Driving and driving cessation after traumatic brain injury: processes and key times of need

Abstract

The processes surrounding driving and driving cessation after TBI are complex. Informational, support and practical needs differ at the different times. There are key times where people may need further support to improve rehabilitation outcomes. Rehabilitation approaches may particularly need to provide clear, consistent information about driving restrictions, and the process required for returning to driving. While recovery time appears necessary for allowing a safe return to driving, active support for continued involvement in the community using alternative transport may reduce the frustration and disengagement experienced by people in the 'on hold' period.

Family members’ needs and experiences related to driving disruption following acquired brain injury

“…There was one article that was specific to individuals with stroke (Griffen et al, 2009) and a study reported over two articles that was unique to individuals with TBI (Liddle et al, 2011;Liddle, Fleming, et al, 2012). In all the articles, there was an almost equal distribution of spouses and other family members (Griffen et al, 2009;Liddle et al, 2011;Liddle, Fleming, et al, 2012 Prior to stopping driving, 63% of females were taking household shopping trips compared to 34% of the males.…”

“…There was one article that was specific to individuals with stroke (Griffen et al, 2009) and a study reported over two articles that was unique to individuals with TBI (Liddle et al, 2011;Liddle, Fleming, et al, 2012). In all the articles, there was an almost equal distribution of spouses and other family members (Griffen et al, 2009;Liddle et al, 2011;Liddle, Fleming, et al, 2012 Prior to stopping driving, 63% of females were taking household shopping trips compared to 34% of the males.  Individuals who were driven by family members for non-essential travel (e.g., leisure trips) rose from 17 to 76%  13% of caregivers reported giving up the worker role while 33% reported missing work occasionally  58% of family members rated the older driver's driving as "good" or "excellent" while 81% individuals did so (p=0.0342)  Regarding driving decisions, 42% of family members and 11% of older drivers felt that they should not be driving (p=0.0027)  While the older driver reported that advice to stop driving all came from their adult children, family members reported that the older driver's friends (22%), adult children (67%) and spouses (11%) had advised as well.…”

“…Failing a driving assessment, therefore, is likely to be unexpected, and individuals with poor self-awareness of their driving ability may find it hard to comprehend and accept the failure. Consequently, individuals may respond with anger, shock or insistence to drive, making it a trying and emotional time for the individuals and their families (Liddle et al, 2011 Roads (transport authority in Queensland) if he or she has any permanent or long-term medical condition that may affect his or her driving ability and capacity (Queensland Government, 2016a). This medical condition reporting legislation is known as "Jet's Law"…”

“…Immediately after the injury, family members often want to actively care for their relatives in the hospital, such as providing massages and exercising the limbs, and would prefer healthcare professionals to support and provide them with advice for doing so (Lefebvre & Levert, 2012b). In this phase, issues related to driving disruption tend to be a peripheral issue for individuals with TBI and their family members whose attention is focussed on other factors such as survival (Liddle et al, 2011). While some people may be discharged straight home from acute care, those with more severe injuries are often transferred to rehabilitation, and the level of involvement of family members changes at this time.…”

“…In several articles, family members described indicators of unsafe driving, such as increasing instances of getting lost, driving at inappropriate speeds, poor judgement or getting agitated easily (Adler, 2010;Croston et al, 2009;Jett et al, 2005;Liddle et al, 2013;Liddle et al, 2011;Liddle et al, 2008;Perkinson et al, 2005;Ralston et al, 2001;Sterns, 2001). For individuals with TBI, family members recognised that physical, cognitive and behavioural changes could compromise the individual's driving safety (Liddle et al, 2011).…”