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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
Although the correlations between the scores above and below the cut-off pass/fail composite scores and the ability to drive were clearly demonstrated, making driving recommendations based on the borderline scores was a major focus of later articles in this series (Engum et al. 1988; Lambert et al. 1990; Lambert & Engum, 1992). It was suggested that evaluators consider external evaluations and the driving history of each patient being tested.
In summary, the research with the CBDI supports the use of actual performance tests with other assessments (e.g., vision, reaction time). In addition to providing more accurate assessments, performance tests can also provide valuable feedback to individuals with TBI, when serious deficiencies in driving are not comprehended.
Driving Simulator Studies
Driving simulators have been used in a number of studies to determine their value as predictors of on-the-road performance and as training aids in helping people overcome challenges resulting from TBI. Kewman, Siegerman, Kintner, and Chu (1985) investigated whether specific cognitive remediation efforts (i.e., training tasks simulating different aspects of driving) would generalize to actual driving of an automobile for survivors of TBI who were more than six months post-injury. Results indicated that individuals who received training with an Amigo electric vehicle showed greater improvement in their on-the-road performances than did people with brain injuries who did not receive specific training. Although the Amigo training did not improve the experimental group's skills to the level of the able-bodied control group, the researchers concluded that the simulation training did generalize to on-the-road performance. They were unable to follow the experimental group to see how many went on to receive driver's licenses, and if they were able to drive in a safe manner.
Bowen, Hershler, Laszlo, and Miller (1989) investigated the use of the Computerized Driver Assessment Module to assess driving potential of people with brain injuries. Performance on the simulator appeared to predict passing or failing an on-the-road exam for the experimental group. Finally, Galski et al. (1992), as previously noted, incorporated a driving simulator (the Doron L225 Driving System) in the battery of diagnostic assessments, and found that the use of the simulator enhanced the predictive results of the other pre-driving tests by 6%, while assessment of driving skills performed in a parking lot enhanced predictive ability by 23%. Therefore, the use of driving simulators can help in (a) predicting the ability of individuals with TBI to pass driving exams, and (b) improving driving skills.
Assessments of Visual Processes
Most of the previously cited studies included some assessment of vision in their research protocols. There was divergence about which aspects of vision and visual processing were examined and the importance given to the various aspects. The studies of visual processing suggest that (a) standard optometric examinations are not sufficient and rehabilitation optometric examinations should be made a standard part of diagnosis and treatment for survivors of brain injury (Gianutos, Ramsey, & Perlin, 1988; Warren, 1992), and (b) driver rehabilitation specialists must be prepared to assess possible visual deficits associated with various disabilities (including brain injury), which might not be evident in standard optometric screenings (Strano, 1993).
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