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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Online ISSN 1973-9095
RETURN TO DRIVING AFTER TRAUMATIC BRAIN INJURY - Part I
Guest Editors: Bruno Gradenigo, Anna Mazzucchi
From the Department of Neurorehabilitation University Hospital, Linköping, Sweden
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.