RETURN TO DRIVING AFTER TRAUMATIC BRAIN INJURY - Part I
Guest Editors: Bruno Gradenigo, Anna Mazzucchi Free access

Europa Medicophysica 2001 December;37(4):275-8

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Hemianopsia and driving

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.