The Driver’s Seat and Parkinson’s Disease: How to Stay Safe and Independent on the Road

“Most people will do well for many years, as long as we address their symptoms,” says Dr. Nicolás M. Phielipp, MD, a neurologist at University of California Irvine Health. “Sometimes it’s hard to realize when things have changed,” he says, though, making it important for you and your loved ones to stay vigilant about your driving capabilities over time.

Fortunately, there are ways to assess how well you’re doing behind the wheel, from self checkups to a comprehensive driving assessment. Here’s how to get started.

• Trouble turning your head to check mirrors
• Forgetting to check mirrors
• Feeling anxious or stressed while driving
• Feeling angrier than usual in traffic
• More near misses or minor mistakes on the road
• Slower reaction times
• Wandering thoughts while driving
• More traffic tickets or similar warnings
• Visual-spatial issues, including hallucinations
• Finding dings and dents on your vehicle
• Driving during “off” periods
• Family and friends expressing concerns about your driving
  

If you’re still not sure if you’re safe behind the wheel, Dr. Phielipp recommends asking yourself if you would feel safe driving your grandchild (or another vulnerable loved one) in your car. If you’re starting to have some concerns, he recommends getting a formal driving evaluation.

If you want to take things a step further than a self-assessment, seek out a certified driving rehabilitation specialist (CDRS), who can administer a comprehensive driver evaluation. These specialists, certified by ADED: The Association for Driver Rehabilitation Specialists, will either have a healthcare background or extensive experience in driver rehabilitation.

Amalie Andrew Ward, a CDRS at MedStar Good Samaritan Hospital in Baltimore, says she uses her medical knowledge to assess people’s ability to drive after they’ve been diagnosed with a new disability. She recommends finding a CDRS via ADED, the American Occupational Therapy Association, or your state’s motor vehicle association.

Once you’ve booked your two-part evaluation, here’s what you can expect:

• Clinical Assessment The first step is an assessment that includes a vision test, a strength test of your arms and legs, and a sensation test. “We also have some pencil-and-paper cognitive testing,” says Ward. The CDRS also takes background information, such as your health history, whether you’re right- or left-handed, and what medications you’re taking. This will help you figure out the best time to schedule the assessment, accounting for how medications may affect your driving.
• Behind-the-Wheel Test “This takes place in our adapted driving vehicle, with extra mirrors and a brake on the passenger side,” says Ward. You’ll start in a parking lot and then move onto smaller roads and, eventually, busier streets. “By the end of the hour and a half, if you’re doing well, we’re on the highway, making sure you’re able to drive in all conditions,” she says.

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If the CDRS determines you can still drive safely, they’ll also recommend some helpful car modifications and other routine adjustments to make to continue driving.

“If the person is having tremors or spasms in their leg during the brake reaction test, and they can’t get their foot to the pedal, that’s a problem,” says Ward. In this case, the CDRS will teach you how to drive with hand controls, where you control the gas and brake with your arms, using a steering knob with the other arm.”

Another issue Ward sees frequently in people with Parkinson’s is forward posturing or a really stiff neck that makes it hard to turn their head when reversing or checking blind spots. For this, Ward says, they can train you on how to position your mirrors for maximum visibility.

“We can also add additional mirrors, such as an all-view mirror, which clips right on top of your regular mirror,” says Ward. She also recommends getting mirrors that clip to the tops of your side mirrors to extend visibility.

Other physical modifications include a left-foot gas pedal and a signal crossover bar so you can use your turn signal with your right hand

You can easily buy the mirrors online or get a prescription to purchase adaptive equipment from a National Mobility Equipment Dealers Association Quality Assurance Program certified vendor. Afterward, you’ll return to the CDRS to be trained on how to use the equipment.

As for when you should be hitting the road, Phiellip advises scheduling driving for when medication is working best and avoiding driving if you feel any drowsiness. And limit high-risk driving conditions, such as driving at high speeds, on the highway, or while multitasking.

He also recommends staying active to manage Parkinson’s and support your driving abilities. Phiellip says this includes “things that would challenge your mind and keep you fit, physically and mentally,” such as exercise, learning new things, and social interaction.

It’s normal to be fearful of needing to give up driving because of Parkinson’s, but the good news is that many people can continue to drive long after being diagnosed. The key is to work with your doctor — and, eventually, a CDRS — to ensure you’re able to stay safe on the road for as long as possible.

• Having Parkinson’s disease does not mean having to give up driving right away.
• Start by performing a self-assessment of your driving skills and how you feel behind the wheel.
• Reach out to a certified driving rehabilitation specialist for a comprehensive driving assessment to see where you might be having some challenges.
• To stay safe, listen to your specialist’s suggestions and make any physical modifications to your vehicle, as well as behavioral changes to your driving routine.