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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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RETURN TO DRIVING AFTER TRAUMATIC BRAIN INJURY - Part I
Guest Editors: Bruno Gradenigo, Anna Mazzucchi
Netz J., Wolbers T. *
From the Neurologisches Therapiezentrum an der
*Heinrich Heine Universität, Düsseldorf, Germany
Background. Many countries have set strict rules for permitting driving of patients with homonymous hemi-anopsia. This study investigates the effects of compensatory eye movements on the driving ability of patients with homonymous hemianopsia.
Methods. Patients and controls are examined on a highly advanced interactive driving simulator. The search time criterion was used to divide the patients into two groups. Patients with search times exceeding the average search time of the control group plus two standard deviations were labelled “patients with exploratory deficits”, patients whose search times fell below this cut-off value were labelled “compensators”. The driving behaviour was assessed based on a detailed observation sheet that contained every traffic situation with the actions required by the driver.
Results. The performance of the patients with exploratory deficits was significantly worse compared to the control subjects. Even though these patients drove at substantially lower speeds and performed less overtaking manoeuvres than both the controls and the compensators, they were unable to drive safely and to react quickly and adequately in dangerous traffic situations. In both patients groups with a quadrantanopsia and with a complete hemianopsia there were some able to compensate and some not. So the problems of patients with homonym anopic lesions can not be directly related to the size of the homonymous defect in a simple manner. Patients who can compensate for their field defects either spontaneously or after a successful exploration training seem to be able to meet the requirements of modern traffic.
Conclusions. Consequently, it should be discussed whether it is adequate to deny these patients driving permission in general or whether this decision should be based on the results of a practical/simulator driving test and an assessment of the visual exploration.