A Controversial Assessment of Fitness to Fly After a Traumatic Brain Injury.

INTRODUCTION: After traumatic brain injury (TBI), cognitive, behavioral alterations and seizures frequently occur. Beside instrumental examinations, neuropsychological testing is the common clinical practice for detecting cognitive deficits. However, in highly skilled individuals, subtle changes with a large impact on fitness to fly may be neglected.CASE REPORT: A 28-yr-old Italian Air Force pilot with almost 700 flying hours suffered a TBI. After 2 yr of cognitive retraining programs, as the neuropsychological evaluation executed in a public hospital was within the standards and repeated EEGs had all been normal, the pilot was allowed to resume flying duties. During the refresh flight training, he was not considered proficient for solo flight and was again referred to the Institute of Aerospace Medicine (IMAS), where, due to the absence of a neuropsychologist, the pilot was referred to a public hospital. Again, he was within the normal range and received a fitness to fly with limitations. Nevertheless, the flight instructors noticed the presence of cyclic errors. Consequently, he was sent for a third time to the IMAS, where the cooperation between a neuropsychologist and a flight surgeon allowed a tailored testing.DISCUSSION: With a proper evaluation, the subject showed deficits in topographic visuospatial learning and in prospective memory. After 5 yr, he was finally declared permanently unfit to fly. Specific neuropsychological batteries, simulated flight tests, and aeromedical evaluations are described here.Verde P, Guadagno AG, D'Angelo A, Vitalone R, Di Vita A, Piccardi L. A controversial assessment of fitness to fly after a traumatic brain injury. Aerosp Med Hum Perform. 2022; 93(2):116-122.

Domain-Specific Interference Tests on Navigational Working Memory in Military Pilots.

INTRODUCTION: Human navigation is a very complex ability that encompasses all four stages of human information processing (sensory input, perception/cognition, selection, and execution of an action), involving both cognitive and physical requirements. During flight, the pilot uses all of these stages and one of the most critical aspect is interference. In fact, spatial tasks competing for the same cognitive resource cause greater distraction from a concurrent task than another task that uses different resource modalities. METHODS: Here we compared and contrasted the performance of pilots and nonpilots of both genders performing increasingly complex navigational memory tasks while exposed to various forms of interference. We investigated the effects of four different sources of interference: motor, spatial motor, verbal, and spatial environment, focusing on gender differences. RESULTS: We found that flight experts perform better than controls (Pilots: 6.50 ± 1.29; Nonpilots: 5.45 ± 1.41). Furthermore, in the general population, navigational working memory is compromised only by spatial environmental interference (Nonpilots: 4.52 ± 1.50); female nonpilots were less able than male nonpilots. Also, the flight expert group showed the same interference, even if reduced (Pilots: 5.24 ± 0.92); moreover, we highlighted a complete absence of gender-related effects. DISCUSSION: Spatial environmental interference is the only interference producing a decrease in performance. Nevertheless, pilots are less affected than the general population. This is probably a consequence of the need to commit substantial cognitive resources to process spatial information during flight.