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PubMed2002

Drug addiction as drive satisfaction ("antidrive") dysfunction.

Drug addiction is a complex brain disorder, characterized by the loss of control over drug seeking and drug taking behavior, and by the risk of relapse, even after a prolonged period of abstinence. This disorder may have its source in a disturbed balance of drive-related behaviors, which control appetitive reactions aimed at seeking contact with an addictive substance. The act of consumption becomes more and more attractive, and the behavior takes on compulsive character. We suppose that drug addiction may involve a change in the mechanism of satisfaction of drives and states of satiation as well. To understand how the motivational processes are changed with the development of dependence, one must consider the mechanism of drive satisfaction and satiation states that occur in relation to the consumatory reflex. When a given drive is satisfied a state of fulfillment occurs. This state may be a result of a so-called "antidrive" mechanism (Konorski 1967). While a drive activity is characterized by general activation and tension, the drive satisfaction state ("antidrive") is characterized by relaxation and relief. When a particular drive is satisfied, the operation of other drives become possible. Therefore, we postulate that dysfunction of drive satisfaction leads to the sustained activation related to the current drug-related drive, which blocks the operation of other drives. In effect, uncontrolled compulsive appetitive behavior is released, and the operation of other drives is restrained, thus forcing the organism to focus on drug-related drive. The reason for an "antidrive" dysfunction may be related to adaptive changes which develop during a contact with an addictive substance.

Drive↗
PubMed2003

Driving resumption and its predictors after stroke.

BACKGROUND AND PURPOSE: Despite the prevalence of ischemic stroke, little is known regarding driving resumption and its determinants after stroke. This study documents driving resumption poststroke and describes the relationship between specific variables and driving resumption. METHOD: Between May 2001 and January 2002, 110 consecutive patients admitted to Hartford Hospital with acute ischemic stroke, who had driven during the month before admission, were enrolled in this cohort study. Stroke outcome measures including the NIH Stroke Scale, Barthel Index, Short Form (SF-12), COOPS social support scale, and an original questionnaire were administered. Patients were followed up at three and six months to establish poststroke driving status. The relationship between driving resumption and the predictor variables was determined using correlations (point-biserial and phi coefficients) and forward multiple logistic regression. RESULTS: Forty (50%) of the surveyed patients resumed driving within one month of their strokes. The best logistic regression model (R2 = 0.391) for predicting resumption of driving after stroke included the variables prestroke driving frequency (OR = 7.74 [2.47-24.3]), poststroke Barthel Index score (OR = 1.16 [1.06-1.27]), and marital status (OR = 3.55 [1.28-9.83]). CONCLUSION: Resumption of driving is early after mild strokes. Factors other than the specific consequences of the stroke contribute to the prediction of driving resumption. While factors such as prestroke driving frequency, functional independence and marital status should not be used as a sanction for driving resumption, they offer insights to individuals who are likely to resume driving early after an ischemic stroke.

Aged↗
PubMed1997

Prevalence of alcohol-impaired driving. Results from a national self-reported survey of health behaviors.

OBJECTIVE: To estimate how frequently adults in the United States drive while impaired by alcohol. DESIGN: Telephone survey. SETTING: The 49 states (and the District of Columbia) that participated in the Behavioral Risk Factor Surveillance System (BRFSS) in 1993. PARTICIPANTS: A total of 102,263 noninstitutionalized adults aged 18 years or older. MAIN OUTCOME MEASURES: The percentage of respondents who reported alcohol-impaired driving; number of episodes of alcohol-impaired driving per 1000 adult population; and total number of episodes of alcohol-impaired driving-each by age, sex, race, level of education, and state. RESULTS: Overall, 2.5% of adults reported an estimated 123 million episodes of alcohol-impaired driving in 1993. This corresponds to 655 episodes of alcohol-impaired driving for each 1000 adults (range among states per 1000 adults, 165-1550). Alcohol-impaired driving was most frequent among men aged 21 to 34 years (1739 episodes per 1000 adults) and was nearly as frequent among men aged 18 to 20 years (1623 episodes per 1000 adults), despite legislation in all states that prohibited the sale of alcohol to persons younger than age 21 years in 1993. CONCLUSIONS: Alcohol-impaired driving is common even among underage persons. Strict enforcement of laws that discourage alcohol-impaired driving is needed along with community and patient education to reduce the prevalence of alcohol-impaired driving and prevent injuries and deaths from alcohol-related motor vehicle crashes. Data from the BRFSS, an ongoing source of national and state-specific data on the number of episodes of alcohol-impaired driving, are potentially useful for monitoring trends and evaluating the effect of future efforts to reduce alcohol-impaired driving.

Accidents, Traffic↗
PubMed2006

The effect on teen driving outcomes of the Checkpoints Program in a state-wide trial.

Crash rates among teenagers are highly elevated during the first months of licensure. Parent-imposed driving restrictions on initial driving privileges can reduce exposure to high-risk driving conditions, thus reducing crash risk while teens' driving proficiency develops. This report describes the effect of the Checkpoints Program on driving limits and outcomes. Connecticut teens who obtained a learners permit over a 9-month period were recruited, providing a final sample of 3743 who obtained driver licenses. Families were randomized to the intervention or comparison condition. Intervention families received by mail a series of persuasive communications related to high-risk teen driving and a parent-teen driving agreement, while comparison families received on the same schedule general information on driving and vehicle maintenance. Relative to the comparison group, teens and parents in the Checkpoints Program reported significantly greater limits on high-risk teen driving conditions at licensure, 3-, and 6-months post-licensure; and intervention teens reported significantly less risky driving at each reporting period. By the 12-month follow up teens in the intervention group were significantly less likely than those in the comparison group to have had a traffic violation. However, no treatment group effect was found for crashes. This is the first study to report significant effects on teen driving behavior and performance of education designed to increase parental-imposed teen driving limits.

Accidents, Traffic↗
PubMed2004

Validation of the propensity for angry driving scale.

PROBLEM: This study examined the validity of the Propensity for Angry Driving Scale (PADS). Measuring road rage: Development of the Propensity for Angry Driving Scale in predicting aggressive driving. METHOD: The PADS and the Driving Anger Scale. Development of a driving anger scale. Psychological reports, 74, 83-91.) were administered to 232 college student volunteers with measures of aggressive and risky driving. RESULTS: Convergent and discriminant validity of the PADS were supported through relationships among measures of similar constructs. The PADS significantly (p<.05) predicted moving tickets, minor accidents, aggressive driving, risky driving, and maladaptive driving anger expression, above and beyond gender, miles driven per week, and trait anger. DISCUSSION: Findings suggest that the PADS is a useful predictor of aggressive driving and has some advantages over the DAS. IMPACT ON INDUSTRY: The PADS is an effective predictor of aggressive driving that complements established measures like the DAS and provides researchers with another valuable tool for the assessment of aggressive driving.

Accidents, Traffic↗
PubMed2004

The ARTEMIS European driving cycles for measuring car pollutant emissions.

In the past 10 years, various work has been undertaken to collect data on the actual driving of European cars and to derive representative real-world driving cycles. A compilation and synthesis of this work is provided in this paper. In the frame of the European research project: ARTEMIS, this work has been considered to derive a set of reference driving cycles. The main objectives were as follows: to derive a common set of reference real-world driving cycles to be used in the frame of the ARTEMIS project but also in the frame of on-going national campaigns of pollutant emission measurements, to ensure the compatibility and integration of all the resulting emission data in the European systems of emission inventory; to ensure and validate the representativity of the database and driving cycles by comparing and taking into account all the available data regarding driving conditions; to include in three real-world driving cycles (urban, rural road and motorway) the diversity of the observed driving conditions, within sub-cycles allowing a disaggregation of the emissions according to more specific driving conditions (congested and free-flow urban). Such driving cycles present a real advantage as they are derived from a large database, using a methodology that was widely discussed and approved. In the main, these ARTEMIS driving cycles were designed using the available data, and the method of analysis was based to some extent on previous work. Specific steps were implemented. The study includes characterisation of driving conditions and vehicle uses. Starting conditions and gearbox use are also taken into account.

Air Pollutants↗
PubMed2002

Effects of alprazolam on driving ability, memory functioning and psychomotor performance: a randomized, placebo-controlled study.

Alprazolam is prescribed for the treatment of anxiety and panic disorder. Most users are presumably involved in daily activities such as driving. However, the effects of alprazolam on driving ability have never been investigated. This study was conducted to determine the effects of alprazolam (1 mg) on driving ability, memory and psychomotor performance. Twenty healthy volunteers participated in a randomized, double-blind, placebo-controlled crossover study. One hour after oral administration, subjects performed a standardized driving test on a primary highway during normal traffic. They were instructed to drive with a constant speed (90 km/h) while maintaining a steady lateral position within the right traffic lane. Primary performance measures were the Standard Deviation of Lateral Position (SDLP) and the Standard Deviation of Speed (SDS). After the driving test, subjective driving quality, mental effort, and mental activation during driving were assessed. A laboratory test battery was performed 2.5 h after treatment administration, comprising the Sternberg Memory Scanning Test, a Continuous Tracking Test, and a Divided Attention Test. Relative to placebo, alprazolam caused serious driving impairment, as expressed by a significantly increased SDLP (F(1,19) = 97.3, p <.0001) and SDS (F(1,19) = 30.4, p <.0001). This was confirmed by subjective assessments showing significantly impaired driving quality (F(1,19) = 16.4, p <.001), decreased alertness (F(1,19) = 43.4, p <.0001), decreased mental activation (F(1,19) = 5.7, p <.03) and increased mental effort during driving (F(1,19) = 26.4, p <.0001). Furthermore, alprazolam significantly impaired performance on the laboratory tests. In conclusion, alprazolam users must be warned not to drive an automobile or operate potentially dangerous machinery.

Adult↗
PubMed2000

Simulated driving performance following prolonged wakefulness and alcohol consumption: separate and combined contributions to impairment.

The separate and combined effects of prolonged wakefulness and alcohol were compared on measures of subjective sleepiness, simulated driving performance and drivers' ability to judge impairment. Twenty-two males aged between 19 and 35 years were tested on four occasions. Subjects drove for 30 min on a simulated driving task under conditions determined by the factorial combination of 16 and 20 h of wakefulness and blood alcohol concentrations of 0.00 and 0.08%. The simulated driving session took place 30 min postingestion; subjects in the two alcohol conditions participated in a second 30-min driving session 90-min postingestion. Subjects made simultaneous ratings of their impairment while driving and retrospective ratings at the end of each test session. Subjective sleepiness measures were completed before and after each driving session. The combination of 20 h of prolonged wakefulness and alcohol produced significantly lower ratings of subjective sleepiness and driving performance that was worse, but not significantly so, than would be expected from the additive effects of each condition alone. Driving performance was always worse in the second driving session, during the elimination phase of alcohol metabolism, despite blood alcohol concentrations being lower than during the first driving session. There was a modest association between perceived and actual impairments in driving performance following prolonged wakefulness and alcohol. The findings suggest that the combination of prolonged wakefulness and alcohol consumption produced greater decrements in simulated driving performance than each condition alone and that drivers have only a modest ability to appreciate the magnitude of their impairment.

Adult↗
PubMed2001

Car-driving abilities of people with tetraplegia.

OBJECTIVES: To examine the relationship between the spinal cord injury (SCI) level, age, and car-driving ability in people with tetraplegia and to explore the association between car-driving ability and social activity. DESIGN: Retrospective clinical survey. SETTING: Rehabilitation center in Japan. PATIENTS: Sixty-two subjects with traumatic complete tetraplegia. INTERVENTIONS: Driving evaluation; comprehensive driver's training (muscle strengthening, transfer training, adjustment of equipment, on-road training); and questionnaire (car-driving status, employment, participation in sports). MAIN OUTCOME MEASURES: The SCI level (Zancolli's classification), age, functional status of activities of daily living (ADLs), and driving ability were obtained from the medical records. Vocational status and engagement in sports activities were investigated by questionnaire. RESULTS: The SCI level and age strongly influenced the patients' ability to drive a car independently. The highest neurologic level in which independent driving was achievable was C6A. Toilet transfer ability almost paralleled the ability to drive a car. Eighty-four percent of the people with tetraplegia who had a defined job could drive independently and 70% of the driving-independent individuals held a job. Half of driving-independent individuals participated in some sports activities. CONCLUSIONS: Toilet transfer ability is a reliable indicator for driver's training. Driving ability is an important factor that allows individuals with tetraplegia to participate in work and sports-related activities.

Activities of Daily Living↗
PubMed2005

Predictive validity of driving-simulator assessments following traumatic brain injury: a preliminary study.

OBJECTIVE: To evaluate whether driving simulator and road test evaluations can predict long-term driving performance, we conducted a prospective study on 11 patients with moderate to severe traumatic brain injury. Sixteen healthy subjects were also tested to provide normative values on the simulator at baseline. METHOD: At their initial evaluation (time-1), subjects' driving skills were measured during a 30-minute simulator trial using an automated 12-measure Simulator Performance Index (SPI), while a trained observer also rated their performance using a Driving Performance Inventory (DPI). In addition, patients were evaluated on the road by a certified driving evaluator. Ten months later (time-2), family members observed patients driving for at least 3 hours over 4 weeks and rated their driving performance using the DPI. RESULTS: At time-1, patients were significantly impaired on automated SPI measures of driving skill, including: speed and steering control, accidents, and vigilance to a divided-attention task. These simulator indices significantly predicted the following aspects of observed driving performance at time-2: handling of automobile controls, regulation of vehicle speed and direction, higher-order judgment and self-control, as well as a trend-level association with car accidents. Automated measures of simulator skill (SPI) were more sensitive and accurate than observational measures of simulator skill (DPI) in predicting actual driving performance. To our surprise, the road test results at time-1 showed no significant relation to driving performance at time-2. CONCLUSION: Simulator-based assessment of patients with brain injuries can provide ecologically valid measures that, in some cases, may be more sensitive than a traditional road test as predictors of long-term driving performance in the community.

Adolescent↗
PubMed2004

A review of drug use and driving: epidemiology, impairment, risk factors and risk perceptions.

The existing literature on the prevalence of drug driving, the effects of drugs on driving performance, risk factors and risk perceptions associated with drug driving was reviewed. The 12-month prevalence of drug driving among the general population is approximately 4%. Drugs are detected commonly among those involved in motor vehicle accidents, with studies reporting up to 25% of accident-involved drivers positive for drugs. Cannabis is generally the most common drug detected in accident-involved drivers, followed by benzodiazepines, cocaine, amphetamines and opioids. Polydrug use is common among accident-involved drivers. Studies of impairment indicate an undeniable association between alcohol and driving impairment. There is also evidence that cannabis and benzodiazepines increase accident risk. The most equivocal evidence surrounds opioids and stimulants. It is apparent that drugs in combination with alcohol, and multiple drugs, present an even greater risk. Demographically, young males are over-represented among drug drivers. Although there is an association between alcohol use problems and drink driving, it is unclear whether such an association exists between drug use problems and drug driving. Evidence surrounding psychosocial factors and driving behaviour is also equivocal at this stage. While most drivers perceive drug driving to be dangerous and unacceptable, there is less concern about impaired driving among drug drivers and drink drivers than from those who have not engaged in impaired driving. Risk perceptions differ according to drug type, with certain drugs (e.g. cannabis) seen as producing less impairment than others (e.g. alcohol). It is concluded that drug driving is a significant problem, both in terms of a general public health issue and as a specific concern for drug users.

Automobile Driving↗
PubMed2004

Driving behavior of alcohol, cannabis, and cocaine abuse treatment clients and population controls.

BACKGROUND/INTRODUCTION: A paucity of research exists on driving after use of cannabis or cocaine among clients in substance abuse treatment and changes in this behavior after treatment. OBJECTIVES: The objectives of this research are to compare treatment clients and population controls before and after treatment in terms of: 1) amount of driving; 2) alcohol, cannabis, and cocaine consumption; 3) driving after use of alcohol, cannabis, and cocaine; and 4) driving infractions. METHOD: Telephone interviews were conducted with a sample of 110 clients who received treatment in 1995 for a primary problem of alcohol (n = 44), cannabis (n = 37), or cocaine (n = 29) abuse. A random sample of 104 drivers from the general population, frequency matched by age and sex was also interviewed. Participants were asked to describe their driving habits and driving infractions before and after 1995. RESULTS: Both treatment and control groups reported about the same amount of driving. The treatment group reported significantly more consumption of alcohol, cannabis, and cocaine than did the control group before treatment. Significant declines in use for each substance were found for the treatment group after treatment, but use for the control group remained stable over the two time periods. Similarly significant declines in driving after use of alcohol, cannabis, and cocaine were found for the treatment group but the control group remained stable. Finally driving infractions, including speeding tickets, collisions, and license suspensions, significantly declined for the treatment group but not the control group. DISCUSSION: The results confirm that before treatment, the treatment subjects drove more frequently after consuming alcohol, cannabis, or cocaine than the control group. Declines in substance use and driving after treatment were accompanied by reductions in some types of driving infractions. Differences between groups, and over time in terms of driving while under the influence of psychoactive substances better explain the results than differences between groups in impulsivity/risk-taking or sleep problems.

Adult↗
PubMed2005

Driving and dementia of the Alzheimer type: beliefs and cessation strategies among stakeholders.

PURPOSE: Although driving by persons with Alzheimer's disease (AD) is an important public health concern, we know little about the attitudes and perceptions of key stakeholders regarding driving safety in these individuals or the factors that precipitate and influence driving assessment and cessation decisions. DESIGN AND METHODS: We convened 10 focus groups composed of persons intimately involved in driving decisions for older adults to identify and compare beliefs and perceptions concerning AD and driving and to identify effective strategies to limit or cease unsafe driving. The 68 focus-group participants included health professionals, transportation and law-enforcement professionals, current and former drivers with AD, and family caregivers of current and former drivers with the disease. RESULTS: With few exceptions, participants said that a diagnosis of very mild AD alone did not preclude driving. Most regarded family members as pivotal in monitoring and managing unsafe driving and recognized their need for institutional and medical support, especially support from physicians in counseling and evaluation of health-related fitness of older drivers. Members of each group acknowledged their own roles and responsibilities in driving decisions and described difficulties they experienced in making assessments and implementing decisions to limit or stop the driving of given individuals with AD. IMPLICATIONS: Education of families, professionals, and transportation specialists is needed to understand the influence of AD severity on driving abilities, identify problem driving behaviors, make appropriate referrals of unsafe drivers, and access available resources for drivers with AD and those most responsible for their safety.

Accidents, Traffic↗
PubMedDate not supplied

Barriers to driving and community integration after traumatic brain injury.

OBJECTIVE: To examine the relations among driving status, perceptions of barriers to the resumption of driving, and community integration outcomes after traumatic brain injury (TBI). DESIGN: Correlational research using logistic and multiple regression analyses, analyses of variance, and covariance. PARTICIPANTS: Fifty-one survivors of TBI, 6 months to 10 years postinjury. MAIN OUTCOME MEASURES: Driving status postinjury, Community Integration Measure, and Craig Hospital Assessment and Reporting Technique. RESULTS: Perceptions of barriers to driving provided unique information in predicting subjective and objective indices of community integration, even after accounting for other potentially pertinent variables (eg, injury severity, social support, negative affectivity, and use of alternative transportation). Moreover, survivors who had not resumed driving showed poorer community integration than did those who had resumed driving. Social barriers such as directives against driving from significant others accounted for the most variance in survivor driving status. Decisions to cease driving were more common among those with no formal driving evaluation than among survivors who had been evaluated. CONCLUSIONS: Significant others have substantial influence on post-TBI driving outcome. The findings highlight the importance of independent driving to community integration, as well as psychoeducation of survivors and their families.

Adolescent↗
PubMed2003

Risky driving behaviour in young people: prevalence, personal characteristics and traffic accidents.

OBJECTIVES: This research aimed to examine the prevalence of risky driving behaviour among young people, the characteristics of those who engage in risky driving behaviour, and the association between risky driving behaviours and accident risk. METHODS: Data were gathered during the course of the Christchurch Health and Development Study. As part of this longitudinal study, data were gathered on self-reported risky driving behaviours (18-21 years), traffic accidents (18-21 years) and a variety of individual characteristics for 907 participants who reported having driven a motor vehicle. RESULTS: More than 90% of drivers engaged in some form of risky driving behaviour. Those most likely to engage in frequent risky driving behaviours were: males (p < 0.0001), who exhibited alcohol (p < 0.0001) or cannabis abuse (p < 0.001) in adolescence, who were involved in violent/property crime (p < 0.01) and who affiliated with delinquent or substance-using peers (p < 0.05). There was a strong (p < 0.0001) association between the extent of risky driving behaviour and traffic accident risk. CONCLUSIONS: Risky driving behaviours are common among young people, particularly among young males prone to externalizing behaviours (substance abuse, crime and affiliations with deviant peers). Risky driving is strongly linked to traffic accident risk. IMPLICATIONS: There is a continued need to target risky driving behaviours among young people. Efforts to reduce risky driving should be targeted in particular at the high-risk group of young males prone to externalizing behaviours. More generally, the results suggest the need for a multistrategy approach to the reduction of traffic accidents that focuses on the full spectrum of risky driving behaviours.

Accidents, Traffic↗
PubMed2005

Prediction of on-road driving performance in patients with early Alzheimer's disease.

OBJECTIVES: Physicians and family members frequently are asked to provide information about driving ability in patients with Alzheimer's disease (AD), yet there has been little research on the validity of their assessments of driving performance. DESIGN: Cross-sectional. SETTING: Participants were recruited from the neurology department of a community hospital affiliated with Brown Medical School. PARTICIPANTS: Participants included 75 older adults (17 with mild AD, 33 with very mild AD, and 25 elderly controls). MEASUREMENTS: The participant him/herself, an informant, and an experienced neurologist rated each participant's driving ability on a 3-point rating scale (safe, marginal, unsafe). A professional driving instructor also completed a standardized 108-point on-road driving assessment of each participant and then rated driving ability on the 3-point scale. Ratings were compared with the on-road driving score and with each other. RESULTS: Only the neurologist's rating of the participants' driving abilities was significantly related to on-road driving score. When related to the instructor's safety rating, the neurologist's ratings were the most sensitive and specific. Mini-Mental State Examination score was a borderline covariate for the neurologist's rating. Overall, the instructor was the most stringent rater of participant driving ability, followed by the neurologist, the informant, and the participant. CONCLUSION: An experienced neurologist's assessment of driving competence may be a valid predictor of driving performance of patients with early AD.

Adult↗
PubMed1992

Driving restrictions advised by midwestern cardiologists implanting cardioverter defibrillators: present practices, criteria utilized, and compatibility with existing state laws.

Although some patients remain at risk of losing physical control or collapsing after implantation of a cardioverter defibrillator for sustained ventricular arrhythmias, little is known about restrictions advised by arrhythmia specialists to patients with implanted devices concerning physical activities such as driving. In this study, all of the 58 cardiologists implanting cardioverter defibrillators in three contiguous midwestern states were surveyed to determine present practices and the compatibility of these practices with existing state law. Of the 51 respondents (88%), 27 cardiologists (53%) advised only those implanted patients who had had arrhythmia-induced presyncope or physical collapse to cease driving. Twenty two of the remaining cardiologists (43%) advised all implanted patients to cease driving, whereas two cardiologists (4%) never advised any implanted patient to restrict driving. Permanent driving abstinence was advised by seven of the responding cardiologists (14%), while temporary driving abstinence for periods of 2-12 months (mean 6 +/- 3 months) was recommended by the remaining 42 respondents (82%) who advised against driving. The criteria utilized, driving restrictions advised, and durations advised for driving restrictions were not uniform in any of the 13 surveyed university and nonaffiliated cardiology practices with greater than or equal to 2 implanting cardiologists. Overall, 38 cardiologists (74%) advised against driving and recommended durations that equaled or exceed their state's minimum legal requirements, although only 27 of the 51 cardiologists (53%) based their practice upon knowledge of their state's driving laws. The results of this survey suggest that the majority of cardiologists who implant cardioverter defibrillators advise their patients against driving postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Automobile Driving↗
PubMed2001

Return to driving after head injury.

OBJECTIVES: To determine whether patients who return to driving after head injury can be considered safe to do so and to compare the patient characteristics of those who return to driving with those who do not. METHODS: In a multicentre qualitative study 10 rehabilitation units collectively registered 563 adults with traumatic brain injury during a 2.5 year period. Recruitment to the study varied from immediately after hospital admission to several years after injury. Patients and their families were interviewed around 3 to 6 months after recruitment. A total of 383 (67.5%) subjects were interviewed within 1 year of injury, of whom 270 (47.6%) were interviewed within 6 months of injury. Main outcome measures were the presence or absence of driving related problems reported by drivers and ex-drivers, and scores on driving related items of the functional independence/functional assessment measure (FIM+FAM). RESULTS: Of the 563 patients 381 were drivers before the injury and 139 had returned to driving at interview. Many current drivers reported problems with behaviour (anger, aggression, irritability; 67 (48.2%)), memory ( 89 (64%)), concentration and attention (39 (28.1%)), and vision (39 (28.1%)). Drivers reported most driving related problems as often as ex-drivers, main exceptions were epilepsy and community mobility. Current drivers scored significantly higher on the FIM+FAM (were more independent), than ex-drivers. The driving group had sustained less severe head injuries than ex-drivers; nevertheless, 78 (56.2%) current drivers had received a severe head injury. Few (61 (16%)) previous drivers reported receiving formal advice about driving after injury. CONCLUSIONS: The existence of problems which could significantly affect driving does not prevent patients returning to driving after traumatic brain injury. Patients should be assessed for both mental and physical status before returning to driving after a head injury, and systems put in place to enable clear and consistent advice to be given to patients about driving.

Adolescent↗