Exploring associations between self-regulatory mechanisms and neuropsychological functioning and driver behaviour after brain injury

Abstract

The objective of this prospective one-year follow-up study was to explore the associations between self-regulatory mechanisms and neuropsychological tests as well as baseline and follow-up ratings of driver behaviour. The participants were a cohort of subjects with stroke and traumatic brain injury (TBI) who were found fit to drive after a multi-disciplinary driver assessment (baseline). Baseline measures included neuropsychological tests and ratings of self-regulatory mechanisms, i.e., executive functions (Behavior Rating Inventory of Executive Function-Adult Version; BRIEF-A) and impulsive personality traits (UPPS Impulsive Behavior Scale). The participants rated pre-injury driving behaviour on the Driver Behaviour Qestionnaire (DBQ) retrospectively at baseline and after one year of post-injury driving (follow-up). Better performance on neuropsychological tests was significantly associated with more post-injury DBQ Violations. The BRIEF-A main indexes were significantly associated with baseline and follow-up ratings of DBQ Mistakes and follow-up DBQ Inattention. UPPS (lack of) Perseverance was significantly associated with baseline DBQ Inattention, whereas UPPS Urgency was significantly associated with baseline DBQ Inexperience and post-injury DBQ Mistakes. There were no significant changes in DBQ ratings from baseline (pre-injury) to follow-up (post-injury). It was concluded that neuropsychological functioning and self-regulatory mechanisms are related to driver behaviour. Some aspects of driver behaviour do not necessarily change after brain injury, reflecting the influence of premorbid driving behaviour or impaired awareness of deficits on post-injury driving behaviour. Further evidence is required to predict the role of self-regulatory mechanisms on driver behaviour and crashes or near misses.

Fitness to drive after acquired brain injury: Results from patient cognitive screening and on‐road assessment compared to age‐adjusted norm values

“…Thus, the patient's metacognition, awareness of his/her own cognitive capacity, is important for coping with cognitive impairments. All these factors correspond to the distal context influencing driving capacity (Rike et al, 2018).…”

“…S€ umer (2003) proposed a model describing different factors to consider for safe driving that could be applicable in a clinical setting. The general contextual model as modified by Rike, Johansen, Ulleberg, Lundqvist & Schanke (2018) distinguishes between distal and proximal contexts as predictors of involvement in traffic accidents (Fig. 1).…”

“…1). This model considers cognition, personality traits and demographic variables as factors in a distal context that indirectly influence accident tendency through driver behavior; abnormal driver behavior, speeding and errors are one proximal context that is directly related to accident risk (Rike et al, 2018). Using S€ umer's modified model helps us to understand the role of neuropsychological tests, corresponding to the distal context.…”

“…Using S€ umer's modified model helps us to understand the role of neuropsychological tests, corresponding to the distal context. However, using only cognitive tests might be insufficient in a driving assessment, because the proximal context is not taken into account (Rike et al, 2018). To fully consider driving behavior, a standardized on-road or simulated driving assessment is recommended (Patomella, Tham, Johansson & Kottorp, 2010).…”

Driving Outside the Wire: Examining Factors Impacting Veterans’ Postdeployment Driving

“…Lew and colleagues (2010) described overlap between mTBI and PTSD symptoms, including attentional impairments, anxiety, and irritability. Although both mTBI and PTSD are associated with emotional dysregulation and affect driving performance, a diagnosis of PTSD was more likely to be associated with aggressive driving (Rike et al, 2018; Van Voorhees et al, 2018). The co-occurrence of three or more combat-related disorders is known as polytrauma (Cifu et al, 2013).…”