Right after my stroke I thought that I might never be able to drive again. That thought was very depressing and disheartening. If I could not drive again, I would have to always depend on others to take me places. I live in a rural area with very limited public transportation. My son suggested that I might have to move somewhere where there would be more access to public transport. But I love it here. I am in the country, on a mountain, with woods and creeks to hike along, with deer, squirrels, racoons and birds all around. I did not want to move.
As my vision slowly improved, I started feeling kind of hopeful that I would be able to drive again. But the road back to driving has been long and tedious. I have had no access to a rehabilitation program or facility. The neurologists I consulted were of no help whatsoever in terms of helping me recover my vision. I was left to my own devices.
I was scared. Driving a car is a huge responsibility. I would be putting my life and other people's lives into danger if I did not correct all the deficits that were interfering with my seeing well. And in that I had to be both evaluator and trainer: I had to establish criteria of what "seeing well enough" for driving was; and I had to find ways to correct the visual problems that interfered.
In my previous posts I have described in detail the problems associated with hemianopsia and stroke, and how they were addressed. Here I want to describe the process of dealing with these challenges in order to be able to drive again.
Overall, I felt that as each visual challenge was resolved, its absence made another one more evident. It was like peeling an onion! And then, one day there were no new problems arising, and the extent of the impairment was so reduced that I could live with it and drive with it. Getting there involved a process that was very tiring and at times tedious. It required that I pay meticulous attention to what was happening, what I could and could not do, and that I invent ways to start doing what I could not do.
This is what happened in the beginning as a result of the acupuncture and the eye exercises:
- The dizziness subsided
- The visual field expanded
- Letters started combining into words easily
- I could see and read words and sentences out of a moving car
- My capacity to visualize returned and I could plan trips in my mind
- The visual hallucinations diminished and then stopped
- The "blind area" started shrinking
At that point I became very aware that there was still a distortion in my right visual field. And it was a critical distortion because it could mask the presence of a car or a pedestrian or an animal. I tried different ways to remove it from view. I found that moving the midpoint of my vision a few degrees to the right made the blurry area fall outside the image I was looking at. I practiced this consistently when I was the passenger in a car and eventually I could see the whole road without any visual blurriness. I also practiced scanning the road from left to right and back again, repeatedly scanning to see what was on the right, the problem side.
Then I noticed that being in traffic was very tiring to my eyes. I would often feel overwhelmed and need to close them while I was being driven places. Acupuncture helped with that. I think it improved the speed with which my brain processed visual stimuli. I also spent a lot of time observing what I was doing and how I was feeling while looking out of the passenger side windows. I wanted to understand the sources of the overwhelm. Was I overdoing the scanning? Did I need to practice getting used to looking at many moving objects? Soon it became evident that the source of the visual fatigue was not the constant scanning. My brain did need more exposure to multiple stimuli. And a major contributor to the overwhelm were my emotions.
I noticed that cars coming from the right scared me. They made me anxious and somehow confused. That is when I realized that the one-sided inattention and the memory problems, which I mentioned in my previous posts, were contributing to confusion and overwhelm.
Cars would appear on the right and would startle me. How did that happen? I watched myself watching the road. I would look to the right, see a car, then look straight ahead, then look to the right again and get startled. I appeared to have forgotten that there was a car there. So I practiced adding words to the visual stimuli to improve the remembering of them. I would think: "black car on the right". I would then look forward repeating the words, then look back to the right, and there was the black car as I was expecting. After very many such repetitions, (really very very many), the whole thing became automatic, and I stopped having to do it consciously.
Then I started expanding the number of visual stimuli I would name. I would look to the front, right, left and the side mirror and name and try to remember all the vehicles around the car I was in. In that way nothing would surprise me, distract me or scare me. At the same time I was doing exercises at home to improve the processing of visual stimuli on the right side, and improve my visual memory.
I got to a point where, as a passenger, I was able to scan, see and remember everything around the car. I could visualize the whole trip and give instructions to the driver. I could read all the signs. I was not getting startled by cars or motorcycles weaving in and out the traffic. I did not feel visually overwhelmed by being in a moving car in heavy traffic.
But I was still worried that I might not see cars, bicycles, people or animals because of my "blind area" or the one- sided inattention. Yes, I could read, I could see the entire field, I could cope with the many stimuli of the road, but what if I got distracted and stopped paying attention to the right? Again I spent lots of time practicing "attending and naming and remembering" what was on the right, checking and counterchecking.
Car trips were very fatiguing and tedious for a while. But slowly things got easier and my attention seemed to be able to do what it was supposed to do, that is stay alert and focused.
So, one day I drove from my house to the post office at a time of little traffic, and I practiced all the things I had been doing as a passenger. After a week of cautiously driving around the community where I live, and noticing what was going well and what needed correcting, I dared drive to the next town, 4 miles away. At first I drove when there was no traffic, and a few days later I drove when school was letting out and I had to stop constantly to let people cross the street.
The article on hemianopsia and driving from the hemianopsia.net website that I list below (1), mentions an experiment where evaluators assessed the driving performance of people with normal vision and of people with with visual defects. In that study 73% of the people with hemianopsia were assessed as being safe drivers. The article's authors stress that each case of hemianopsia is different and that the deficits to be addressed are both cognitive and visual. In the absence of formal and professional evaluators, I had to be my own evaluator and assess my cognitive and visual deficits and my driving performance.
When local driving was evaluated as adequate, safe, and not stressful, I decided to drive on the freeway. The first time I did it with another person in the car. As that was a pleasant and uneventful trip, I decided that from then on I could drive by myself and even go on longer trips. Since then I have been driving near and far, alone and with passengers, remaining alert and vigilant all the time.
I made only one mistake during my "training" period. The first time I drove at night, I parked in front of a driveway that was on my right and that I did not notice. I got a ticket for $63. That motivated me to pay double attention to where I was parking and to what was on the right.
My advice to people who are trying to get back to driving with some degree of hemianopsia is to find a professional to evaluate them and rehabilitate them so that they can drive safely. But if this is not feasible, then they will have to do what I did: develop a rehabilitation plan and execute it step by step. Repeat things endlessly until they become automatic. Do not get discouraged when progress is not fast enough. Brains are plastic and they can heal themselves, but they require lots of practice. And finally, be very stringent evaluators of their performance behind the wheel.
In my own rehabilitation I received lots of help from scalp acupuncture. There are also several other aids to improving hemianopic vision that can facilitate safe driving: prisms that can be added to glasses, and different apparatuses for visual restoration therapy. I plan to write about them in a next post.
Links
1. Click here for a very interesting article on hemianopsia and driving from the heminopsia.net website.
2. Another interesting article on hemianopsia that addresses driving can be accessed here.
3. For State's vision requirements for driving click here
