The relationship of cognitive retraining to neurological patients' driving status: the role of process variables and compensation training.
OBJECTIVE
To explore the relationship of cognitive retraining performance to discharge driving status.


METHODS
One hundred and three brain-injured patients from a holistic milieu-oriented work/school re-entry programme.


METHODS
Initial, last, mean, and best cognitive retraining scores; Behavioural Checklist ratings; Working Alliance (WA) scores.


RESULTS
At the time of discharge, 50.5% of the sample were cleared to drive. Better performance on a cognitive retraining task addressing information processing and motor speed, focused attention, visual scanning and memory was associated with clearance to drive. Patients' behavioural approach to cognitive retraining tasks (use of compensations, organizational and procedural skills) and higher mean and discharge WA scores with staff were associated with driving clearance. Higher mean WA scores were also related to an enhanced behavioural approach to cognitive retraining tasks, including timeliness to sessions, compensation use, better communication pragmatics, decreased distractibility and the ability to apply the 'big picture' benefits of cognitive retraining to the 'real world'.


CONCLUSIONS
Cognitive retraining exercises that incorporate skill remediation, 'process' variables and metacognitive skills, as well as a better WA with patients, positively related to clearance to drive at the time of discharge from a holistic milieu-oriented programme.
Klonoff
Pamela S
PS
Catholic Healthcare West, Barrow Neurological Institute, Center for Transitional NeuroRehabilitation, Phoenix, AZ 85013, USA. pamela.klonoff@chw.edu
Olson
Karen C
KC
Talley
Melanie C
MC
Husk
Kristi L
KL
Myles
Stephen M
SM
Gehrels
Jo-Ann
JA
Dawson
Lauren K
LK
D000293:Adolescent; D000328:Adult; D001334:Automobile Driving / Q000523:psychology*; D001930:Brain Injuries / Q000534:rehabilitation*; D003072:Cognition Disorders / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests / Q000592:standards; D011597:Psychomotor Performance / Q000502:physiology*; D013647:Task Performance and Analysis; D014796:Visual Perception / Q000502:physiology*; D055815:Young Adult