Rethinking Driving Against Medical Advice: The Situated Nature of Driving After Stroke

Abstract

Background: As stroke can result in functional impairments that impact driving ability, many jurisdictions mandate a 30-day period of driving restriction post-stroke. However, between 26% and 38% of clients drive against medical advice during this period. Purpose: Informed by critical reflexivity of the literature and the first author's practice, this critical analysis paper (1) explicates and critiques how adherence to guidelines regarding driving after stroke in the first 30 days is conceptualized in individualistic, biomedically centred research and (2) argues for expanded understandings of driving based on a transactional occupational perspective. Key Issues: Individualistic, biomedical perspectives view driving against medical advice as an individually located phenomenon, generating partial understandings and individually focused solutions. Re-conceptualizing driving after stroke as a transactional occupational choice provides a productive basis for understanding and addressing driving within practice and research. Implications: Concepts from occupational science can generate new insights for research and client-centred practice regarding driving following stroke.

Impact of Spatial Neglect on Activity and Participation: A Mixed-Methods Study

“…However, driving evaluation protocols (i.e., clinical assessments, on-road testing) and state regulations in the United States regarding driving after stroke vary considerably. Some countries in the World automatically restrict driving for a period of time after stroke until further evaluation and recommendations can be made, yet adherence to these restrictions remains an issue (Vander Veen & Rudman, 2022). While there are a number of barriers (e.g., public policy, funding, lack of education) to having all stroke survivors undergo driving evaluations, driving rehabilitation programs that are evaluating stroke survivors may need to include more extensive testing for neglect to ensure that it is safe for them to resume driving (Vander Veen & Laliberte Rudman, 2022).…”

“…However, driving evaluation protocols (i.e., clinical assessments, on-road testing) and state regulations in the United States regarding driving after stroke vary considerably. Some countries in the World automatically restrict driving for a period of time after stroke until further evaluation and recommendations can be made, yet adherence to these restrictions remains an issue (Vander Veen & Laliberte Rudman, 2022).…”

“…While there are a number of barriers (e.g., public policy, funding, lack of education) to having all stroke survivors undergo driving evaluations, driving rehabilitation programs that are evaluating stroke survivors may need to include more extensive testing for neglect to ensure that it is safe for them to resume driving (Vander Veen & Laliberte Rudman, 2022).…”

Addressing Driving in Acute Care: Perceived Relevance and Competence

“…With decreasing availability of community occupational therapy services, however, acute care often becomes the only opportunity to discuss driving, despite the barriers which preclude in-depth assessment and intervention in hospital settings. Occupational therapists need to be attuned to the ways opposing risks transact with each other and the practical realities of the health care system when addressing driving in acute care settings (Vander Veen & Rudman, 2022).…”

“…Therapists must consider intersecting threats to client and public safety together with the potential negative consequences to client community mobility if driver status is jeopardized. Given the pervasiveness of “car culture,” and the ongoing prioritization of car travel over other transport alternatives, (Mattioli et al, 2020) clients not only risk restrictions to community mobility if their license is suspended following driver screening, but also threats to identity, autonomy, and independence (Vander Veen & Rudman, 2022). Indeed, some open text responses raised concerns related to addressing driving in acute care when individuals may be at their “worst moments.” With decreasing availability of community occupational therapy services, however, acute care often becomes the only opportunity to discuss driving, despite the barriers which preclude in-depth assessment and intervention in hospital settings.…”