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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
(a) assessment of the spectrum of factors that are required for visual processing;
(b) behavioral observations that address the capacity for self-evaluation, decision making skills and deficits in executive functions;
(c) a battery of neuropsychological tests that primarily measure visual function and attention; and
(d) some type of on-the-road test with a trained evaluator.
Simulators may also be of use in conjunction with these other measures. The on-the-road tests should be of gradually increasing complexity, starting in a controlled area such as a parking lot and moving to residential and then high-traffic areas and highways, if appropriate.
2. Visual screening must include more than testing acuity and a simple test of visual fields. Both the physical and cognitive components of visual processing must be evaluated by personnel trained to assess these abilities.
Information gathered from the full range of assessments can help some individuals with brain injury succeed in therapeutic driver training programs through remediation, compensation, or rehabilitation technology. Aging drivers who experience cognitive losses and slowed reaction time appear to make compensatory decisions at the strategic and tactical levels that allow them to drive safely despite limitations in operational skills. Some drivers with brain injury can be trained to make the same types of decisions.
Liability of physicians and other rehabilitation personnel varies widely from state to state. Ideally, attempts should be made by national bodies concerned with this issue to establish appropriate guidelines. Physicians who do not specialize in evaluating and treating neurologic and cognitive dysfunction, but who nonetheless are asked to determine patients' fitness to drive, as well as state licensing personnel would benefit from further training on these subjects. Our governmental institutions have taken responsibility for determining who should and should not drive by the establishment of licensing procedures that exist in every state. Some degree of uniformity is needed for making decisions about people with disabilities and/or special needs, including those with brain injuries. It is likely that these governmental bodies will be forced to address this issue in the near future as the provisions of the Americans with Disabilities Act require equal treatment of all citizens, regardless of disability.
Considerations for Future Investigation
There are many questions still to be answered and issues to be addressed regarding driving after brain injury. A few of the researchers (e.g., Brooke et al. 1992; Engum et al., 1988; Gouvier et al., 1989; Summers, 1986) mention the importance of controlling costs, but in most cases, these were costs to the facilities and institutions offering driving evaluation and remediation programs. Costs to the consumer are a separate issue that has not been addressed. In many states, Medicaid and Medicare will not pay for driving evaluations, and some insurance companies will similarly not reimburse practitioners. Given that the Commission for Accreditation of Rehabilitation Facilities (CARF) requires a rehabilitation center to provide driving rehabilitation services either directly or through referral (Pierce, 1993), this issue becomes critical. Better statistical data on the driving performance of people with brain injuries approved by facilities to drive will be vital in addressing fiscal issues. Insurance rates for drivers who have had their licenses medically restricted may present an additional complication.
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