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Driving after Brain Injury: A Clinical Model Based on a Quality Improvement Project

机译：脑损伤后驾驶：基于质量改进项目的临床模型

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The question of whether a person can resume driving after acquired cognitive dysfunction is raised in primary care services and in hospital departments where patients suffering from brain injury are treated. These organizations rarely have a specialized program that evaluates driving fitness. This article describes a semi-structured and individualized model that serves as clinical guidelines for determining fitness to drive. The model is based on former research and clinical experience. It is exemplified by the procedure of forty-three individuals with congenital or acquired cognitive dysfunction due to head trauma or disease. A multidisciplinary team including medical, neuropsychological, occupational, and practical driving specialists optimised the clinical applicability of a driving assessment using quantitative and qualitative methods. The team discussions, including several professional evaluations and assessments, are considered very important for interpreting results, for understanding whether the cognitive impairments will have consequences on driving, and whether the individual can compensate for cognitive difficulties. The current way to determine a patient’s fitness to drive after cognitive dysfunction is an individually adapted combination of assessment methods that are often performed stepwise. This well-practiced evaluation process reveals that in many cases neither off-road tests nor on-road tests alone are sufficient to ensure sound decisions. To improve on these evaluations, this study concludes that a team-based consensus approach consisting of specialized national teams should be established to support primary care services in assessing fitness to drive in more complicated cases.
机译：在基层医疗服务机构和治疗脑损伤患者的医院部门中，提出了一个人是否可以在获得性认知功能障碍后恢复驾驶的问题。这些组织很少有专门的程序来评估驾驶适应性。本文介绍了一种半结构化和个性化的模型，可作为确定驾驶适应性的临床指南。该模型基于以前的研究和临床经验。它是由四十三名因头部外伤或疾病而患有先天性或后天性认知功能障碍的人的手术来举例说明的。一个由医学，神经心理学，职业和实践驾驶专家组成的跨学科团队，使用定量和定性方法优化了驾驶评估的临床适用性。车队的讨论，包括几次专业评估和评估，被认为对于解释结果，理解认知障碍是否会对驾驶产生影响以及个人是否可以弥补认知障碍非常重要。确定患者在认知功能障碍后是否适合驾驶的当前方法是对评估方法进行单独调整的组合，这些评估方法通常是逐步执行的。这一实践良好的评估过程表明，在许多情况下，仅越野测试或公路测试都不足以确保做出正确的决策。为了改善这些评估，该研究得出的结论是，应建立由专业国家团队组成的基于团队的共识方法，以支持初级保健服务评估在更复杂情况下驾驶的适应性。

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