Safe return to driving following severe acquired brain injury: role of a short neuropsychological assessment.

BACKGROUND: Driving is a complex ability requiring a broad range of motor, cognitive-behavioral and visual skills that may be impaired after severe acquired brain injury (sABI). Resumption of driving is perceived as a major need by patients, being closely linked to personal autonomy, work and social activities. AIM: The objective of this study was to identify a short battery of neuropsychological tests with predictive value with regard to safe return to driving after sABI. DESIGN: Observational study. SETTING: Outpatient of a rehabilitation center for sABI. POPULATION: A continuous series of 127 patients with stable sABI, well-reintegrated at a family and social level, dismissed since at least one year from the end of their intensive rehabilitation, enrolled between 2006 and 2014. METHODS: Patients underwent an extensive battery of neuropsychological tests (pencil and paper and specific PC programs), aimed at assessing cognitive functions, in performance and verbal tasks. The results were analyzed in relation to their on-road performance during the driving test conducted by the office of the Italian Government Authority (success or failure of the test). RESULTS: No correlations were found between demographic data, etiology, driving experience, verbal competence and the decision of the competent authority. Significant correlation was found between attention, executive functions, overall visual-spatial exploration and driving performance. CONCLUSIONS: Both "pencil and paper" and computerized tests in the cognitive domains of attentive functions, and those involving performance with visual-spatial material, are significantly correlated with the driving test outcome, even if there is not enough evidence of the relative value of off-road compared to direct on-road tests. CLINICAL REHABILITATION IMPACT: We propose a small neuropsychological battery of tests with normative data for Italian population, predictive with respect to the ability to drive safely. We recommend to use it as first screening before submitting patients to more demanding and risky on-road driving tests.

The two sides of spatial representation in neglect patients: the same spatial distortion for different patterns of performance.

Patients with neglect show disorders in horizontal space perception. It has been argued that these disorders may depend on a distortion of space that takes the form of a left-right relaxation of the representational medium that becomes progressively "relaxed" toward the contralesional space and progressively "compressed" toward the ipsilesional space (the space anisometry hypothesis). In the present paper we tested this hypothesis by using the Oppel-Kundt illusion that consists of the perception of a filled space as larger than an empty space of the same size. Two experiments were carried out with 14 brain-damaged patients with neglect, 9 brain-damaged patients without neglect and 12 healthy subjects. In the first experiment participants were requested to bisect and read words with different letter spacing simulating the way space is thought to be distorted in neglect. In the second experiment we asked the participants to physically and numerically bisect numerical intervals. The results of the two experiments are in line with the predictions of the space anisometry hypothesis. Specifically, with a background resembling the space distortion proposed by the space anisometry hypothesis, neglect signs are ameliorated in reading words and in numerically bisect numerical intervals, while they are worsened in bisecting words and physically bisect numerical intervals. These results support the idea that the abnormalities observed in typical neglect tests are due to a distorted internal representation of the outside world that takes the form of a mental continuum logarithmically distorted along the horizontal dimension.