Assessment of fitness to drive after acquired brain injury: The role of neuropsychological tests

It is a well established fact that Acquired Brain Injury (ABI) can affect fitness to drive. Some cognitive functions have been emphasized as particular important when driving e.g. attention, reaction time, visual perception, and executive functioning. Research attempts have been made in order to identify a neuropsychological test battery to predict driving ability. However, there is no consensus as to which test such a test battery should consist of. The aim of this study was to explore the relationship between some neuropsychological test results and the results of an on-road test. The participants of this study were 45 persons with ABI who had attended a rehabilitation programme at Center for Brain Injury in Copenhagen. Their results from the Trail Making Test A&B, Wisconsin Card Sorting test and clinical assessment of neglect were compared with their performance on an on-road test. Only the results of the clinical assessment of neglect and TMT A showed statistical significant relationships with performance on the on-road test. The participants did not show any noteworthy signs of executive dysfunction possible due to the location of their injuries. Therefore tests of executive functioning e.g. WCST will not predict the driving ability of this group. This illustrates that many things can affect the predictive value a neuropsychological test and the belief that neuropsychological testing on its own cannot predict fitness to drive. As findings in the field of driving assessment of older people show they can at best be used for screening. Ideally, the assessment of a person with ABI’s fitness to drive should be conducted by an interdisciplinary team consisting of medical doctors, neuropsychologists, occupational therapists and driving instructors. In addition, the evaluation should always include an assessment of neglect and anosognosia.