Posts Tagged driving

[WEB SITE] Driving after brain injury

Although we may take it for granted, driving is a very complex activity requiring a number of cognitive and physical skills, as well as the ability to co-ordinate these. Any of these skills may be impaired after a brain injury.

Can I drive after brain injury?

Fortunately, many people who have sustained a brain injury retain most of their previous driving abilities, and are able to return to driving soon afterwards. However, there are legal requirements which must be adhered to.

It is sensible to take precautions such as having a driving assessment, even if you feel that your driving skills remain intact. It should be remembered that a car is a potentially lethal weapon: many people with a brain injury were themselves injured in a road traffic collision.

It can be relatively straightforward to make adaptations to a vehicle in order to compensate for physical disabilities. However, the less obvious effects of brain injury – on thinking, memory, judgement, decision making and emotions – can be more difficult to overcome.

Ultimately, the decision on whether someone is safe to drive lies with the licensing authorities. This booklet explains the processes involved in reporting a medical condition and provides advice on minimising cognitive and physical impairments.

What are the legal requirements for driving after brain injury?

If you drive and have had a brain injury, you must inform the licensing authorities. This applies to any ‘notifiable’ condition which could affect your ability to drive and failure to inform the authorities could result in a fine of up to £1000. It would also mean that your licence is not valid and that you would be uninsured in the event of an accident.

As a general rule, the medical standards state that after a traumatic brain injury drivers with an ordinary car or motorcycle (Group 1) licence should cease driving for 6 to 12 months, depending on factors such as post-traumatic amnesia, seizures, and clinical recovery. Other forms of acquired brain injury have slightly different rules, but if there are lasting impairments which affect driving ability then the licence is likely to be removed for a period.

However, because every brain injury is different, each case is considered on an individual basis.

Further information on the legal requirements, rules for professional drivers and how to inform the authorities is contained in the Headway booklet Driving after brain injury, which is available to download in the Related resources section.

Support with driving after brain injury

As your driving ability can change after a brain injury, you may need support to get back on the road.

If you are receiving the higher rate mobility component of Disability Living Allowance or the enhanced rate moving around component of Personal Independence Payment, you may be able to get a car through Motability. They also have a list of accredited suppliers who can make adaptations to your car if you find it hard to operate because of a physical disability.

You might need to get an assessment before getting back on the road, to see if you are fit to drive and/or to get advice on adaptations you might need. For more information, contact Driving Mobility.

Further information

Our booklet Driving after brain injury (PDF) provides detailed information on the subject, from the legal requirements and the effect of brain injury on driving, to the process of returning to driving and financial support for those who wish to do so.

You can download it now using the link above or through our information library.

via Driving after brain injury | Headway

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[Abstract] Driving rules : first seizure and epilepsy.

For patients with epilepsy, the occurrence of a traffic accident due to an epileptic seizure is a major problem. In order to reduce the risk of an accident, the Road Traffic Commission of the Swiss League against Epilepsy has issued guidelines concerning the driving ability of a vehicle in case of epilepsy. These directives were last modified in 2015. According to these directives, the waiting period differs according to the category of the vehicle concerned and the origin of the event (first crisis provoked or not provoked). At the occurrence of the first episode, an exhaustive evaluation is mandatory in order to avoid unnecessarily prolonged restrictions. These directives are available on :


via [Driving rules : first seizure and epilepsy]. – Abstract – Europe PMC

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[WEB SITE] Driving and Epilepsy: Issues to Discuss With Your Patients

epilepsy, driving

Dr Sanchez is Assistant Professor and Dr Krumholz is Professor Emeritus, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD.

Worldwide there are more than 65 million individuals with epilepsy.1In the US because driving an automobile is such an important aspect of our culture, driving restriction is an enormous problem for many of these individuals and their families. Indeed, surveys find individuals with epilepsy report driving as a major concern.2 Physicians and other medical providers play an important role educating and counseling people with seizures and their families regarding driving. Here, we provide some background and guidance regarding this issue.

Individuals with seizures are restricted from driving because of concerns that a seizure while driving might result in loss of control of the vehicle and a crash, potentially injuring the driver or others, and damaging property. Tragically, such crashes cause fatalities.3 Therefore every state in the US restricts some individuals with epilepsy from driving. Driving restrictions vary by state and are ultimately determined by the Department of Motor Vehicles (DMV).4 Physicians and other medical providers are involved to varying degrees throughout this process of driving regulation and restriction. They serve as advisers to patients, with a duty to inform patients regarding rules and regulations as well as consultants to state regulatory authorities.

To properly counsel patents, it is important that physicians and other medical providers are familiar with the rules governing driving for patients with seizure disorders. Our recommended approach to counseling patients with seizures and epilepsy regarding driving is illustrated in some of the following examples and discussion.

Case example
A 23-year-old woman presents to your office with new-onset seizures. She generally feels well, has no other relevant history, and her examination is normal. Brain MRI with and without contrast and EEG were performed and were normal.

Question: As the medical provider, how would you counsel this patient regarding driving after her first unprovoked seizure (a seizure not related to an acute precipitating cause)?

Answer: She should be informed that a seizure while driving could be dangerous and result in a motor vehicle crash. Since she has had a seizure, she is at risk for further seizures. Regulations exist in an effort to prevent injury, death, or property damage that might result if a seizure were to occur while driving. She should be informed to stop driving and that patients are required by law to report their seizures to the DMV in their state. In some states, physicians and other medical providers are also required to report (Table 1) that a patient has had a seizure.4 The DMV will determine when she may resume driving.

A seizure-free interval is typically necessary for the DMV to approve a person to drive after a first seizure, this too varies by state. The typically required seizure-free interval may be as short as three months to as long as one year.4 There may be positive or negative modifiers that shorten or lengthen the seizure-free interval (Table 2).5 Antiseizure medication (ASM) is not always prescribed after a first seizure; this is a variable that may be considered on a case by case basis.6

After reporting her seizures to the DMV, the patient and the medical provider are required to complete paperwork regarding the condition. A medical advisory board or similar type of state review will consider the case and make recommendations. Then a final decision regarding any driving restrictions will be made by the DMV. Decisions may be appealed by the patient.


via Driving and Epilepsy: Issues to Discuss With Your Patients | Neurology Times

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[VIDEO] Epilepsy is manageable but beware the risks

A person with a seizure disorder may put lives of others at risk. Photo: Thato Mahlangu.

Being epileptic doesn’t mean you cannot drive a car, according to Epilepsy SA.

It is, however, important for people with epilepsy to understand that the decision to drive is a great responsibility since they could be putting the public at risk if they lose consciousness while behind the wheel.

It was not only a seizure itself that could cause an accident but the anticonvulsant medication epilepsy sufferers take could result in drowsiness and lead to loss of control of consciousness.

ALSO READ: Urgent search launched for man with epilepsy

“Not all people who appear to have seizures have epilepsy,” said ER24 chief medical officer Dr. Robyn Holgate.

“About ten percent of the population will have seizures, and only one percent will be diagnosed with epilepsy.”

Holgate said that while some epilepsies were genetic there were many causes.

The condition can be traced to various factors, including:

– Head trauma as a result of a car accident or other injury.

– Brain conditions such as brain tumours or strokes can cause epilepsy. (Stroke is a leading cause of epilepsy in adults older than age 35.)

– Infectious diseases, such as meningitis, AIDS, and viral encephalitis.

– Prenatal injury. Before birth, babies are sensitive to brain damage that could be caused by things such as an infection in the mother, poor nutrition or oxygen deficiencies.

Watch the video here:

The myths about epilepsy that should be debunked, include:

– Swallowing one’s tongue during a seizure.

“It is physically impossible to swallow your tongue. If left on your back, your tongue may obstruct your airway, but it’s not possible to swallow your tongue,” she said.

– You should force something into victim’s mouth when they are having a seizure.

“Absolutely not. This could damage teeth, the patient’s jaw and gums. The correct first aid technique is to gently roll somebody onto their side and put something soft under their head (such as a pillow). You should also never restrain somebody having a seizure.”

– Epilepsy is contagious.

“You cannot catch epilepsy from another person.”

– Only kids get epilepsy.

ALSO READ: Why did 94 psychiatric patients have to die?

“Epilepsy may affect people of any age, but in our older population, the causes may be as a result of health rather than genetics.”

– People with epilepsy should not be in jobs with any responsibility.

“Epilepsy is a chronic medical problem, which can be managed with medication. When this condition is well-managed, those suffering from epilepsy can be active and valuable members of society. Some people may be able to identify what triggers their epilepsy. This may include lack of sleep, illness, stress, bright or flashing lights, caffeine or alcohol, and skipping meals. Where a trigger is identified, these triggers should be avoided if possible.”[…]


via VIDEO: Epilepsy is manageable but beware the risks | Centurion Rekord

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[WEB SITE] Local rehabilitation center uses virtual reality to help patients

SPOKANE, Wash. — Virtual reality technology makes it possible to visit a new world, or test drive a new ride from the comfort of your home. But it offers more than just a good time.

Saint Luke’s Rehabilitation Institute is using our region’s first ever virtual reality driving simulator to provide patients with rehab exercises.

“There’s a lot of anxiety of even though they’ve been told by a therapist that they can drive, or that they might be ok to drive, they still have that question of ‘am I ready’ or ‘is this safe?'” St. Luke’s Occupational Therapist Devin Hatch said. “This allows them to get more comfortable.”

Hatch said their virtual reality simulator helps patients who have suffered a stroke, spinal cord or brain injury re-learn safe driving skills before trying it out in reality.

“There was no real good bridge between actual driving and in-clinic stuff,” Hatch said. “So this has given us the bridge to cover the gap of what we do in the clinic and actual on the road driving.”

The VR driving simulator allows Hatch to assess his patient’s brain injury with steering and braking, and how they manage typical distractions they would experience on the road. Scenarios range from city driving to country roads.

“It’s nice to see what people are coming up with and how we can apply that to a health care setting to let people practice things without putting anyone at danger,” Hatch said.

© 2018 KREM-TV

via Local rehabilitation center uses virtual reality to help patients |

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[WEB SITE] Driving after Stroke: What You Must Know

Sometimes the side effects of a stroke can impair your ability to drive. The good news is that 80% of stroke survivors will work their way back to driving safely again. Here’s a comprehensive guide on how to get there.

Warning Signs

First, evaluate your warning signs. This will help you determine if you can drive safely right now or if you need to do some training first. Here are some warning signs of unsafe driving:

  • Driving too fast or too slow for road conditions or posted speed
  • Needing help or instructions from passengers
  • Making slow or poor distance decisions
  • Becoming easily frustrated or confused
  • Getting lost frequently in familiar areas
  • Having accidents or close calls
  • Drifting unintentionally across lane markings

If you’ve experienced any of these signs while driving after stroke, then you aren’t ready to drive yet. And if you can’t attempt driving but want to know if you’ll be able to do so safely, you can ask friends and family members if they’ve seen a change in your communication, thinking, judgement, or behavior. Those who observe you frequently can provide a good outside opinion.

Driving Evaluations

To properly determine if you’re able to drive again, you need to participate in a driver evaluation. During this evaluation, a trained professional can help you determine your readiness and, if you’re not ready, help train you to do so.

A driver’s evaluation will usually include:

  • Assessment of functional availability
  • Reaction time testing
  • Visual testing
  • Perceptual testing
  • In-car testing

To find a qualified driver education training program, ask your doctor or occupational therapist for a recommendation; or you can search for a driver specialist on the AOTA website.

Driving Adaptations

Some physical impairments can be temporarily solved with the use of assistive devices or car adaptations. For example, if you can only use one hand, a spinner knob can be attached to the steering wheel to enable steering with one hand. Also, if your right side is impaired, then a left gas pedal and spinner knob can be installed on your car.


There are also adaptive solutions for stroke survivors in wheelchairs. The National Mobility Equipment Dealers Association is a great resource for adaptive transportation that can help you reclaim independence behind the wheel. Choosing a modified vehicle is a big decision, so be sure to do extensive research before investing.

With the help of trained specialists and adaptive equipment, driving after stroke is a possibility that many stroke survivors can successfully work towards.

Source: Driving after Stroke: What You Must Know – Flint Rehab

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[BLOG POST] Driving After Stroke: Is it Safe? – Saebo

After having a stroke, many survivors are eager to start driving again. Driving offers independence and the ability to go where you want to go on your own schedule, so it is no surprise that survivors want to get back behind the wheel rather than rely on someone else for their transportation needs.

Unfortunately, having a stroke can have lasting effects that make driving more difficult. A survivor might not be aware of all of the effects of their stroke and could misjudge their ability to drive safely. Driving against a doctor’s orders after a stroke is not only dangerous, it may even be illegal. Many stroke survivors successfully regain their ability to safely drive after a stroke, but it is important that they do not attempt to drive until they are cleared by their healthcare provider.


How Stroke Affects the Ability to Drive

Having a stroke can affect an individual’s ability to drive in numerous ways, whether it be because of physical challenges, cognitive changes, or other challenges.


Physical Challenges


After a stroke, it’s common to experience weakness or paralysis on one side of the body, depending on which side of the brain the stroke occurred. More than half of all stroke survivors also experience post-stroke pain. Minor physical challenges may be overcome with adaptive driving equipment, but severe challenges like paralysis or contracture can seriously affect an individual’s ability to drive.


Cognitive Effects


Driving requires a combination of cognitive skills, including memory, concentration, problem solving, judgement, multitasking, and the ability to make quick decisions. A stroke can cause cognitive changes that limit the ability to do many of those things.


Vision Problems


As many as two-thirds of stroke victims experience vision impairments as a result of a stroke. This can include vision loss, blurred vision, and visual processing problems. Stroke survivors with vision problems should not drive until their problems are resolved and they have been cleared by a doctor.




Fatigue is a common physical condition after a stroke that affects between 40 and 70 percent of stroke survivors. Fatigue can arrive without warning, so it is dangerous to drive when suffering from post-stroke fatigue.


Warning Signs of Unsafe Driving


Stroke survivors are not always aware of how their stroke has limited their ability to drive. If they are choosing to drive after their stroke against their doctor’s advice, it is important for them and their loved ones to look out for warning signs that they might not be ready to start driving. Here are some of the common warning signs to look out for:

  • Driving faster or slower than the posted speed or the wrong speed for the current driving conditions
  • Consistently asking for instruction and help from passengers
  • Ignoring posted signs or signals
  • Making slow or poor decisions
  • Becoming easily frustrated or confused
  • Getting lost in familiar areas
  • Being in an accident or having close calls
  • Drifting into other lanes


If you or your loved one is showing any of these warning signs, immediately stop yourself or them from driving until your or their driving is tested.


Driving Again After a Stroke

Before a stroke survivor begins driving again, they should speak with their doctor or therapist to discuss whether or not it would be safe for them to continue driving. Many states require mandatory reporting by a physician to the DMV if their patient has impairments that may affect their driving after a stroke. Even if their doctor clears them to drive, they still will likely need to be evaluated by the DMV before they regain their driving privileges.


Driver rehabilitation specialists are available to help stroke survivors evaluate their driving ability from behind the wheel. There are also driver’s training programs that provide a driving evaluation, classroom instruction, and suggestions for modifying a car to the individual driver’s needs. For instance, an occupational therapist can provide a comprehensive in-clinic evaluation of a client’s current skills and deficits relative to driving.


From there a client could be sent for an in-vehicle assessment for further evaluation by a certified driver rehabilitation specialist (CDRS). They can assess driving skills in a controlled and safe environment. An in-vehicle driving test is the most thorough way to gauge a driver’s abilities. Each assessment takes about 1 hour and involves driving with a trained evaluator or driving in a computer simulator.


The “behind-the-wheel” evaluation will include testing for changes in key performance areas such as attention, memory, vision, reaction time, and coordination. After this assessment the CDRS can determine if the client is safe to drive, can not drive at all, or may drive with additional recommendations.


Often times clients may require certain modifications to their car in order to drive safely. In addition, some clients may benefit from on-going classroom training and simulation training in order to meet safety standards. These are all services that a driver rehabilitation specialist can provide. To help find these resources, The Association for Driver Rehabilitation Specialists has a directory of certified driver rehabilitation specialists, driver rehabilitation specialists, and mobility equipment dealers and manufacturers.


Get Back Behind the Wheel

Many stroke survivors successfully drive after a stroke; however, not all are able to. While reclaiming independence is important, staying safe is the greatest concern. It is important for stroke survivors to listen to their doctors and wait until they are fully ready before attempting to drive again. With some hard work and patience, getting back behind the wheel is possible.


All content provided on this blog is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. If you think you may have a medical emergency, call your doctor or 911 immediately. Reliance on any information provided by the Saebo website is solely at your own risk.

Source: Driving After Stroke: Is it Safe? | Saebo

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[WEB SITE] Hemianopsia and Driving: Are We Asking the Right Questions? –

Laura K. Windsor, O.D., F.A.A.O.  and Richard L. Windsor, O.D., F.A.A.O,

“All great truths begin as blasphemies.”
— George Bernard Shaw

To understand the issues of driving with a homonymous hemianopsia, we have to better define the question. Too often the question is presented as, “Can an individual with homonymous hemianopsia drive safely?” This is the wrong question! The question today should be “Which homonymous hemianopsia patients are safe to drive?” Many research studies have found that even without the kind of clinical patient selection criterion, adaptive devices, therapy and driver’s training that a potential hemianopsia driver should undergo, a significant portion of hemianopsia patients in these studies demonstrated that they may have potential to drive safely.

If we look at the group of all hemianopsia patients, those who are safe to drive will be a very small group. This is owing to the great variability of associated problems of cognition, visual neglect, visual perception, alertness and ability to compensate. No clinician or researcher would ever argue that all hemianopsia patients are safe to drive.

Let us look instead at a limited group of hemianopsia patients for whom the higher order deficits have been screened to rule out cognitive deficits, visual neglect, and poor processing speed. In this group visual field expanders have been prescribed where indicated and the patients trained with these devices and given scanning training. Then these patients have been screened with a behind-the-wheel driving evaluation, we would see a much smaller group. But within that group, would emerge a patients that could have the potential to return to driving.

It is less about the visual field

Another question I see that demonstrates a failure for some to understand where the problem resides is “How much visual field is required to drive safely?” As clinicians that have worked for many decades with hemianopsia patients, we have learned that the visual field defect is only a small part of the driving safety issue. It is usually about the constellation of problems from the brain injury and each individual’s ability to compensate.

While the type and size of visual fields are factors, the higher order cognitive functions are far more important to safe driving than the size of the visual field. These higher cognitive and perceptual functions determine if the patient can safely compensate. The real question should be expanded to, “On a case-by-case basis does this patient with an acquired brain injury from stroke, tumor, trauma or other cause, have the higher-level cognitive skills, compensatory skills, optical devices, experience, stamina driving skills and discipline to drive with a reduced visual field?”

All hemianopsia are not created equal!

Let us look at two patients with identical measurable visual field, both presenting with left homonymous hemianopsias. The first has an isolated stroke in the right occipital lobe no deficits other than the visual field loss. This patient has no visual neglect and no deficits in saccadic eye movements that would impair compensatory scanning and searching into the area of loss. With training and appropriate devices, this patient may have potential to return to safe driving. The second patient has an identical appearing left homonymous hemianopsia but from a stroke in a different location, the right parietal lobe. Thus this patient also has severe left visual neglect, impairments in saccadic eye movements and thus will never return to driving. If we only look at the visual field results, these patients look identical, but they are totally different cases.

If a state law looks only at the visual field loss to determine if driving is possible, they would treat both patients the same, denying them both the option of a driver’s license. While the second patient should not drive, this can needlessly devastate the first patient’s life, robbing the patient of independence, ability to get to work, and to lead an otherwise normal life.

How do we predict safety?

The other question we must ask is, “What tests and evaluations best predict safe driving and what are the potential weaknesses that must be addressed in training?” Various neuropsychological tests can give us information on who may have potential to drive safely. More research to establish which tests give us the most effective data is needed. Additionally, behind-the-wheel research studies continue to expand our information on the unique driving behaviors of the hemianopsia driver.

Driving, however, is a complex function. Prior experience, stamina, motivation, and discipline combined with visual status and mental functioning all can shape the impact on safety. After all the testing and treatments are completed to help select those who show potential to drive, a behind-the-wheel driving evaluation with a driving rehabilitator experienced with acquired brain injury and hemianopsia is needed. Only during the behind-the-wheel examination and training can the full complexity of driving be evaluated and training performed to improve specific skills like lane position, use of optical devices and mirrors.

The most important question is, “Have we learned to treat each person as a unique individual, understanding that impairment, disability and handicap are not one in the same?”

Should state laws prevent all Hemianopsia driving?

Setting an arbitrary visual field width to discriminate against all hemianopsia patients is now seen by many current researchers as a needless burden on the portion of hemianopsia patients that have the ability to return to safe driving. Below is what a number of researchers have observed:

As Dr. Eli Peli, Senior Scientist from Harvard’s Schepens Eye Research Institute stated in Driving With Confidence, A Practical Guide to Driving with Low Vision:

“It is clear that not all people with hemianopia function at the same level and many probably could not drive safely. However, a fair percentage of these patients may compensate for their visual loss to such an extent that they can drive as safely as any driver.”

In Automobile Driving Performance of Brain-Injured with Visual Field Defects , T Schulte, H Strasburger, E Muller-Oehring, E Kasten and B Sabel 1999, American Journal of Physical Medicine & Rehabilitation, researchers performed a driving simulator-based study of six hemianopsia patients and a similar size group of normally sighted. They summarized:

“Contrary to our expectations, the findings showed no reliable difference in the performance of visually impaired and the normally sighted subjects on a driving simulator. …Thus on a practical level our results indicate that the suspension of driving privileges for persons having visual field impairments may be unwarranted on the basis of visual field loss alone.”

In a study by Racette & Casson (1999), Visual field loss and driving performance: a retrospective study Abstracts of the Eighth International Conference Vision in Vehicles, they studied 13 homonymous hemianopsia patients and 7 homonymous quadranopsia patients. They determined those who were unsafe, those who need additional assessment, and those who were safe. Only 23% of the hemianopsia patients were found unsafe and none of the quadranopsia patients were deemed unsafe.

“Clearly, the evidence provided by these reports indicate that homonymous visual field defect and homonymous hemianopia by itself can not be an absolute and inevitable contra-indication for practical fitness to drive.”

A 2009 study, On-road driving performance by persons with hemianopia and quadrantanopia, Investigative Ophthalmology Vis Sci 50 (2) 2009, J. Wood, G. McGwin, J. Elgin, M. Vaphiades, R. Braswell, D. DeCarlo, L Kline, G Meek, K Searcy and C. Owsley studied 22 hemianopsia and 8 quadranopsia patients and a normal control group driving over a 14.1 mile course of city and interstate driving. Two back seat evaluators, who were masked to the status of the patient, evaluated the drivers. They found 100% of normal drivers were safe to drive and 73% of hemianopsia and 88% of quadranopsia patients were safe to drive.

The study concluded that:

“Some drivers with hemianopia or quadrantanopia are fit to drive compared with age-matched control drivers. Results call into question the fairness of governmental policies that categorically deny licensure to persons with hemianopia or quadrantanopia without the opportunity for on-road evaluation.”

Continued research is crucial to define all of the parameters of hemianoptic driving. Information from these studies helps us define the best candidate, the areas of weakness and will guide driving rehabilitation specialists in training these patients.

A study by Bower et al, from The Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts, Driving with Hemianopia, I: Detection Performance in a Driving Simulator, published November 2009 in Investigative Ophthalmology and Visual Science, tested twelve hemianopsia patients without visual neglect or cognitive loss and twelve matched normals on a simulator test over a two hour period. The hemianopsia patients were tested without visual field expanding systems and they demonstrated significantly more difficulty in detection of suddenly appearing pedestrians on their impaired side inside the simulator.

There was great variability in pedestrian detection among the small group of 12 hemianopsia patients with older driver’s demonstrating lower rates. The authors of this study warned that simulator studies may not match results in real world driving and they further suggested that this also means we must look at each driving candidate individually. They stated:

“In determining fitness to drive for people with HH, the results underscore the importance of individualized assessments including evaluations of blind-side hazard detection.”

The same scientists now plan to do similar tests with patients using visual field expanders. Our years of work would support that the visual field expanders and training can help fill in detection of pedestrians in many patients, but more research is needed.

How could states regulate hemianopsia licensing?

It is clear from the research that we cannot make generalizations about the driving safety of all hemianoptic drivers. Thus simply removing visual field requirements could lead to hemianopsia drivers being licensed who have other cognitive or perceptual problems at make them unsafe.

States that still contain absolute prohibitions against driving with homonymous hemianopsias should consider removing these, and replacing them with a process to judge each patient individually based on current science. The process should include mandatory evaluation with a low vision specialist experienced in hemianopsia for evaluation and treatment followed by additional therapy/training as needed including occupational therapy if indicated. Then a behind-the-wheel driving evaluation and training as appropriate to each case with a certified driving rehabilitation specialist should be completed.

Then, the doctor with the report of the driving rehabilitation specialist would file a special application with the state. The states medical advisory committee would review each case individually. If the application is approved, the patient would have to demonstrate adequate driving skills on an extended state behind-the-wheel test by the state driver’s license bureau. Restrictions on type of driving and time of day could be considered in each case cases.

Please contact us if you have any questions:

The Low Vision Centers of Indiana
Richard L. Windsor, O.D., F.A.A.O., D.P.N.A.P.
Craig Allen Ford, O.D., F.A.A.O.
Laura K. Windsor, O.D., F.A.A.O.
Indianapolis (317) 844-0919
Fort Wayne (260) 432-0575
Hartford City (765) 348-2020

From, The Low Vision Centers of Indiana. Used with permission.

Source: Hemianopsia and Driving: Are We Asking the Right Questions?

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[BLOG POST] 17 Things Everyone Should Know About Epilepsy

Written By Drusilla Moorhouse

Don’t you dare put that spoon in my mouth.

1. Epilepsy is a brain disorder that causes seizures, which are basically like electric storms in your brain.

Epilepsy, also known as a seizure disorder, is a disorder of the brain that causes recurrent, unprovoked seizures. Those seizures are caused by surges of electrical activity in the brain, often compared to an electric storm.

Epilepsy is a brain disorder that causes seizures, which are basically like electric storms in your brain.

In most cases, the cause of epilepsy is unknown. “Our challenge now is to understand the genetic architecture underlying each individual epilepsy,” Dr. Ley Sander, medical director at the Epilepsy Society in the U.K. and professor of neurology at University College London, told BuzzFeed. “We are also trying to understand why some people will respond well to a certain drug while others won’t.”

2. Not everyone with epilepsy has convulsive, jerking seizures.

In fact, most people with epilepsy experience “partial” (or focal) seizures. These affect one area of the brain and can result in an aura, physiological reactions, or motor and sensory changes. They can cause a person to stare blankly and/or smack their lips, pluck at their clothing, wander around, or perform other bizarre (but involuntary) actions.

Not everyone with epilepsy has convulsive, jerking seizures.

The dramatic convulsions that most people associate with epilepsy are a result of a seizure affecting both sides of the brain at once. These “generalized” seizures can also cause “staring spells,” brief body jerking, and “drop attacks” (suddenly falling to the ground).

3. When someone’s having a convulsive seizure, keep them safe, supported, and on their side.

When a person is having a convulsive seizure (or you know/they have indicated they are about to), gently roll them on one side (to allow any fluids to drain out of their mouth and keep their airway open), support their head, remove any dangerous objects nearby (including their glasses), and time the seizure.

If a seizure lasts longer than five minutes, call 911.

“Seizures usually end within a few minutes and keeping a person safe from injury during a seizure and paying attention to the seizure duration are the best first aid,” Dr. John Stern, director of the Epilepsy Clinical Program at UCLA, tells BuzzFeed. “If a seizure is longer than five minutes, then the risks may be greater and emergency care may become more important. If a person is not known to already have epilepsy or has a complicated medical condition, then emergency care may be needed sooner.”

When someone's having a convulsive seizure, keep them safe, supported, and on their side.

For other types of seizures, it is important to remain with the person, gently guide them from danger (but avoid restraining them), and call 911 if the seizure lasts longer than five minutes.

4. NEVER force something into the mouth of someone having a seizure.

It’s physically impossible to swallow your tongue, and a “bite block” (wooden spoon, wallet, etc.) could cause serious injury.

A person having a convulsive seizure may briefly stop breathing and have a blue skin color, but Stern explains that “this is mostly due to the diaphragm becoming stiff along with the other muscles for breathing.”

NEVER force something into the mouth of someone having a seizure.

This is normal and brief, and the person will start breathing normally again as soon as their muscles relax. Do not attempt mouth-to-mouth or CPR during a convulsive seizure. Positioning the person on their side with their mouth pointed downward is the best way to keep their airway open.

5. Please remain with the person after they have a seizure to calm and reassure them.

They will be very confused and disoriented (after my first seizure I believed I had been in a plane crash!), and usually surrounded by frightened faces. It is extremely helpful if you are direct and candid and explain what just happened, who and where you are, and try to give them as much privacy as possible.

Please remain with the person after they have a seizure to calm and reassure them.

And if a person has urinated (which can happen with some seizures), cover that up to help limit any embarrassment, suggests Sander. Because after reassuring us and making sure we’re safe, the best thing you can do is help us restore our dignity.

6. Seizures are scary!

Seizures are truly terrifying, whether you’re the person experiencing an aura or someone witnessing a grand mal seizure with convulsions. During a seizure, you lose consciousness, your muscles violently contract (I once broke a bed frame during a seizure), and your skin often turns blue from lack of oxygen.

Although we aren’t awake for the convulsions (and don’t remember them afterward), the aura preceding them (which is actually a seizure itself) is frightening for a host of other reasons: We could just be enjoying a hilarious kitten video at home or out running errands when suddenly we’re overcome by one or more of these unnerving sensations: a feeling of dread, déjà vu, blurry or tunnel vision, a strange sensation in our bellies, and/or the inability to speak.

Seizures are scary!

Fortunately, my own auras last long enough that I’m able to text people to alert them about what’s happening (I have aphasia so I can’t actually tell them) but that also means that I have longer to experience the terrifying knowledge that my brain is about to fuck me up big time.

7. Epilepsy is actually not unlike The Wizard of Oz.

Epilepsy is actually not unlike The Wizard of Oz.

Picture yourself fleeing an evil witch who wants to take your little dog Toto when suddenly a tornado strikes and you’re tossed around in a twister. Then you wake up and don’t know where you are (it’s definitely not Kansas) or why the fuck you’re surrounded by diminutive townspeople singing your praises in an absurdly bright, colorful, and unfamiliar place.

8. Seizure “hangovers” are the absolute worst.

Imagine the worst hangover of your life, combined with food poisoning, a migraine, sore muscles, and memory loss. Like Dorothy in Oz, you don’t just have a seizure and automatically return to normal.

Seizure “hangovers” are the absolute worst.

“A seizure consists of a wave of abnormal electrical activity spreading through different parts of the brain,” explains Dr. Jacqueline French, a neurologist and the chief scientific officer for the Epilepsy Foundation. “Once the ‘wave’ of electricity goes past, the brain that it affected becomes exhausted, and often is unable to function.” That fog and confusion can last anywhere from a few minutes to a few days.

9. Seizures aren’t just triggered by flashing lights.

In fact, less than 2% of people with epilepsy have photosensitive epilepsy, says Sanders. They’re more commonly triggered by stress or being overtired.

Other common triggers include specific times of day or night (for instance, I’ve had most of my seizures just before sunset); sleep deprivation; stress; illness; flashing bright lights or patterns; caffeine, alcohol, or drug use; menstrual cycles or other hormonal changes; poor diet; and certain medications.

Seizures aren't just triggered by flashing lights.

“Epilepsy affects everyone differently,” emphasizes Sander. “Although there can be similarities, people tend to have different triggers for their seizures, while some have none. Recognizing those triggers and trying to avoid them is an important part of self-management.”

10. Having a seizure isn’t the same as having epilepsy.

 Seizures are symptoms of epilepsy, and you can have a seizure (or seizures) without being diagnosed with epilepsy. A diagnosis usually comes when someone has two unprovoked seizures (meaning it wasn’t caused by an injury, infection, drug or alcohol withdrawal, or other health condition) or one unprovoked seizure with the likelihood of more, says Sander.

11. Medications can control seizures in most people with epilepsy.

Anti-epileptic drugs (AEDs), aka anticonvulsants, taken daily can control seizures “by reducing the excessive electrical activity in the brain that causes the seizures,” explains Sander. “The exact mechanism of AEDs is not well understood, but it is likely that different AEDs work in slightly different ways. The aim of optimal therapy is to get maximum seizure control with minimum side effects.”

Medications can control seizures in most people with epilepsy.

According to the Epilepsy Foundation, medication controls seizures in about 7 out of 10 people with epilepsy.

12. Even though there are risks associated with taking anti-seizure medication during pregnancy, for many it would be riskier to stop treatment.

“Although there is no anti-seizure medication that is proven safe during pregnancy, the risks for several are low and are believed to be reasonable in the context of the risks of seizures during pregnancy if treatment is stopped,” says Stern. “Pregnancy is overall safer when the seizures are best controlled, and this should be considered in the planning.”

Faye Waddams, who has documented her experience in the award-winning blog Epilepsy, Pregnancy, Motherhood and Me, tells BuzzFeed, “My neurologist advised me that although there is a risk with any anti-epileptic drug, my epilepsy was so uncontrolled that the risks of not taking it and having a seizure, causing harm to myself and the baby, was greater than any risk from the medication.”

Even though there are risks associated with taking anti-seizure medication during pregnancy, for many it would be riskier to stop treatment.

And although Waddams (pictured above with her son, Noah) unfortunately did have seizures during her pregnancy despite the medication and was hospitalized several times, she is happy to report that she has “a healthy, happy, perfect baby boy who turns 1 this week.” (Waddams also ran a half marathon “nine months to the day” after giving birth to Noah!)

13. People with epilepsy can lead very active lives.

Eric Wheeler (shown above) is a marathoner and triathlete who — like many other athletes — also happens to have epilepsy. According to Stern, “A healthy lifestyle is important for everyone and it should not be avoided because of epilepsy. Moreover, some people with epilepsy find their seizures are better controlled when they are active. Exercise and recreation can help reduce stress, improve mood, and help brain health, which can benefit seizure control.”

Of course, seizures should be well-controlled — through medication, healthy habits (like avoiding known triggers), and sometimes even brain surgery — before a person with epilepsy participates in sports like triathlons.

People with epilepsy can lead very active lives.

As Stern emphasizes, “the activities need to be safe ones with regard to the person’s seizure risk.”

14. Driving is…complicated.

State laws require that most people with epilepsy be seizure-free for six months to a year before they can drive again.

“The driving restrictions vary among the states, but six months is a common period of restriction after a seizure,” says Stern. “This time period is somewhat arbitrary, but it relates to the fact that the likelihood of a seizure decreases as time passes after a seizure. Most of the risk is in the first year and much of it is in the first six months. The six-month period is intended to reduce the risk of injury at the time when the risk of a seizure is highest.”

Driving is...complicated.

The Epilepsy Foundation of America has a helpful database of state driving laws pertaining to epilepsy.

15. Epilepsy is probably more common than you think.

According to the World Health Organization, “Approximately 50 million people worldwide have epilepsy, making it one of the most common neurological diseases globally.”

Epilepsy is probably more common than you think.

Many epilepsy advocacy organizations cite a startling statistic: One in 26 people will develop epilepsy in their lifetime. That number, based on a life expectancy of 80 years, “seems inaccurate because people do not talk about epilepsy even when they have it. In actuality, epilepsy is more common than Parkinson’s disease, multiple sclerosis, ALS, and cerebral palsy combined,” asserts French, the Epilepsy Foundation’s chief scientific officer.

16. And we’re in good company with lots of famous people.

And we're in good company with lots of famous people.

Celebrities with epilepsy include Prince (who referenced his childhood epilepsy in the song “The Sacrifice of Victor”), the Beastie Boys’ Adam Horovitz, Danny Glover, Lil Wayne, Neil Young, NFL twins Tiki and Ronde Barber, and Harriet Tubman.

17. People with epilepsy are strong and resilient as hell.

It’s easy to get caught up in the things that people with epilepsy lose: our dignity, our independence (especially when our driving privileges are revoked), and, for many, our ability to participate in certain activities ranging from scuba diving to bathing (because of the risk of drowning).

That’s why we appreciate every moment we have without a seizure, finding an anticonvulsant that is effective without debilitating side effects, and victories like being seizure-free for six months and longer.

People with epilepsy are strong and resilient as hell.

We’re fighting like hell to not only manage this disease but also dispel the stigma associated with epilepsy. We are people to admire, not fear, and the best thing you can do for us is to learn more about this disease and first aid guidelines. Don’t be afraid to ask us questions — we want to talk about it!

Source: 17 Things Everyone Should Know About Epilepsy – health care vision

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[WEB SITE] Study Sheds Light on Safety of Driving With Epilepsy

By Robert Preidt

Monday, December 5, 2016

HealthDay news imageSUNDAY, Dec. 4, 2016 (HealthDay News) — People with epilepsy who experienced longer seizures during a simulated driving test may face an increased risk for crashes while on the road, a new study suggests.
About 75 percent of people with epilepsy use medication to control their seizures and are able to drive. The remainder of patients typically keep a journal of seizures, noting how long they last, and doctors use that information to determine whether patients can drive safely, the study authors explained.The new study included 16 people with epilepsy who used a driving simulator for between one to 10 hours, most for an average of three to four hours. In total, the patients had 20 seizures, seven of which resulted in “crashes.”

The longer the seizure, the greater the chance of a “crash.” Seizures lasted an average of 75 seconds among patients who crashed and 30 seconds among those who didn’t crash.

The study was to be presented Sunday at the annual meeting of the American Epilepsy Society, in Houston.

“Our goal is to identify if certain types of seizures — coming from a specific part of the brain or causing a particular brain wave pattern — are more likely to lead to a crash. That information could then be used by doctors to objectively determine who can safely drive and who should not,” said study author Dr. Hal Blumenfeld, director of the Yale Clinical Neuroscience Imaging Center, in New Haven, Conn.

Blumenthal, who is also a professor of neurology, neuroscience and neurosurgery at Yale, added that it isn’t clear why people who have longer seizures are more likely to crash.

“It’s going to take a lot more data to come up with a reliable way of predicting which people with epilepsy should drive and which should not,” Blumenfeld said in a news release from the epilepsy society.

“We want to unearth more detail, to learn if there are people with epilepsy who are driving who shouldn’t be, as well those who aren’t driving who can safely drive,” he said.

SUNDAY, Dec. 4, 2016 (HealthDay News) — People with epilepsy who experienced longer seizures during a simulated driving test may face an increased risk for crashes while on the road, a new study suggests.

SOURCE: American Epilepsy Society, news release, Dec. 4, 2016

Source: Study Sheds Light on Safety of Driving With Epilepsy: MedlinePlus Health News

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