On-road assessment of driving competence after brain impairment: review of current practice and recommendations for a standardized examination.
OBJECTIVE
To examine the approaches to on-road assessment of driver competence in persons with brain impairment. Items examined were procedures, standardization, scoring methods, equipment requirements, and determination of fitness to drive.


METHODS
All studies identified through citation or Medline search.


METHODS
The studies reviewed were those published from 1971 to the present that examined driving competence after brain impairment, as measured by a driving test.


METHODS
A qualitative review of published studies reporting methodologies and authors' conclusions abstracted from sourced publications.


RESULTS
Off-road driving assessments examine proficiency in operating a motor vehicle, but not ability to drive in traffic or accurate prediction of safe driving. On-road driving assessments have been used to examine the predictive validity of other driving assessment methods or the driving performance of subjects with brain impairment. Determining a subject's competence to drive is frequently a subjective evaluation. With a standardized driving test, a significant correlation between the objective driving score and the rater's global evaluation of fitness has been reported.


CONCLUSIONS
Closed-course, off-road driving tests are recommended for examining vehicle operation skills and readiness for in-traffic evaluation only. This allows practice with any vehicle adaptations before on-road evaluation and identification of clients who are unsafe to proceed on-road. A practical driving test in traffic, with standardized route and driving maneuvers, is recommended for determining driver competence. Scoring of driving performance should be standardized, reliable, and specific, to identify deficient driving skills that may be amenable to training. Driving performance should be evaluated according to predefined criteria, and the judgment regarding competence should be closely related to this objective measure.
Fox
G K
GK
Rehabilitation Studies Unit, University of Sydney and Royal Rehabilitation Centre Sydney, Australia.
Bowden
S C
SC
Smith
D S
DS
D001333:Automobile Driver Examination / Q000523:psychology / Q000706:statistics & numerical data; D001334:Automobile Driving / Q000523:psychology; D001930:Brain Injuries / Q000175:diagnosis*; D017408:Guidelines as Topic; D006801:Humans; D016743:Mental Competency; D008959:Models, Neurological; D008960:Models, Psychological; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012107:Research Design