundMe or, you know, some sort of social media request to try to help get funded for driving equipment because it can be expensive.
I can only imagine, yeah. But, um, I guess one of the other questions that I had, I'm trying to remember now, um, Just went out of my brain.
I'm thinking that we'd like to hear about your particular program that you run.
Sure, so at Pate Rehabilitation, as you guys know, we specialize in brain injury rehab and it's post acute, so a lot of our patients are at that point where they're getting ready to return to driving. And I would say what's unique about Pate's program is that it's part of our Day Neuro Program. Like it's not a, it's every aspect of our program is, you know, is to treat your whole, you know, all of your goals.
So if you, if, although we have OT, PT, speech, if you have a goal to return to driving, you're probably working on those driving related skills in all of those therapies. So it's not a distinct Driving, you know, that's all you do. You're going for this comprehensive program, and we know you want to return to driving. So we're incorporating driving related tasks in all of your programs. you know, all of your programming. And so there is a clinical evaluation that we complete.
We get, we help you get a doctor's order for an on the road evaluation. And then, um, we'll take you out on the road and we'll see, you know, how did you do. We have a specific route that tests all the different skills. And the nice thing is, is if you don't, If we feel like, oh, there's a couple of things that we're concerned about, then we work on those things in therapy.
And you might go do some training sessions out on the road, um, or say you have just a little bit of, say it is something like, um, You just have a little bit of weakness in your right foot and it's difficult for you to press the gas as much, you know, as quickly as you should. PT's on it. They're working on that with you in the clinic. So, um, the nice thing is, is then it's part of your comprehensive program. It's covered by whatever insurance you have.
So that's, I think, a really unique aspect about our driver rehab program. Um, it's because it's, it doesn't end up being private pay then, it's part of the program that you're getting.
May I further ask, is it available at all the paid locations, including Fort Worth?
Mm hmm, it is available at all the locations. So we have, um, Right now, we have two driver rehab specialists that take people out on the road. Um, and one is located at the Fort Worth location, and then the person that works at our Los Colinas location also covers driver rehab at our Anna location. So, it's available everywhere.
So, yeah. Is there anything else you'd like to say that we missed? That's put you in the spot.
No, I think you guys did a great job of covering a lot of the basics. Um, so I appreciate you, yeah, having me on and talking this through with me. But the other thing is, I will say is, I know I mentioned as part of our program, we do also offer just driver rehab. If that's, if someone's not in a comprehensive therapy program, say they're a little bit further out, they're done with their therapy, and then later on they decide, hey I do want to return to driving.
We do offer it as a standalone program as well. That's, I probably should mention that, and that is on a private pay basis.
That's nice to know you have that availability. Yeah, it's awesome. Do you recommend that everyone goes back through a certified driving?
You know, not everyone is going to need something that comprehensive. I'll, you know, I think, I think if someone has a mild brain injury, has really good recovery, there's no other issues. Usually, usually driving, driving's a pretty complicated task.
So if someone can like cook a dinner, like a multi course dinner, you know, and they, they're able to multi task, they're able to stay safe, their, their mobility's good, they don't have any vision problems, and they're able to do something like, you know, create a complex dinner. Then they have most of the skills. Like I would, somebody who can do all of that, I would say probably doesn't need to go through a comprehensive driver rehab.
They just need to go straight to the DPS and they can take their test there. Um, if someone's having difficulty with some other aspects of their life, like maybe they're having trouble with multitasking or maybe they notice they kind of get lost in familiar areas, you know, you usually know when you're having You know, you're having trouble with other complex tasks, then you know driving is going to be risky for me. And so going through a program is probably best in those cases.
Okay. It's good to know.
Well, Christine, we really appreciate your time. Thank you for coming. My pleasure. And we would like all the listeners to, uh, to thank you also. Uh, we, we appreciate the listeners for watching you. And, you know, we really think the world of the driving programs that you have. Thank you. Thank you very much.
Thank you guys. Appreciate it.
And for our listeners, again, if you'd like to contact us, you can email us at bindwaves@thebind.org. Um, you can also visit our website, thebind.org/bindwaves. And if you're interested in becoming a member of BIND, or a volunteer to help us out with our different things, you can also just visit thebind.org to find more information.
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Until next time.
We hope you've enjoyed listening to BIND Waves and continue to support BIND and our non profit mission. We support brain injury survivors as they reconnect into the life, the community, and their workplace. And we couldn't do that without great listeners like you. We appreciate each and every one of you. Continue watching. Until next time. Until next time.