Evidence Based Review of Fitness-to-Drive and Return-to-Driving Following Traumatic Brain Injury

Abstract

The purpose of this study was to conduct an evidence-based review to determine predictors of fitness to drive and return to driving in persons with traumatic brain injury (TBI). Relevant databases (MEDLINE/PubMed, CINAHL, Cochrane Library, and SCOPUS) were searched for primary articles published before June 2016 using MeSH search terms. Using the American Academy of Neurology’s classification criteria, 24 articles were included after reviewing 1998 articles. Studies were rated by class (I–IV), with I being the highest level of evidence. Articles were classified according to TBI severity, as well as types of assessments (on-road, simulator and surveys). There were no Class I studies. Based on Class II studies, only Post-traumatic amnesia (PTA) duration was found to be probably predictive of on-road driving performance. There is limited evidence concerning predictors of return to driving. The findings suggest further evidence is needed to identify predictors of on-road driving performance in persons with TBI. Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with TBI are needed by policy makers and clinicians to develop evidence-based guidelines.

Development and Validation of Psychological Fitness to Drive Scale for Filipinos

“…In Austria, assessment involves testing driving abilities and the driver's willingness to adapt to traffic conditions, while in Portugal perceptive-cognitive, psychomotor, and psychosocial dimensions are included in their psychological exam for safe driving behavior. Switzerland, Sweden, and Italy have their legal frameworks for assessing fitness to drive (Schuhfried, 2015;Palubiski & Crizzle, 2016).…”

Traumatic brain injury hinders learning of road hazard awareness by repeated exposure to video-based hazards.

“…Cyr and colleagues (2009) observed that in a simulated driving environment, TBI survivors who resumed driving were significantly more likely to crash in reaction to a surprising and challenging event compared with noninjured matched control individuals. A recently published literature review found no standard neuropsychological tests for predicting driving performance of TBI survivors (Palubiski & Crizzle, 2016). Nevertheless, a better characterization of the cognitive limitations of TBI survivors in the specific context of driving could be translated into an adapted retraining effort that could combine a cognitive training protocol within a driving context (Ross, Ponsford, Di Stefano, Charlton, & Spitz, 2016).…”