The link between Brain Injury Rehabilitation and Mobility John Macfarlane Consultant in Rehabilitation Medicine, Walkergate Park, Newcastle

An early case l 39 yo man re-admitted 11 years post TBI l Identified uncontrolled seizures l Transpired he had continued to drive

An early case (2) l Note in medical file 10 years previously re “driving despite advice” l Still reluctant to heed advice despite reassurance l GP, MDU, County Council x 3, l No driving mobility centre

Brain Injury - Driving

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

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

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

Mobility Centres & TBI- 2003

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

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

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

Risk

Personal (inexpert!) views l Criteria for driving licensing - risk l ? Gold standard of “on-road” l 72% prediction of assessment on pre-injury status l Current system - all or nothing l Graded licensing system - limits by law rather than choice l Better links with services l Better prevention systems

A Plea!

References 1. Annegers JF, Coan SP. Seizure: 2000 Oct;9(7): Fisk G, Scnheider J, Novack T. Brain Injury 1998;12:683–95 3. Hawley CA. JNNP (6); Kersten et al Disability and Rehabilitation. 2002:24;16: McCabe et al. Brain Inj Feb;21(2): Formisano et al, Brookes & Hawley. Brain Inj March 2005: 19