Navigating Invisible Injuries on the Road
Occupational therapy research offers insight to service members’ hyper- vigilance, anxiety behind the wheel
A large number of service members returning home from Iraq and Afghanistan are suffering from post- traumatic stress disorder (PTSD) and traumatic brain injury (TBI). Side- effects run the gamut of medical symptoms including hyper- vigilance, fear, and even rage, but there is one task many veterans share a new anxiety about: driving.
“Many returning service members report that they go through stop signs and red lights, are distracted by sounds from outside the vehicle, focus intently on other drivers and objects, and drive erratically through tunnels or under overpasses. One person I spoke with was missing turnoffs because he was focusing on pedestrians and trash, not on road signs,” said Erica Stern, PhD, OTR/L, FAOTA, an associate professor of occupational therapy at the University of Minnesota who is conducting research through a grant from the Department of Defense Congressionally Directed Medical Research Programs (CDMRP). “The driving behaviors that kept them safe in a war zone may make them less safe on the roads at home.”
As Stern and her graduate students reported in a brochure now published by the Rehabilitation and Reintegration Division (R2D) of the Office of the Surgeon General, operations in Iraq and Afghanistan involve extensive ground travel. When driving in combat situations, service members often need to use combat driving maneuvers to help avoid insurgent attacks. These maneuvers include:
- Driving down the middle of the road, away from things or people at roadside;
- Driving off the road to avoid threats that could be hidden in common objects, animal carcasses, or the roadway itself;
- Speeding to avoid attack or driving slowly enough to be able to watch for threats;
- Being extremely vigilant of vehicles, objects, buildings, vehicle drivers, and people on or near the roadway; and
- Asserting right of way in all situations, and thus not stopping at intersections or traffic jams.
An earlier regional study by Stern and a group of master’s degree occupational therapy students compared the driving behaviors and driving- related anxieties of 150 soldiers who had returned from Operation Iraqi Freedom (OIF) to 49 soldiers who had not been deployed. Returned soldiers' reporting on their past 30 days of American driving indicated significantly worse driving behaviors, with a large percentage of post-deployment soldiers reporting that they sometimes or always fell into combat driving behaviors, e.g., drove through stop signs (25%), drove in the middle of the road or into oncoming traffic (23%), drove erratically in a tunnel (11%), or made turns or lane changes without signaling (35%). Nearly a third of the group had been told by others that they drove dangerously. These soldiers were a general sample, without known PTSD or TBI, yet in addition to their slips into combat driving behaviors, they also reported significantly more frequent anxiety than their non-deployed comrades. Twenty percent were anxious when driving at any time, with larger numbers being anxious in specific civilian driving situations that mimic combat threats associated with driving, such as when driving near roadside debris (31%), near parked cars (25%), or when another car approached quickly or boxed them in (49%).
Occupational therapy rehabilitation and reintegration programs in Veterans’ and military treatment facilities strive to provide successful and meaningful reintegration of service members, including their return to safe driving.
Marc Samuels, MS, OTR/L, CDRS, evaluates service members and veterans who are seen at the polytrauma rehabilitation center—1 of just 5 in the nation—at Palo Alto Veterans Affairs Health Care System in California. In his work with veterans he has observed extreme apprehension about things most drivers do not even notice.
“I was out driving on the freeway with one guy and when we got to the off- ramp to exit, he spotted a bag of trash left from a road crew. He drove off the road and off the ramp to stay away from it. He was being hyper-vigilant of IEDs [improvised explosive devices],” Samuels said. “Fresh asphalt in a pothole is scary because it signals something dangerous buried there; building construction resembles a blown-out building. All soldiers, even passengers, in a convoy have duties. Each passenger is assigned a quadrant or an area of the road to watch so the driver can focus straight ahead. One guy I worked with was so hyper-vigilant that he was watching quadrants even as he was driving. And if he saw a guy off to the side and his wife did not report to him that the guy was OK, he would get mad at his wife.”
Identifying the triggers for these reactions is the first step in helping service members and veterans cope with the effects of PTSD and TBI. The goal of occupational therapy is to enable individuals with functional impairments, regardless of the cause, to attain their maximum level of participation and independence. Occupational therapists help wounded warriors return to their military roles and responsibilities or transition into civilian life by helping them to develop or regain the skills and strategies that allow them to be successful in all areas of their lives.
To interview an occupational therapy practitioner about PTSD and TBI-related driving research or evaluations, please call AOTA Media Relations Manager Katie Riley, 301-652-6611, ext. 2963 or email firstname.lastname@example.org. More strategies, resources, and tips dedicated to PTSD, TBI, and safe driving are offered through AOTA’s Web site, www.aota.org. The Web site of the Rehabilitation and Reintegration Division of the Office of The Surgeon General (Army) provides brochures for service members and their families and friends with suggestions for simple actions to help smooth return to civilian roads.
Founded in 1917, the American Occupational Therapy Association (AOTA) represents the professional interests and concerns of more than 140,000 occupational therapists, assistants, and students nationwide. The Association educates the public and advances the profession of occupational therapy by providing resources, setting standards including accreditations, and serving as an advocate to improve health care. Based in Bethesda, Md., AOTA’s major programs and activities are directed toward promoting the professional development of its members and assuring consumer access to quality services so patients can maximize their individual potential. For more information, go to www.aota.org.