The link between Brain Injury The link between Brain Injury Rehabilitation and MobilityRehabilitation and Mobility

John MacfarlaneJohn MacfarlaneConsultant in Rehabilitation Medicine, Consultant in Rehabilitation Medicine,

Walkergate Park, NewcastleWalkergate Park, Newcastle

An early caseAn early case

39 yo man re-admitted 11 years post TBI39 yo man re-admitted 11 years post TBI Identified uncontrolled seizuresIdentified uncontrolled seizures Transpired he had continued to driveTranspired he had continued to drive

An early case (2) An early case (2)

Note in medical file 10 years previously re Note in medical file 10 years previously re “driving despite advice”“driving despite advice”

Still reluctant to heed advice despite Still reluctant to heed advice despite reassurancereassurance

GP, MDU, County Council x 3, GP, MDU, County Council x 3, No driving mobility centreNo driving mobility centre

Brain Injury - Driving

Facts & FiguresFacts & Figures

20-50% of TBI due to road traffic accidents20-50% of TBI due to road traffic accidents Risk of epilepsy after TBI: Risk of epilepsy after TBI: Mild : 1.5 Mild : 1.5

(Annegers et al) (Annegers et al) Mod : 2.9Mod : 2.9

Severe: 17.2 Severe: 17.2 50% with severe TBI resume driving -up to 2/3 50% with severe TBI resume driving -up to 2/3

without formal evaluation (Fisk et al)without formal evaluation (Fisk et al) Increase in accident rate? 2.3 (Formisano et al)Increase in accident rate? 2.3 (Formisano et al)

Rehabilitation for drivingRehabilitation for driving

Cognitive assessments variably (20-94%) predict Cognitive assessments variably (20-94%) predict on road driver assessment - cognitive rehabon road driver assessment - cognitive rehab

Recent interest in driving simulators for Recent interest in driving simulators for rehabilitation as well as assessmentrehabilitation as well as assessment

Systematic review of community reintegration - Systematic review of community reintegration - no RCTs or good evidence (McCabe)no RCTs or good evidence (McCabe)

UK perspectivesUK perspectives

16% previous drivers reported receiving 16% previous drivers reported receiving formal advice about driving after injury formal advice about driving after injury (Hawley)(Hawley)

Driving frequently identified as important Driving frequently identified as important to individuals after TBIto individuals after TBI

16% of young stroke patients report 16% of young stroke patients report unmet need relating to driving (Kersten unmet need relating to driving (Kersten et al)et al)

Mobility Centres & TBI- 2003Mobility Centres & TBI- 2003

QuickTime™ and aTIFF (LZW) decompressor

are needed to see this picture.

Local caseLocal case

DH 31 yo Male DH 31 yo Male Anoxic brain injury, secondary to horse Anoxic brain injury, secondary to horse

riding accident 2003riding accident 2003 Inpatient rehabilitation x 6/12Inpatient rehabilitation x 6/12 Diplopia - corrected with occluded lensDiplopia - corrected with occluded lens Slurred speechSlurred speech

Local Case Local Case

As outpatient cogntive, behavioural and As outpatient cogntive, behavioural and emotional issues problematic, mainly with emotional issues problematic, mainly with partnerpartner

Driver for 10 years at time of accidentDriver for 10 years at time of accident 2006 - 2 1/2 years post injury issue of 2006 - 2 1/2 years post injury issue of

driving was addresseddriving was addressed

AssessmentAssessment

Mild slowed information processing on Mild slowed information processing on cognitive screeningcognitive screening

Performed well on track test drive and on-Performed well on track test drive and on-road drivingroad driving :-):-)

Returned driving but reduced amount and Returned driving but reduced amount and patternspatterns

RiskRisk

Personal (inexpert!) viewsPersonal (inexpert!) views

Criteria for driving licensing - riskCriteria for driving licensing - risk ? Gold standard of “on-road”? Gold standard of “on-road” 72% prediction of assessment on pre-injury status72% prediction of assessment on pre-injury status Current system - all or nothingCurrent system - all or nothing Graded licensing system - limits by law rather Graded licensing system - limits by law rather

than choicethan choice Better links with servicesBetter links with services Better prevention systems Better prevention systems

A Plea!A Plea!

ReferencesReferences

1.1. Annegers JF, Coan SP. Seizure: 2000 Annegers JF, Coan SP. Seizure: 2000 Oct;9(7):453-7Oct;9(7):453-7

2.2. Fisk G, Scnheider J, Novack T. Brain Injury Fisk G, Scnheider J, Novack T. Brain Injury 1998;12:683–951998;12:683–95

3.3. Hawley CA. JNNP 2001. 70(6)Hawley CA. JNNP 2001. 70(6);;761-766761-7664.4. Kersten et al Kersten et al Disability and Rehabilitation. Disability and Rehabilitation.

2002:24;16:860-8662002:24;16:860-8665.5. McCabe et al. Brain Inj. 2007 Feb;21(2):231-57McCabe et al. Brain Inj. 2007 Feb;21(2):231-576.6. Formisano et al, Brookes & Hawley. Brain Inj Formisano et al, Brookes & Hawley. Brain Inj

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