To drive or not to drive (after TBI)? A review of the literature and its implications for rehabilitation and future research.

Development of reliable procedures to assess fitness to safe driving after traumatic brain injury (TBI) is a crucial step in rehabilitation. However, prior studies are highly inconsistent in the choice of measures recommended for predicting driving fitness from different pre-driving measures. In the present paper the relevant literature is reviewed with the aim of shedding light on the reasons for these inconsistencies. The discrepant results reflect investigative choices which differ in five aspects: (1) the type of predictors used as pre-driving screening; (2) the type of measures considered as the criterion for the determination of fitness to drive after TBI; (3) the severity of the TBI in the sample of patients studied; (4) the extent of the neural structures damaged by TBI and the overlap of these areas with those involved in driving tasks; (5) the length of the follow-up considered. The strengths and weaknesses of the different methods and measures are discussed with their implications for future research and clinical rehabilitation. Encouraging findings come from recent studies that combined together medical, psychosocial, and personality measures, thereby improving the explanatory power of the predictors used. The use of post-injury driving fitness measures with great ecological and external validity seems equally promising in assessing actual driving in the real world.

Role of premorbid factors in predicting safe return to driving after severe TBI.

PRIMARY OBJECTIVE: The present study explored the possibility of predicting post-injury fitness to safe driving in patients with severe traumatic brain injury (TBI) (n = 66). METHODS AND PROCEDURE: Sixteen different measures, derived from four domains (demo/biographic, medico-functional, neuropsychological, and psychosocial) were used as predictor variables, whereas driving outcomes were assessed in terms of driving status (post-TBI drivers versus non-drivers) and driving safety (number of post-TBI car accidents and violations). MAIN OUTCOMES AND RESULTS: About 50% of the patients resumed driving after TBI. Compared to post-TBI non-drivers, post-injury drivers had shorter coma duration. With regard to driving safety, the final multiple regression model combined four predictors (years post-injury, accidents and violations before TBI, pre-TBI-risky-personality-index, and pre-TBI-risky-driving-style-index) and explained 72.5% of variance in the outcome measure. CONCLUSIONS: Since the best three predictors of post-injury driving safety addressed patients' premorbid factors, the results suggest that in order to evaluate the actual possibility of safe driving after TBI, it would be advisable to consider carefully patients' pre-TBI histories.