title: Driving with cognitive deficits: neurorehabilitation and legal measures are needed for driving again after severe traumatic brain injury.
abstract: OBJECTIVE
  This article presents a retrospective study on a group of survivors of severe traumatic brain injury with the purpose of discerning whether post-traumatic cognitive deficits prevent them from safely resuming driving and to see if holistic neurorehabilitation improves the rate of patients fit for returning to driving.
  
  
  METHODS
  We studied 17 patients who had suffered severe traumatic brain injury (TBI) as measured by Glasgow Coma Scale scores. All subjects underwent a holistic, intensive and multidisciplinary neurorehabilitation program during a mean period of 10.53 months in the Centro de Rehabilitación de Daño Cerebral (CRECER)--Center for Brain Injury Rehabilitation--in Seville, Spain. Patients were divided into two different groups: drivers (patients who drove despite strong and repeated recommendations from the Center to desist from doing so when they began the rehabilitation program) and non-drivers (patients not driving at the time they began the rehabilitation program although they had a pre-injury driver's license). The FIM+FAM-Revised Scale [1] was administered both before commencing treatment and upon termination.
  
  
  CONCLUSIONS
  (1) Patients showing physical functionality above 80% returned to driving, regardless of their cognitive and/or emotional deficits, and against doctor recommendations. (2) Severe TBI survivors that have not been certified as fit to drive are at increased risk for driving incidents other than collisions and traffic accidents. This is illustrated by significant incidents involving some of the subjects in our study that were due to disorientation, confusion and confrontations with people or situations. (3) We found that neurorehabilitation is worthwhile; after integral and multidisciplinary neurorehabilitation more than 70% of survivors of severe TBI can return to driving with regular safety. (4) We also suggest that laws be introduced to keep not-clinically-apt patients from driving.
authors.affiliation: Department of Experimental Psychology, University of Seville, Spain. leoncarrion@us.es
authors.forename: J
authors.initials: J
authors.lastname: Leon-Carrion
authors.forename: M R
authors.initials: MR
authors.lastname: Dominguez-Morales
authors.forename: J M Barroso Y
authors.initials: JM
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D001333:Automobile Driver Examination; D001334:Automobile Driving / Q000331:legislation & jurisprudence* / Q000592:standards; D001930:Brain Injuries / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation*; D003071:Cognition; D015600:Glasgow Coma Scale; D006801:Humans; D009483:Neuropsychological Tests; D015397:Program Evaluation; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012189:Retrospective Studies; D013030:Spain