From the Guidelines
Patients should not drive for at least one month after a stroke, and then undergo a comprehensive assessment to determine their fitness to drive, as recommended by the Canadian Council of Motor Transport Administrators (CCMTA) Medical Standards for Drivers 1. When considering returning to driving after a stroke, it is essential to evaluate physical and cognitive abilities, including vision, strength, coordination, reaction time, judgment, and awareness.
- A comprehensive neurological assessment, including sensorimotor function and cognitive ability, should be performed to disclose no residual loss of functional ability and no obvious risk of sudden re-occurrence 1.
- The assessment should focus on:
- Sensory evaluation: vision, visual fields, visual attention, and reading comprehension
- Motor assessment: strength, coordination, and reaction time
- Cognitive assessment: perception, problem-solving, speed of decision making, and judgment
- If residual neurological deficits are present, a full comprehensive driving evaluation, including a government-sanctioned on-road assessment, is recommended to determine fitness to drive 1.
- Patients can be referred to training programs, such as simulator-based training, to help prepare for a road test or the resumption of driving 1. It is crucial to prioritize road safety and follow the guidelines to minimize the risk of accidents, as stroke can affect critical skills needed for safe driving.
From the Research
Fitness to Drive after Stroke
- The decision to allow a patient to drive after a stroke is complex and depends on various factors, including the severity of the stroke and the presence of any residual deficits 2.
- A study published in the Journal of Stroke and Cerebrovascular Diseases found that 64% of post-stroke patients received a favorable fitness-to-drive recommendation, with the presence of instrumental sequelae, such as aphasia, being a significant predictor of fitness-to-drive recommendations 2.
- The time interval between the stroke and the assessment was also found to be a significant factor, with patients who were assessed later being more likely to be deemed unfit to drive 2.
Medication and Stroke Risk
- The use of antiplatelet therapy, such as aspirin and clopidogrel, is common in patients who have had a stroke or transient ischemic attack (TIA) to reduce the risk of further strokes 3, 4, 5, 6.
- However, the risk of bleeding associated with these medications is a concern, particularly in aspirin-naïve patients 5.
- A meta-analysis published in Vascular Medicine found that dual antiplatelet therapy with aspirin and clopidogrel reduced the risk of recurrent stroke by 26%, but increased the risk of moderate or severe bleeding by 88% compared to aspirin monotherapy 4.
Driving Assessment after Stroke
- A standardized multi-professional fitness-to-drive assessment is recommended to determine a patient's fitness to drive after a stroke 2.
- The assessment should take into account the patient's individual characteristics, including their medical history, cognitive and physical abilities, and any residual deficits from the stroke.
- The use of a comprehensive assessment tool, such as a driving simulator or on-road test, can help to evaluate a patient's ability to drive safely and make an informed decision about their fitness to drive.