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

Europa Medicophysica 2001 December;37(4):235-40

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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

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.