Interventions for resuming driving after traumatic brain injury

Abstract

Purpose: To describe the goals, processes, resources and outcomes of on-road training lessons provided to drivers with traumatic brain injury (TBI) who failed an initial occupational therapy (OT) driver assessment.

Method: Descriptive cohort study using file audit design of 340 drivers with mild to severe TBI. Measures included; number and goals of on-road training lessons and reassessments, time from injury to independent driving, license restrictions, years licensed, physical/visual impairments and injury severity.

Results: Initial OT driver assessment was passed by 72% (n = 246) cases. Of the 28% (n = 94) who failed, 93% (n = 87) resumed driving following on-road training; 42 (45%) with an open licence, 45 (48%) with restricted licence and seven (7%) failed to meet licencing standards. Individuals required, on average, 7.0 driving lessons (14 driving instructor hours), and 2.5 on-road reassessments, (9.8 OT and 3.8 driving instructor hours). Lesson goals were recommended to develop compensatory strategies for cognitive impairments (64%), improve previously learned driving skills (57%), improve confidence (53%), and address physical (26%) or visual impairment (16%).

Conclusions: Investment in on-road training lessons addressing individual goals, followed by reassessment and use of restricted licenses, can achieve successful return to driving following TBI.

Implications for Rehabilitation

• Driver rehabilitation specialists should offer on-road driver training to individuals with moderate to severe TBI who fail an initial driver assessment.

• Goal directed driving lessons can train individuals with moderate to severe TBI to compensate for cognitive, physical, visual, and psychological barriers to driving, enabling them to pass a reassessment and return to driving.

• Restricted licences may enable some drivers with TBI to meet their driving needs and achieve safe return to driving.

Keywords:

• Head injury
• automobile driving
• occupational therapy
• on-road training
• licence restrictions
• driver rehabilitation

Disclosure statement

The corresponding author was awarded an RACV Sir Edmond Herring Memorial Scholarship in 2009.

The remaining authors report no declarations of interest.