Cognitive impairments resulting from brain injury affect driving performance. The question of fitness to drive often arises during rehabilitation. Healthcare professionals need reliable criteria against which decisions about driving fitness can be made. Nouri et al. developed the Stroke Drivers Screening Assessment (SDSA), which was found predictive of on-road driving performance in stroke patients. The purpose of this study was to determine whether the SDSA, either alone or combined with other tests, predicted fitness to drive in brain injured people. Fifty-two participants were assessed on the SDSA plus additional cognitive tests. Their fitness to drive was examined on the public road. The SDSA predictions based on equations developed for stroke patients were not an accurate predictor of road test performance. Discriminant analysis was used to identify tests predictive of fitness to drive. Results indicated that a combination of the SDSA, the Stroop and the AMIPB Information Processing tasks correctly classified 87% of cases and may be useful predictors of driving fitness following brain injury. However, cross-validation on an independent sample of people with brain injury is required.

In 1986 all 90 children aged 4-19 years with Down's syndrome attending school in the area served by the Southern Derbyshire Health Authority underwent radiography to identify atlantoaxial instability (AAI). This study details repeat observations five years later. Full results were available on 67 (74%/o), information on health status was available on the remaining 19 (21%); four (4%) were untraced.There was an overall significant reduction in the atlanto-axial gap over five years. No one developed AAI on repeat testing who had not had it earlier. One child who had previously had normal neck radiography developed acute symptomatic AAI after ear, nose, and throat surgery.Radiographs were done on three occasions on the same day in 49 individuals, ensuring full flexion of the upper neck. There were no significant differences between the radiographs, even in five subjects with AAI.

SUMMARY 112 actively parachuting sport (free fall) parachutists with more than 200 descents each and 109 veteran military parachutists no longer active returned a postal questionnaire about their parachuting activities, injuries, and current and past musculoskeletal symptoms. A high frequency of fractures and injuries was reported by each group, both in relation to parachuting and to other activities. 58 sport parachutists aged 23 to 57 years (mean 33-3 years) had weight-bearing anteroposterior and lateral radiographs taken of each knee. These showed a prevalence of radiological osteoarthrosis of 10-4 % which was mild in degree in all but one knee in one subject. 46 ex-military parachutists aged 50 to 70 years (mean 552 years) had weight-bearing anteroposterior radiographs taken of both knees and showed a prevalence of radiological osteroarthrosis of 41 -3 %. Moderate and severe changes were found in 10-9 %. In both groups of parachutists six of the eight knee joints showing either moderate or severe radiological osteroathrosis had been subjected to a previous meniscectomy.Forty ex-military parachutists had anteroposterior radiographs of the ankles (talotibial articulation) and showed a prevalence of osteoarthrosis of 17-5 %, with the majority showing mild changes. There was a poor correlation between radiological osteoarthrosis, ankle symptoms, and previous fractures.With the reservation that the great majority of the sport group are still young (95 % aged <50 years), it is concluded that parachutists as a group do not show an increased prevalence of radiological osteoarthrosis of the knee or ankle.

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SUMmARY Spinal injuries and symptoms were studied in 109 ex-military parachutists and 112 sport (free fall) parachutists by means of postal questionnaires. 46 ex-military parachutists aged 50 years or over had a radiological examination of the lumbar spine and 58 sport parachutists had a radiological examination of the cervical spine as part of the survey. A history of back pain was significantly (P<0O01) associated with body weight in sport parachutists but not with the number of descents or with the subject's age. In the older ex-military group neither age, weight, nor the number of descents was significantly associated with backache.Of those ex-military parachutists x-rayed, 10 (21 * 7 %) were found to have vertebral body fractures (most frequently at D12), and 8 of these were unaware of these lesions. Vertebral fractures caused no disability and did not permanently curtail parachuting activities in either the sport or ex-military group.Of the ex-military parachutists x-rayed, 84 7 % had lumbar disc degeneration of all grades of severity, 17 4 % had moderate changes, and 10 8 % had severe changes. The frequency of moderate and severe disc degeneration was significantly related to age but not to body weight or to the number of descents. Spondylolysis was found in 2 subjects (4 *3 %) and spondylolisthesis unassociated with spondylolysis in 4 (8 7 %). Spondylolisthesis was always associated with a history of back pain.A low prevalence of radiological cervical intervertebral disc degeneration of all grades of severity of 8 7 % was found among the free fall parachutists (mean age 33 years). 2 cases of cervical vertebral body fracture were seen, one related to a parachute landing injury and the other to a parachute opening injury.This study does not implicate parachuting as a cause of intervertebral disc degeneration, either cervical or lumbar, nor as a cause of spondylolysis or spondylolisthesis. Serious long-term disability from pain appears to be uncommon among parachutists despite the frequency of the spinal trauma they sustain.Parachuting is well known to cause injury to the spinal column, most commonly vertebral body fractures unassociated with spinal cord or nerve root damage (Essex-Lopresti, 1946;Ciccone and Richman, 1948;Neel, 1951;Kirby, 1974). The distribution of these is characteristic with maximal frequency occurring at or around the first lumbar vertebra, and with 30% of cases having more than the vertebra involved (Neel, 1951;Kirby, 1974). The fractures are typically ofthe wedge compression type described by Holdsworth (1970), and are usually caused by