Returning to driving

Driving

For many people, one of the first things they focus on after their initial recovery from their brain injury, is when they can get back to driving. However, as we know, driving uses many complex thinking and physical skills which may have been affected by a brain injury.

You may be safe to drive now or sometime in the future. This will depend on how your brain injury has affected you. Some people will need to have their cars adapted or change to driving an automatic. Other people may have to accept that they are no longer able to drive safely.

Here, we provide you with the current facts regarding returning to driving, along with tips and advice based on research and people’s own experiences.

The current guidelines for drivers with illnesses or disabilities are the Medical Fitness to Drive Guidelines, 2022. These guidelines are updated every year. You will find the latest version on www.ndls.ie. It is your responsibility to check that you have met all current requirements before you return to driving. Speak to your GP for guidance.

How a brain injury affects driving

A brain injury can affect your ability to drive in many different ways. Some of the effects are obvious because they are physical, while other effects can be invisible or hidden.

When we drive, we use many different mental and physical abilities – for example: being aware of our surroundings, ignoring distractions, as well as using the car controls such as the pedals, gears and steering wheel. Many different effects following a brain injury can impact on a person’s ability to drive.

Physical effects include:

• Seizures or epilepsy.
• Weakness in the arms or legs, or paralysis.
• Tiredness (fatigue).
• Difficulties with balance, movement or coordination.
• Changes in your sight or hearing.

Hidden effects include:

• Slowed thinking speed and reaction times.
• Memory – for example: remembering where you are going and how to get there.
• Being more impulsive or prone to anger outbursts.
• Loss of ability to read signs or maps.
• Reduced ability to concentrate, to anticipate danger, to plan ahead or to be aware of your own limitations.

When can I return to driving?

This depends on how severe your injury was and what after-effects you still have. Before returning to drive, you need to allow yourself plenty of time to recover and to adjust to any changes from your brain injury.

If any after-effects you have are likely to impact on your ability to drive safely, you must get yourself checked as safe to drive by a registered medical professional. This can be your consultant or your GP. They must base their decision on their medical judgement and the current Medical Fitness to Drive Guidelines. You can check what the medical guidelines are for your condition at www.ndls.ie.

If you are able to return to driving, it will usually be a number of months after your brain injury. Your doctor may ask you to get an assessment done to help them to make their decision if you are ready to return to driving. You can also apply to get a driving assessment done yourself by contacting your nearest assessment provider.

Driving for a living

This section is mainly for anyone driving their own car. If you drive a truck or a bus, you need to make sure you comply with the Medical Fitness to Drive Guidelines for truck and bus drivers (called Group 2 drivers). The Group 2 guidelines are much stricter than for driving a private car. Talk to your employer and your GP about this.

If you are not able to meet the requirements for returning to work as a truck or bus driver, this does not automatically mean you cannot drive your own car. Discuss this with your GP.

If you cannot drive for work any longer, in most cases, your employer is obliged to take reasonable steps to give you different duties. This known as ‘reasonable accommodation’. Talk to your employer about this or contact Citizens Information for advice t: 0818 07 4000 or visit www.citizensinformation.ie.

Taxi drivers and cab drivers

If you hold a Small Public Service Vehicle licence (SPSV), you are required by law to tell the licensing authority of any illness or physical disability you have that could affect your ability to safely drive a taxi or cab. Talk to your GP or consultant about this. They should tell you if you are safe to return to driving or if you need to report any change in your abilities to the licencing authority.

Physical and hidden changes that affect driving

If your brain injury has caused any of the physical or hidden changes listed, it is important to:

• Give yourself plenty of time to adjust.
• Visit your GP.
• Check with your GP or pharmacist that none of your medications will interfere with your driving.

Hearing loss

Many people can drive safely with hearing loss by using their mirrors more and being more observant of what is going on around them.

Difficulty communicating (Aphasia)

It is possible for people with receptive aphasia to continue to drive. Receptive aphasia is where someone has difficulty understanding written or spoken language. It is advisable to bring someone with you initially to make sure you are comfortable finding your way. Give yourself extra time. Many people who can no longer read road signs or maps find a Sat Nav (Satellite Navigation System) or the map function on their phones, invaluable.

Changes in eyesight and visual perception

You may still be able to drive a motorcycle, car or tractor if you have adequate vision and meet the necessary eyesight standards. Ask your GP or consultant about this.

Perception is the mental process of recognising and interpreting objects, through one or more of the senses. The most important sense for driving is vision.

Depth perception: This is the ability to recognise and interpret the distance from yourself to an object or the distance between two objects. Depth perception is very important in being able to drive safely. If you can only see with one eye, it is possible to perceive depth but it is more difficult than using both eyes.

Physical disability and car adaptations

If your brain injury has affected you physically, it is a good idea to get an in-car assessment done by an Occupational Therapist or Driving Assessor. They will be able to see if you need any adaptations made to your car. If you get your car adapted, you must inform your insurance provider. If you do not inform your insurance provider, your insurance may be invalid.

Before making any decision about ordering adaptive equipment or making changes to your car, arrange a demonstration and try out using the adaptation yourself. It is very important to practice using any adaptations yourself to make sure they work well for you.

Epilepsy and seizures

Getting enough sleep at night, and having a good routine to fall asleep, are really important in tackling fatigue. These habits can help you increase your chances of a good night’s sleep:

• Try to get some exercise during the day. It can make you feel better and tire you out naturally. Try to exercise earlier in the day and avoid strenuous exercise in the period before bedtime.
• Keep it regular. Try to go to bed, and wake up, at roughly the same time every day.
• Half an hour before going to bed, start to wind down. Turn off the TV or listen to quiet music. Develop your own calming routine.
• Only try to sleep when you are sleepy. Otherwise you can end up lying awake in bed. If you haven’t fallen asleep after 20 minutes, get up and do something calming until you feel tired. Then return to bed and have another try.
• Don’t watch the clock during the night. Checking the time too often will wake you up and can cause worry and frustration. This can make falling back to sleep even more difficult.
• Make your sleeping space comfortable. Check that your bedroom isn’t too hot and that it is dark enough. If your curtains are not thick enough, use an eye mask to block out early morning light. Use earplugs to block out noise.

Try not to put on the main lights during the night. This is because bright light tells your brain that it is time to wake up. Try plug-in night lights instead.

Driving assessments

If none of the tips listed are working for you, talk to your GP to see what else might help.

If you continue to have difficulties with sleeping, it is important not to ignore them. Your GP can give you advice and go through the possible reasons for your sleep difficulties. They may also want to make sure you don’t have an underlying medical condition or a sleep disorder that are affecting you.

Your GP may also suggest you keep a sleep diary to help them understand your sleeping patterns more clearly. A sleep diary is a worksheet on which you record the hours and times that you sleep and wake up.

“Sometimes I wake up and I know I’ve slept for eight hours but I feel like I haven’t slept at all.” – Anne from Limerick

Driving licence

Is my licence still valid?

Your current licence is still valid unless your GP:

• Tells you not to drive or
• Tells you that you need to inform the National Drivers Licence Service (NDLS).

The current Medical Fitness to Drive Guidelines state that people with epilepsy, or with certain disabilities caused by their brain injury, or with certain types of brain injury, must notify the NDLS. Your GP will advise you if this rule applies to you or not.

If your GP says you can drive but your condition means that you must notify the NDLS, you notify them by applying for a change in personal details on your driving licence. However:

• You do not have to re-sit your driving test and
• You do not have to pay a fee for the new licence.

To make a change in personal details on your licence, you need to:

• Make an appointment to visit your local NDLS centre.
• Get a Driving Licence Medical Report form filled in by your GP. On the form, your GP can certify you to drive for one year, for three years or for ten years.
• Fill in a driving licence application form.
• Bring proof of your PPSN (Personal Public Service Number).
• Bring your current driving licence.

Temporary Learner Permit

If your GP believes you are not safe to drive on your own yet and that you should get a driving assessment done, they can apply to the Medical Fitness section in the Road Safety Authority (RSA) for a temporary learner permit for you.

Renewing your licence

If your driving licence has expired since your brain injury, you need to apply to renew it. To do this you fill out the licence renewal form and personally go to one of the National Driver Licencing Service centres (NDLS). If you have one of the disabilities or conditions specified on the driving licence renewal form, your GP will need to fill in a Medical Report form.

Some of the conditions that require a medical report form are:

• Stroke.
• Epilepsy.
• Brain surgery.
• Some changes in hearing or sight.
• Restricted movement in your arms and legs.
• If your car has already been adapted to accommodate a physical disability.

If you have not already had one, your GP may ask you to have a driving assessment done. This assessment is to make sure you are still safe to drive or to see if you should have some driving lessons or get adaptations done to your car.

Contact the National Driver Licencing Service for driving licence forms and information – t: 0818 700 800 or visit www.ndls.ie.

Motor insurance

Do I need to tell my insurance company?

Before you start driving again, you need to let your motor insurance company know about your medical condition. Otherwise, it could make your insurance invalid and affect any claims you make in the future.

If your doctor says you are fit to return to driving, your insurance company cannot charge you more for your cover. They also cannot refuse to provide you with cover

If you have been refused a quotation for motor insurance, you can request the reasons in writing from your insurance provider.

If you are not satisfied, you are entitled to go to the Declined Cases Committee of Insurance Ireland. Insurance Ireland is the representative body for most insurance companies in Ireland — t: 01 676 1914.

If you get your car adapted, you must inform your insurance provider. If you do not inform your insurance provider, you may not be covered.

You can get clear information and advice on car insurance from the Competition and Consumer Protection Commission. Helpline t: 01 402 5555 or visit The Competition and Consumer Protection Commission (ccpc.ie).

Tax relief and parking

Disabled Drivers and Disabled Passengers Scheme

If you have a severe physical disability, you may be eligible to apply for tax relief for adapting a car, buying an adapted car and other expenses, under the Disabled Drivers and Disabled Passengers Scheme.

• The scheme is for people who wish to buy a vehicle or have one adapted. You can apply if you are the driver of the car being adapted or the passenger.
• However, to qualify for this scheme, you must have a severe or permanent physical disability and hold what is called a Primary Medical Certificate. This certificate is issued by the HSE.
• Any adaptations must be done by a company which is licenced by the National Standards Authority of Ireland (NSAI).

Call the HSE Infoline for information on applying for a Primary Medical Certificate t: 1800 700 700.

You can get the rules of the Disabled Drivers and Disabled Passengers Scheme, and how to apply, from: Citizen’s Information on t: 076 107 4000 or The Revenue Commissioners on t: 047 621 00. 

Disabled Parking Badge

A blue Disabled Parking Badge allows permit holders to use official disabled parking spaces.

• You can get one as a driver or as a passenger.
  The parking badge is issued to the person with the disability so they can use it for any vehicle in which they are travelling.
• To be eligible, you usually need to have a permanent condition or disability that severely restricts your ability to walk.
• If you are registered blind or have a Primary Medical Certificate, you will be automatically entitled to a Disabled Parking Badge.

You can get further information on the rules and how to apply for a Disabled Parking Badge from the Irish Wheelchair Association (IWA) or the Disabled Drivers Association of Ireland (DDAI). These two organisations process all applications for the parking badges on behalf of the Department of Transport, Tourism and Sport.

Many people find that a simple way to make driving easier is to change to an automatic car. If you would like to consider this, get advice and make sure you take a few test drives to check if an automatic car suits you.

If I cannot continue driving — what then?

Not everyone can go back to driving after their brain injury. This can be very challenging and hard to accept. Everyone reacts to this news in different ways. However, there are a few points to bear in mind:

• Your abilities may improve over time. If this is the case, if may be helpful to get another driving assessment done. Ask your doctor or Driving Assessor about this.
• If you cannot drive, consider what alternatives could work for you: lifts from family or friends, public transport, taxis or local accessible transport companies. Accessible transport services are listed here: www.transportforireland.ie or phone t: 01 879 8300.
• Consider applying for any entitlements that can help you maintain your independence. Some options may be: the Disabled Drivers and Disabled Passengers Scheme, the Disabled Parking Badge or the Free Travel Pass. Citizens Information can advise you on your options— t:0818 07 4000  or www.citizensinformation.ie.
• Link in with support services and meet up with other people with brain injuries. Contact Headway for names of organisations in your area – t: 1800 400 478 

Answers to frequently asked questions

My doctor has told me I am medically safe to drive but I don’t feel confident enough.

• Travel as a passenger as often as you can. Try to think as if you were driving the car. This will give you practice in anticipating danger, reading road signs and finding your way.
• Some people find it a very helpful to do some lessons with an experienced driving instructor or your driving assessor. Ask around to find someone who is patient and understands that you might be a bit nervous.
• If you have any after-effects from your brain injury that affect your driving, tell your instructor.

Is it safe to have one drink and still drive?

• It is not safe to drink any alcohol at all if you are driving. Your brain is more sensitive to alcohol because of your brain injury.

I’m ready to get driving again but I’m not sure what is the best way to start.

• First, check with your doctor that they are happy for you to drive. Then, just sit in the car and go through the controls.
• Perhaps try your first bit of driving somewhere like a quiet car park.
• The first time you’re going to drive out on the road, bring someone supportive with you. They can act as an extra pair of eyes and ears for you in case you don’t notice something.
• Take your first drive on the roads on a short route you know well, at a quiet time of day. If you live in a busy area, get someone to drive you to a quiet place before you start

I have a full driver’s licence. I recently had my car adapted and will be returning to drive. Do I have to re-take my driving test?

• No. Provided you hold a full licence for the vehicle you are driving, if you have it adapted and return to or continue to drive, you are not required to re-take a driving test. However, you will need to apply for a change of personal details on your licence.

I’m sure I am fine to drive but my doctor and my family say I’m not. What can I do?

• Being told you are not ok to drive can be very hard to accept. It’s normal to feel upset and angry — especially if you cannot see any reason for it. This is very understandable.
• Talk to someone you trust about how you are feeling.
• If you’re not clear why the doctor is saying you shouldn’t drive now, ask them to write down the specific reasons that, in their opinion, it is not safe for you to drive.
• Consider getting an off-road pre-driving assessment done by an Occupational Therapist. If they also feel that you should not continue driving, it may be easier to accept this when it comes from an independent professional who does not know you.
• It may be helpful to have your safety to drive re-assessed after a number of months if your health or abilities improve.
• Some people who have had an injury to the front part of their brain lose the ability to realise things about themselves that other people can see clearly. This is known as a loss of insight. If you are told this has happened to you, try to accept that the doctor, or other professionals, may be right, even if you cannot recognise the reasons yourself.

I am ok driving on short journeys but I get very tired on longer ones. Any advice?

• Most people find they get tired more quickly after a brain injury. See the booklet ‘Fatigue and Sleep’ in this Brain Injury Series for more information and tips.
• Plan regular breaks on longer journeys, even if you didn’t have to before.
• It is much more tiring to drive through busy traffic. So, plan your journey so you will not be going through busy areas during rush hour.
• Share the driving with someone else.

Summary of key points

• Driving uses many skills that can be affected by a brain injury.
• Your GP or consultant has to decide when, or if, you can return to driving.
• A driving assessment can help you identify your level of ability to drive and indicate anything you need to work on.
• If you have had a seizure or suffer from epilepsy, the Medical Fitness to Drive Guidelines are very specific on driving. Ask your consultant for more information.
• You need to inform your insurance company about your brain injury but they cannot charge you more if your doctor has said you can drive.
• You may need to inform the National Driver Licencing Authority. Your doctor should advise you.
• You may be entitled to tax relief or a disabled parking permit.

Return to driving checklist

Before driving again, you must:

1.  Visit your GP, or consultant, and comply with the Medical Fitness to Drive Guidelines 
2. Inform your insurance provider about
   your brain injury 
3. Inform your insurance provider if you are
   having your car adapted 
4. Apply for a change in personal details on your driving licence if instructed to by your GP 

Other things to do:

1. Get a driving assessment done if needed 
2. Take a couple of refresher driving lessons 
3. Bring someone with you the first time
   you drive 
4. Make sure you are physically comfortable
   and can control the steering wheel, pedals
   and indicators, for example 
5. If you do not feel safe driving, get
   additional advice or more lessons 

Help and Information

Advice on the disabled parking badge, driving assessments, lessons and car adaptations.

Disabled Drivers Association of Ireland,

Claremorris, Co Mayo. t: 094 936 4054 or visit www.ddai.ie.

Irish Wheelchair Association – various centres

t: 045 893 094 or visit www.iwa.ie.

There are other regional providers of these services, contact Headway for a list .

Car adaptations

For a list of licenced car adaptation companies, contact the National Standards Authority of Ireland on t: 01 807 3800 or visit www.nsai.ie.

Medical Fitness

Road Safety Authority t: 096 25000 or visit www.rsa.ie

Driving Licence and medical reports

The National Driver Licence Service (NDLS) has centres throughout Ireland. t: 0818 700 800  and www.ndls.ie

Grants and Entitlements

Contact Citizens Information for assistance and forms. Lo-call t: 0818 07 4000 or visit www.citizensinformation.ie.

Tax relief

The Revenue Commissioners, Central Repayments Office, Monaghan. t: 047 621 00 or visit www.revenue.ie.

Primary Medical Certificate

Contact the HSE’s Information Line for rules and how to apply. t: 1800 700 700 or visit www.hse.ie.

Insurance cover

Insurance Ireland provides an information service on all insurance matters. They also deal with complaints about Insurance companies who are members of Insurance Ireland. t: 01 676 1914 or visit www.insuranceireland.eu.

The Competition and Consumer Protection Commission offer independent information and advice on insurance. t: 01 402 5555 or visit www.consumerhelp.ie.

Epilepsy and seizures

Epilepsy Ireland can give you advice and support. t: 01 455 7500 or visit www.epilepsy.ie.