The link between Brain Injury Rehabilitation and Mobility

1
The link between Brain Injury Rehabilitation and
Mobility

• John Macfarlane
• Consultant in Rehabilitation Medicine, Walkergate
  Park, Newcastle

2
An early case

• 39 yo man re-admitted 11 years post TBI
• Identified uncontrolled seizures
• Transpired he had continued to drive

3
An early case (2)

• Note in medical file 10 years previously re
  driving despite advice
• Still reluctant to heed advice despite
  reassurance
• GP, MDU, County Council x 3,
• No driving mobility centre

4
Brain Injury - Driving
5
Facts Figures

• 20-50 of TBI due to road traffic accidents
• Risk of epilepsy after TBI Mild 1.5
• (Annegers et al) Mod 2.9
• Severe 17.2
• 50 with severe TBI resume driving -up to 2/3
  without formal evaluation (Fisk et al)
• Increase in accident rate? 2.3 (Formisano et al)

6
Rehabilitation for driving

• Cognitive assessments variably (20-94) predict
  on road driver assessment - cognitive rehab
• Recent interest in driving simulators for
  rehabilitation as well as assessment
• Systematic review of community reintegration - no
  RCTs or good evidence (McCabe)

7
UK perspectives

• 16 previous drivers reported receiving formal
  advice about driving after injury (Hawley)
• Driving frequently identified as important to
  individuals after TBI
• 16 of young stroke patients report unmet need
  relating to driving (Kersten et al)

8
Mobility Centres TBI- 2003
9
Local case

• DH 31 yo Male
• Anoxic brain injury, secondary to horse riding
  accident 2003
• Inpatient rehabilitation x 6/12
• Diplopia - corrected with occluded lens
• Slurred speech

10
Local Case

• As outpatient cogntive, behavioural and emotional
  issues problematic, mainly with partner
• Driver for 10 years at time of accident
• 2006 - 2 1/2 years post injury issue of driving
  was addressed

11
Assessment

• Mild slowed information processing on cognitive
  screening
• Performed well on track test drive and on-road
  driving -)
• Returned driving but reduced amount and patterns

12
Risk
13
Personal (inexpert!) views

• Criteria for driving licensing - risk
• ? Gold standard of on-road
• 72 prediction of assessment on pre-injury status
• Current system - all or nothing
• Graded licensing system - limits by law rather
  than choice
• Better links with services
• Better prevention systems

14
(No Transcript)
15
A Plea!
16
References

1. Annegers JF, Coan SP. Seizure 2000
   Oct9(7)453-7
2. Fisk G, Scnheider J, Novack T. Brain Injury
   19981268395
3. Hawley CA. JNNP 2001. 70(6)761-766
4. Kersten et al Disability and Rehabilitation.
   20022416860-866
5. McCabe et al. Brain Inj. 2007 Feb21(2)231-57
6. Formisano et al, Brookes Hawley. Brain Inj
   March 2005 19