Awareness of Deficits and On-Road Driving Performance

Abstract

This study examined the relationship of neuropsychological and on-road driving evaluations among adults with acquired brain injury (ABI), and the extent to which that relationship is moderated by awareness of deficit. Participants were 62 pairs of adults with ABI and significant-other informants and 40 healthy controls (N = 102). Adults with ABI and controls completed neuropsychological and on-road evaluations. Multiple regression indicated that neuropsychological performance and the interaction between awareness of deficit and neuropsychological performance each explained significant variance in driving performance (i.e., the relationship between neuropsychological performance and on-road outcome depends on level of awareness). The moderation effect was illustrated by different relationships between neuropsychological and on-road performances among awareness groups: Among adults with impaired awareness (n = 21), neuropsychological functioning was substantially related to driving outcomes; in contrast, driving outcome showed weak relation to neuropsychological functioning among those with intact awareness (n = 24) or hypervigilance (n = 17) toward deficits. An exception was that processing speed showed modest relation to on-road outcome for all groups, including controls. Awareness of deficit has a considerable influence on driving outcomes both directly and as a moderator between the relationship of neuropsychological functioning and driving performance. When adults with ABI lack appreciation for their impairments, their neuropsychological status is especially important in predicting driving outcomes.

Metacognitive function poststroke: a review of definition and assessment

“…Self-awareness was the predominant term used and component examined in the studies. Two studies used an operational definition of metacognition (eg, discrepancy between a person's self-assessment and an external criterion of the person's ability) 38 48. Seven studies did not define the term 2 30–32 42 44 47.…”

“…The majority of assessment tools5 6 29 37 38 41 42 46 48 49 52 58 applied discrepancy scores, a comparison between the patient's self-rating and that of a proxy rater (eg, caregiver, significant other or health professional), based on the operational definition of self-awareness deficits. These assessments include the PCRS and AQ, but also include tools that assess specific functions.…”

Behavioural ratings of self-regulatory mechanisms and driving behaviour after an acquired brain injury

“…All these regions may be affected by a brain injury to cause self-regulatory deficits. Performancebased measures of executive functions, such as the Trail Making Tests, Colour Trail Test, Wisconsin Card Sorting Test, Stroop Colour Word Test and Tower of London, are significantly related to driving abilities [3,4,[43][44][45]. However, performance-based executive tests may in some cases fail to identify self-regulatory deficits that are observed in daily living [16,46].…”

“…The influence of cognitive deficits on driving fitness has been extensively studied, especially in older drivers and those with dementia of Alzheimer type, stroke and/or traumatic brain injury (TBI) [2]. Previous literature states that $40-80% of TBI and stroke survivors resume driving [3][4][5][6][7][8]. However, many patient groups that participate in international studies do not receive formal medical and/or psychological evaluations due to differences in national legislations and other reasons [9][10][11].…”

The development and initial validation of a new tool to measure self‐awareness of driving ability after brain injury

“…Following brain injury, individuals who return to driving often have to adjust for injury‐related impairments that may impact upon their ability to drive (Lundqvist & Rönnberg, ). Previous studies have identified awareness as a factor associated with poor on‐road driving performance after brain injury and was predictive of on‐road assessment outcomes (Coleman et al ., ; Griffen, Rapport, Bryer, Bieliauskas & Burt, ; Lundqvist & Alinder, ; Schanke & Sundet, ). It has been postulated that this association may be due to individuals with poor awareness having difficulty recognising and compensating for post‐injury changes leading to poor on‐road performance (Griffen et al .…”