🚘 TBI Recovery in Michigan: How OT Gets You Driving Again 🧠

For many survivors of a traumatic brain injury (TBI), the ability to drive represents independence, freedom, and a return to normal life. However, regaining this skill after a car accident or other head trauma requires more than time. It takes expert evaluation, cognitive and physical retraining, and emotional readiness.

Why Driving Is Complicated After a TBI

After a TBI, especially one caused by a motor vehicle accident, many individuals experience changes in:

• Attention and reaction time

• Visual perception and depth perception

• Problem solving and decision making

• Emotional regulation and impulse control

• Fatigue and motor coordination

These challenges make driving not only more difficult but also potentially dangerous if not properly assessed and rehabilitated. Occupational therapists play a vital role in evaluating driving readiness and creating individualized plans to restore skills (Classen et al., 2014).

How Occupational Therapy Supports Driving Rehabilitation After Brain Injury

1. Comprehensive Evaluation of Driving Readiness

A licensed occupational therapist trained in driving rehabilitation begins with a holistic assessment:

• Cognitive testing for attention, memory, and executive function

• Visual motor integration screening

• Physical strength, coordination, and endurance assessment

• Screening for mood disorders, frustration tolerance, and safety judgment

Occupational therapists may also partner with Certified Driver Rehabilitation Specialists (CDRS) to complete a behind the wheel evaluation using a dual controlled vehicle. These evaluations align with best practice guidelines developed by the American Occupational Therapy Association (AOTA) and the Association for Driver Rehabilitation Specialists (ADED) (AOTA, 2020; Classen et al., 2014).

2. Skill Building and Neurorehabilitation

If the evaluation shows the individual is not yet ready to return to driving but demonstrates potential, a targeted therapy plan is developed to support progress:

• Cognitive retraining through simulated navigation, multitasking, and divided attention exercises

• Visual scanning and tracking activities

• Reaction time drills using software, lights, or real world tasks

• Executive function training that includes route planning, decision making, and navigating traffic scenarios

Occupational therapists may also use driving simulators, which allow for safe, controlled practice of real world scenarios while promoting brain rewiring through neuroplasticity (Lew et al., 2009). A study by Devos et al. (2015) found that simulator based rehabilitation significantly improved on road performance and reduced errors in drivers with brain injuries.

3. Adaptive Equipment and Training

For clients with co-occurring physical or visual impairments, occupational therapists recommend and provide training in the use of adaptive equipment such as:

• Hand controls

• Left foot accelerators

• Spinner knobs

• Extended mirrors or visual supports

These tools are introduced only when they align with safe, functional recovery and are often reviewed in collaboration with a CDRS or Michigan based driver rehabilitation program. Therapists also help with documentation for medical clearance and licensing through the Michigan Department of State.

4. Support for Emotional Readiness and Confidence

Driving after a brain injury can come with a sense of fear, grief, or anxiety. Occupational therapy addresses emotional readiness through:

• Graded exposure to driving environments

• Support in processing trauma or fear of driving

• Confidence building through positive performance feedback and therapeutic coaching

• Education for family members or caregivers to promote safe and supported reintegration

Emotional readiness is a key factor in long term success behind the wheel. Studies show that individuals who receive emotional support in addition to skills training are more likely to regain independence and avoid future accidents (Ponsford et al., 2014).

Real Life Examples

Case Example 1

A 32 year old man recovering from a moderate TBI after a rollover crash began therapy with difficulty managing memory, fatigue, and visual confusion. Through 12 weeks of occupational therapy after brain injury, he progressed from simulator based training to completing a road test with adaptive equipment. He passed his re-licensure exam and now drives independently to work and school. See reference list below.

Case Example 2

A 56 year old woman with a history of severe TBI and hemiparesis after a high speed crash worked with our team to rebuild cognitive stamina, left visual field scanning, and reaction timing. Her therapy included emotional support sessions for driving anxiety. After successfully completing a behind the wheel assessment with a CDRS, she resumed driving locally with hand controls and now volunteers in her community three days a week. See reference list below.

Navigating the Legal and Practical Landscape in Michigan

If your TBI was the result of a car accident in Michigan, it is important to understand the following:

• Michigan Auto No Fault insurance may cover occupational therapy services, including driving rehab and evaluation

• Medical clearance and a specialized driving test may be required before returning to driving

• Occupational therapy documentation may be used to support applications for restricted or reinstated licenses

Our clinic can coordinate with Michigan driving programs, certified driving specialists, physicians, and neuropsychologists to ensure a smooth, legal, and supported return to driving.

The Road Ahead

At Neuroplastic Rehab, we believe that recovery is not just possible, it is achievable with the right support, strategy, and care. You can look up a nearby Certified Driver Rehabilitation Specialist (CDRS) today, or let us know for a list in Michigan. As we continue to learn more about this specialized field, we will provide more information through our website and through our regular articles.

References

1. American Occupational Therapy Association. (2020). Driving and community mobility. https://www.aota.org/practice/practice-settings/driving

2. Classen, S., Monahan, M., & Wang, Y. (2014). Driving rehabilitation programs: A systematic review of intervention components. The American Journal of Occupational Therapy, 68(6), 662–670. https://doi.org/10.5014/ajot.2014.011254

3. Devos, H., Vandenberghe, N., Tant, M., Akinwuntan, A. E., & De Weerdt, W. (2015). Influence of simulator training on driving after traumatic brain injury: A randomized controlled trial. Neurorehabilitation and Neural Repair, 29(3), 287–295. https://doi.org/10.1177/1545968314541345

4. Lew, H. L., Poole, J. H., & Guillory, S. B. (2009). The use of virtual reality in brain injury rehabilitation. Physical Medicine and Rehabilitation Clinics of North America, 20(1), 119–133. https://doi.org/10.1016/j.pmr.2008.06.007

5. Ponsford, J., Sloan, S., & Snow, P. (2014). Traumatic brain injury: Rehabilitation for everyday adaptive living. Psychology Press.