Two brief measures of executive function in the prediction of driving ability after acquired brain injury

Abstract

The question of fitness to drive following acquired brain injury is commonly encountered in rehabilitation settings. Pre-driving assessments are usually performed prior to on-road assessments, but there is no uniformity as to the instruments employed. Neuropsychological tests are often employed to assess different functional domains. One domain that has been suggested to be critical to driving is executive functioning. The present study examined the utility of the Frontal Assessment Battery (FAB) and the Trail Making Test Part B (TMTB) in predicting on-road driving performance after stroke or traumatic brain injury. While the TMTB has previously been demonstrated to be useful in this regard, the FAB has never been examined for this purpose. Participants were 76 patients referred for driving assessment after diagnosis of stroke or traumatic brain injury. Results indicated that scores on the TMTB, but not the FAB, were significantly predictive of on-road driving performance (p < .05). A cutoff score of 90 seconds or greater on the TMTB correctly identified 77% of those failing on-road evaluation. Implications and limitations are discussed.

Keywords:

• Stroke
• Brain injury
• Driving
• Prediction
• Executive functioning
• Rehabilitation

Acknowledgments

The authors gratefully acknowledge Elizabeth S. Allen, PhD and David B. Arciniegas, MD for their input and guidance, as well as the work of the personnel in the medical records department at the study site hospital for redacting the data. Portions of this research were presented at the annual meeting of the American Academy of Clinical Neuropsychology, Boston, June 2008.