Self-regulation upon return to driving after traumatic brain injury

Driving patterns, confidence, and perception of abilities following moderate to severe traumatic brain injury: a TBI model system study

OBJECTIVE

Describe driving patterns following moderate-to-severe traumatic brain injury (TBI). Participants: Adults (N = 438) with TBI that required inpatient acute rehabilitation who had resumed driving.

DESIGN

Cross-sectional, observational design.

SETTING

Eight TBI Model System sites.

MAIN MEASURES

A driving survey was completed at phone follow-up.

RESULTS

Most respondents reported driving daily, although 41% reported driving less than before their injury. Driving patterns were primarily associated with employment, family income, sex, residence, and time since injury, but not injury severity. Confidence in driving was high for most participants and was associated with a perception that the TBI had not diminished driving ability. Lower confidence and perceived loss of ability were associated with altered driving patterns.

CONCLUSION

Most people with moderate-to-severe TBI resume driving but perhaps not at pre-injury or normal levels compared to healthy drivers. Some driving situations are restricted. The relationship between low confidence/perceived loss of ability and driving patterns/restrictions suggests people with TBI are exhibiting some degree of caution consistent with those perceptions. Careful assessment of driving skills and monitoring during early stages of RTD is warranted, particularly for younger, male, and/or single drivers who express higher levels of confidence.

Modelling braking behaviour and accident probability of drivers under increasing time pressure conditions

Drivers apply brakes to reduce the speed of a vehicle based on the perceived risk while approaching a certain event. Inadequate or excessive braking can lead to serious consequences. The current study analyses the braking behaviour and accident probability of the drivers under increasing time pressure conditions. Two perilous events (pedestrian crossing and obstacle overtaking) were designed to examine Brake Pedal Force (BPF) and Brake-To-Maximum Brake (BTMB) transition time on a driving simulator. Eighty-five Indian licensed drivers drove the simulator in three different time pressure conditions: No Time Pressure (NTP) (baseline), Low Time Pressure (LTP), and High Time Pressure (HTP). Random parameters Tobit model was used for analysing BPF and duration analysis approach was considered for BTMB analysis. Further, generalized linear mixed model with logit link function was used to study the effect of BPF and BTMB on accident probability of the drivers. The model results showed that gender, driving profession, approach speed, age, driving history, and driving condition significantly affected braking behaviour of the drivers. It was observed that in pedestrian crossing event, LTP and HTP driving conditions resulted in 42.31 % and 87.28 % increase in BPF and 13 % and 23 % reduction in BTMB respectively with respect to NTP driving condition and the corresponding changes were slightly lower in case of obstacle overtaking event. The accident probability model showed that female drivers needed 119.70 % and 186.08 % more BPF and 37.55 % and 58.51 % less BTMB in LTP and HTP driving conditions respectively to have equivalent risk levels as observed for male drivers. Further, non-professional drivers had to increase their BPF by 166.83 % in LTP and 219.93 % in HTP to offset their increased accident risk as compared to professional drivers under time pressure conditions.

Driving Behaviors 2-3 Years After Traumatic Brain Injury Rehabilitation: A Multicenter Case-Control Study

Introduction: Driving an automobile is an important activity for the social participation of individuals with traumatic brain injury (TBI). Return to safe driving is usually addressed during rehabilitation, but we know little about driving behaviors in the years following TBI rehabilitation.

Objective: To explore self-reported and objective (official driving records) post-rehabilitation driving behaviors and offenses in individuals with TBI: (a) having passed a driving evaluation, (b) who did not undergo a driving evaluation, and (c) non-injured controls.

Methods: Cross-sectional design with 162 adults: (a) 48 participants with mild, moderate, or severe TBI whose drivers' license was suspended and reinstated following a driving evaluation during rehabilitation (TBI-DE; M = 42.2 years of age, SD = 11.5); (b) 24 participants with TBI who maintained their driving privileges without undergoing a driving evaluation (TBI-NE; M = 36.5 years of age, SD = 9.9); (c) 90 non-injured controls (M = 43.8 years of age, SD = 11.4). Participants with TBI were recruited from seven rehabilitation centers, 2–3 years after the end of rehabilitation in the province of Quebec, Canada. During a telephone interview, data were obtained regarding self-reported driving: (a) habits; (b) self-efficacy; (c) anger expression; (d) sensation-seeking; (e) violations/errors; (f) accidents, driving offenses, and demerit points for the two-year interval predating the study. Objective data for driving offenses, accidents, and demerit points were obtained from the automobile regulatory body for the same period and for the two-year interval before the injury for the TBI groups.

Results: Compared to non-injured controls, the TBI-DE group reported significantly lower scores for self-reported verbal aggressive expression of anger and driving violations/errors. Conversely, their official driving records showed significantly more demerit points for the last 2 years, and a significantly higher frequency of serious post-rehabilitation accidents (10), compared to the TBI-NE group (one) and the control group (none). Compared to pre-injury levels, individuals with TBI had significantly more demerit points post-rehabilitation.

Conclusions: Individuals with TBI may underestimate risky driving behaviors even if they have been deemed fit to drive. Reduced self-awareness, memory, and dysexecutive problems following TBI could influence self-report of driving behaviors and explain discrepancies between self-reported and objective driving-related behaviors. Recommendations for research and practice are provided.