Return to Driving

For those who have an ABI, the cessation of driving is one of the most challenging consequences, as the ability to drive is often seen as a key determinant of an individual’s level of social engagement and general independence (Lane & Benoit 2011). Individuals with ABI often return to driving in an effort to feel independent, even if they are not fit to do so (Liddle et al. 2011, 2012) (Leon-Carrion et al. 2005). Driving a motor vehicle requires effective function in multiple domains that may be impaired by the injury, including perception, cognition, communication, and coordination. In particular, driving depends on functional vision and rapid reliable responses, as well as the ability to make quick decisions and remain attentive despite distractions. Individuals with ABI may have difficulty driving due to deficits in monitoring simultaneous inputs (Formisano et al. 2005; Masson et al. 2013; Ortoleva et al. 2012) and anticipating dangerous situations (van Zomeren et al. 1987). Adjusting to post-injury abilities can also be an issue among returning drivers, as some individuals were less likely to modify their driving style and behaviour following ABI, particularly younger male drivers (Labbe et al. 2014). All of these factors contribute to the increased likelihood that individuals with ABI will be involved in more accidents than the general population (Bivona et al. 2012; Formisano et al. 2005). Schanke et al. (2008) argued that this is due to a lack of adequate compensation for the post-injury cognitive deficits, particularly those relating to executive function.

Individual Studies

Table: Return to Driving (Intervention Studies)

Table: Return to Driving (Non-Intervention Studies)

Discussion

In the literature, 32% to 75% of individuals returned to driving following ABI (Fleming et al. 2014; Formisano et al. 2005; Hawley 2001; Leon-Carrion et al. 2005; Liddle et al. 2012; Perumparaichallai et al. 2014; Pietrapiana et al. 2005). Those who returned to driving showed improved community reintegration and reported less barriers to their independence (Fleming, Liddle, et al. 2014; Rapport et al. 2006). However, those who did not return to driving needed to find alternate means of transportation, and thus their caregivers reported higher levels of strain (Fleming, Liddle, et al. 2014).

A number of factors are associated with return to driving among individuals with ABI. An individual’s pre-injury driving experience and the chronicity of their injury were predictive of their subsequent return to driving (McKay et al. 2015); although the evidence regarding injury severity was conflicting (Cullen et al. 2014a; Ross et al. 2015). Performance on tests of visual attention, working memory, processing speed, and task switching (Perumparaichallai et al. 2014) as well as psychomotor speed and cognitive flexibility (Cullen et al. 2014a) were correlated with return to driving. Those who resumed driving scored higher on the Mayo-Portland Adaptability Inventory (Fleming, Liddle, et al. 2014) and the Functional Independence and Assessment Measures (Cullen et al. 2014b; Hawley 2001; Leon-Carrion et al. 2005) than those who did not resume. Deficits of vision and mobility, as well as recurrent seizures, were significant limiting factors in return to driving (Hawley 2001). Moreover, pre-injury behaviours play a role in post-injury driving fitness. Driving violations and accidents, risky driving styles, and risky personality before injury all decreased the likelihood of driving fitness after injury (Pietrapiana et al. 2005).

Following ABI, it is imperative that individuals are evaluated before they return to driving, as they may pose a risk to themselves and others on the road. While 66% to 79% of individuals passed initial driving assessments following ABI (McKay et al. 2015; Ross et al. 2015), one study found that 30% were driving upon admission to rehabilitation despite not being fit to do so (Leon-Carrion et al. 2005). As well, individuals with ABI performed poorly on driving simulations and related assessments when compared to healthy controls (Lew et al. 2005; Masson et al. 2013). Careful clinical review can identify appropriate augmentative and/or compensatory strategies to target the specific deficits and adapt the related tasks. Participation in a multidisciplinary neurorehabilitation program has been shown to improve driving-related deficits, and thus increase the rate of individuals returning to driving following ABI (Leon-Carrion et al. 2005; Perumparaichallai et al. 2014).

Conclusions

There is Level 4 evidence that participation in a multidisciplinary rehabilitation program increases the number of patients that return to driving post ABI.

 

Pre-injury driving accidents, violations, and behaviours are predictors of post-injury driving fitness.

Accidents are more common among individuals with ABI who return to driving, which may be related to patients prematurely returning to driving.

Participation in a multidisciplinary rehabilitation program increases the number of patients who return to driving post ABI.

Return to driving is more likely for individuals with less severe injuries.