None — Traumatic Brain Injury
Traumatic brain injury (TBI) is damage to the brain caused by a blow to the head, sudden jolting (like in severe shaking, or acceleration and quick deceleration in a car accident) or penetration by an object. The injury can range from mild (like a concussion) to severe. The most common causes of TBI include: falls (35.2 percent of cases), motor vehicle accident (17.3 percent), striking an object/being struck (16.5 percent) and assault (10 percent).
According to the Centers for Disease Control and Prevention, about 17 million Americans receive a TBI annually. Men are affected about 1.4 times more often than women. Each year, TBI leads to 1.365 million visits to hospital emergency rooms, 275,000 hospitalizations and 52,000 deaths.
TBI and Driving
The effects of a TBI depend upon the severity of the injury and location of brain damage. Though the physical injuries eventually heal, patients may have trouble with thinking, concentration and memory, coordination and balance. Those problems can affect the ability to remain independent or perform some types of daily activities.
For the average person, one of the greatest markers of independence is the ability to drive. That's especially true for those who may have temporarily lost their independence due to a TBI. Researchers estimate between 40 and 60 percent of TBI patients eventually get back behind the wheel. However, driving can be risky for these patients. The brain injury can cause problems with reaction time, hand-eye coordination, visual perception, attention span, planning, judgment and problem solving skills. Those who recognize their limitations may drive less frequently or adjust their driving habits to compensate for the problem. Those that don't may show signs of dangerous driving behaviors, like driving too fast or too slow, drifting across driving lanes, getting lost in previously familiar places, and failure to observe traffic signs and lights. About 15 percent of TBI patients have a traffic accident after they resume driving. The more severe the brain injury, the greater the risk for accidents and other driving problems.
Technology to Assist Drivers
Driver Rehabilitation Specialists are professionals trained to help people, such as those who have had a TBI, learn how to safely drive once they have recovered from their physical injuries. Michele Luther-Krug, Driver Rehab Specialist with the Shepherd Center in Atlanta, GA, says some patients adapt well when they have someone in the car to remind them to engage in safe driving habits, like checking the mirror, keeping a reasonable distance from a car in front of the vehicle or judging the distance needed to make a turn or stop for a light or stop sign. However, there isn't always a passenger to help the driver pay attention to driving cues.
Now rehabilitation specialists at The Shepherd Center are using a device, called the Electronic Driving Coach, a computerized system that's installed in a client's car. Luther-Krug says each time the driver performs a specific task (like checking speed, spatial distance of the car and objects in the mirror) he/she pushes a button. That sets off a verbal response from the computer providing positive reinforcement for performing the action. If several minutes have elapsed and the driver has forgotten to perform one of the actions, the computer is programmed to prompt the driver with a verbal reminder.
Luther-Krug says patients with TBI often need constant stimulation to help them pay appropriate attention to the tasks associated with driving. The Electronic Driving Coach provides positive reinforcement for following safe driving habits, hopefully causing those habits to eventually become automatic behaviors. In the future, the system may be combined with GPS technology to warn drivers of approaching "dangers" like a stop sign, traffic signal or need to turn.
Research compiled and edited by Barbara J. Fister
AUDIENCE INQUIRY
For information about driving after a TBI:
The Association for Driver Rehabilitation Specialists, driver-ed.org
For general information about TBI: The Brain Injury Association of America, biausa.org
The Brain Trauma Foundation, braintrauma.org
Centers for Disease Control and Prevention, cdc.gov/TraumaticBrainInjury
National Institute of Neurological Disorders and Stroke, ninds.nih.gov/disorders/tbi/tbi