0:02

Instrumental music playing

0:11

Hi, I'm Karl TBI survivor

0:13

and member of BIND.

0:14

And Hi I'm Carrie a stroke survivor and a member

0:17

of BIND as well and today we have

0:19

Christine Nelson with us. She's a licensed occupational

0:22

therapist and also a certified driver

0:24

specialist certified Driver

0:27

Rehab Specialist. Trying to say it without

0:29

reading. Um, with a background in neurorehabilitations.

0:32

She has an MBA in strategic

0:34

management and oversees the operations across

0:37

all the PATE locations. So, Christine,

0:39

welcome. We're happy to have you here today.

0:41

Thank you so much for having me. Absolutely. Pleasure

0:43

to be here.

0:44

Welcome to BINDWAVES, the official

0:46

podcast of the Brain Injury Network

0:48

of Dallas. I'm Brian White,

0:50

BIND's Executive Director. On

0:52

each episode, we'll be providing insight

0:55

into the brain injury community. We'll

0:57

be talking to members and professionals regarding

0:59

their stories and the important role

1:02

of BIND's Clubhouse. We work

1:04

as a team to inspire hope, community,

1:07

and a sense of purpose to survivors,

1:09

caregivers, and the public. Thank

1:11

you for tuning into BINDWAVES. BINDWAVES Let's

1:14

get on with the show.

1:15

Great. Well, and we know, like, independence

1:18

is key for brain injury survivors, and one of

1:20

the biggest ways to get our independence back is

1:22

driving. I know that's one of the questions

1:24

that every new brain injury survivor Asks

1:26

me. So that brings us to our first

1:28

question is who decides

1:31

when someone's ready to go back to driving?

1:33

That's a really great question. It's actually a,

1:36

it's a team decision, really. I mean, the families,

1:38

um, you know, the, the brain injury survivor,

1:41

um, ultimately it's the decision

1:43

of the department of public safety, the DPS,

1:45

and there's a medical advisory board within

1:48

that department. So, um, they have

1:50

the ultimate decision making capacity, but

1:52

really, um, uh, the doctor weighs in

1:54

on the decision. A lot of times the treatment

1:56

team, um, the family, the survivor

1:58

themselves. So, but the ultimate say

2:01

is the DPS.

2:03

So, ultimately, what exactly is

2:05

the process for someone with a brain

2:07

injury to get back to driving?

2:10

So, there's a lot of different ways you

2:12

can go about getting back to driving. But the first

2:14

thing to do is usually to talk with your doctor.

2:16

Um, the doctor can, um, can let you

2:18

know if you're medically,

2:21

um, you know, fit to drive if

2:23

you're medically at that point. And then

2:25

a lot of people choose to go through a driver rehab

2:28

program. Um, and it's a

2:30

really good idea because you get

2:32

an assessment of all the different skills

2:34

related to driving in that kind of a program.

2:37

Um, if you go through a driver rehab program,

2:39

you'll know if you're, if you have the physical

2:41

capacity or whether you might need some adaptive

2:43

equipment. Um, you'll get, um,

2:45

cognitive testing, vision screening,

2:48

those kinds of things. So, um, If

2:50

you go through a driver rehab program,

2:52

um, you'll know when it's time to get out on the road

2:55

and start doing maybe some driving training.

2:57

Um, with a, um, driver rehab specialist

3:00

or even a driving school if, if

3:02

maybe you don't have a lot of, um, um,

3:04

therapy needs, maybe you just go to a driving school

3:06

and get some time out on the road to see if you're, you

3:08

know, ready to take the, the driving test again

3:10

and then when you get kind of through

3:13

that program, you'll go to the DPS

3:15

and you'll, you'll retake the test with

3:17

them and you'll be, you should be

3:19

ready to go at that point.

3:21

Are there any additional steps that a

3:23

brain injury survivor needs to take to,

3:26

um, get their license renewed after

3:28

having a brain injury?

3:29

Yeah, so it's because in

3:31

Texas the doctors are not, it's

3:33

not a mandatory report state. So doctors

3:35

don't have to, you know, report to the medical

3:38

advisory board if, um, if

3:40

there's a brain injury. So it's really,

3:42

um, the individual driver's responsibility

3:45

to disclose their brain injury to the

3:47

DPS. And with that, um,

3:49

being said, once you've disclosed that,

3:52

um, that injury, they'll usually

3:54

have you retake the test. Um, sometimes

3:56

I will say there are some DPS offices

3:59

that we've been to that, um, that

4:01

they'll take like a, a driver eval from,

4:03

you know, um, from us or that

4:05

kind of thing. But if you go through a driving program

4:08

that is a driving school, a lot of times you can take

4:10

the test with them. Um, but extra

4:12

steps, you have to have a valid license

4:14

when you go to take the test. So a drive, either,

4:16

either a valid permit or a valid

4:18

license. So if your license has expired,

4:21

Um, in, you know, during your injury, you have

4:23

to get it renewed first before you can

4:25

retake the test. Okay.

4:28

Is there anything that, uh, has to be done differently

4:31

for visual motor, uh, problems?

4:34

Yeah, so a lot of people with brain injuries

4:37

do, um, experience maybe some,

4:39

um, impaired reaction time, visual motor

4:41

reaction time, that kind of thing. So we do

4:43

some of the testing, um, for that

4:45

in these driver rehab programs. There's almost

4:47

always some way to assess. You

4:50

know, are people able to process visual information

4:52

and react to it in a timely manner?

4:54

So there's a lot of different ways we can do

4:56

that. We can use, um, computer,

4:58

you know, type tests where a, you know, a stimulation

5:01

is put on the, stimuli is put on the screen

5:03

and then you have to react as quickly as you can.

5:06

Um, sometimes it's like a DynaVision.

5:08

Sometimes it's a, um, a pedal

5:11

that you have to hit, like a brake pedal you have

5:13

to hit once you see, So

5:15

we do have a way to test it, and

5:17

depending on what method you're using, there

5:19

are some, like, protocols. If

5:21

it's below this visual reaction time,

5:24

it's probably not a good idea to get on the road

5:26

at this time. So, yeah, there are

5:28

some ways we can test that and work

5:30

on those things.

5:32

Okay, and then kind of going back with the license,

5:35

I know a lot of people with brain injuries end

5:37

up with seizures. Mmhmm.

5:40

Are there different guidelines if you have seizure

5:42

problems? As opposed to just brain

5:44

injury?

5:44

Yes, so in the state of Texas,

5:46

it's different. Every state kind of determines their

5:48

own rules, but in the state of Texas, if

5:50

you have ongoing and persistent seizures,

5:53

you are not permitted to drive. However, if

5:55

you don't, if you just have intermittent or it's

5:57

been a while, you've had a seizure there

6:00

for a Class C license, you have to be three

6:02

months Seizure free. There

6:04

are different guidelines for, um,

6:07

like more commercial licenses or like,

6:09

you know, um, Class A, AB,

6:11

you know, you have different, um, guidelines, but

6:14

for Class C, which most of us are, uh,

6:16

have, that would be at least three months seizure free.

6:18

And that's, that's for, you know, someone that

6:20

isn't, hasn't experienced pervasive

6:22

ongoing seizures. So

6:24

it's, it's definitely, there are some guidelines

6:27

and then that's something to talk to the doctor about.

6:29

As some certain medications, um,

6:32

And certain, you know, there are certain things that increase

6:34

seizure risk, and so you'd want to talk

6:36

to your doctor about those things. Because even if it's

6:38

been three months, you don't want to increase your

6:40

seizure risk and then, you know, be driving, so.

6:44

Are there any basically common

6:47

reasons for brain injuries to be denied

6:49

from getting their license back?

6:51

Sure. Some of the kind of more pervasive things

6:53

that happen to be the case with brain

6:55

injury survivors is sometimes, um,

6:58

like attention, um, working

7:01

memory. A lot of the executive function

7:03

stuff, stuff that goes on in your frontal lobe, those

7:05

are the kinds of things that sometimes make it hard

7:07

to return to driving or to be fit to drive.

7:10

As you can imagine, um, you

7:12

know, your distractibility, you know, your ability

7:15

to attend to the things that you're supposed to and not

7:17

get distracted by something that's not important,

7:19

like a noise in the back seat or the radio

7:21

or those kinds of things. So attention and memory are kind

7:24

of some of the big ones. Um, there are

7:26

other things that can sometimes happen where

7:28

someone can get, um, Um,

7:31

you know, maybe quickly, like you're, uh,

7:33

maybe quick, quick to anger, those kinds of

7:35

things. Obviously that would put you at risk for

7:37

driving. But other things, you know, sometimes,

7:40

um, you know, having some

7:42

visual spatial issues, like if you,

7:44

if you have a, like, maybe a right parietal

7:47

brain injury and you have visual spatial issues,

7:49

sometimes it's hard to, you know, detect distance

7:51

or gap, you know, like, is there a large enough

7:53

gap for me to pull out in front of that car?

7:55

You know, so the visual spatial stuff, um, also,

7:58

um, um, You know, sometimes people with brain

8:00

injuries have field cuts. And

8:03

there are some restrictions on field

8:05

cuts if they're not compensated, if you're not able to compensate

8:07

for them, like, um, and then

8:09

also things like left neglect, those

8:12

kinds of things.

8:12

Yeah, I know that. I worried about that a lot.

8:14

Right. So you probably had to work, you

8:17

know, hard to overcome and to compensate

8:19

for some of these visual spatial things.

8:21

Yeah, I did. And I still drive in the middle lane

8:23

just to be safe.

8:24

So you have a strategy. Yeah, exactly. So

8:26

learning strategies, learning to compensate

8:28

for what you know is going on. And that's

8:30

where, A comprehensive driver rehab program

8:32

can really help, um, because

8:35

you, you can, you can figure out what

8:37

your issue is and work on that specific thing,

8:39

so.

8:40

And I know, like, some people have memory

8:42

issues and, like, remembering where

8:44

to go. We have GPS, which is great now, but

8:47

how does, like, aphasia or memory affect,

8:50

Being able to drive.

8:51

So, people with aphasia, you

8:53

know, generally, that doesn't, you know, preclude

8:55

people from being able to drive, um, because,

8:58

you know, especially in familiar environments, you are going

9:00

to have trouble, like, reading signs,

9:02

potentially, communicating with other

9:04

people out on the road, like, if you get pulled over,

9:07

those kinds of things. So, there, there are things that if

9:09

you have aphasia, you kind of need to do differently,

9:11

but usually, aphasia doesn't, it doesn't,

9:14

just because somebody has aphasia, even

9:16

if it's fairly severe, it doesn't mean they can't drive.

9:18

The other thing that usually goes along with aphasia,

9:21

though, is, you know,

9:23

difficulty with movement of the right side of the body,

9:25

right? So you might need some physical, if

9:27

you had a left hemisphere stroke, you might need some accommodations

9:30

for your physical impairments as well. But

9:32

aphasia alone doesn't, you know, doesn't preclude

9:34

you from, or, you know, doesn't exclude you from being

9:36

able to drive. There might be some strategies

9:38

that you have to use.

9:40

Speaking of that, what other

9:43

modifications to vehicles

9:45

are available for the brain injured?

9:48

Yeah, so there's a lot of things. Um, like I

9:50

already kind of mentioned the right, you know,

9:52

movement problems on the right side. Well, think about

9:54

all the things you do or you need to be able to do on

9:56

the right side. And the same thing if you have,

9:58

you know, a left sided, you know, a left

10:01

hemiparesis, you might not be able to do

10:03

the turn signals and things like that

10:05

as the car is made. But

10:07

there are some items like crossover

10:09

turn signals. You can move the turn signal to

10:11

the right side. Or you can use

10:13

a left foot accelerator

10:16

so that you're not having to use your right leg to push

10:18

on the gas. You could actually use a left foot

10:20

accelerator. So you can drive primarily

10:22

with the left foot. It takes some, takes some practice.

10:25

You don't want to just go out on the road and do that. But with,

10:27

with a therapist working with you and

10:29

you know, there's a lot of adaptive equipment. There's spinner

10:31

knob on your, on your steering

10:33

wheel so that you don't, you know, so you can

10:35

drive one handed better. There's a lot

10:38

of different things. There's mirrors that you can have,

10:40

um, placed in certain places to help

10:42

you, um, to help you see if you have difficulty

10:45

with like neck mobility or, or that

10:47

kind of thing. So there's quite a bit that can be done.

10:49

Nice.

10:50

Yeah, that's cool. I have a, my mother has

10:52

a friend who has a PT Cruiser

10:55

that was modified so that she could, you know, Can

10:57

roll her wheelchair up into it from the back

10:59

and exactly and then drive that way which I

11:01

think isn't

11:01

Yeah so when you start looking at other,

11:04

you know other Types of injuries

11:06

like spinal cord injuries things like that, which I know

11:08

isn't the topic of this conversation

11:10

But it's amazing. You can drive from

11:12

your wheelchair. You can drive with completely

11:15

adapted equipment like a lot of basically

11:19

what we consider high tech equipment where you

11:21

don't have to have a lot of movement to be able to drive.

11:23

It's pretty neat.

11:25

It sounds like it. Um,

11:27

what, I guess what that goes along, all

11:29

those modifications cost a lot of money. Are

11:31

there any programs or companies

11:34

or grants that help fund that kind

11:36

of stuff?

11:36

So, there, I'm not aware of a lot of grants.

11:39

Um, there are some, depending on

11:41

the diagnosis, sometimes like the, like,

11:44

um, associations, um, like,

11:46

I'll just give you an example even though it's not brain injury

11:48

related, but like the ALS foundation might have

11:50

some money for somebody for driving equipment.

11:53

But what, what we see a lot of times in brain

11:55

injury is that the, um,

11:57

if you're returning to drive

11:59

will help you get back to work. The Texas Workforce

12:01

Commission, the voc

12:04

rehab program will a lot of times pay

12:06

for adaptive equipment in vehicles or driving

12:08

programs because it helps that brain injury

12:10

survivor get back to work. And

12:12

so they buy it, um, the equipment

12:14

for you, um, if you qualify. And

12:16

then if you got hurt on the job, um, Workers

12:19

Comp is a funding source that a lot of times

12:21

will pay for driving equipment. So there are

12:23

a few things out there. For the most

12:25

part, a lot of the driving equipment is

12:29

private pay and so some, a lot

12:31

of people will do like a GoFundMe or,

12:33

you know, some sort of social media request

12:36

to try to help get funded for driving equipment

12:39

because it can be expensive.

12:41

I can only imagine, yeah. But,

12:43

um, I guess one of the other questions

12:45

that I had, I'm trying to remember now, um,

12:51

Just went out of my brain.

12:52

I'm thinking that we'd like to hear about

12:54

your particular program that you

12:57

run.

12:58

Sure, so at Pate Rehabilitation, as

13:00

you guys know, we specialize in brain injury

13:02

rehab and it's post acute, so a

13:04

lot of our patients are at that point where they're getting

13:06

ready to return to driving. And I would say

13:08

what's unique about Pate's program

13:11

is that it's part of our Day

13:13

Neuro Program. Like it's not a, it's

13:16

every aspect of our program is, you

13:18

know, is to treat your whole, you know,

13:20

all of your goals. So if you, if,

13:22

although we have OT, PT, speech, if

13:24

you have a goal to return to driving,

13:27

you're probably working on those driving related

13:29

skills in all of those therapies. So it's not

13:31

a distinct Driving, you

13:33

know, that's all you do. You're going

13:36

for this comprehensive program, and we know

13:38

you want to return to driving. So

13:40

we're incorporating driving related tasks

13:42

in all of your programs. you know, all of your

13:44

programming. And so there is a clinical

13:47

evaluation that we complete. We get, we

13:49

help you get a doctor's order for an on the road

13:51

evaluation. And then, um,

13:54

we'll take you out on the road and we'll see, you know,

13:56

how did you do. We have a specific

13:58

route that tests all the different skills. And the nice

14:00

thing is, is if you don't, If

14:02

we feel like, oh, there's a couple of things that we're concerned

14:04

about, then we work on those things in therapy.

14:07

And you might go do some training sessions

14:09

out on the road, um, or say

14:11

you have just a little bit of, say it is something

14:13

like, um, You

14:16

just have a little bit of weakness in your right foot and

14:18

it's difficult for you to press the gas

14:20

as much, you know, as quickly as you should.

14:22

PT's on it. They're working on that with you

14:24

in the clinic. So, um,

14:27

the nice thing is, is then it's part of your comprehensive

14:29

program. It's covered by whatever insurance you

14:31

have. So that's, I think, a really

14:33

unique aspect about our driver rehab program.

14:36

Um, it's because it's, it doesn't end up being

14:39

private pay then, it's part of the program

14:41

that you're getting.

14:43

May I further ask, is it available

14:45

at all the paid locations, including

14:47

Fort Worth?

14:48

Mm hmm, it is available at all the locations. So

14:50

we have, um, Right now, we have two driver

14:52

rehab specialists that take people out on the road.

14:55

Um, and one is located at the Fort Worth location,

14:57

and then the person that works at our Los

15:00

Colinas location also covers driver rehab

15:02

at our Anna location. So, it's

15:04

available everywhere.

15:05

So, yeah. Is there anything

15:08

else you'd like to say that we missed?

15:10

That's put you in the spot.

15:13

No, I think you guys did a great job

15:15

of covering a lot of the basics. Um, so

15:17

I appreciate you, yeah, having

15:20

me on and talking this through with

15:22

me. But the other thing is, I will say is,

15:24

I know I mentioned as part of our program, we do also

15:26

offer just driver rehab.

15:28

If that's, if someone's not in a comprehensive

15:31

therapy program, say they're a little bit further

15:33

out, they're done with their therapy, and then later

15:35

on they decide, hey I do want to return to driving. We

15:37

do offer it as a standalone program

15:40

as well. That's, I probably should mention

15:42

that, and that is on a private

15:45

pay basis.

15:46

That's nice to know you have that availability. Yeah,

15:49

it's awesome. Do you recommend that everyone

15:51

goes back through a certified driving?

15:55

You know, not everyone is going to need

15:57

something that comprehensive. I'll, you know,

15:59

I think, I think if someone

16:01

has a mild brain injury,

16:04

has really good recovery, there's no other

16:06

issues. Usually, usually

16:08

driving, driving's a pretty complicated

16:10

task. So if someone can like cook

16:12

a dinner, like a multi course dinner,

16:14

you know, and they, they're able to multi task,

16:17

they're able to stay safe, their, their mobility's

16:19

good, they don't have any vision problems, and

16:21

they're able to do something like, you know, create

16:24

a complex dinner. Then they have

16:26

most of the skills. Like I would, somebody who can

16:28

do all of that, I would say probably doesn't need to

16:30

go through a comprehensive driver rehab. They

16:32

just need to go straight to the DPS and they can

16:34

take their test there. Um,

16:36

if someone's having difficulty

16:38

with some other aspects of their life, like

16:40

maybe they're having trouble with multitasking

16:43

or maybe they notice they kind of get

16:45

lost in familiar areas,

16:47

you know, you usually know when

16:49

you're having You know, you're

16:52

having trouble with other complex tasks,

16:55

then you know driving is going to be risky

16:57

for me. And so going through a program is probably

16:59

best in those cases.

17:00

Okay. It's good to know.

17:03

Well, Christine, we really appreciate

17:05

your time. Thank you for coming. My

17:07

pleasure. And we would like all the listeners

17:10

to, uh, to thank you also.

17:13

Uh, we, we appreciate the listeners

17:15

for watching you. And, you know,

17:17

we really think the world

17:19

of the driving programs

17:21

that you have. Thank you. Thank you very much.

17:23

Thank you guys. Appreciate it.

17:25

And for our listeners, again, if you'd like to contact

17:27

us, you can email us at [email protected].

17:32

Um, you can also visit our website, thebind.org/bindwaves.

17:36

And if you're interested in becoming a member of BIND,

17:39

or a volunteer to help us out with our

17:41

different things, you can also just visit thebind.org

17:43

to find more information.

17:47

And don't forget to like, share,

17:49

and subscribe.

17:51

To, uh, to the, uh,

17:54

platform. We would like to

17:56

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17:59

And also don't forget to hit that notify button on

18:01

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18:03

can see us and not just hear us. But

18:06

again, you can find us every Thursday on your favorite

18:08

platform, whichever that may be. And

18:11

we thank you again for your time and for listening. So

18:13

until next time.

18:14

Until next time.

18:16

We hope you've enjoyed listening to BIND Waves and

18:18

continue to support BIND and our non profit mission.

18:21

We support brain injury survivors as

18:24

they reconnect into the life, the community,

18:26

and their workplace. And we couldn't do that without

18:28

great listeners like you. We appreciate each and

18:30

every one of you. Continue watching. Until

18:32

next time. Until next time.