Driving competence after severe brain injury: A retrospective study

R. Formisano, U. Bivona, S. Brunelli, M. Giustini, F. Taggi

Research output: Contribution to journalArticlepeer-review


Background. Evaluating fitness to drive after cerebral injury includes the possible presence of: sensory deficiencies, motor difficulties, cognitive impairments, personality or behavioral disturbances. Driving is in fact a complex interaction of cognitive and perceptual abilities (especially related to visual input), motor skills and environmental factors. At the moment no criteria are available to decide whether patients have sufficiently recovered from their injury to resume participation in traffic as drivers. Michon studied the cognitive control of driving describing a conceptual model with three-level hierarchy: - Operational Level: involves the execution of the basic actions of driving, such as steering or braking. Time pressure may be high, especially for maneuvers aimed at avoiding acute danger; - Tactical Level: concerns behavior and decision in traffic; time pressure is intermediate; - Strategic Level: involves decisions about choice of route, avoiding rush hour traffic or decision not to drive at all in particular environmental conditions; time pressure is low and planning is an important feature. Aim of the study was to evaluate if the accident rate of our population (11 out of 29 patients) was a worrying percentage, in comparison with normal subjects. Methods. Several methods of assigning scores to road tests have been proposed in the Literature. Likewise, the tests have also been evaluated by a number of different observers (occupational therapists, driving instructors). The use of driving simulators might prove a useful means of automatically calculating data related to driving performance. On the other hand, simulators should be fitted with suitable means for increasing the perception of movement, tactile and kinesthetic sensations, visual field. Road tests using a closed and protected circuit might not have sufficient ecological validity, especially with regard to the ability to drive in traffic. Road tests are generally considered the best, but their reliability, standardisation and validity require further study. Results. Out of 90 patients admitted to the Santa Lucia Foundation 29 (32%) resumed driving; 11 of the 29 patients (38%) were involved in a road accident, after resuming driving. The result was that the foreseen cases was 4.7 and the observed 11. Our preliminary and retrospective data show that a person who suffered from severe brain injury (GCS

Original languageEnglish
Pages (from-to)257-266
Number of pages10
JournalEuropa Medicophysica
Issue number4
Publication statusPublished - 2001


  • Automobile driver examination
  • Brain injuries
  • Driving

ASJC Scopus subject areas

  • Rehabilitation


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