Driving after a traumatic brain injury

Last Modified: 3/29/2021


According to the Centers for Disease Control and Prevention (CDC), roughly 5 million people in the U.S. currently live with a traumatic brain injury. To highlight this debilitating condition and recognize National Traumatic Brain Injury Awareness Month, we asked Audrey Sofair, MD, PPG – Pediatric Physiatry, to explain what it is and how it can affect your daily life.

What is a traumatic brain injury?

A traumatic brain injury (TBI) is a violent blow, jolt or head injury that disrupts the brain’s function, resulting in short- or long-term problems with independent function. Often there is either a direct or indirect force that travels across the cranium or skull that gets transmitted to brain tissue, causing a disruption.

Unfortunately, TBIs are a leading cause of death and disability in the United States. Each year an estimated 1.5 million Americans sustain a TBI, of these:

  • 230,000 people get hospitalized (and survive)
  • 80,000 to 90,000 people experience long-term disability
  • 50,000 people die from the injury
What are the most common causes of a TBI?

While there are many causes, some of the most common reasons for TBIs can include the following types of events:

  • Falls: This type of TBI is most common overall and often seen in the elderly or young children. Falls from a bed, down stairs, in the bathtub or bathroom, and due to tripping on area rugs can account for about 35% of TBI cases.
  • Motor vehicle accidents: This category refers to collisions involving cars and motorcycles, with most individuals being between the ages of 15 and 25 years of age.
  • Sports injuries: Many TBIs also occur due to a variety of different sports, including, but not limited to soccer, boxing, football, baseball, lacrosse, skateboarding, hockey and other high-impact, contact or extreme sports. This type of TBI is seen most often in youth and young adults.
  • Violence or assault: Sadly, another reason for TBIs is domestic violence, gunshot wounds, shaken baby syndrome, child abuse and other forms of assault.
  • Blast injuries: Another common cause is explosive blasts and blast injuries involving active-duty military personnel in war zones or training environments. When a bomb explosion occurs, there is hot gas that expands rapidly, causing pressure waves throughout the atmosphere. This pressure wave passes through the brain, mimicking being hit by a blunt object, and significantly disrupts brain function.
How does a TBI affect the brain and body?

Think of the brain as a bundle of nerves. When there’s an injury to those nerves, they stop functioning correctly. What exactly does that mean? Well, the nerves carry a form of electrical activity throughout the body. They have ions running through them. Those ions have positive and negative charges, which allows them to carry charges like an electric wire. If the nerve stretches and the paths the ions travel is disrupted, it can affect how the nerves work. The nerves can no longer produce the chemical messages (known as neurotransmitters) needed for brain function. Depending on where in the brain this happens, it can cause different kinds of deficits and dysfunction including, but not limited to, memory loss, loss of consciousness, fatigue, seizures, muscle weakness or tightness and even swallowing difficulties. Some effects can improve quickly, while others may take more time or never fully resolve and become a long-term issue. However, everyone is different, and their TBI may present a unique set of physical effects.

Can someone fully recover from a TBI? (reversed or cured)

Yes, people can fully recover from a TBI, but it does depend on the severity of the injury and their age and functionality before their injury. It’s important to remember that recovery is a long process and involves several stages. An accurate diagnosis of the level of consciousness is essential. It can help predict short- and long-term outcomes. It can also help in treatment planning and informing important decisions early in someone’s recovery. Many people often benefit from a rehabilitation program that specializes in treating those with a severe TBI.

Should someone drive after a TBI?

After a TBI, many patients have trouble with thinking, judgment and multitasking. For this reason, their cognitive functions need to be assessed carefully before considerations are made concerning driving. Also, because driving is such a complex act, it requires mental, physical and visual capabilities. A brain injury can disrupt and slow down skills that are essential for responsible driving, including the following:

  • Accurate vision
  • Hand-eye coordination
  • Reaction time
  • Safety awareness
  • Overall judgment
  • Problem-solving skills and ability
  • Concentration over long periods
  • Ability to maintain a constant position in a single lane
  • Memory function or recalling of directions

Because these skills can be affected after a TBI, people must work closely with their healthcare provider to assess their physical, visual and cognitive function. This crucial step will help reduce the risk of accidents or incidents while driving.

Furthermore, this assessment is not just to screen for unsafe driving. It will also allow a person’s healthcare team to see what kinds of support, training, or rehabilitation they might need, all positive steps to help them regain their independence.

What steps can people take toward preventing TBIs?

Many TBIs are preventable. Here are a few strategies to help everyone from young children to older adults avoid injury:

  • Seat belts and car seats: Always wear a seat belt in a motor vehicle. A small child should always sit in the back seat of a car secured in a child safety seat or booster seat appropriate for their size and weight.
  • Helmets: Wearing a helmet or appropriate head protection during sports or while riding a bicycle, skateboard, motorcycle, or all-terrain vehicles can go a long way in preventing TBIs.
  • In-home precautions: Preventative measures to take within your home could include installing handrails in bathrooms and on staircases, putting safety gates at the top and bottom of stairways, placing non-slip mats in the bathtub or shower, removing or securing loose area rugs, improving lighting in darkened areas, decluttering and more.
  • Personal precautions: Make sure you are getting regular checkups, both general wellness, and vision, as well as staying physically active with regular exercise.

Taking the appropriate steps and measures toward preventing brain injuries can help reduce the rate of TBIs and their devastating effects.

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