Returning to driving after a concussion: questions to ask before you get behind the wheel
How driving readiness is assessed and what to ask at your next visit
Imagine a 52 year old warehouse supervisor who was rear ended on the highway in August. Ten weeks later, his headaches come only in the late afternoon. Busy stores still wear him out, and his wife has been driving him to work. He has a follow up visit next week and wants to ask about driving, but he is not sure what to ask.
A brain injury fact sheet notes that many people go back to driving after a brain injury without ever having their driving skills checked [5].
This guide is built for that conversation: who can judge your readiness, what an evaluation includes, how to prepare, and what to ask.
Why driving needs its own conversation
Driving uses many skills at once, from vision and reaction time to focus, memory, lane keeping and problem solving [5]. A concussion can affect any of them.
Canada’s Living Concussion Guidelines ask clinicians to warn patients that blurred vision, dizziness, fatigue, headache and thinking problems can affect driving [1]. Its advice is to wait until symptoms settle to the point where safe driving is possible [1]. Its introduction goes further: anyone whose concussion symptoms have not cleared is advised to stay out of the driver’s seat [1].
In the United States, the CDC urges physicians to hold back on clearing a patient to drive [8]. Extra care is called for when a patient’s attention, reaction time or processing speed is affected [8]. Processing speed is how quickly the brain takes in information and acts on it.
What the research says, and where it falls short
A 2021 study tested 14 people with a concussion and 14 healthy people matched for age, sex and driving experience [2]. Its summary does not say how old they were or whether they played sports. The people with a concussion were tested in a simulator no more than two days after their symptoms went away, about two weeks after injury on average [2]. Their combined driving reaction time was slower by about three tenths of a second [2]. A computer reaction test given in the clinic did not track closely with how fast they reacted while driving [2].
A 2026 study from the same research group followed 26 college athletes with a concussion and 23 athletes without one [9]. Each was tested in a simulator three times: in the first few days, once symptoms were gone, and at full medical clearance [9]. This time, driving reaction time did not clearly differ between the groups [9]. The authors wrote that a short simulated drive may miss real differences, that clinic test results related poorly to driving reaction time, and that more research is needed [9].
Both studies were small and used a driving simulator, and their results point in different directions. The second one included only college athletes. Both found that clinic tests did a poor job of predicting driving reaction time. For now, Canada’s guideline ties the decision to your symptoms, and a formal evaluation can help when there is doubt [1].
Who can help decide whether you are ready
Several kinds of professionals check driving readiness. A 2014 framework from the American Occupational Therapy Association, written mainly with older drivers in mind, sorts driver services into levels, from basic education up to a full evaluation [3].
- A driver screen is done by a health care professional, such as a physician, social worker or neuropsychologist. They talk with you about the risks tied to your condition and can refer you on [3].
- A clinic evaluation is done by an occupational therapy practitioner. It looks at changes in your vision, thinking, senses and movement, and how those could affect driving [3]. Occupational therapy helps people do everyday tasks again.
- A driver rehabilitation program does a comprehensive driving evaluation, with a clinic part and an on road part. This is the level designed to decide whether a person is fit to drive [3].
- A driving school helps healthy drivers build skills [3]. A lesson with an instructor is no substitute for a medical driving evaluation.
Credentials to look for
ADED, the Association for Driver Rehabilitation Specialists, calls the certified driver rehabilitation specialist (CDRS) credential the gold standard in the field [10]. A CDRS has to follow ADED’s best practice guidelines, which aim to keep evaluations standard and objective [10]. ADED also offers a driver rehabilitation professional (DRP) credential for basic and low tech programs [10]. Some therapists and driving instructors work in the field without either credential, and each state sets its own training rules for this work [10].
ADED suggests at least one year of driver rehabilitation experience, and it keeps a searchable list of specialists [4].
For veterans
The VA offers driver rehabilitation through occupational therapy to veterans who qualify [11]. In 2023, the VA reported that more than 49 of its hospitals had driver training programs [11]. Ask your VA care team whether you qualify and how a referral works.
Comparison compiled by Safety Behind the Wheel Foundation
Who does what in a driving readiness check
| Who | What they look at | What it can tell you |
|---|---|---|
| Your doctor or care team | Symptoms, medicines, health history | Your risks and whether you need more testing |
| Occupational therapy practitioner | Vision, thinking, senses, movement | Your level of risk and need for follow up |
| Driver rehabilitation specialist or CDRS | Clinic tests plus driving in real traffic | Whether you are fit to drive; training or limits |
| Driving school instructor | Skills of healthy drivers | Practice only; not a medical evaluation |
| State licensing agency | Medical statements, vision, road test | Whether you keep, limit or lose your license |
Sources: AOTA Spectrum of Driver Services [3]; ADED [10]; New York DMV [6]; Alaska DMV [7]. Roles vary by state and program.
What happens during a driving evaluation
You may be able to set up an evaluation yourself. ADED says referrals can come from physicians, eye doctors, occupational therapists, driving schools, spouses or parents, or the drivers themselves [4].
The clinic part
ADED says the office part usually tests physical function, vision, perception, attention, movement and reaction time [4]. A doctor who knows you, a neuropsychologist or an occupational therapist may handle this part [5]. In one VA program, it includes a look at your medical and driving history, physical and vision checks, thinking tests, and a simulator that measures reaction time and attention [11].
The on road part
An evaluator grades how safely you handle different kinds of traffic and whether you follow state driving laws [5]. The VA program’s route, for example, covers parking lots, neighborhood and business streets, and interstate highways [11]. The whole evaluation averages three to eight hours [4]. Plan a ride to and from the appointment. If you have not been cleared to drive, do not drive yourself there.
Possible results
- You may be able to go back to driving [5].
- You may need retraining, or changes to your car, first [5].
- You may need to pass a state licensing exam for any limits placed on your license [4].
If the result is “not yet,” ask what would need to change and when you can be tested again.
Cost
Costs vary by provider and by type of program [4]. Some providers bill health insurance, while others set a price per service [4]. Your state’s vocational rehabilitation agency may cover part of the cost of an evaluation or car changes [5]. Ask about cost, billing and financial help before you book [4]. Our guide to returning to driving after brain injury or surgery covers cost in more detail.
Getting ready for the driving conversation
Notes show your care team how symptoms play out in real life. They also help with a common problem after brain injury: many people cannot spot changes in their own driving [5]. Someone who rides with you, or sees you in busy places, may notice what you miss.
Imagine the warehouse supervisor asks his wife what she has seen. She says he loses track of conversations by evening and once walked right past their parked car in a lot he knows well. Those details tell his care team far more than “I feel fine most days.”
The MSKTC fact sheet counts near misses, crashes and getting lost in familiar places as warning signs for drivers recovering from a brain injury [5]. If any of these has happened since your concussion, note when and where.
Medicines
Bring a full list of what you take, including medicines bought without a prescription and any supplements. Some prescription and store bought medicines can cause strong drowsiness or dizziness [12]. A label that warns against running heavy machinery applies to driving a car too [12]. Every state, along with Washington, D.C., outlaws driving while impaired by drugs [12]. Do not stop, skip or adjust a medicine by yourself so that you can drive. Ask the person who prescribed it, or a pharmacist, first.
Worksheet from Safety Behind the Wheel Foundation
My driving readiness notes
| What to note | What I have noticed |
|---|---|
| Symptoms on a typical day: when and how strong | |
| Symptoms on a bad day, and what sets them off | |
| Sleep this week and any daytime drowsiness | |
| Vision: blur, glare, double vision | |
| Dizziness when I turn my head or look over my shoulder | |
| Thinking: slow, foggy, losing track, getting lost | |
| Medicines and side effects I notice | |
| What family or friends have noticed | |
| Near misses, crashes or wrong turns since the injury | |
| Trips I need to make: where, how far, what time |
Fill this in during the week before your visit and bring it with you. Topics drawn from MSKTC [5] and the Living Concussion Guidelines [1].
Checklist from Safety Behind the Wheel Foundation
- Fill in the readiness notes for at least one week.
- Ask one person who knows you well what they have noticed.
- Make a full medicine list, including supplements.
- List the trips you most need, such as work, school pickup or the pharmacy.
- Write your most pressing driving questions at the top of a page.
- Bring a support person if you tend to forget what was said.
- Ask for the driving advice in writing before you leave.
When symptoms get worse, driving waits
After a head injury, phone 911 at once, or have someone rush you to the nearest emergency room, if any of these happen [13]:
- Your headache keeps building and does not fade.
- Part of your body goes weak or numb, you turn clumsy, or you have a seizure or convulsions.
- You throw up again and again.
- Your speech slurs, or you behave in ways that are not like you.
- One pupil, the black circle at the center of the eye, is wider than the other.
- You do not know familiar people or places, or you feel confused, restless or agitated.
- You black out, feel extremely drowsy, or no one can wake you.
Do not get behind the wheel to reach this care.
Questions for a driver rehabilitation program
ADED advises asking about costs, billing and financial help, and choosing a program that suits your needs [4].
Comparison compiled by Safety Behind the Wheel Foundation
Questions to ask before you book
| Question | Why it helps |
|---|---|
| Is the evaluator a CDRS, and how long have they done this work? | ADED suggests at least one year of experience |
| Do you often see people after a concussion? | Thinking and vision problems need the right tests |
| What happens in the clinic part and the road part? | You know what to expect and how long it takes |
| Whose car is used for the road test? | You can plan your ride and what to bring |
| What does it cost, and do you take my insurance? | Some programs bill insurance; others charge a fee |
| Who gets a copy of the results? | You know who will see the report |
| What happens if I am not ready yet? | Ask about training, therapy and a retest date |
Based on ADED guidance on choosing a program [4, 10] and the AOTA Spectrum of Driver Services [3].
State licensing rules and medical review
Rules for drivers with medical conditions differ from state to state. The MSKTC fact sheet tells people returning to driving after a brain injury to look up the laws where they live [5]. It adds that many states restrict driving in the six months after a serious neurological event, which can include a brain injury [5]. Some states want the motor vehicle agency to evaluate the driver, even one who already holds a license [5]. The fact sheet does not name these states.
In many states, a medical advisory board staffed by physicians makes the final call on a driver under medical review [14]. A study of state rules in November 2022 found six states that required physicians to report certain conditions: California, Delaware, Nevada, New Jersey, Oregon and Pennsylvania [14]. It also found 37 states that protected physicians from legal liability when they report [14]. Laws may have changed since then [14].
Two examples of how review works
New York’s Medical Review Unit looks into reports about drivers [6]. Physicians report on one form (DS-6), and other people can ask for a review on another (DS-7), with each case decided on its own [6]. A driver under review may need an interview, a physician’s statement (MV-80), a vision test, and the same road test new drivers take [6]. Missing the interview or the paperwork can lead to a suspended license [6].
In Alaska, state rules let anyone recommend that a driver be reexamined, including courts, physicians, police, friends and relatives, using Form 411 [7]. Alaska has no law that makes physicians report, but they may choose to [7]. The state can ask for a physician’s exam, a vision test, a written test or a road test [7]. Not following through can lead to a canceled or suspended license [7].
These two states are examples only, and rules change. Check with your own state’s driver licensing agency, and ask your care team whether any rule applies to you.
When the answer is not yet
Hearing “not yet” is hard when you need to get to work or care for others. Ask your care team what would need to improve, which treatment could help, and when you will talk about driving again. Put that date on your calendar.
Keep filling in the readiness notes each week. A month of notes gives a clearer picture than one good morning. CDC guidance tells clinicians to let any return of symptoms guide how much activity is safe, so a flare after a busy day is worth writing down [8].
Do not test yourself on public roads. Even a quick drive around the block puts you, your passengers and people walking nearby at risk. If the wait feels too long, ask for a formal evaluation so the decision rests on clear results.
While you wait, line up other ways to get around. Our guide on rides, appointments and errands while you are not driving has a transportation plan worksheet, scripts for asking for rides, and programs that may help.
Questions to ask your care team before you drive again
Question checklist from Safety Behind the Wheel Foundation
- Do you think I am ready to drive now, and which findings tell you that?
- Which of my symptoms worry you most when it comes to driving?
- Is a talk with you enough, or should I have a clinic evaluation or a full driving evaluation?
- Can you refer me to an occupational therapist or a driver rehabilitation specialist?
- Could any of my medicines, alone or together, slow me down or make me drowsy?
- If I start driving again, should I begin with limits, such as short trips in daylight?
- Which symptom changes are a signal to stop driving and call you?
- When should we check my readiness again?
- Under our state’s rules, do either of us need to tell the licensing agency anything?
- Can you write your driving advice in my visit summary?
Frequently asked questions
Can my doctor clear me to drive after an office visit?
Your doctor can advise you, and for some people that is enough. CDC guidance asks physicians to be cautious, most of all for patients with slowed reactions or attention problems [8]. In one study, a clinic computer reaction test was a poor stand in for reaction time while driving [2]. Ask whether a formal evaluation makes sense for you.
Will the results be sent to the DMV?
Ask the program before you book, because reporting rules differ by state. As of late 2022, six states required physicians to report certain conditions [14]. Your state’s licensing agency can tell you its current rules.
The bottom line
Recommendation from Safety Behind the Wheel Foundation
Driving after a concussion is a decision to make with your care team, and it rests on more than how you feel on a good day. Guidelines advise waiting until symptoms have eased enough for safe driving [1]. Research on driving after symptoms clear is small and mixed [2, 9].
Prepare for the visit with notes on symptoms, sleep, medicines and what others have seen. Ask whether you need a clinic review or a full driving evaluation, and question a program before you book. Licensing rules differ, so check with your own state’s driver licensing agency before you drive again.
Sources and further reading
- 1Living Concussion Guidelines. Initial management (section 2), recommendation 2.6. Updated August 2022. concussionsontario.org/…/initial_management
- 2Lempke LB, Lynall RC, Hoffman NL, Devos H, Schmidt JD. Slowed driving-reaction time following concussion-symptom resolution. Journal of Sport and Health Science. 2021;10(2):145-153. doi.org/10.1016/j.jshs.2020.09.005
- 3American Occupational Therapy Association. Spectrum of driver services: right services for the right people at the right time. 2014. aota.org/…/Spectrum-of-Driving-Services.pdf
- 4ADED, the Association for Driver Rehabilitation Specialists. Frequently asked questions. Accessed October 2026. aded.net/page/FAQs
- 5Novack T, Marwitz J, Hollis K, Rapport L, Klebine P. Driving after traumatic brain injury. Model Systems Knowledge Translation Center. 2024. msktc.org/…/driving-after-traumatic-brain-injury
- 6New York State Department of Motor Vehicles. DMV medical review program. Accessed October 2026. dmv.ny.gov/…/dmv-medical-review-program
- 7Alaska Division of Motor Vehicles. Medically impaired drivers. Accessed October 2026. dmv.alaska.gov/…/medically-impaired-drivers
- 8Centers for Disease Control and Prevention. HEADS UP: clinical guidance for health care providers. Reviewed July 2025. cdc.gov/…/clinical-guidance/index.html
- 9Drattell JD, Fu SD, Shumski EJ, et al. Longitudinal assessment of post-concussion driving reaction time. Traffic Injury Prevention. 2026;27(3):337-344. doi.org/10.1080/15389588.2025.2497066
- 10ADED, the Association for Driver Rehabilitation Specialists. Who provides driver rehabilitation services. Accessed October 2026. aded.net/page/230
- 11U.S. Department of Veterans Affairs, Phoenix VA Health Care System. Phoenix VA driver rehab program helps hundreds of Veterans. August 1, 2023. va.gov/…/phoenix-va-driver-rehab-program-helps-hundreds-of-veterans
- 12National Highway Traffic Safety Administration. Drug-impaired driving. Accessed October 2026. nhtsa.gov/risky-driving/drug-impaired-driving
- 13Centers for Disease Control and Prevention. Symptoms of mild TBI and concussion. Updated September 15, 2025. cdc.gov/…/signs-symptoms/index.html
- 14Tran EM, Lee JE. Reporting requirements, confidentiality, and legal immunity for physicians who report medically impaired drivers. JAMA Network Open. 2024;7(1):e2350495. jamanetwork.com/…/2813610
This article reflects the safety priorities of concussion recovery and road safety education. It offers general information, not medical or legal advice. Licensing and medical review rules vary from state to state and change over time, so confirm them with your state’s driver licensing agency. Decide when to drive again together with your own care team or a qualified driver rehabilitation program. Reviewed October 2026.
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