Driving and community integration after traumatic brain injury.
Rapport LJ, Bryer RC, Hanks RA. Department of Psychology, Wayne State University, Detroit, MI 48202, USA. Arch Phys Med Rehabil. 2008 May;89(5):922-30.
OBJECTIVE: To examine resumption of driving after traumatic brain injury (TBI) and its relation to community integration.
DESIGN: Cross-sectional cohort study; survey and cognitive data.
SETTINGS: Inpatient rehabilitation hospital of the Traumatic Brain Injury Model Systems and community.
PARTICIPANTS: Persons (N=261) ranging from 3 months to 15 years postinjury.
INTERVENTIONS: Not applicable.
MAIN OUTCOME MEASURES: Barriers to Driving Questionnaire, Driver Survey, Community Integration Measure, and Craig Hospital Assessment and Reporting Technique.
RESULTS: Forty-four percent of survivors had resumed driving; of nondrivers, 48% reported a strong desire to resume driving. Nondriver survivors who sought to resume driving generally rated themselves as currently fit to drive, viewed themselves as having physical and cognitive profiles like those of survivor drivers, and reported their greatest barriers to driving as social and resource related. However, cognitive functioning was similar to nondriver survivors who did not seek to resume driving and significantly worse than survivors who were currently driving. Nondrivers showed poorer community integration than did drivers, even after accounting for injury severity, social support, negative affectivity, and use of alternative transportation. Use of alternative transportation was common among nondrivers, but it was unrelated to community integration outcomes. Cognitive functioning moderated risk of adverse incident: among survivors with low cognitive functioning and high self-estimates of driving ability, which is indicative of unawareness of deficit, adverse incidents showed positive relation to amount of driving and inverse relation to cognitive functioning.
CONCLUSIONS: Driving status has unique and independent association with post-TBI community integration. Additional research is needed to evaluate transportation barriers that undermine full engagement in community living after TBI and to determine which barriers to driving reflect valid risk to survivors and the public.
Barriers to driving and community integration after traumatic brain injury.
Rapport LJ, Hanks RA, Bryer RC. Department of Psychology, Wayne State University, Detroit, Michigan 48226, USA. rapport@sun-science.wayne.edu J Head Trauma Rehabil. 2006 Jan-Feb;21(1):34-44.
OBJECTIVE: To examine the relations among driving status, perceptions of barriers to the resumption of driving, and community integration outcomes after traumatic brain injury (TBI).
DESIGN: Correlational research using logistic and multiple regression analyses, analyses of variance, and covariance.
PARTICIPANTS: Fifty-one survivors of TBI, 6 months to 10 years postinjury.
MAIN OUTCOME MEASURES: Driving status postinjury, Community Integration Measure, and Craig Hospital Assessment and Reporting Technique.
RESULTS: Perceptions of barriers to driving provided unique information in predicting subjective and objective indices of community integration, even after accounting for other potentially pertinent variables (eg, injury severity, social support, negative affectivity, and use of alternative transportation). Moreover, survivors who had not resumed driving showed poorer community integration than did those who had resumed driving. Social barriers such as directives against driving from significant others accounted for the most variance in survivor driving status. Decisions to cease driving were more common among those with no formal driving evaluation than among survivors who had been evaluated.
CONCLUSIONS: Significant others have substantial influence on post-TBI driving outcome. The findings highlight the importance of independent driving to community integration, as well as psychoeducation of survivors and their families.