A verbal cuing device for persons with brain injury: development and proof-of-concept case study

Return-to-driving following acquired brain injury: A neuropsychological perspective

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.

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.

Driver rehabilitation: a systematic review of the types and effectiveness of interventions used by occupational therapists to improve on-road fitness-to-drive

OBJECTIVE

Driver rehabilitation has the potential to improve on-road safety and is commonly recommended to clients. The aim of this systematic review was to identify what intervention approaches are used by occupational therapists as part of driver rehabilitation programmes, and to determine the effectiveness of these interventions.

METHOD

Six electronic databases (MEDLINE, CINAHL, PsycInfo, Embase, The Cochrane Library, and OTDBase) were searched. Two authors independently reviewed studies reporting all types of research designs and for all patient populations, provided the interventions could be administered by occupational therapists. The methodological quality of studies was assessed using the 'Downs and Black Instrument', and the level of evidence for each intervention approach was established using 'Centre for Evidence Based Medicine' criteria.

RESULTS

Sixteen studies were included in the review. The most common type of intervention approach used was computer-based driving simulator training (n=8), followed by off-road skill-specific training (n=4), and off-road education programmes (n=3). Car adaptations/modifications were used in one of the included studies. There was significant variability between studies with regards to frequency, duration, and total number of intervention sessions, and the diagnoses of the participants. Of the four intervention approaches, there is evidence to support the effectiveness of off-road skill-specific training (with older clients), and computer-based driving simulator training (with both older clients and participants with acquired brain injury).

CONCLUSION

Three types of intervention approaches are commonly reported, however, there is limited evidence to determine to effectiveness of these in improving fitness-to-drive. Further research is required, with clients from a range of diagnostic groups to establish evidence-based interventions and determine their effectiveness in improving these clients' on-road fitness-to-drive.