Driving and Community Integration After Traumatic Brain Injury

Abstract Rapport LJ, Coleman Bryer R, Hanks RA. Driving and community integration after traumatic brain injury. Objective To examine resumption of driving after traumatic brain injury (TBI) and its relation to community integration. Design Cross-sectional cohort study; survey and cognitive data. Settings Inpatient rehabilitation hospital of the Traumatic Brain Injury Model Systems and community. Participants Persons (N=261) ranging from 3 months to 15 years postinjury. Interventions Not applicable. Main Outcome Measures Barriers to Driving Questionnaire, Driver Survey, Community Integration Measure, and Craig Hospital Assessment and Reporting Technique. Results Forty-four percent of survivors had resumed driving; of nondrivers, 48% reported a strong desire to resume driving. Nondriver survivors who sought to resume driving generally rated themselves as currently fit to drive, viewed themselves as having physical and cognitive profiles like those of survivor drivers, and reported their greatest barriers to driving as social and resource related. However, cognitive functioning was similar to nondriver survivors who did not seek to resume driving and significantly worse than survivors who were currently driving. Nondrivers showed poorer community integration than did drivers, even after accounting for injury severity, social support, negative affectivity, and use of alternative transportation. Use of alternative transportation was common among nondrivers, but it was unrelated to community integration outcomes. Cognitive functioning moderated risk of adverse incident: among survivors with low cognitive functioning and high self-estimates of driving ability, which is indicative of unawareness of deficit, adverse incidents showed positive relation to amount of driving and inverse relation to cognitive functioning. Conclusions Driving status has unique and independent association with post-TBI community integration. Additional research is needed to evaluate transportation barriers that undermine full engagement in community living after TBI and to determine which barriers to driving reflect valid risk to survivors and the public.