5.6 Return to Driving

Case Study (continued)

The patient notes that if he is going to return to work he needs to be able to return to driving.  Otherwise, he will be dependent on friends, family or taxis for transportation.

Why do individuals who sustain a brain injury have trouble returning to driving?

  1. Driving requires effective function in the realms of perception, cognition, communication and coordination.
     
  2. Driving requires functional vision, rapid, reliable responses, quick decision-making and the ability to remain attentive despite distractions.
  • Driving a motor vehicle requires effective function in multiple domains, including perception, cognition, communication, and coordination.
     
  • First and foremost, driving depends on functional vision and rapid reliable responses, as well as quick decision-making and the ability to remain attentive despite distractions.

What results in the higher incidence of accidents seen in ABI survivors who return to driving?

  1. There is high incidence of accidents in ABI survivors who return to driving which may be related to patients prematurely returning to driving.
     
  2. 50% of persons with severe TBI and 75% of those with moderate TBI actually resume driving a motor vehicle following injury.
     
  3. Those individuals who return to driving against professional recommendations have a high probability of being involved in traffic accidents.
  • The ability to drive is seen by many as a key determinant for an individual’s social competence and independence.
     
  • Persons with an ABI may have difficulty driving due to an inability to keep track of many simultaneous inputs, as found in complex traffic situations 18.
     
  • Perino and Rago 19estimated that only 50% of persons with severe TBI (and 75% of persons with moderate TBI) actually resume driving a motor vehicle following injury.

What factors are likely to influence the likelihood of driving fitness following an ABI?

Patients with more severe injuries are less likely to be successful returning to driving.

  1. Pre-injury personality and behaviours such as violations before injury, pre-injury risky personality and pre-injury risky driving styles all decrease the likelihood of driving fitness post ABI.
     
  2. There is Limited evidence that participation in a multidisciplinary rehabilitation program increases the percentage of patients who return to driving following an ABI.
  • It is believed that ABI patients return to driving in an effort to feel independent, even if they are not fit to do so 20
     
  • This contributes to the higher likelihood for ABI survivors to be involved in accidents compared with the general population 17
     
  • Driving simulators have proven useful in predicting actual driving performance.
     
  • Return to driving may be more likely for patients with less severe injuries21
     
  • It has also been reported thatviolations before injury, pre-injury risky personality, and pre-injury risky driving styles all decrease the likelihood of driving fitness following ABI 20.
     

For more information on driving post ABI please see ERABI/Community Reintegration Post ABI/Driving.

What is the process for assessment of driving in an ABI patient for whom there are concerns about driving?

  1. All patients with moderate to severe ABI need to be assessed by a physician with experience in brain injury and access to a multidisciplinary team.
     
  2. Advise the appropriate government body about the ABI, neurological impairments and concerns about driving safety.
     
  3. Ensure the patient and their caregivers are aware of the law and driving post ABI.
     
  4. If the patient’s fitness to drive is unclear, a comprehensive assessment of capacity to drive should be undertaken at an approved driving assessment centre.

According to ABIKUS Recommendations 13

Driving

For all patients with a moderate to severe ABI, including adolescents, a physician with experience of brain injury should screen patients who wish to drive, in accordance with legislation, where appropriate in liaison with the multidisciplinary team.  (ABIKUS C, adapted from RCP, G156, p.49) (G90-p.31)

If members of the interdisciplinary rehabilitation team during assessment or treatment determine that the person’s ability to operate a motor vehicle safely may be affected, then they should:

  • Advise the patient and/or their advocate that they are obliged by law (if applicable) to inform the relevant government body that the individual has suffered a neurological or other impairment and to provide the relevant information on its effects
  • Provide information about the law and driving after brain injury
  • Provide clear guidance for the GP, other treating health professionals and family/caregivers, as well as the patient, about any concerns about driving, and reinforce the need for disclosure and assessment in the event that return to driving is sought late post-injury

(ABIKUS C, adapted from RCP, G157, p.49) (G91-p.31)

If the patient’s fitness to drive is unclear, a comprehensive assessment of capacity to drive should be undertaken at an approved driving assessment centre (ABIKUS C, adapted from RCP, G157, p.49) (G92-p.31)