Return to driving after head injury
Hawley, Carol. (2001) Return to driving after head injury. Journal of Neurology Neurosurgery and Psychiatry , Vol.70 (No.6). pp. 761-766. ISSN 0022-3050
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Official URL: http://dx.doi.org/10.1136/jnnp.70.6.761
To determine whether patients who return to driving after head injury can be considered safe to do so and to compare the patient characteristics of those who return to driving with those who do not.
In a multicentre qualitative study ten rehabilitation units collectively registered 563 adults with traumatic brain injury during a 2.5 year period. Recruitment to the study varied from immediately after hospital admission to several years post injury. Patients and their families were interviewed around three to six months following recruitment. 383 (67.5%) subjects were interviewed within one year of injury, of whom 270 (47.6%) were interviewed within 6 months of injury. Main outcome measures were the presence or absence of driving related problems reported by drivers and ex-drivers, and scores on driving related items of the Functional Independence/Functional Assessment Measure (FIM+FAM).
Of the 563 patients 381 were drivers before the injury and 139 had returned to driving at interview. Many current drivers reported problems with behaviour (anger, aggression, irritability) (67 (48.2%)), memory ( 89 (64%)), concentration and attention (39 (28.1%)), and vision (39 (28.1%)). Drivers reported most driving-related problems as frequently as ex-drivers, main exceptions were epilepsy and community mobility. Current drivers scored significantly higher on the FIM+FAM (i.e. more independent), than ex-drivers. The driving group had sustained less severe head injuries than ex-drivers, nevertheless 78 (56.2%) of current drivers had received a severe head injury. Few (61, 16%) previous drivers reported receiving formal advice about driving following injury.
The existence of problems which could significantly affect driving do not prevent patients returning to driving after TBI. Patients should be assessed for both mental and physical status before returning to driving after a head injury, and systems put in place to enable clear and consistent advice to be given to patients regarding driving.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry|
|Divisions:||Faculty of Medicine > Warwick Medical School|
|Library of Congress Subject Headings (LCSH):||Brain -- Wounds and injuries, Head -- Wounds and injuries, Automobile driving|
|Journal or Publication Title:||Journal of Neurology Neurosurgery and Psychiatry|
|Page Range:||pp. 761-766|
|Access rights to Published version:||Open Access|
Version accepted by publisher (post-print, after peer review, before copy-editing)
British Society of Rehabilitation Medicine.(1998).Rehabilitation after traumatic brain injury. London: British Society of Rehabilitation Medicine.
NHS Health Advisory Service. (1996).Thematic review of mental health services: heading for better care. Commissioning and providing mental health services for people with Huntington’s Disease, Acquired Brain Injury and Early Onset Dementia. London: HMSO.
Rimel, R.W., Jane, J.A. and Bond, M.R. (1990).Characteristics of the head injured patient. In: Rosenthal, M., Griffith, E.R., Bond, M.R., Miller, J.D., eds. Rehabilitation of the adult and child with traumatic brain injury. 2nd ed. Philadelphia: F. A. Davis.
McMillan, T., Greenwood, R. (1991).Rehabilitation programmes for the brain injured adult. Discussion paper for the Department of Health, London.
Social Services Inspectorate Social Services Department. (1995).Information strategies and systems (with reference to community care): inspection overview. London: Department of Health.
McKinlay, W.W., Brooks, D.N., Bond, M.R., Martinage, D.P., Marshall, M.M. (1981).The short-term outcome of severe blunt head injury as reported by relatives of the injured persons. Journal of Neurology, Neurosurgery and Psychiatry, 44, pp. 527-533.
Tate, R.L., Lulham, J.M., Broe, G.A., Strettles, B., Pfaff, A. (1981). Psychosocial outcome for the survivors of severe blunt head injury: the results from a consecutive series of 100 patients. Journal of Neurology, Neurosurgery and Psychiatry, 52, pp. 1128-1134.
Thomsen, I.V. (1992). Late psychosocial outcome in severe traumatic brain injury. Preliminary results of a third follow-up study after 20 years. Scandinavian Journal of Rehabilitation Medicie, Supplement, 26, pp.142-152.
Koskinen, S. (1998). Quality of life 10 years after a very severe traumatic brain injury (TBI): the perspective of the injured and the closest relative. Brain Injury, 12, pp. 631-648.
Van Zomeren, A.H., Brouwer, W.H., Minderhoud, J.M. (1987). Acquired brain damage and driving: a review. Archives of Physical Medicine and Rehabilitation, 68, pp. 697-705.
Legh-Smith, J., Wade, D.T., Hewer, R.L. (1986). Driving after a stroke. J R Soc Med, 79(4), pp. 200-203.
Taylor, J.F., ed. (1995). Medical aspects of fitness to drive. a guide for medical practitioners. London: The Medical Commission on Accident Prevention.
Schutte, P., Barker, J. (1995). Medico-legal considerations. In: Taylor, J.F., ed. Medical aspects of fitness to drive. a guide for medical practitioners. London: The Medical Commission on Accident Prevention.
Hawley, C.A., Stilwell, J., Davies, C., Stilwell, P. (2000). A national multicentre study of post-acute rehabilitation for adults after traumatic brain injury. British Journal of Therapy and Rehabilitation.7(3), pp. 116-122.
Stilwell, J., Hawley, C., Stilwell, P., Davies, C. (1998). The report of The National Traumatic Brain Injury Study. University of Warwick, Coventry: Centre for Health Services Studies.
Teasdale, G. and Jennett, B. (1974). Assessment of coma and impaired consciousness: a practical scale. Lancet. 2, pp. 81-83.
Medical Disability Society (1988). The management of traumatic brain injury. London: Royal College of Physicians.
Hall, K.M., Hamilton, B.B., Gordon, W.A., Zasler, N.D. (1993). Characteristics and comparisons of functional assessment indices: Disability Rating Scale, Functional Independence Measure, and Functional Assessment Measure. Journal of Head Trauma Rehabilitation. 8(2), pp. 60-74.
State University of New York at Buffalo. (1989). FAM decision tree. Buffalo, New York.
Hawley, C.A., Taylor, R., Hellawell, D.J., Pentland, B. (1999). The use of the functional asessment Measure (FIM + FAM) in head injury rehabilitation: a psychometric analysis. Journal of Neurology, Neurosurgery and Psychiatry, 67(6), pp. 749-754.
Fisk, G.D., Schneider, J.J., Novack, T.A. (1998). Driving following traumatic brain injury: prevalence, exposure, advice and evaluations. Brain Injury, 12(8), pp. 683-695.
Hall, K.M., Mann, N., High, W.M., Wright, J., Kreutzer, J.S., Wood, M.S. (1996). Functional measures after traumatic brain injury: ceiling effects of FIM, FIM+FAM, DRS, and CIQ. Journal of Head Trauma Rehabilitation, 11(5) pp. 27-39.
Drivers Medical Group, DVLA. (1996). For medical practitioners: at a glance guide to the current medical standards of fitness to drive. Swansea: DVLA.
Pidikiti, R.D., Novack, T.A. (1991). The disabled driver: an unmet challenge. Archives of Physical Medicine and Rehabilitation, 72(2) pp.109-11.
Shute, R.H., Woodhouse, J.M. (1990). Visual fitness to drive after stroke or head injury. Opthal Physiol Opt, 10, pp.327-332.
Munton, G. (1995). Vision. In: Taylor, J.F., ed. Medical aspects of fitness to drive. a guide for medical practitioners. London: The Medical Commission on Accident Prevention.
Mortimer, R.G.(1986). Night driving. In: Rubens, M.L. et al, eds. Vision in vehicles. New York: Elsevier.
Jennett, B. (1995). Epilepsy and Neurosurgical Disorders. In: Taylor, J.F., ed. Medical aspects of fitness to drive. a guide for medical practitioners. London: The Medical Commission on Accident Prevention.
Headway. (1989). Driving after a head injury. National Head Injuries Association.
Priddy, D.A., Johnson, P., Lam, C.S. (1990). Driving after a severe head injury. Brain Injury, 4(3), pp.267-272.
Van Zomeren, A.H., Brouwer, W.H., Rothengatter, J.A., Snoek, J.W. (1988). Fitness to drive a car after recovery from severe head injury. Archives of Physical Medicine and Rehabilitation, 69, pp. 90-96.
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