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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
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  RETURN TO DRIVING AFTER TRAUMATIC BRAIN INJURY - Part I
Guest Editors: Bruno Gradenigo, Anna Mazzucchi
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Europa Medicophysica 2001 December;37(4):235-40

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Cognitive functions in drivers with brain injury-anticipation and adaptation. Neuropsychological aspects of driving after brain lesion

Lundqvist A.

From the Department of Neurorehabilitation University Hospital, Linköping, Sweden


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Bakground. To ­drive a ­car ­requires a ­set of com­plex ­skills, cog­ni­tive ­and ­motor func­tions. Every ­year ­many peo­ple suf­fer ­from trau­ma caus­ing cere­bral ­lesions. Special con­cern is ­required to ­the poten­tial ­effects of cog­ni­tive impair­ment ­when driv­ing is ­resumed ­after ­brain dam­age. If a per­son is dis­suad­ed ­from driv­ing ­his/­her ­life ­will ­change con­sid­er­ably ­with ­regard to con­ven­ience ­and ­social ­life. The pur­pose of my the­sis ­was to ­improve ­the under­stand­ing of ­what cog­ni­tive func­tions ­are impor­tant ­for driv­ing per­for­mance, inves­ti­gate ­the ­impact of ­impaired cog­ni­tive func­tions on driv­ing ­and ­study adap­ta­tion strat­e­gies ­for main­tain driv­ing per­for­mance ­after ­brain inju­ry. Finally, ­the pre­dic­tive val­ue of a neu­ro­psy­cho­log­i­cal ­test bat­tery ­for driv­ing per­for­mance ­was eval­u­at­ed.
Methods. Data com­bined quan­ti­ta­tive ­and qual­ita­tive ­research meth­ods. In ­two stud­ies a ­between-­group ­design ­with ­patients suf­fer­ing ­from ­acquired ­brain inju­ry ­and con­trol sub­jects ­was ­used to ­study ­the rela­tion­ship ­between cog­ni­tive func­tions ­and driv­ing per­for­mance. Data ­were col­lect­ed by ­means of ­test ­results, rat­ing ­scales ­and ques­tion­naires. In ­two stud­ies a qual­ita­tive ­research ­approach ­was ­used to ­describe ­the con­tent in ­the quan­ti­ta­tive empir­i­cal find­ings. Data ­were ­then col­lect­ed by ­open-end­ed inter­views ­with ­one offi­cial driv­ing inspec­tor ­from driv­ing occa­sions ­with ­brain-­injured ­patients.
Results. Cognitive func­tions in ­terms of atten­tion­al ­and dynam­ic work­ing mem­o­ry-relat­ed func­tions ­are rel­e­vant ­for driv­ing per­for­mance. Neuropsychologi-­cal impair­ments in infor­ma­tion pro­cess­ing ­speed, divid­ed ­and ­focused atten­tion, requir­ing work­ing mem­o­ry, ­are asso­ciat­ed to lim­i­ta­tions in driv­ing per­for­mance ­after ­brain inju­ry. Qualitative ­aspects of driv­ing prob­lems ­like ­impaired orien­ta­tion, deci­sion-mak­ing, con­fi­dence, ­and espe­cial­ly ­impaired antic­i­pa­to­ry atten­tion, ­appeared to con­strain driv­ing per­for­mance. A neu­ro­psy­cho­log­i­cal ­test bat­tery assess­ing ­speed of infor­ma­tion pro­cess­ing ­and atten­tion in ­terms of work­ing mem­o­ry pre­dict­ed driv­ing per­for­mance. Adaptive strat­e­gies in ­terms of driv­ing ­speed adjust­ment ­and antic­i­pa­to­ry atten­tion ­were sali­ent ­for driv­ing per­for­mance ­after ­brain inju­ry. In addi­tion, inter­est in driv­ing, moti­va­tion ­for driv­ing safe­ly ­and driv­ing expe­ri­ence ­appeared rel­e­vant ­for driv­ing per­for­mance ­after ­brain inju­ry. Collaboration ­between med­i­cal, neu­ro­psy­cho­log­i­cal ­and driv­ing exper­tise ­was dem­on­strat­ed to pro­mote a ­total eval­u­a­tion of driv­ing per­for­mance ­after ­brain inju­ry.
Conclusions. Cognitive func­tions in ­terms of atten­tion­al ­and dynam­ic work­ing mem­o­ry-relat­ed func­tions ­are rel­e­vant ­for driv­ing per­for­mance. Anticipatory atten­tion ­was con­sid­ered a work­ing mem­o­ry ­based atten­tion­al ­system, direct­ing ­the pro­cess­ing resourc­es flex­ibly ­and appro­pri­ate­ly ­between ­the dif­fer­ent infor­ma­tion pro­cess­ing com­po­nents dur­ing driv­ing. Thus, antic­i­pa­to­ry atten­tion dem­on­strat­ed qual­ita­tive­ly ­that work­ing mem­o­ry is a prom­i­nent func­tion in a ­real driv­ing con­text.

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