Driving after brain injury: Self-awareness and coping at the tactical level of control

Objective: To study whether metacognition is a prerequisite for coping at the tactical level of driving. Research design: A consecutive series of 30 drivers with acquired brain injury were assessed concerning cognitive functions and driving performance. In addition the drivers assessed their driving performance through self-rating. Results: On average the drivers had cognitive impairments compared to a healthy reference group. The group that passed the driving test and the group that failed the driving test did not differ in terms of cognitive functions. Neither did they differ in their self-ratings of driving performance. However, the group that failed the driving test significantly over-estimated their performances as compared to the assessments made by the professional driving inspector, while the group that passed the test made more accurate self-ratings. Conclusions: One interpretation of these results is that the group that made a more realistic evaluation of their driving performance were more aware of their cognitive capacity compared to those who failed the driving test. They seemed to have a better ability to adjust their driving behaviour at a tactical level. Thus, the subject's metacognition, awareness of his/her own cognitive capacity, is important for coping with cognitive impairments at tactical driving.

[1]  C. Weinstein.  Cognitive remediation. , 1994, The American journal of psychiatry.

[2]  W van Winsum,et al.  Time Headway in Car following and Operational Performance during Unexpected Braking , 1997, Perceptual and motor skills.

[3]  Teresa C. Brobeck,et al.  Training awareness and compensation in postacute head injury rehabilitation. , 1989 .

[4]  Christopher Hertzog,et al.  Metacognitive development in adulthood and old age. , 1994 .

[5]  H Alm,et al.  Neuropsychological aspects of driving after brain lesion: simulator study and on-road driving. , 1997, Applied neuropsychology.

[6]  John A. Michon,et al.  A critical view of driver behavior models: What do we know , 1985 .

[7]  J. Fuster.  Frontal lobes , 1993, Current Opinion in Neurobiology.

[8]  T. Ownsworth,et al.  Self-awareness and psychosocial functioning following acquired brain injury: An evaluation of a group support programme , 2000 .

[9]  A. Baddeley.  Human Memory: Theory and Practice, Revised Edition , 1990 .

[10]  S. Folkman,et al.  Stress, appraisal, and coping , 1974 .

[11]  H Summala,et al.  EFFECTS OF DRIVING EXPERIENCE, PERSONALITY, DRIVER'S SKILL AND SAFETY ORIENTATION ON SPEED REGULATION AND ACCIDENTS , 1997 .

[12]  Donald T. Stuss,et al.  Biological and psychological development of executive functions , 1992, Brain and Cognition.

[13]  J. A. Rothengatter,et al.  Fitness to drive a car after recovery from severe head injury. , 1988, Archives of physical medicine and rehabilitation.

[14]  D. Schacter,et al.  Unawareness of deficits in neuropsychological syndromes. , 1989, Journal of clinical and experimental neuropsychology.

[15]  A. Lundqvist.  Cognitive functions in drivers with brain injury : Anticipation and adaption , 2001 .

[16]  P. Carpenter,et al.  Individual differences in working memory and reading , 1980 .

[17]  Jerker Rönnberg,et al.  Cognitive and communicative function : The effects of chronological age and "handicap age" , 1990 .

[18]  C Lundberg,et al.  Can a Physician Recognize an Older Driver with Increased Crash Risk Potential? , 1996, Journal of the American Geriatrics Society.

[19]  Ursula Kirk,et al.  Understanding awareness deficits following brain injury. , 2000, NeuroRehabilitation.

[20]  W. Brouwer,et al.  Driving competence in older persons. , 1994, Disability and rehabilitation.

[21]  B. Gerdle,et al.  Neuropsychological aspects of driving after a stroke—in the simulator and on the road , 2000 .

[22]  W. Sturm,et al.  Neuropsychological assessment , 2007, Journal of Neurology.

[23]  G. Fox,et al.  Identifying safe versus unsafe drivers following brain impairment: the Coorabel Programme. , 1992, Disability and rehabilitation.

[24]  C. Ray,et al.  The concept of coping , 1982, Psychological Medicine.

[25]  V Sahgal,et al.  Driving safety after brain damage: follow-up of twenty-two patients with matched controls. , 1990, Archives of physical medicine and rehabilitation.

[26]  I. Altman,et al.  Impaired awareness of behavioral limitations after traumatic brain injury. , 1990, Archives of physical medicine and rehabilitation.

[27]  S. Folkman,et al.  Stress, Appraisal, and Coping. New York, NY: Springer; , 1984 .

[28]  A. Lundqvist,et al.  Cognitive functions in drivers with brain injure , 2001 .

[29]  N. Katz,et al.  Occupational Performance and Metacognition , 1997 .

[30]  A. Luria.  Higher Cortical Functions in Man , 1980, Springer US.

[31]  J. Fleming,et al.  Self-awareness of deficits in adults with traumatic brain injury: how best to measure? , 1996, Brain injury.

[32]  Jerker Rönnberg,et al.  Driving problems and adaptive driving behaviour after brain injury: A qualitative assessment , 2001 .

[33]  Kurt Johansson,et al.  Older automobile drivers : medical aspects , 1997 .

[34]  D. Stuss.  Disturbance of self-awareness after frontal system damage. , 1991 .

[35]  Wiebo Brouwer,et al.  Fitness to drive after traumatic brain injury , 1997 .

[36]  N. Zasler.  Rehabilitation of the Adult and Child with Traumatic Brain Injury , 1990 .