Cognitive Challenge of Driving After TBI: Kelly Part Twenty Two
One of the most difficult dilemmas after a brain injury, is the intersection of competing interests between recovery and safety. Without integrating the survivor back into the real world, no meaningful recovery can occur. Yet, no one is more at risk for a bad result from a brain injury than someone who has already had a brain injury. Further complicating this challenge is that virtually every symptom of brain injury, makes an individual more likely to have an accident. This is a cognitive challenge of driving.
The cost benefit analysis in allowing a return to driving is a perhaps the most critical intersection of the needs for reintegration versus the risk of harm. Take a look at this typical list of brain injury symptoms and cognitive challenge of driving :
- Blurred Vision
- Sleep Disturbance
- Sensory Loss
- Executive Functions
- Quickness to Anger
Some of these are obvious. Driving requires attention, vision, awareness and alertness. But even the less obvious ones can create serious risk factors. Memory problems can involve getting lost, which has a secondary result of increasing distraction. Irritability, anger, disinhibition and mistakes in judgment all can have bad consequences behind the wheel. A delay in making decisions can also wind up badly. Yet, in today’s world, driving may be the key element to regaining legitimate independence after a brain injury. I explored these issues with Kelly.
There’re a number of cognitive challenge of driving that do show up when you’re driving a car. You bring up one. You have the memory. Do you have any problems remembering?
None at all.
Did you grow up in this area?
Yes, I’ve lived here all my life.
So you knew the area of Tennessee that you live in.
Yes, very well.
Another cognitive challenge of driving that can happen when you’re driving is lots of distractions happening at once. The traffic gets bad and, and things start to happen quickly. Did you have any problems with that?
No sir, not really. Not unless we were in very heavy traffic.
What would happen in very heavy traffic?
I’d get frustrated with people not making appropriate decisions as far as lane changing and things of that nature.
Another cognitive challenge of driving is you have to plan ahead, such as planning out where you are going. In those things you were okay with?
Did the therapy help you think about what you might have to do when you were driving on your own?
I attended a seminar on TBI in older people in the last week and one of the presenters made this analogy to provide guidance as to when survivors should have driving privileges limited:
“Mildly impaired survivors are the same as 16 year olds, moderately impaired, same as drunk drivers. We let 16 year olds drive, don’t let drunks drive.”
I found this an apt analogy, but I would take it further. We know how much trouble 16 year olds can get into with a car. Thus, to responsibly allow them to drive, it is important to set up limits. While I am a strong advocate for returning TBI survivors to driving, I believe it must be done with an eye towards limiting the situations where the synergistic combination of brain injury symptoms, doesn’t make a catastrophic mistake likely.