Rationale: Driving is a meaningful occupation for many people and is largely valued for the functionality of getting around one's own community and accessing activities outside the home. However, driving itself is an occupation that requires both physical and cognitive engagement. After a traumatic brain injury (TBI), there may be changes to one's ability to drive, leading to devastating impacts on quality of life. The purpose of this study was to describe the goals, resources and outcomes of on-road training lessons provided to drivers with TBI who failed an initial OT driver assessment.
Method: 340 drivers with mild to severe TBI were included in this cohort study. On and off-road OT driver assessments were completed. The measures included number and goals of on-road training sessions and reassessments, time from injury to independent driving, license restrictions, years licensed, physical/visual impairments and injury severity.
Results: Of the 340 participants, 72.3% resumed driving without on-road training after passing their initial on-road assessment with an OT. The remaining 27.6% failed the initial OT driver assessment and required training. Of the 94 participants who received on-road training, 44.6% of drivers resumed driving with an open and unrestricted license, and 47.8% required a restricted license. Restrictions were categorized as area restrictions (geographical parameters), automatic transmission only, and adaptive equipment.
An average of seven on-road training lessons were required to deliver the intervention. Following the on-road training, an average of 2.6 on-road assessments were required equating to 9.8 OT hours.
A greater percentage of women received driving lessons to address confidence than men; whereas men were significantly more likely to require driving lessons to address cognitive issues. Further, those requiring interventions targeted at cognitive functioning initially had more severe TBI.
Conclusion: OT driver assessor-directed on-road training was needed for a broad range of factors contributing to poor driving performance after TBI. Investing in on-road training lessons addressing individuals goals, followed by reassessment and use of restricted licenses can enable successful return to driving following a TBI.
Implications for OT:
- Driver rehab specialists should offer on-road training to individuals with moderate to severe TBI who fail an initial driver assessment. This may require a referral to an OT working in driver rehab who can provided graded lessons for a safe re-introduction to driving.
- Goal directed driving lessons that are tailored to the needs and abilities of the individual with the TBI can teach compensatory strategies or improve existing strengths and resources from prior driving experience.
- Offering a restricted license if a driver is able to meet some but not all of the criteria for independent driving may enable some people with TBI to meet their driving needs and achieve a safe return to driving.
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