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Industry: Email Alert RSS FeedDriving after brain injury
Journal of Rehabilitation, April-June, 1995 by Barbara S. Handler, Jeanne Boland Patterson
1. People with TBI are much slower than individuals without TBI, but reaction time is not predictive of on-the-road driving performance (Stokx & Gaillard, 1986).
2. Positive correlations exist between inability to return to driving and persistent visual problems, certain motor difficulties, an estimated post-injury IQ of 80 or less, failure on a driver simulation test, and post-traumatic amnesia of 11 weeks or longer (Hopewell, 1988). Hopewell suggested that a driver who sustained traumatic brain injury may present a "quadruple risk" in terms of impaired executive functions, overestimation of ability and denial of disability, generally slowed overall reaction time, and in some cases, the inherent higher level of risk represented by young males who historically have high accident rates.
3. Although individuals with and without TBI committed the same number of errors in the standardized on-the-road driving test, the errors of individuals with TBI are considered more serious. There was no particular pattern of deficits identified that was predictive of ability to drive, nor was the neuropsychological test battery predictive. A significant but non-conclusive correlation was found between driving experience and success in the on-the-road driving test (van Zomeren, Brouwer, & Rothengatter (1988). When the compensatory techniques and strategies used by aging drivers (undefined in this study; see Footnote 1) and drivers with brain injuries were compared, both groups were found to compensate for their shortcomings at the operational level by making better decisions at the tactical and strategic levels. The young men with brain injuries selected for this study had, with varying degrees of success, already returned to driving at the time of the study. Not all individuals with brain injuries are capable of the level of insight and self-awareness, which would enable them to evoke the hierarchical decision-making process regarding driving (van Zomeran, Brouwer, & Rothengatter, 1988).
4. Psychometric tests (particularly the Oral Symbol Digit Test), performance tasks (i.e., Driver Performance Test [Weaver, 1989], and operation of a "Small Scale Vehicle" in an adapted parking lot) were found to be valid predictors of driving. Although these findings were not externally validated with an on-the-road test, this study was an attempt to create a simple test battery to (a) screen out drivers who might present a significant danger to themselves and the behind-the-wheel evaluator, (b) identify deficits that might be ameliorated through remediation or compensation, and (c) control the costs of driving evaluations (Gouvier et al., 1989).
5. The lack of significant differences (a) between an experimental group of individuals who had successfully completed driving assessments and returned to driving and a matched control group in the types and incidences of driving mishaps and (b) results of the neuropsychological test battery given to members of the experimental group who had and had not had driving difficulties suggests that an initial comprehensive driving assessment (i.e., neuropsychological testing, extensive visual screening, ability to meet certain physical standards, and simulator and on-the-road evaluation) sets a reasonable standard for decision making about return to driving (Katz et al., 1990).
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