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Rosenfeld M, Goverover Y, Weiss P. Self-awareness predicts fitness to drive among adults referred to occupational therapy evaluation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005025. [DOI: 10.3389/fresc.2022.1005025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
BackgroundDriving is associated with independence, well-being, quality of life, and an active lifestyle. Driving requires cognitive, motor, and visual skills, including self-awareness and processing speed. This study examines whether driver self-awareness, motor processing speed, and cognitive processing speed can predict fitness to drive among individuals referred to occupational therapy evaluation due to concerns about their driving ability.MethodIn this cross-sectional study, 39 participants were referred to off- and on-road driving evaluation to determine their fitness to drive due to changes in health status, advanced age, license renewal requirement, or prior automobile accidents. A registered occupational therapist (OT) classified 23 of the participants as fit to drive and 16 as unfit to drive. Motor and cognitive processing speed were assessed by the Stationary Perception-Reaction Timer and the Color Trails Test, respectively. Driving self-awareness was assessed by comparing the DI and OT evaluations to the participants' estimation of their own on-road driving performance.ResultsThe fit-to-drive participants had a better motor and cognitive processing speed than those unfit-to-drive. The unfit-to-drive group overestimated their driving ability, whereas the fit-to-drive group accurately or almost accurately estimated their driving ability. Driving self-awareness was a significant predictor of participants' fitness to drive.ConclusionsThis study demonstrates the importance of self-awareness for predicting fitness to drive among people at risk for compromised driving skills. Thus, driving self-awareness should be addressed as part of fitness-to-drive evaluations and interventions.
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Steward KA, Kretzmer T. Anosognosia in moderate-to-severe traumatic brain injury: A review of prevalence, clinical correlates, and diversity considerations. Clin Neuropsychol 2022; 36:2021-2040. [PMID: 34429014 DOI: 10.1080/13854046.2021.1967452] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
METHOD A comprehensive search of peer-reviewed articles was conducted from September to November 2020 using Google Scholar and PubMed databases. Key terms included "anosognosia," "self-awareness," "traumatic brain injury," and variants thereof. Our search was restricted to articles published in English within the last 25 years, although a few historical articles were included due to scientific merit. Articles were chosen based on methodological quality, inclusion of solely or predominantly msevTBI sample, and relevance to the current topic. CONCLUSIONS Anosognosia is a multifaceted and domain-specific construct that affects the majority of those with msevTBI. It is related to TBI severity, injuries in right-hemispheric and cortical midline regions, specific aspects of executive function, psychological function, and cultural factors. We offer pragmatic advice for clinicians working with this population and discuss implications for the field regarding "best practices" of anosognosia assessment and intervention.
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Affiliation(s)
- Kayla A Steward
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Tracy Kretzmer
- Department of Mental Health and Behavioral Sciences, James A. Haley Veterans' Hospital, Tampa, FL, USA
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Hirano D, Kimura N, Yano H, Enoki M, Aikawa M, Goto Y, Taniguchi T. Different brain activation patterns in the prefrontal area between self-paced and high-speed driving tasks. JOURNAL OF BIOPHOTONICS 2022; 15:e202100295. [PMID: 35103406 DOI: 10.1002/jbio.202100295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/18/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
The purpose of this study was to investigate the effects on prefrontal cortex brain activity when participants attempted to stop a car accurately at a stop line when driving at different speeds using functional near-infrared spectroscopy (fNIRS). Twenty healthy subjects with driving experience drove their own cars for a distance of 60 m five times each at their own pace or as fast as possible. The variation in the distance between the stop line and the car was not significantly different between the self-paced and high-speed tasks. However, oxygenated hemoglobin concentration in the prefrontal cortex was significantly higher in the high-speed task than in the self-paced task. These findings suggest that driving at high speed requires more divided attention than driving at self-paced speed, even though the participants were able to stop the car at the same distance from the target. This study shows the advantages and usefulness of fNIRS .
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Affiliation(s)
- Daisuke Hirano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Naotoshi Kimura
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Rehabilitation, International University of Health and Welfare Ichikawa Hospital, Ichikawa, Chiba, Japan
| | - Hana Yano
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
| | - Miku Enoki
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Rehabilitation, International University of Health and Welfare Shioya Hospital, Yaita, Tochigi, Japan
| | - Maya Aikawa
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Rehabilitation, International University of Health and Welfare Shioya Hospital, Yaita, Tochigi, Japan
| | - Yoshinobu Goto
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Faculty of Medicine, School of Medicine, International University of Health and Welfare, Narita, Chiba, Japan
- Department of Occupational Therapy, School of Health Sciences at Fukuoka, International University of Health and Welfare, Okawa, Fukuoka, Japan
| | - Takamichi Taniguchi
- Graduate School of Health and Welfare Sciences, International University of Health and Welfare, Minato, Tokyo, Japan
- Department of Occupational Therapy, School of Health Sciences, International University of Health and Welfare, Otawara, Tochigi, Japan
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4
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Stamatelos P, Economou A, Stefanis L, Yannis G, Papageorgiou SG. Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role. Neurol Sci 2021; 42:4953-4963. [PMID: 34581880 DOI: 10.1007/s10072-021-05610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Driving is a complex task requiring the integrity and the cooperation of cognition, motor, and somatosensory skills, all of which are impacted by neurological diseases. OBJECTIVE Identification of neurologist's role when assessing fitness to drive of cognitively impaired individuals. METHODS We performed a systematic review of the guidelines/recommendations (G/Rs) regarding the evaluation of driving fitness of patients with mild cognitive impairment (MCI) and/or dementia. Emphasis was put on the neurological and neuropsychological aspects of the evaluation. RESULTS Eighteen G/Rs were included in the review (9 national guidelines, 5 recommendation papers, 3 consensus statements, and 1 position paper). All G/Rs referred to drivers with dementia and 9/18 referred to drivers with MCI. A common approach among G/Rs is the initial trichotomization of patients in safe to drive, unsafe to drive, and undetermined cases, which are referred to a second-line evaluator. First-line evaluators are general practitioners in 10/18 G/Rs; second-line evaluators are neurologists in 7/18 G/Rs. Specific neuropsychological tests are proposed in 11/18 G/Rs and relative cut-off values in 7/18. The most commonly used tests are the MMSE, TMT, and CDT. A thorough neurological examination is proposed in only 1/18 G/R. CONCLUSION Although extensive multi-disciplinary research has provided useful information for driving behavior of cognitively impaired individuals, we are still far from a widely accepted approach of driving ability evaluation in this increasing population. A comprehensive assessment from a multi-disciplinary team in which the neurologist plays a critical role seems to be required, although this has not yet been implemented in any G/Rs.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece.
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5
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Perna R, Pundlik J, Arenivas A. Return-to-driving following acquired brain injury: A neuropsychological perspective. NeuroRehabilitation 2021; 49:279-292. [PMID: 34420988 DOI: 10.3233/nre-218026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Return to driving after an acquired brain injury (ABI) has been positively associated with return to employment, maintenance of social relationships, and engagement in recreational and other community activities. Safe driving involves multiple cognitive abilities in a dynamic environment, and cognitive dysfunction resulting from ABI can negatively impact driving performance. OBJECTIVE This manuscript examines the post-injury return-to-driving process, including performances on the in-office and on-road assessments, and the role of a rehabilitation neuropsychologist in helping patients resume driving. METHOD In this study, 39 of 200 individuals (approximately 20%) treated at an outpatient neurorehabilitation facility, who performed satisfactorily on a pre-driving cognitive screening, completed a behind-the-wheel driving test. RESULTS Of the 200 individuals, 34 (87%) passed the road test. Among the remaining five individuals who did not pass the road test, primary reasons for their failure included inability to follow or retain examiner directions primarily about lane position, speed, and vehicle control. The errors were attributable to cognitive difficulties with information processing, memory, attention regulation, and dual tasking.CONCLUSIONThe rehabilitation neuropsychologist contributed to the process by assessing cognition, facilitating self-awareness and error minimization, providing education about driving regulations and safety standards, and preparing for the road test and its outcomes.
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Affiliation(s)
| | | | - Ana Arenivas
- The Institute of Rehabilitation Research (TIRR), Memorial Hermann, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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6
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Dromer E, Kheloufi L, Azouvi P. Impaired self-awareness after traumatic brain injury: A systematic review. Part 2. Consequences and predictors of poor self-awareness. Ann Phys Rehabil Med 2021; 64:101542. [PMID: 34029754 DOI: 10.1016/j.rehab.2021.101542] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 04/19/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Impaired self-awareness (ISA) has frequently been found both frequent and deleterious in patients with moderate to severe traumatic brain injury (TBI). OBJECTIVES This is the second of a two-part systematic review on ISA after TBI, focusing on the consequences and predictors of ISA after TBI. METHODS Following the PRISMA guidelines, 95 articles meeting the inclusion criteria were included; 46 were specifically related to this second part of the review. RESULTS Among 16 studies that investigated the effect of ISA on outcome, most (n=13) found poor self-awareness associated with poor rehabilitation, functional, social and vocational outcome and with increased burden on relatives. Multiple factors have been found associated with increased frequency of ISA. ISA was found significantly related to injury severity in 8 of 10 studies, impaired executive functions in 12 of 15 studies, and poor social cognition in 3 studies, but paradoxically inverse associations were repeatedly found between self-awareness and emotional status (11 of 12 studies). Finally, although research in the field is still scarce, ISA seems associated with a dysfunction within brain networks involving the anterior cingulate cortex, anterior insula and fronto-parietal control network. CONCLUSIONS ISA is a complex and multifaceted disorder associated with poor rehabilitation outcome, severe injuries, and deficits of executive functions and social cognition but has an inverse association with mood impairments.
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Affiliation(s)
- Emilie Dromer
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - Lyes Kheloufi
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France
| | - Philippe Azouvi
- AP-HP, GHU Paris-Saclay, Service de Médecine Physique et de Réadaptation, Hôpital Raymond Poincaré, Garches, France; Université Paris-Saclay, UVSQ, Inserm, CESP, Team DevPsy, 94807 Villejuif, France.
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7
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Novack TA, Zhang Y, Kennedy R, Rapport LJ, Marwitz J, Dreer LE, Goldin Y, Niemeier JP, Bombardier C, Bergquist T, Watanabe TK, Tefertiller C, Brunner R. Driving patterns, confidence, and perception of abilities following moderate to severe traumatic brain injury: a TBI model system study. Brain Inj 2021; 35:863-870. [PMID: 34096418 DOI: 10.1080/02699052.2021.1934730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Thomas A Novack
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Jennifer Marwitz
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Laura E Dreer
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yelena Goldin
- Department of Physical Medicine and Rehabilitation, JFK Rehabilitation Institute, Edison, New Jersey, USA
| | - Janet P Niemeier
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles Bombardier
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Thomas Bergquist
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, Moss Rehabilitation at Elkins Park/Einstein Healthcare Network, Elkins Park, Pennsylvania, USA
| | | | - Robert Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
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8
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Dimech-Betancourt B, Ponsford JL, Charlton JL, Ross PE, Gooden JR, Stolwyk RJ. Investigating feasibility and preliminary efficacy of a simulator-based driving intervention for people with acquired brain injury: A randomised controlled pilot study. Clin Rehabil 2021; 35:1277-1289. [PMID: 33810776 DOI: 10.1177/02692155211002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the feasibility and preliminary efficacy of a driving simulator intervention on driving outcomes following acquired brain injury. DESIGN Pilot randomised controlled trial. SETTING Occupational therapy driver assessment and rehabilitation service. SUBJECTS Individuals post-acquired brain injury aiming to return to driving. INTERVENTION Eight sessions of simulated driver training over four weeks, in addition to usual care. Control: Usual care only. MAIN MEASURES Feasibility outcomes: Participant recruitment and retention; data completeness; therapy attendance and fidelity; adverse events. Performance outcomes: on-road driving performance; Simulator Sickness Questionnaire; Brain Injury Driving Self-Awareness Measure and Driving Comfort Scale - Daytime, assessed at baseline and five weeks post-randomisation. RESULTS Out of 523 individuals screened, 22 (4%) were recruited and randomised, with 20 completing their allocated group (n = 12 Simulator, n = 8 Usual Care). For those who completed training, session attendance was 100% with simulator sickness rated, on average, as mild. Six individuals (50%) in the Simulator group failed the on-road assessment, versus two (25%) in the Usual Care group (P = 0.373). On average, the Simulator group reported a positive change in confidence ratings (M = 5.77, SD = 13.96) compared to the Usual Care group, who reported a negative change (M = -6.97, SD = 8.47), P = 0.034. The Simulator group (M = 0.67, SD = 3.34) demonstrated no significant change in self-awareness relative to the Usual Care group (M = -0.83, SD = 1.83, P = 0.325). CONCLUSIONS With adjustments to inclusion criteria and recruitment strategies, it may be feasible to deliver the intervention and conduct a larger trial. There is potential benefit of simulator training for improving driver confidence after acquired brain injury.
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Affiliation(s)
- Bleydy Dimech-Betancourt
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia
| | - Jennie L Ponsford
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.,Epworth Rehabilitation, Melbourne, VIC, Australia
| | - Judith L Charlton
- Monash University Accident Research Centre, Monash University, Melbourne, VIC, Australia
| | - Pamela E Ross
- Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia.,Epworth Rehabilitation, Melbourne, VIC, Australia
| | - James R Gooden
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia
| | - Renerus J Stolwyk
- School of Psychological Sciences, Turner Institute for Brain and Mental Health, Monash University, Melbourne, VIC, Australia.,Monash-Epworth Rehabilitation Research Centre, Melbourne, VIC, Australia
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9
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Dimech-Betancourt B, Ponsford JL, Charlton JL, Ross PE, Stolwyk RJ. User experiences and perspectives of a driving simulator intervention for individuals with acquired brain injury: A qualitative study. Neuropsychol Rehabil 2020; 31:773-796. [PMID: 32114901 DOI: 10.1080/09602011.2020.1731555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Driving a motor vehicle is a common rehabilitation goal following acquired brain injury (ABI). There is increasing interest in the use of driving simulators for driver rehabilitation post-ABI; however, there is still limited research demonstrating efficacy and acceptability. This study sought to examine the user experience of a driving simulator intervention for ABI survivors. Semi-structured interviews were conducted with 14 individuals, including 12 ABI survivors (42% male; Mean age = 53.92 years, SD age = 17.63) who completed the intervention, and 2 occupational therapist driver assessors who facilitated the intervention. Thematic analysis was adopted to analyse interview data. Findings suggest that individual differences (e.g., anxiety, previous experience) influenced participant response to training. The intervention allowed participants to practise various driving skills, re-familiarize themselves with the task of driving, and prepare for return to on-road driving within a safe environment. The intervention was perceived to be useful for enhancing driver self-awareness, autonomy, confidence and patience. Fidelity and simulator sickness were considered limitations of the simulator technology. Subjective accounts of the appropriateness of intervention components are also documented. Overall, the simulator intervention was reported to be a positive experience for participants. Themes emerging from this study can inform future driving simulator interventions for ABI survivors.
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Affiliation(s)
- Bleydy Dimech-Betancourt
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
| | - Jennie L Ponsford
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.,Epworth Rehabilitation, Richmond, Australia
| | - Judith L Charlton
- Monash University Accident Research Centre, Monash University, Clayton, Australia
| | - Pamela E Ross
- Monash-Epworth Rehabilitation Research Centre, Richmond, Australia.,Epworth Rehabilitation, Richmond, Australia
| | - Renerus J Stolwyk
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Australia.,Monash-Epworth Rehabilitation Research Centre, Richmond, Australia
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10
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A Systematic Review and Meta-Analysis on the Association Between Driving Ability and Neuropsychological Test Performances after Moderate to Severe Traumatic Brain Injury. J Int Neuropsychol Soc 2019; 25:868-877. [PMID: 31084639 DOI: 10.1017/s1355617719000456] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Guidelines on return-to-driving after traumatic brain injury (TBI) are scarce. Since driving requires the coordination of multiple cognitive, perceptual, and psychomotor functions, neuropsychological testing may offer an estimate of driving ability. To examine this, a meta-analysis of the relationship between neuropsychological testing and driving ability after TBI was performed. METHODS Hedge's g and 95% confidence intervals were calculated using a random effects model. Analyses were performed on cognitive domains and individual tests. Meta-regressions examined the influence of study design, demographic, and clinical factors on effect sizes. RESULTS Eleven studies were included in the meta-analysis. Executive functions had the largest effect size (g = 0.60 [0.39-0.80]), followed by verbal memory (g = 0.49 [0.27-0.71]), processing speed/attention (g = 0.48 [0.29-0.67]), and visual memory (g = 0.43 [0.14-0.71]). Of the individual tests, Useful Field of Vision (UFOV) divided attention (g = 1.12 [0.52-1.72]), Trail Making Test B (g = 0.75 [0.42-1.08]), and UFOV selective attention (g = 0.67 [0.22-1.12]) had the largest effects. The effect sizes for Choice Reaction Time test and Trail Making Test A were g = 0.63 (0.09-1.16) and g = 0.58 (0.10-1.06), respectively. Years post injury (β = 0.11 [0.02-0.21] and age (β = 0.05 [0.009-0.09]) emerged as significant predictors of effect sizes (both p < .05). CONCLUSIONS These results provide preliminary evidence of associations between neuropsychological test performance and driving ability after moderate to severe TBI and highlight moderating effects of demographic and clinical factors.
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11
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McKerral M, Moreno A, Delhomme P, Gélinas I. Driving Behaviors 2-3 Years After Traumatic Brain Injury Rehabilitation: A Multicenter Case-Control Study. Front Neurol 2019; 10:144. [PMID: 30899239 PMCID: PMC6417438 DOI: 10.3389/fneur.2019.00144] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/05/2019] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Michelle McKerral
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada.,Departement of Psychology, Université de Montréal, Montreal, QC, Canada
| | - Alexander Moreno
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Patricia Delhomme
- French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), Versailles, France
| | - Isabelle Gélinas
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR) - CISSS de Laval, and School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
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12
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Brown T, Peres L. A critical review of the Motor-Free Visual Perception Test—fourth edition (MVPT-4). JOURNAL OF OCCUPATIONAL THERAPY SCHOOLS AND EARLY INTERVENTION 2018. [DOI: 10.1080/19411243.2018.1432441] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Victoria, Australia
| | - Lisa Peres
- Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University – Peninsula Campus, Frankston, Victoria, Australia
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13
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Stolwyk RJ, Charlton JL, Ross PE, Bédard M, Marshall S, Gagnon S, Gooden JR, Ponsford JL. Characterizing on-road driving performance in individuals with traumatic brain injury who pass or fail an on-road driving assessment. Disabil Rehabil 2018; 41:1313-1320. [DOI: 10.1080/09638288.2018.1424955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Renerus J. Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Judith L. Charlton
- Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | | | - Michel Bédard
- Centre for Research and Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Shawn Marshall
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - James R. Gooden
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Jennie L. Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
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Gooden JR, Ponsford JL, Charlton JL, Ross P, Marshall S, Gagnon S, Bédard M, Stolwyk RJ. Self-regulation upon return to driving after traumatic brain injury. Neuropsychol Rehabil 2016; 29:92-106. [DOI: 10.1080/09602011.2016.1261716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- James R. Gooden
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Epworth Rehabilitation Research Centre, Clayton, VIC, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Jennie L. Ponsford
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Epworth Rehabilitation Research Centre, Clayton, VIC, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Judith L. Charlton
- Monash Accident Research Centre, Monash University, Clayton, VIC, Australia
| | - Pamela Ross
- Epworth Rehabilitation, Richmond, VIC, Australia
| | - Shawn Marshall
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Michel Bédard
- Centre for Research and Safe Driving, Lakehead University, Thunder Bay, Canada
| | - Renerus J. Stolwyk
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia
- Monash Epworth Rehabilitation Research Centre, Clayton, VIC, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
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