Return-to-driving following acquired brain injury: A neuropsychological perspective.

BACKGROUND: Return to driving after an acquired brain injury (ABI) has been positively associated with return to employment, maintenance of social relationships, and engagement in recreational and other community activities. Safe driving involves multiple cognitive abilities in a dynamic environment, and cognitive dysfunction resulting from ABI can negatively impact driving performance. OBJECTIVE: This manuscript examines the post-injury return-to-driving process, including performances on the in-office and on-road assessments, and the role of a rehabilitation neuropsychologist in helping patients resume driving. METHOD: In this study, 39 of 200 individuals (approximately 20%) treated at an outpatient neurorehabilitation facility, who performed satisfactorily on a pre-driving cognitive screening, completed a behind-the-wheel driving test. RESULTS: Of the 200 individuals, 34 (87%) passed the road test. Among the remaining five individuals who did not pass the road test, primary reasons for their failure included inability to follow or retain examiner directions primarily about lane position, speed, and vehicle control. The errors were attributable to cognitive difficulties with information processing, memory, attention regulation, and dual tasking.CONCLUSIONThe rehabilitation neuropsychologist contributed to the process by assessing cognition, facilitating self-awareness and error minimization, providing education about driving regulations and safety standards, and preparing for the road test and its outcomes.

Mild TBI in interdisciplinary neurorehabilitation: Treatment challenges and insights.

BACKROUND: Traumatic brain injury (TBI) has an estimated prevalence rate of 1.7 million occurrences a year in the United States with over 75% of traumatic brain injuries classified as 'mild.' The majority of individuals with mild traumatic brain injuries resume their daily functioning fairly quickly, and many fully within the first year. However, a minority of persons with mild TBI (mTBI), with estimates ranging between 1% and 20%, develop persistent cognitive, emotional, behavioral, and physical symptoms. Clinicians vary considerably in their clinical opinions regarding these individuals and there is no consensus on the treatment protocol for this population. OBJECTIVE: This manuscript presents four case studies of mild TBI with persistent symptoms treated by a transdisciplinary team in an outpatient neurorehabilitation setting based on community reintegration. Clinical challenges and insights involved in conceptualizing and effectively treating these individuals are discussed to facilitate future direction. METHODS: Four different mild TBI cases, each with persistent symptoms, but different injury mechanisms, dynamics, and factors affecting symptom persistence, expression, course, and outcome were included in the analysis of their treatment course and outcome. The treatment protocol included: brain injury education combined with supportive counseling for cultivation of positive expectancy effects, symptom-based, graded treatment involving most disciplines, frequent treatment team consultations, collaborations, and planning, and consistent team messages about post-injury recovery and expected return to community activities. Treatment outcomes were assessed with self and family reports, as well as the Mayo Portland Adaptability Inventory (MPAI-4) at admission and at discharge. RESULTS AND CONCLUSIONS: Each of the individuals made functional progress during rehabilitation, as evidenced by self and family reports and the MAPI-4. The cases posed various challenges to the treatment team, though a transdisciplinary team under the guidance of a rehabilitation physician and rehabilitation neuropsychologist was able to help patients navigate the path to their functional recovery. In addition to the specific treatment protocol, transdisciplinary team collaboration guided by rehabilitation neuropsychology contributed to treatment success.