Driving After Traumatic Brain Injury (TBI)

Physical disabilities and cognitive impairment are the main reasons that an individual may be unable to drive after a traumatic brain injury.

Doctors are required to inform the Superintendent of Motor Vehicles that a person has a health condition which impairs their ability to drive. However, this does not mean a person will never drive again. Nonetheless, individuals that have sustained serious traumatic brain injuries (TBIs) should not drive unless their doctor tells them it is safe to do so.

Some of the factors that affect the likelihood that a TBI survivor will eventually be able to drive include:

  • Age (Younger TBI survivors are more likely to recover than older ones.)
  • Mental outlook and effort in recovery
  • Support team, including his or her doctors, therapists, family and friends (strong, reliable support teams aid recovery.)
  • The severity of the primary injury and the resulting complications
  • Whether or not the individual had driving experience before the injury (prior driving experience makes re-learning driving easier.)

Evaluating Individual’s Driving Ability
Determining whether a person with an acquired brain injury can safely drive again involves a number of professionals and assessments, including: medical or neurophysical exams, visual tests, and active driving tests (simulated or on-road).

Getting Back on the Road, in British Columbia
In British Columbia, once the survivor, their doctor, and/or healthcare team are confident in their ability to drive safely, the Office of the Superintendent of Motor Vehicles (OSMV) determines the legality of driving – usually authorized testing is all that is required.

Office of the Superintendent of Motor Vehicles (OSMV)
The OSMV is a BC provincial agency that is in charge of road safety and driver behaviour. The OSMV reviews information from the medical community, law enforcement agencies, and Insurance Corporation of British Columbia (ICBC) licensing when making decisions about a driver’s license.

The Superintendent of Motor Vehicles may require a driver to take a vision test, a functional driving assessment, a medical and/or other evaluation, in order to help determine whether they are able to drive safely. These may include:

  1. Driver Medical Examination (DME)
    The driver’s doctor must conduct a driver medical examination at the request of the OSMV and submit a completed assessment form to the OSMV
  2. Functional Driving Assessment
    The driver may be asked to complete one of these two assessments:
  • Driver Rehab Assessment
    • For persons who are seen as being likely to drive safely again after an illness or injury
    • The goal is to help the individual to get driving again by offering assessments, lessons, strategies and vehicle modification, if necessary
    • This assessment may be the best one for persons with a brain injury
    • Community Therapists
      Unlike other services which are heavily computerized and focus on a rigid “pass/fail” methodology with little or no opportunity for training, the Community Therapists methodology focuses on the assessment of the client’s rehabilitation potential to return to driving. Where appropriate, clients are offered a comprehensive driver rehabilitation program to facilitate a return to this vital daily activity. For more information about Community Therapists, visit their website.
  • DriveABLE
    • Assessment involves an in-clinic perceptual and cognitive assessment and may be followed by an on-road evaluation
    • Rehabilitation and compensatory strategies are not addressed
    • Not appropriate for those with visual or physical impairment
    • Is best for persons with progressive cognitive conditions and impairments
    • For more information about DriveABLE visit their website.

Where can I get a functional driver assessment?

  • For information about driver rehabilitation programs in British Columbia, visit the brainstreams.ca website.
  • Do an OT search through BC Society of Occupational Therapists and select “Driver Rehab Assessment”

How long does the whole process take?
The entire process can take a significant amount of time. The duration depends on the individual’s injury as well as the activity of the groups involved – healthcare team, driver rehab centre, OSMV, licensing.

How much does it cost?

  • You may need to pay for the cost of the assessment yourself. The cost can usually be submitted as a medical expense on your income tax return.
  • If you have a claim against a third party, speak to your lawyer or call Workers Compensation Board if it covers your claim.
  • Functional Driving Assessments centres set their own fees
  • Funding may be available from third-party funders (e.g. ICBC, WorkSafe BC) and extended health plans, or through OSMV.


Article References:

G.F. Strong Rehab Centre Acquired Brain Injury Programs

G.F. Strong hosts a number of workshops for suvivors of brain injury and stroke, their family and friends. These workshops provide an open, informal forum in which to discuss and learn about the brain, how it works, and its recovery. Attendees concerns, questions and experiences guide the session.

Understanding Traumatic Brain Injury: A Workshop for Families & Friends

This open, informal workshop is facilitated by a doctor and educator from the Acquired Brain Injury Program at GF Strong Rehab Centre.

Topics of discussion include:

  • the brain and how it works
  • the many changes that happen after a brain injury
  • practical rehabilitation strategies to help
  • life after brain injury and resources to help you through your journey

Dates:
September 21, 2011: 6.00 – 9.00pm
November 17, 2011: 6.00 – 9.00pm

 

Understanding Stroke: A Workshop for Families & Friends

Topics of discussion include:

  • the brain and how it works
  • the many changes that happen after a stroke
  • practical rehabilitation strategies to help
  • life after stroke and resources to help you through your journey

Dates:
October 19, 2011: 6.00 – 9.00pm
December 15, 2011: 6.00 – 9.00pm

 

Building Community Connections: A Workshop for Suvivors, Families and Friends

This workshop is facilitated by the Community Intervention Coordinator. The workshop is interactive, with open group discussions, opportunities for sharing and problem solving with others. Survivors and caregivers share their personal journeys and discuss some of the successes and challenges they encountered in returning to the community.

Learn more about:

  • What is community and why is it important to link people with resources in their local community?
  • How do we build community connections?
  • What are some of the available resources in my community?
  • What experiences have others had connecting with resources?

Dates:
September 14, 2011: 6.00 – 8.00 pm
November 9, 2011: 6.00 – 8.00 pm

 

Location
GF Strong Rehab Centre
4255 Laurel Street
Vancouver, BC V5Z 2G9
Social Services Seminar Room (#189, main floor)

Do I need to register?
Registration is not needed and these workshops are free to attend, but please contact GF Strong at 604-737-6221 to let them know how many of your family and friends will be attending.

More questions?
For more information please call the GF Strong Educator at 604-737-6221.

Read the latest issue of THE Challenge!

The Brain Injury Association of America authors a quarterly publication, THE Challenge!, which offers readers advice, support and guidance for those who have sustained a traumatic brain injury and their families.

The latest issue of THE Challenge! features several compelling stories including Communication Strategies Following a Brain Injury, Caregiving, Year after Year: How to Ask the Family for Help, and Classifying Brain Injury as a Chronic Disease. Read it online now.

Webster & Associates are proud supporters of Brain Injury Associations across British Columbia. We are proud to provide legal services, guidance and support to survivors of traumatic brain injury and their families.

Impaired facial affect recognition as a result of TBI

Impaired facial affect recognition appears to be a significant problem for survivors of traumatic brain injury. These difficulties can be partially attributed to problems with emotion perception. Mounting scientific evidence shows facial affect recognition to be particularly difficult after TBI. Facial affect recognition is achieved by interpreting important facial features and processing one’s own emotions. These skills are often affected by TBI, depending on the areas of the brain that are damaged. Impaired facial affect recognition can present a huge challenge for many people after traumatic brain injury (TBI), resulting in problems with communication and social relationships.

A study published in Neuropsychology has attempted to estimate the magnitude and frequency of this problem. Scientists conducted a meta-analysis of existing scientific evidence examining the magnitude and frequency of facial recognition difficulties after TBI. This was calculated from 13 studies (296 adults) comparing adults with moderate to severe TBI to healthy controls on static measures of facial affect recognition. Based on this data, they were able to estimate that 13-39% of people with moderate to severe TBI may have significant difficulties with facial affect recognition.

This area clearly needs more attention, particularly in examining possible rehabilitation techniques for this deficit. Impaired facial affect recognition is one of many problems faced by survivors of TBI. It is important that survivors, their families and friends are educated about this and other impairments.

Reference:
“Meta-analysis of facial affect recognition difficulties after traumatic brain injury”
in Neuropsychology (2011) . By DR Babbage, J Yim, B Zupan, D Neumann, MR Tomita and B Willer.

Study Links Brain Injury and Depression

A recent study produced by researchers at Vanderbilt University Medical Center found that 30% of individuals who suffer a traumatic brain injury (TBI) will experience depression after the injury. “Any patient who has a traumatic brain injury is at a real risk for developing depression, short and long term,” said study co-author Dr. Oscar Guillamondegui. “It doesn’t matter where on the timeline that you check the patient population — six months, 12 months, two years, five years — the prevalence is always around 30 percent across the board.”

This study reinforces the fact that patients and their families need to be educated about the potential problems that survivors of traumatic brain injury may experience. For more information on the impact of brain injuries on survivors and their families see the ‘Traumatic Brain Injury and the Family’ section of our website.

 

References:

Aquired Brain Injury: The Story of Six Brain Injury Survivors

“Aquired Brain Injury” was produced by Dean Powers, a Rehabilitation Consultant and Vocational Expert. The video follows a Q&A format, documenting the feedback of six suvivors with varying degrees of brain injury. It looks at the impact of brain injury on these individuals’ personal and professional lives, including the barriers to employment they have faced.

A Day in the Life of a Traumatic Brain Injury Survivor

Christina MacEachern was injured on September 12th, 2005, when her head came into contact with a semi-trailer truck. She suffered severe bi-frontal lobe injuries.

A 60-minute video of Christina (post-injury) was produced by Shawn Serdar of Pacific Producers Group and was shown during Christina’s trial. This 13 minute, edited version of the video has kindly been made available by Christina’s guardian for educational purposes.

High profile cases draw attention to the prevalence and severity of concussion in professional and amateur athletes.

Sidney Crosby http://en.wikipedia.org/wiki/Sidney_CrosbyEven off the ice Sidney Crosby can’t help but make the headlines.  Since January 5th of this year, the Pittsburgh Penguin’s captain and Canada’s golden boy has been recovering from concussion, after enduring two massive blows to the head only days apart.  Hockey fans, the media, and medical professionals alike are on edge, waiting for the star to recover and wondering what kind of impact this injury will have on the young player’s season and his future career.

More and more medical evidence is showing that concussions (actually a ‘mild traumatic brain injury’), especially multiple concussions, can cause long term problems.  In our practice the most common difficulties are difficulty concentrating, problems with sleep, headaches and cognitive fatigue.

The recent suicide of former Chicago Bears safety, Dave Duerson, has also drawn attention to the long-term damage and persistent health problems that can be caused by chronic traumatic encephalopathy (CTE). Duerson shot himself in the heart with the hope that his brain would be used to research the long-term effects of concussion on the brain.

Despite the tragedy of Duerson’s suicide and the problems caused to Crosby’s health and career, these cases are drawing much needed attention to an area of brain injury that generally goes unreported or even undiagnosed. The media attention has highlighted to the public, the fact that those involved in amateur and professional sports of all kinds, need to increase their awareness and knowledge of concussions.

Concussion is just another word for brain injury – but people still don’t want to talk about brain injuries.  This is, in part, due to a lack of education, but is also due to the inherent difficulty in treating concussions. In a motor vehicle context, a person may have a “mild” or even “moderate” brain injury, but are discharged from hospital because there is no specific treatment.  Concussions and brain injuries have various symptoms, and can even occur without the person being knocked out.

The real problem, to be discussed in a later blog, is the variable recovery from concussions. I think that most people would realize that you could have Sidney Crosby over for dinner and have a normal conversation with him, while recognizing that we he can’t go to work.  Unfortunately, those we talk to don’t always have that response.  They are often treated sceptically, with comments like “it was just a ding to the head”, or “she can get to appointments, why can’t she go back to work”.  According to scientific literature approximately 15% of people who have received a brain injury have ongoing symptoms, beyond two years after the incident.  We call them the “walking wounded”.  For Sydney Crosby, and the rest of Canada, let’s hope he isn’t part of that unlucky group.


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Related resources:

 

Peer group support can enhance well-being after brain injury

three people walking arm in armOur experience with survivors of TBI certainly accords with proposition that both survivors and their families need support to enhance the survivor’s functional capabilities and everyone’s well-being. Recent research agrees with us.  A six-week group intervention study looked at patients with acquired brain injury and their significant others and found that support enhanced both client well-being and psychosocial outcomes. Both higher levels of community integration and improvements in depression scores were noted where support had been provided.

We work hard to ensure that survivors and their families are connected with support through brain injury programs or even with therapists that we know have experience in brain injury. It’s not just the ‘touchy feely stuff’ either.  Many family members struggle with questions like “How do I encourage my loved one to improve his memory without doing it for them” or “How do I respond to anger or frustration that I think comes from the brain injury”. It’s essential that this support is provided, either through community groups or by allowing your brain injury lawyer to organize that high level of therapy and training.

To review this study see: “Evaluation of an outpatient, peer group intervention for people with acquired brain injury based on the ICF ‘Environment’ dimension” in Disability & Rehabilitation (2009, Vol. 31, No. 20 : Pages 1666-1675). This research was produced by Jennifer Fleming, Pim Kuipers, Michele Foster, Sharon Smith and Emmah Doig.

Drivers with TBI are slower to anticipate traffic hazards

traffic signs indicating construction areaUnfortunately, the consequences of brain injury are far reaching, and the risk of further injury after an initial brain injury is a real risk that many of our clients face.  Most clients find that the struggle through rehabilitation is hard enough, but as they are told that they can’t (or shouldn’t) go back to the activities that they used to enjoy, they become even more frustrated.

A recent study was conducted to examine the effect of traumatic brain injury (TBI) on drivers’ ability to anticipate traffic hazards. Slower anticipation of hazards has been associated with higher crash rates, but this driving skill has never been assessed after TBI.

The study found that participants with TBI were significantly slower to anticipate traffic hazards than controls. Within the TBI group, while hazard perception response times were significantly related to duration of post-traumatic amnesia, they were not significantly related to Glasgow Coma Scale scores. Not surprisingly participants with a complicated mild TBI (which means that the initial injury met the ‘mild’ criteria, but upon imaging damage was noted) were significantly faster in anticipating traffic conflicts than participants with moderate to severe TBI.

This is not to say that people with past TBI’s can never drive, but for many of our clients, driver training is an essential part of the recovery process. Supporting a return to activities is really important (one of the consequences of prohibiting a return to activities is depression and a decrease in functioning) but proper rehab and therapy is essential to make sure it is done safely.

To review this study see: “Assessment of drivers’ ability to anticipate traffic hazards after traumatic brain injury” from the Journal of Neurology, Neurosurgery & Psychiatry with Practical Neurology (Sept 2010). By Megan Preece, Mark Horswill, and Gina Geffen.
Most clients find that the struggle through rehabilitation is hard enough, but as they are told that they can’t or shouldn’t go back to the activities that they used to enjoy, they become even more frustrated.