Abstract
The question of whether a person can resume driving after acquired cognitive dysfunction is raised in primary care services and in hospital departments where patients suffering from brain injury are treated. These organizations rarely have a specialized program that evaluates driving fitness. This article describes a semi-structured and individualized model that serves as clinical guidelines for determining fitness to drive. The model is based on former research and clinical experience. It is exemplified by the procedure of forty-three individuals with congenital or acquired cognitive dysfunction due to head trauma or disease. A multidisciplinary team including medical, neuropsychological, occupational, and practical driving specialists optimised the clinical applicability of a driving assessment using quantitative and qualitative methods. The team discussions, including several professional evaluations and assessments, are considered very important for interpreting results, for understanding whether the cognitive impairments will have consequences on driving, and whether the individual can compensate for cognitive difficulties. The current way to determine a patient’s fitness to drive after cognitive dysfunction is an individually adapted combination of assessment methods that are often performed stepwise. This well-practiced evaluation process reveals that in many cases neither off-road tests nor on-road tests alone are sufficient to ensure sound decisions. To improve on these evaluations, this study concludes that a team-based consensus approach consisting of specialized national teams should be established to support primary care services in assessing fitness to drive in more complicated cases.
Highlights
In 2007, Kofi Annan, former Secretary-General of the United Nations, called the high traffic accident rate in the world “the hidden epidemic” (Annan, 2007)
The team-based clinical assessment procedure was used to evaluate 43 persons suffering from cognitive dysfunction due to congenital or acquired brain injury, mild dementia, or cognitive dysfunction related to other neurological disease and to heart disease
The 43 persons were the total number of patients who were referred to the driving assessment team in 2007 and 2008
Summary
In 2007, Kofi Annan, former Secretary-General of the United Nations, called the high traffic accident rate in the world “the hidden epidemic” (Annan, 2007). Alcohol is the predominant factor that kills people in car accidents every year (Vägverket, 2008; National Institutes of Health Department of health and human services USA, 2009), illness and injury that affect the brain are factors that cause traffic accidents (Boake, Macleod, High, & Lehmkuhl, 1998; Pietrapiana, Tamietto, Torrini, Mezzanato, & Perino, 2005; Schanke, Rike, Mølmen, & Østen, 2008). A person’s fitness to drive means the driver can manage traffic situations without being a traffic risk, anticipate demands in specific traffic situations, and prepare oneself for action. A person’s fitness to drive after brain injury must be evaluated with a broad perspective that includes current and pre-morbid medical, psychological, and cognitive functions as well as driving skill (Brouwer & Ponds, 1994)
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