Driving, aging, and traumatic brain injury: Integrating findings from the literature.

Abstract

Objective: In order to address the potential compounded risk in the population of aging traumatic brain injury (TBI) survivors who continue to drive, the authors synthesized literatures regarding the impact of aging or TBI on driving. Study Design: PubMed searches were conducted utilizing combinations of the following terms: driving, aging, elderly, TBI, cognition, seizures, vision, hearing, rehabilitation, sleep, fatigue, and assessment. Additional sources were also identified from the bibliographies of articles obtained and the Transportation Research Information Service electronic database. Clinically relevant human studies written in English were reviewed. Results: Using a conceptual framework developed by W. H. Brouwer and F. K. Withaar (1997), the authors of the current review highlight driving-related obstacles for TBI survivors and aging adults and suggest that individuals aging with TBI may be at increased risk for driving-related problems. Implications: Areas for clinical consideration include seizures, sleepiness and fatigue, vision, cognition, driving assessment, and caregiver involvement. The need for further study of postacute driving assessment and rehabilitation is highlighted.

The relationship of cognitive retraining to neurological patients’ driving status: The role of process variables and compensation training

“…Currently, no specific parameters, protocols, standardized evaluations or regulatory guidelines and mechanisms exist for fail-safe identification of competent drivers after brain injury [5,14,44]. It is hoped that by addressing both the operational (e.g.…”

“…Previous studies have found relationships between neuropsychological deficits and driving ability following brain injury. These include visuoperception [6,[13][14][15], attention/ concentration [6,[14][15][16][17][18][19][20][21], speed of information processing [6,14,[16][17][18][20][21][22][23], working memory/ memory [14,16,24] and executive systems [14-18, 20, 22, 24]. In a recent review of the literature, Tamietto et al [16] identified the domains of planning, concentration, inhibition of distractors, foresight, anticipation, problem-solving capacities, the ability to interpret rapidly complex arrays of multimodal stimuli and prompt, effective and calm reactions, as essential elements for driving following traumatic brain injury (TBI).…”

“…Occupational Therapists or other 'driving specialists' to evaluate drivers and help determine the patient's fitness to drive. These evaluations can include some or all of the following: a behind-the-wheel evaluation (on a protected course and/or in real traffic); a psychometric evaluation; and/ or testing in a simulator [5,14]. Despite all of this input and precautions, the decision of if, when and how a patient should return to driving remains quite complicated and unclear, with a dearth of operationalized guidelines as well as valid and reliable evaluation techniques [5,14,16,28,29].…”

“…These evaluations can include some or all of the following: a behind-the-wheel evaluation (on a protected course and/or in real traffic); a psychometric evaluation; and/ or testing in a simulator [5,14]. Despite all of this input and precautions, the decision of if, when and how a patient should return to driving remains quite complicated and unclear, with a dearth of operationalized guidelines as well as valid and reliable evaluation techniques [5,14,16,28,29]. It is essential to identify and objectify the factors relevant to driving post-brain injury, as often times patients will insist on driving post-injury, despite doctors' recommendations against driving, due to 'unfit' status [9].…”

Driving After Traumatic Brain Injury: Evaluation and Rehabilitation Interventions

“…TBI residual symptoms may be experienced years after the injury, and can include a variety of difficulties (e.g., daytime sleepiness; fatigue; risk of seizures; cognitive, motor, and sensory deficits) 33 . More importantly, the aging process likely compounds these symptoms.…”