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Bassingthwaighte L, Gustafsson L, Molineux M. Lifespace and occupational participation following acquired brain injury during driving disruption: a mixed methods study. Disabil Rehabil 2024:1-15. [PMID: 38592071 DOI: 10.1080/09638288.2024.2338192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE To examine the lifespace of participants referred for occupational therapy driving assessment following acquired brain injury, to understand how, why, where and with whom access and participation in community-based occupations is occurring during the period of driving disruption. MATERIALS AND METHODS The mixed methods, convergent research design utilised a travel diary and Lifespace Mobility Assessment-Composite quantitative elements and semi-structured interviews analysed qualitatively with an interpretive description lens. RESULTS Forty-eight participants (56.25% male) aged between 26 and 65 years, left home on average once/day, primarily to conduct instrumental activities of daily living, health management, and social participation community-based occupations. Most reported restricted lifespace (54.2%) requiring assistance to conduct community occupations (68.1%). Support was primarily provided by family members (80.3%). Analysis of semi-structured interviews (n = 15) created three themes that shaped participant occupational experience during driving disruption: (i) changes to occupational participation; (ii) reliance on others for community access and participation; and (iii) trying to move forward. CONCLUSION The period of driving disruption following the onset of acquired brain injury is a time of occupational disruption which restricts lifespace, changing how, why, where and with whom participation in community-based occupations occurs. Rehabilitation facilitating occupational adaptation process to enhance community access capacity is indicated.
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Affiliation(s)
- Louise Bassingthwaighte
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Driving Assessment and Rehabilitation Service, Princess Alexandra Hospital, Brisbane, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
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Fahmi A, Garon M, Ribon-Demars A, Dubois L, Caouette M, Lamontagne MÈ, Beaulieu-Bonneau S. Learning to drive with neurological conditions: profile of users of an adapted driver training program and cognitive factors associated with success. Disabil Rehabil 2023:1-9. [PMID: 37728095 DOI: 10.1080/09638288.2023.2258332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To describe the sociodemographic and cognitive profile of participants enrolled in an adapted driving program for individuals with neurological conditions, to explore the association between cognitive functioning and driving program outcome, and to describe driving habits after program completion. METHODS This study combined retrospective chart review and cross-sectional data collection. RESULTS The sample included 71 participants with neurological disorders (aged 15-56 years, M = 22.2 ± 8.6; 39% women). Driving program was either successful (47%), failed (7%), discontinued (34%), or ongoing (13%). Among 35 participants with complete neuropsychological and driving program outcome data, those who successfully completed the program showed better attention functioning, and better performance relative to global functioning for attention, executive functions, and working memory, compared to those who discontinued/failed the program. Among 21 participants who completed a telephone questionnaire on average 3.7 years after program enrollment, 67% obtained their driver's license and drove regularly. Participants reported high levels of satisfaction with the program. CONCLUSION These results suggest that approximately half of the persons enrolled in a driver training program designed for learners with neurological conditions, obtain a driver's license; and that attention, and to a lesser extent executive functioning and working memory, are related to driving program success.IMPLICATIONS FOR REHABILITATIONIn individual with neurological conditions, learning how to drive can be challenging.An adapted driver training program, involving collaboration between driving instructors and healthcare professionals, simplification of theoretical learning, and increasing driving practice opportunities, can be effective, both in terms of licensing success and client satisfaction.Conducting a pre-driving program neuropsychological assessment, with identification of cognitive strengths and weaknesses, can provide valuable information for clinicians and driving instructors for optimizing training and predicting outcome.Better performance in attention, and better relative to global cognitive functioning in attention, executive functions, and working memory, are related to higher success rate of an adapted driving program.
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Affiliation(s)
- Adam Fahmi
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Mathieu Garon
- Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke; Sherbrooke, QC, Canada
| | - Alexandra Ribon-Demars
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Laurie Dubois
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Martin Caouette
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Département de psychoéducation, Université du Québec à Trois-Rivières; Trois-Rivières, QC, Canada
| | - Marie-Ève Lamontagne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- École des sciences de la réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
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Bassingthwaighte L, Gustafsson L, Molineux M. On-road driving remediation following acquired brain injury: a scoping review. Brain Inj 2022; 36:239-250. [DOI: 10.1080/02699052.2022.2033837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Louise Bassingthwaighte
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Occupational Therapy Department, Princess Alexandra Hospital, Queensland, Australia
| | - Louise Gustafsson
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
- Menzies Health Institute Queensland, The Hopkins Centre, Australia
| | - Matthew Molineux
- Discipline of Occupational Therapy, School of Health Sciences and Social Work, Griffith University, Queensland, Australia
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Unger A, Winston FK, Ruggieri DG, Remba J. Understanding clinician strategies for discussing driving fitness with patients: An initiative to improve provider-patient discussions about safe driving. TRAFFIC INJURY PREVENTION 2021; 22:S38-S43. [PMID: 34672890 DOI: 10.1080/15389588.2021.1976765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 08/31/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Objective: A frequently overlooked factor contributing to traffic crashes is driver medical conditions, including cognitive and physical impairments, which can compromise individuals' ability to drive safely. Clinicians are in a critical position (and often legally mandated) to identify patients with impairments that may affect their driving ability and counsel them on appropriate next steps. However, prior studies revealed that provider-patient discussions about driving occurred relatively infrequently and that clinician recommendations about when patients could resume driving varied substantially (Chen et al. 2008; Drazkowski et al. 2010). This research aimed to document current driver fitness assessment practices among neurology and neurosurgery clinicians at an academic medical center, with the overall purpose of informing quality improvement efforts.Methods: A cross-sectional, anonymous survey was distributed to physicians and advanced practice providers working in the neurosurgery and neurology departments of a large, Pennsylvania-based academic medical center. Survey question domains included: 1) frequency of discussions about driving, 2) comfort discussing driving with patients, 3) criteria used to assess patient fitness to drive, 4) driver rehabilitation program referral practices, and 5) Pennsylvania Department of Transportation (PennDOT) reporting.Results: The survey revealed that although most providers (68%) had high levels of perceived responsibility for counseling patients about driving, a minority regularly discussed driving issues with their patients (19% prior to discharge, 49% during clinic visits). In addition, only about half (54%) of providers reported having ever filed a report about a patient with the PennDOT, despite Pennsylvania's mandatory driver reporting law. Likelihood of PennDOT reporting was found to be strongly associated with provider knowledge of Pennsylvania unsafe driver reporting laws (p < 0.001).Conclusions: These findings highlight a need to enhance standard of care practices related to driver screening, counseling, and reporting. Overall, providers recognized the importance of their role in advising patients about safe driving and desired standardized protocols for guiding conversations about driving with patients, PennDOT reporting, and referring patients to driver rehabilitation services.
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Affiliation(s)
- Arianna Unger
- Master of Public Health Program, University of Pennsylvania and Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Flaura K Winston
- Center for Injury Research and Prevention at Children's Hospital of Philadelphia, Roberts Center for Pediatric Research and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Dominique G Ruggieri
- Master of Public Health Program and Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua Remba
- Master of Robotics Program, University of Pennsylvania, Philadelphia, Pennsylvania
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Perna R, Pundlik J, Arenivas A. Return-to-driving following acquired brain injury: A neuropsychological perspective. NeuroRehabilitation 2021; 49:279-292. [PMID: 34420988 DOI: 10.3233/nre-218026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Return to driving after an acquired brain injury (ABI) has been positively associated with return to employment, maintenance of social relationships, and engagement in recreational and other community activities. Safe driving involves multiple cognitive abilities in a dynamic environment, and cognitive dysfunction resulting from ABI can negatively impact driving performance. OBJECTIVE This manuscript examines the post-injury return-to-driving process, including performances on the in-office and on-road assessments, and the role of a rehabilitation neuropsychologist in helping patients resume driving. METHOD In this study, 39 of 200 individuals (approximately 20%) treated at an outpatient neurorehabilitation facility, who performed satisfactorily on a pre-driving cognitive screening, completed a behind-the-wheel driving test. RESULTS Of the 200 individuals, 34 (87%) passed the road test. Among the remaining five individuals who did not pass the road test, primary reasons for their failure included inability to follow or retain examiner directions primarily about lane position, speed, and vehicle control. The errors were attributable to cognitive difficulties with information processing, memory, attention regulation, and dual tasking.CONCLUSIONThe rehabilitation neuropsychologist contributed to the process by assessing cognition, facilitating self-awareness and error minimization, providing education about driving regulations and safety standards, and preparing for the road test and its outcomes.
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Affiliation(s)
| | | | - Ana Arenivas
- The Institute of Rehabilitation Research (TIRR), Memorial Hermann, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
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Novack TA, Zhang Y, Kennedy R, Rapport LJ, Marwitz J, Dreer LE, Goldin Y, Niemeier JP, Bombardier C, Bergquist T, Watanabe TK, Tefertiller C, Brunner R. Driving patterns, confidence, and perception of abilities following moderate to severe traumatic brain injury: a TBI model system study. Brain Inj 2021; 35:863-870. [PMID: 34096418 DOI: 10.1080/02699052.2021.1934730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Describe driving patterns following moderate-to-severe traumatic brain injury (TBI). Participants: Adults (N = 438) with TBI that required inpatient acute rehabilitation who had resumed driving. DESIGN Cross-sectional, observational design. SETTING Eight TBI Model System sites. MAIN MEASURES A driving survey was completed at phone follow-up. RESULTS Most respondents reported driving daily, although 41% reported driving less than before their injury. Driving patterns were primarily associated with employment, family income, sex, residence, and time since injury, but not injury severity. Confidence in driving was high for most participants and was associated with a perception that the TBI had not diminished driving ability. Lower confidence and perceived loss of ability were associated with altered driving patterns. CONCLUSION Most people with moderate-to-severe TBI resume driving but perhaps not at pre-injury or normal levels compared to healthy drivers. Some driving situations are restricted. The relationship between low confidence/perceived loss of ability and driving patterns/restrictions suggests people with TBI are exhibiting some degree of caution consistent with those perceptions. Careful assessment of driving skills and monitoring during early stages of RTD is warranted, particularly for younger, male, and/or single drivers who express higher levels of confidence.
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Affiliation(s)
- Thomas A Novack
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Richard Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Jennifer Marwitz
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Laura E Dreer
- Department of Ophthalmology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yelena Goldin
- Department of Physical Medicine and Rehabilitation, JFK Rehabilitation Institute, Edison, New Jersey, USA
| | - Janet P Niemeier
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Charles Bombardier
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Thomas Bergquist
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, Moss Rehabilitation at Elkins Park/Einstein Healthcare Network, Elkins Park, Pennsylvania, USA
| | | | - Robert Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Lempke LB, Lynall RC, Hoffman NL, Devos H, Schmidt JD. Slowed driving-reaction time following concussion-symptom resolution. JOURNAL OF SPORT AND HEALTH SCIENCE 2021; 10:145-153. [PMID: 32961301 PMCID: PMC7987557 DOI: 10.1016/j.jshs.2020.09.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/09/2020] [Accepted: 08/21/2020] [Indexed: 05/31/2023]
Abstract
BACKGROUND Concussed patients have impaired reaction time (RT) and cognition following injury that may linger and impair driving performance. Limited research has used direct methods to assess driving-RT post-concussion. Our study compared driving RT during simulated scenarios between concussed and control individuals and examined driving-RT's relationship with traditional computerized neurocognitive testing (CNT) domains. METHODS We employed a cross-sectional study among 14 concussed (15.9 ± 9.8 days post-concussion, mean ± SD) individuals and 14 healthy controls matched for age, sex, and driving experience. Participants completed a driving simulator and CNT (CNS Vital Signs) assessment within 48 h of symptom resolution. A driving-RT composite (ms) was derived from 3 simulated driving scenarios: stoplight (green to yellow), evasion (avoiding approaching vehicle), and pedestrian (person running in front of vehicle). The CNT domains included verbal and visual memory; CNT-RT (simple-, complex-, Stroop-RT individually); simple and complex attention; motor, psychomotor, and processing speed; executive function; and cognitive flexibility. Independent t tests and Hedge d effect sizes assessed driving-RT differences between groups, Pearson correlations (r) examined driving RT and CNT domain relationships among cohorts separately, and p values were controlled for false discovery rate via Benjamini-Hochberg procedures (α = 0.05). RESULTS Concussed participants demonstrated slower driving-RT composite scores than controls (mean difference = 292.86 ms; 95% confidence interval (95%CI): 70.18-515.54; p = 0.023; d = 0.992). Evasion-RT (p = 0.054; d = 0.806), pedestrian-RT (p = 0.258; d = 0.312), and stoplight-RT (p = 0.292; d = 0.585) outcomes were not statistically significant after false-discovery rate corrections but demonstrated medium to large effect sizes for concussed deficits. Among concussed individuals, driving-RT outcomes did not significantly correlate with CNT domains (r-range: -0.51 to 0.55; p > 0.05). No correlations existed between driving-RT outcomes and CNT domains among control participants either (r-range: -0.52 to 0.72; p > 0.05). CONCLUSION Slowed driving-RT composite scores and large effect sizes among concussed individuals when asymptomatic signify lingering impairment and raise driving-safety concerns. Driving-RT and CNT-RT measures correlated moderately but not statistically, which indicates that CNT-RT is not an optimal surrogate for driving RT.
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Affiliation(s)
- Landon B Lempke
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA
| | - Robert C Lynall
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA
| | - Nicole L Hoffman
- School of Kinesiology and Recreation, Illinois State University, Normal, IL 61790, USA
| | - Hannes Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Julianne D Schmidt
- UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA.
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León-Domínguez U, Solís-Marcos I, López-Delgado CA, Martín JMBY, León-Carrión J. A Frontal Neuropsychological Profile in Fitness to Drive. ACCIDENT; ANALYSIS AND PREVENTION 2020; 148:105807. [PMID: 33069156 DOI: 10.1016/j.aap.2020.105807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/24/2020] [Accepted: 09/27/2020] [Indexed: 06/11/2023]
Abstract
Traffic accidents are a global concern due to the elevated mortality rates of both drivers and pedestrians. The World Health Organization declared 2011-2020 as the Decade of Action for Road Safety, endorsing initiatives to reduce traffic-related deaths. Yet, despite these incentives, fatal accidents still occur. Different studies have linked deficits in executive functions to risky driving attitudes and crashes. The present study focuses on demographic, cognitive and personality factors, related to the prefrontal cortex, that are characteristic of drivers prone to risky behavior behind the wheel. The penalty Points System was used to classify drivers as "safe", with no point loss over a two-year period, or "risky", with full point loss during the same interval. A neuropsychological assessment of prefrontal cognitive functions was carried out on each group to identify variables associated with safe and risky behavior. Neuropsychological indexes were obtained from a continuous performance task without cue (Simple Attention), a continuous performance task with cue (Conditioned Attention), the Tower of Hanoi test and the Neurologically-related Changes in Personality Inventory (NECHAPI). A Discriminant Analysis (DA) found that education level, reaction times in Simple and Conditioned Attention, learning errors in the Tower of Hanoi and vulnerability in the personality test, best predicted whether drivers were likely to be in the safe or risky group. Finally, a cross-validation analysis performed on the same sample correctly classified 87.5% of the drivers. These data suggest that prefrontal dysfunction contributes to risky behavior behind the wheel. The inclusion of cognitive programs to identify and train drivers with this propensity could reduce risky driving, and consequently, save lives on the road.
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Affiliation(s)
- Umberto León-Domínguez
- Human Cognition and Brain Research lab, School of Psychology, University of Monterrey, San Pedro Garza, García, Mexico.
| | - Ignacio Solís-Marcos
- The Swedish National Road and Transport Research Institute (VTI) Linköping, Sweden
| | | | | | - José León-Carrión
- Department of Experimental Psychology, University of Seville, Seville, Spain; Center for Brain Injury Rehabilitation (CRECER), Seville, Spain
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Bassingthwaighte L, Griffin J, Fleming J, Gustafsson L. Evaluating the effectiveness of on-road driving remediation following acquired brain injury: A wait-list feasibility study with follow-up. Aust Occup Ther J 2020; 68:124-134. [PMID: 32909309 DOI: 10.1111/1440-1630.12694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/09/2020] [Accepted: 07/29/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Return to driving is an important goal for people recovering from acquired brain injury. Occupational therapy driving assessments aim to determine the impact of acquired brain injury on a person's capacity to drive and may include on-road driving rehabilitation. The primary objective of this project was to conduct a feasibility randomised controlled trial (RCT) of an on-road driving remediation program for adults with acquired brain injury. Secondary objectives were to measure the effectiveness of the on-road driving program and determine sample size required for a randomised controlled trial. METHODS A wait-list randomised controlled trial with blinded assessment and 6-month follow-up aimed to recruit 10 participants with acquired brain injury. Concealed methods randomly allocated participants to receive the on-road driving rehabilitation program immediately (intervention group) or after 6 weeks (wait-list group). The primary outcome measure of functional fitness to drive, was assessed pre- and post-intervention, and at 6-month follow-up. Driving performance was measured by percentage of correct manoeuvres and driving instructor intervention. RESULTS Eight participants (seven male; average age 46 years; six traumatic brain injury and two stroke) were recruited. The protocol was feasible. Results of the RCT suggest intervention effectiveness initially with two of the three interventions, and no wait-list, participants achieving fitness to drive. This increased to five out of eight participants after the wait-list group completed the intervention. While three participants retained this outcome at 6-month follow-up, universal deterioration in on-road driving performance was evident for all participants at 6-month follow-up. CONCLUSION The trial was feasible and findings suggest that on-road driving remediation assists people with acquired brain injury to achieve functional fitness to drive but the skills may not be maintained 6 months later. A full RCT is warranted to further determine the effectiveness of on-road driving remediation and capacity of participants to maintain the skills developed.
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Affiliation(s)
- Louise Bassingthwaighte
- Driving Assessment and Rehabilitation Service, Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Janelle Griffin
- Brain Injury Rehabilitation, Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Louise Gustafsson
- School of Allied Health Sciences, Griffith University, Brisbane, QLD, Australia
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De Tanti A, Baldari F, Pedrazzi G, Inzaghi MG, Benoldi R, Abbati P, Malangone G, Martini C, Saviola D. Role of vehicle assistive devices for safe return to driving after severe acquired brain injury. Eur J Phys Rehabil Med 2020; 56:386-393. [PMID: 32434312 DOI: 10.23736/s1973-9087.20.06098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Driving is a complex activity that requires a wide range of cognitive, behavioral, sensory and motor competences that are often impaired in cases of severe acquired brain injury (sABI). A safe return to driving is an objective significantly correlated with recovery of personal independence and social-occupational role. AIM The study investigated elements predictive of the possibility of a safe return to driving after sABI, concentrating on motor disability and the need to prescribe vehicle assistive devices. DESIGN Retrospective study. SETTING Out-patients of a rehabilitation center for sABI. POPULATION A series of 217 patients with stable sABI, well reintegrated at family and social level, were enrolled between January 2006 and June 2019. METHODS The subjects were assessed for residual competences. Those who passed assessment of cognitive-behavioral and visual impairment were assessed for motor disability and the need for vehicle assistive devices to enable a safe return to driving. RESULTS About 79% of the population were judged suitable for a return to driving. More than 50% of the latter were only able to return to driving with the aid of vehicle assistive devices. Etiological and demographic variables were not predictive of assessment outcome, whereas the various Griffith motor disability categories were correlated with need for vehicle assistive devices, which are most needed in non-traumatic subjects. CONCLUSIONS Although the literature on return to driving after brain injury focuses mainly on cognitive-behavioral impairment, in a significant percentage of cases it is also necessary to carefully analyse and manage motor disabilities that may result from sABI. CLINICAL REHABILITATION IMPACT Evaluation of the competences necessary for a return to driving after sABI requires a multiprofessional team that must also assess motor disability and know the possible vehicle assistive devices that can enable most candidates to overcome the limits imposed by their disability.
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Affiliation(s)
- Antonio De Tanti
- Centro Cardinal Ferrari - Santo Stefano Riabilitazione, Fontanellato, Parma, Italy -
| | | | - Giuseppe Pedrazzi
- Unit of Neurosciences, Center of Robust Statistics (Ro.S.A.), Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria G Inzaghi
- Laboratory of Neuropsychology, Quarenghi Clinical Institute, S. Pellegrino, Bergamo, Italy
| | - Raffaella Benoldi
- Centro Cardinal Ferrari - Santo Stefano Riabilitazione, Fontanellato, Parma, Italy
| | - Paola Abbati
- Centro Cardinal Ferrari - Santo Stefano Riabilitazione, Fontanellato, Parma, Italy
| | | | | | - Donatella Saviola
- Centro Cardinal Ferrari - Santo Stefano Riabilitazione, Fontanellato, Parma, Italy
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