To drive or not to drive (after TBI)? A review of the literature and its implications for rehabilitation and future research

Abstract

Development of reliable procedures to assess fitness to safe driving after traumatic brain injury (TBI) is a crucial step in rehabilitation. However, prior studies are highly inconsistent in the choice of measures recommended for predicting driving fitness from different pre-driving measures. In the present paper the relevant literature is reviewed with the aim of shedding light on the reasons for these inconsistencies. The discrepant results reflect investigative choices which differ in five aspects: (1) the type of predictors used as pre-driving screening; (2) the type of measures considered as the criterion for the determination of fitness to drive after TBI; (3) the severity of the TBI in the sample of patients studied; (4) the extent of the neural structures damaged by TBI and the overlap of these areas with those involved in driving tasks; (5) the length of the follow-up considered. The strengths and weaknesses of the different methods and measures are discussed with their implications for future research and clinical rehabilitation. Encouraging findings come from recent studies that combined together medical, psychosocial, and personality measures, thereby improving the explanatory power of the predictors used. The use of post-injury driving fitness measures with great ecological and external validity seems equally promising in assessing actual driving in the real world.

Self‐Reported Driving Difficulty in Veterans With Traumatic Brain Injury: Its Central Role in Psychological Well‐Being

“…Most studies of TBI and driving have focused on assessing and predicting driving ability or fitness. These include studies of measures of driving capacity [8,10,11], rates of traffic accidents [12][13][14], the predictive validity of neuropsychological [7,9] or functional tests for return to driving [4], and the impact of TBI-related cognitive impairment on driving outcomes [1][2][3]6,12]. This research has yielded complex and sometimes-contradictory findings, summarized in several literature reviews [1,6,7], but leaves little question that TBI-related deficits often affect driving adversely.…”

“…Michon's conceptual model [1] designates 3 levels of activities required for driving: strategic (planning an itinerary or filling up with gas), tactical (adapting speed to traffic conditions, changing lanes, which must be performed within time constraints), and operational (perceptual and automatic skills, including visuospatial skills, reaction times, and muscle strength). Traumatic brain injury (TBI) may affect any of these activities and also exacerbate anxiety, anger, road rage, or other emotion regulation problems, thereby affecting driving ability and behavior [1‐9].…”

Associations between self and informant ratings of executive functioning and driver behaviour following acquired brain injury

“…Higher-level mental functions include adjoining constructs, such as executive functions, self-regulation and self-awareness (10,11), and may impair driving fitness (12). Executive functions, including abilities such as planning, problem-solving, response inhibition, cognitive flexibility and self-awareness (13), have been found to play a role in adjusting driver behaviour, the ability to make adequate compensatory decisions and the moderation of accident risk (2,11,14).…”

“…Furthermore, predicting fitness to manage driving in daily living extends the frame of an on-road assessment in which more complex cognitive abilities are challenged (30). Studies have yielded mixed results as to whether driving after a brain injury leads to increased accident risk (12).…”

“…Rating measures have traditionally been a lessstudied outcome measure than driving assessments and accident rates (12). However, research has pointed to the fact that daily driving behaviour may serve as a mediating factor between neuropsychological functioning and accident rates (31).…”