title: Interventions for resuming driving after traumatic brain injury.
abstract: OBJECTIVE
  To describe the goals, processes, resources and outcomes of on-road training lessons provided to drivers with traumatic brain injury (TBI) who failed an initial occupational therapy (OT) driver assessment.
  
  
  METHODS
  Descriptive cohort study using file audit design of 340 drivers with mild to severe TBI. Measures included; number and goals of on-road training lessons and reassessments, time from injury to independent driving, license restrictions, years licensed, physical/visual impairments and injury severity.
  
  
  RESULTS
  Initial OT driver assessment was passed by 72% (n = 246) cases. Of the 28% (n = 94) who failed, 93% (n = 87) resumed driving following on-road training; 42 (45%) with an open licence, 45 (48%) with restricted licence and seven (7%) failed to meet licencing standards. Individuals required, on average, 7.0 driving lessons (14 driving instructor hours), and 2.5 on-road reassessments, (9.8 OT and 3.8 driving instructor hours). Lesson goals were recommended to develop compensatory strategies for cognitive impairments (64%), improve previously learned driving skills (57%), improve confidence (53%), and address physical (26%) or visual impairment (16%).
  
  
  CONCLUSIONS
  Investment in on-road training lessons addressing individual goals, followed by reassessment and use of restricted licenses, can achieve successful return to driving following TBI. Implications for Rehabilitation Driver rehabilitation specialists should offer on-road driver training to individuals with moderate to severe TBI who fail an initial driver assessment. Goal directed driving lessons can train individuals with moderate to severe TBI to compensate for cognitive, physical, visual, and psychological barriers to driving, enabling them to pass a reassessment and return to driving. Restricted licences may enable some drivers with TBI to meet their driving needs and achieve safe return to driving.
authors.affiliation: a Occupational Therapy Department , Epworth HealthCare , Melbourne , Australia.
authors.forename: Pamela E
authors.initials: PE
authors.lastname: Ross
authors.affiliation: b School of Occupational Therapy, La Trobe University , Melbourne , Australia.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Di Stefano
authors.affiliation: c Monash University Accident Research Centre, Monash University , Melbourne , Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Charlton
authors.affiliation: d School of Psychological Sciences, Monash University , Melbourne , Australia.|e Monash-Epworth Rehabilitation Research Centre , Melbourne , Australia.
authors.forename: Gershon
authors.initials: G
authors.lastname: Spitz
authors.affiliation: d School of Psychological Sciences, Monash University , Melbourne , Australia.|e Monash-Epworth Rehabilitation Research Centre , Melbourne , Australia.
authors.forename: Jennie L
authors.initials: JL
authors.lastname: Ponsford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001333:Automobile Driver Examination; D001334:Automobile Driving; D000070642:Brain Injuries, Traumatic / Q000534:rehabilitation*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009788:Occupational Therapy; D055815:Young Adult
keywords: Head injury; automobile driving; driver rehabilitation; licence restrictions; occupational therapy; on-road training