| Perumparaichallai et al. (2014)
USA
Case Series
N=128 |
Population: TBI=75, Stroke=36, non-TBI=17; Mean Age=34.7yr; Gender: Male=76, Female=52; Mean Time Post Injury=10.42mo.
Intervention: Patients attended a milieu-oriented neurorehabilitation program consisting of clinic-based therapies (6hr/d, 4d/wk). Neuropsychological evaluations were done before and after treatment to assess fitness to drive.
Outcome Measures: Return to driving, Trail Making Test A and B (TMT-A/B), Wechsler Adult Intelligence Scale (WAIS-III): Arithmetic (ART), Letter Numbering Sequencing (LNS), Symbol Search, Digit Symbol Coding, Block Design, Matrix Reasoning (MR). |
1. Following a neurorehabilitation program, 54% of participants returned to driving.
2. There was a significant difference between the driving and non-driving groups on LNS (p<0.004), Digit span coding (p<0.0001), Symbol Search (p<0.0001), Block Design (p<0.001), TMT-A (p<0.0001), and TMT-B (p<0.001) after treatment.
3. There was no significant difference between groups on MR (p=0.01) or ART (p=0.15) after treatment. |
| Leon-Carrion et al. (2005)
Spain
Pre-Post
N=17 |
Population: TBI; Mean Age=22.94yr; Mean GCS=6; Mean Time Post Injury= 10.94mo.
Intervention: Patients attended a neurorehabilitation program. Patients were assessed based on return to driving at the start of rehabilitation despite recommendations otherwise.
Outcome Measures: Functional Independence Measure + Functional Assessment Measure-Revised Scale (FIM+FAM-R). |
1. Those who returned to driving had significantly higher mean total FIM+FAM scores at admission (p=0.000) and discharge (p=0.001) compared to non-drivers.
2. At discharge, FIM+FAM-R for all participants raised to 80% from 42.5%.
3. At admission, 35.3% were driving despite not being fit to do so; 70.6% were driving at discharge. |
| Kewman et al. (1985)
USA
PCT
NInitial=35, NFinal=35
|
Population: ABI=24, Experimental Group (n=13) + ABI Control Group (n=11): Mean Age=24.2yr; Gender: Not reported; Mean Time Post Injury=3.7yr; Severity: Mild=0, Moderate=0, Severe=24, Normative Control Group (n=11): ABI=0; Mean Age=Not reported; Gender: Not reported; Mean Time Post Injury=N/A; Severity: N/A
Intervention: The Experimental Group received the psychomotor training program with the AMIGO (brand name) vehicle. Training consisted of eight 2hr driving sessions where participants were trained on seven driving-related exercises, including a straightaway, an S-curve, a figure eight, a serpentine, a serpentine with special visual monitoring designed as a divided-attention task, a serpentine with special auditory monitoring designed as a divided-attention task, and a serpentine with both the visual and auditory monitoring tasks combined. The ABI Control Group spent time operating the AMIGO but did not receive training on the specific tasks. The Normative Control Group were trained on some of the tasks with the AMIGO vehicle. Outcome measures were assessed before and at the conclusion of the training program.
Outcome Measures: Driver educator ratings and objective scores of on-the-road driving test performance (lane tracking, accuracy of turns, ability to notice and identify specified road signs, and the number of major safety errors committed over the course of the test), performance on tasks for training exercises.
|
1. Compared to the ABI Control Group, the Experimental Group showed significantly greater improvement in performance on tests of on-the-road automobile driving, in all but one aspect, including percentage of correct tracking (p<.001), percentage of correct signs (p<.05), composite score (p<.01), and driver educator ratings (p<.02).
2. The Experimental Group demonstrated significant improvement in time needed to complete the tasks and accuracy of completion for all training exercises except the S-curve and straightaway (p<.05). |
| Perumparaichallai et al. (2020)
USA
Pre-Post
NInitial=107, NFinal=107 |
Population: TBI=62, CVA=27, Other (Anoxia, Tumor, & Infection)=14; Mean Age=35.81yr; Gender: Male=62, Female=45; Mean Time Post Injury=3.02yr; Severity: Mild=3, Moderate-to-Severe=36, Severe=18, Unknown=3
Intervention: Participants attended holistic milieu-oriented neurorehabilitation between 1996 and 2016. Participants completed one or more of the intervention programs that aimed to facilitate:
· Home and community independence
· Social relationships and quality of life
· Work and/or school re-entry
The intervention programs incorporated individual and group therapies (intervention length=3-5d/wk, 4-6h/d). Primary outcome measures were assessed at program admission, discharge, and follow-up in 2016. Secondary outcome measures were assessed at follow-up in 2016.
Outcome Measures: Primary Outcome measures: Productivity status (e.g., return-to-work/school), driving status. Secondary Outcome Measures: Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study |
1. Only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge. Seventy percent of 107 participants were driving at the time of follow-up.
2. Older age at the time of injury (p=.03), shorter duration between injury and treatment (p=.007), and better functionality indicated by lower MPAI-4 Ability Index scores (p=.01) significantly predicted a return to driving status at the time of study participation. |
| Ross et al. (2018)
Australia
Cohort
NInitial=340, NFinal=340 |
Population: TBI=340; Passed Initial Driver Assessment/No Lessons Group (n=246): Mean Age= 38.65 ± 15.52yrs; Gender: Male=204, Female=60; Mean Time Post Injury= 7.62 ± 7.79mo; Severity: Mean GCS= 9.55 ± 4.37. Failed Initial Driver Assessment/Driving Lessons Group (n=94): Mean Age= 39.50 ± 18.88yr; Gender: Male=63, Female=31; Mean Time Post Injury= 8.21 ± 8.62mo; Severity: GCS= 7.69 ± 4.36
Intervention: Participants first completed an off-road assessment conducted by an occupational therapy (OT) driver assessor and a standard on-road assessment in a dual-controlled automatic vehicle accompanied by a driving instructor and an OT driver assessor (50 to 60min in duration). Those who failed the initial driver assessment completed on-road training lessons addressing individual goals, which were developed by an OT driver assessor, based on issues identified during the off- and on-road assessments (average number of lessons=7, average driving instructor hours=14)
Outcome Measures: Goals of on-road training lessons, on-road driving reassessments license restrictions |
1. Of the 340 participants, 246 passed the initial driver assessment.
2. A significant difference was found in injury severity between those who passed the initial driver assessment and those who required on-road training, with those requiring on-road training having lower GCS scores (p<.001) and longer PTA duration (p<.001).
3. Of those who failed the initial driver assessment, 93% resumed driving following on-road training; 45% with an open license, 48% with a restricted license.
4. 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%). |
