Acquired brain damage and driving: a review.

Five issues in evaluating driving ability after brain damage were addressed through a review of the literature. Some preliminary conclusions were reached: (1) about half of all subjects studied still hold a valid driver's license; (2) brain-damaged drivers could not, in general, be seen as risky drivers, although some individuals show decreased driving skill and risky behavior in traffic; and (3) statistics show no increase in traffic violations or accidents in groups of neurologic patients with acquired brain lesions or diseases. Frequently noted problems of brain-damaged drivers include poor judgment of traffic situations, impulsivity, and visuospatial impairments. Traditional psychologic tests have insufficient predictive value regarding fitness to drive. It is suggested that new techniques be developed to enable more valid statements about the skills needed for safe traffic participation. These assessment techniques should emphasize the higher cognitive levels in driving, ie, the tactical and strategic levels. At the moment, driver training programs in rehabilitation focus mainly on the operational level, with emphasis on handling the car, use of controls and mirrors, and technical adaptation of the vehicle.