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Return to drive after acquired brain damage: What support provided after assessment step?
Annals of Physical and Rehabilitation Medicine 58S (2015) e161–e163
Available online at
ScienceDirect www.sciencedirect.com
Driving Oral communications CO49-002-e
Fitness to drive after acquired brain damage: Who should be assessed, and how? A.C. D’Apolito (Dr)a, J.M. Mazaux (Prof)b,*, J.M. Le Guiet (Dr)c, C. Rossignol d, M. Busnel (Dr)e, F. Lemoine (Dr)f a AP–HP, Garches, France b Universite´ et CHU, France c Centre mutualiste de Kerpape, France d UGECAM Tour-de-Gassies, France e Comete France, France f Ugecam centre He´lio-Marin, France *Corresponding author. E-mail address: [email protected] (J. M. Mazaux) Acquired brain damage such as stroke, traumatic brain injury (TBI), brain anoxia or encephalitis may impair fitness to drive in no less than 300,000 adults every year in France. Identifying peoples at risk and addressing the assessment methods were priority concerns in context of the guidelines developed on behalf of the French Rehabilitation Medicine Society SOFMER, the French Higher Health Authority (HHA) and other groups of interest. Objective To draw from the literature guidelines regarding who should benefit from an assessment of fitness to drive, and how this assessment should be conducted. Method Two hundred and nine studies were analyzed among 326 references from the literature and discussed by a multidisciplinary work group. A preliminary draft was drawn, then submitted to a reviewing group and improved according to recommendations. Then guidelines were submitted to HHA. Results Peoples with mild TBI are advised not to drive again within 24 hours after their TBI. Three processes were defined: – process A: medical examination aiming at detecting mild motor and/or cognitive impairments (Montreal Cognitive Assessment was recommended), and ensuring visual acuity and visual field; – process B: comprehensive fitness to drive assessment including medical examination, cognitive tests (attention, visual scanning, memory and executive functions) and a standardized on road assessment (a least 45 minutes, with different driving situations); – process C: medical advice from a designed general practitioner before a revalidation of the driving license by authorities. Peoples with transient ischemic attack or mild impairment after stroke, brain anoxia or encephalitis: 2 weeks delay before driving again and process A + C. Peoples with moderate to severe TBI, stroke, brain anoxia or encephalitis with significant impairments
1877-0657/
needing rehabilitation: process B + C. Peoples with persistent neglect are urged to refrain from driving. Seizures and/or hemianopia are legal exclusions from driving. Discussion-conclusion The committee emphasized the need for forthcoming studies providing French validated versions of international assessment battery such as: Stroke Driver Screening Assessment, as well as further information about driving simulators. Keywords Automobile driving; Acquired brain injury; Assessment Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.359 CO49-003-e
Return to drive after acquired brain damage: What support provided after assessment step? A.C. D’Apolito (Dr)a, J.M. Le Guiet (Dr)b,*, J.M. Mazaux (Prof)c, C. Rossignol d, M. Busnel (Dr)e, F. Lemoine (Dr)f a AP–HP, hoˆpital R.-Poincare´, Garches, France b Centre mutualiste de Kerpape, France c Universite´ et CHU de Bordeaux, Bordeaux, France d Ugecam Tour-de-Gassies, France e Comete France, France f Ugecam centre He´lio-Marin, France *Corresponding author. E-mail address: [email protected] (J. M. Le Guiet) A consensus exists about the need of assessing effects of unprogressive acquired brain injury (stroke, traumatic brain injury, brain anoxia and encephalitis) on recovery of driving. It is a dynamic process in which the assessment is only one step. It should be completed in terms of conclusion by an individual support focused on the person. Identifying the place of rehabilitation, the accompanying terms, and the place of the person were concerns in context of the guidelines developed on behalf of the French Rehabilitation Medicine Society SOFMER, the French Higher Health Authority (HHA) and other groups of interest. Aim With the aim of maintaining an optimal independence, to determine practical modalities of supporting people, whatever conclusions of the assessment (pass or fail). Method Seventy-seven studies from literature analyzed among 326 references allow the development of a preliminary draft by a multidisciplinary work group. A formal notice was based on a reading group’s recommendations then submitted to HHA. Result In case of successful assessment: information on the administrative and financial procedures for the regularization of driving license. If technical aids are needed, it is necessary to learn
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Driving / Annals of Physical and Rehabilitation Medicine 58S (2015) e161–e163
these control facilities, and useful information for their implementation (choice, cost, financing. . .) are made. In case of failed assessment: the person must be informed of his clinical case and his possible evolution, especially further improvement of driving abilities, and possibilities of cognitive rehabilitation would be considered. Without anosognosia, an on-road retraining of driving may be proposed, but the efficacy cannot be guaranteed. It should not exceed 10 hours, and should be stopped, after few sessions without progress. In case of permanent inability of driving recovery, the person, still supported by a trusted person if possible, should be informed of available driving alternatives, also of financial help mobilized in order to maintain the mobility and the social involvement. Discussion/conclusion The person’s place is central. The role of the information is essential with oral and writing modalities of transmission, with criteria of progressivity, considering experiences and feelings. Keywords Automobile driving; Acquired brain damage; Rehabilitation Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.360 CO49-005-e
Evaluation of driving resumption after acquired brain damage: Garches’s experiment C. Paillat a, A. Massonneau b,*, P. Azouvi (Prof)b, A.C. D’Apolito (Dr)b a Antenne UEROS-Ugecam, Garches, France b Hoˆpital R.-Poincare´, poˆle re´e´ducation-handicap, France *Corresponding author. E-mail address: [email protected] (A. Massonneau) Objective To describe the assessment of driving abilities practices after acquired brain damage, and the factors associated with driving resumption. Material and method Fifty-six traumatic brain injury (TBI) and stroke participants assessed, between 2010 and 2013, from the multidisciplinary consultation of R.-Poincare´ hospital (Garches), associating a medical evaluation, to eliminate possible contraindication of driving resumption and estimate the need of vehicle adaptation, a neuropsychologic assessment, and a road test. Study of personal (gender, age, level of studies, driving experience), medical (pathology, time since the accident, duration of coma or post-traumatic amnesia), functional (vehicle adaptation needed) and cognitive (results of neuropsychological tests) factors, being able to influence the ability of driving resumption. Results Of the 56 patients, 34 (61%) were found suitable to resume driving, at the end of their evaluation. This study advances the impact of several factors on the capacities of driving resumption after acquired brain damage: time since the cerebral accident; severity of the TBI; functional sequelae requiring vehicle adaptations; cognitive disorders. The patients found suitable after the road test, obtained performances significantly better during the neuropsychologic assessment, unless no test, individually considered, allows predicting, in an infallible way, the final result. The measures of time answers in the neuropsychologic tests are the most sensitive. Conclusion This study consolidates the importance of a global evaluation, associating a road test with the clinical, functional and cognitive evaluations, to appreciate the ability of driving resumption after acquired brain injury. Keywords Automobile driving; Brain injury; Cognitive disorders Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.361
CO49-006-e
Two-year assessment of the activity of an evaluation unit of fitness to drive M. Tetard *, I. Hauret (Dr), S. Bardoux, E. Coudeyre (Prof) CHU Gabriel-Montpied, Clermont-Ferrand, France *Corresponding author. E-mail address: [email protected] (M. Tetard) Aim Driving is a complex and essential activity for patient autonomy. High Health Autority practice guidelines for the assessment of brain injury patient ability to drive are to be published in 2015 [1]. The main objective of this study is to analyze the activity of an evaluation unit of driving ability. The second one is to assess the compliance with clinical practice guidelines. Method Retrospective study concerning the relevance and the systematic nature of a medical assessment protocol ability to drive made by a PMR ward in tertiary university Hospital over a two year period. The protocol includes medical and ophthalmological evaluations, occupational therapy (OT) and neuropsychological assessment. Finally an on-road test with a suitable vehicle in the presence of a driving school instructor and an occupational therapist is made. Results A total of 77 patients were evaluated in our unit. We considered after evaluation that about half (23/52) of braindamaged patients assessed in our unit were able to drive. Fortytwo ophthalmologic assessments, 31 neuropsychological assessments and 25 reviews with OT coupled to a road test were performed. Practical analysis confirmed that the multidisciplinary assessment of visual, sensorimotor, cognitive and road test are consistent with the guidelines. However, the highlight of a neglect syndrome had not systematically dissuaded the driving capacity, that is not in line with the HAS guidelines. Discussion The assessment of ability to drive must be standardized, particularly concerning on-road test. Patient and family’s information on the need to make such an assessment must be systematized and made as early as possible. It seems necessary to better estimate driving habits after evaluation of patient, whatever they were validated or not. It is also necessary to analyze post validation risk for accident [2]. Finally, these guidelines should be disseminated and shared by all stakeholders (evaluation unit, licensed physician, Committee on driving license). Keywords Fitness to drive; Brain injury; Assessment Disclosure of interest The authors have not supplied their declaration of conflict of interest. References [1] D’Apolito AC, Massonneau A, Paillat C, Azouvi P. Impact of brain injury on driving skills. Ann Phys Rehabil Med 2013;56(1):63– 80. [2] Schanke AK, Rike PO, Mølmen A, Osten PE. Driving behavior after brain injury: a follow-up of accident rate and driving patterns 6– 9 years post-injury. J Rehabil Med 2008;40(9):733–6. http://dx.doi.org/10.1016/j.rehab.2015.07.362 CO49-007-e
Simulator-based driving assessment after stroke: Interest as a complement to cognitive evaluation C. Palayer a,*, J. Froger (Dr)b, H.Y. Bonnin Koang (Dr)b, S. Proia b, I. Laffont (Prof)a a CHU Lapeyronie, Montpellier, France b Centre hospitalier du Grau-du-Roi, France *Corresponding author. E-mail address: [email protected] (C. Palayer) Introduction Driving is a complex activity that requires motor, visuo-perceptual, behavioral and cognitive abilities, which all
Available online at
ScienceDirect www.sciencedirect.com
Driving Oral communications CO49-002-e
Fitness to drive after acquired brain damage: Who should be assessed, and how? A.C. D’Apolito (Dr)a, J.M. Mazaux (Prof)b,*, J.M. Le Guiet (Dr)c, C. Rossignol d, M. Busnel (Dr)e, F. Lemoine (Dr)f a AP–HP, Garches, France b Universite´ et CHU, France c Centre mutualiste de Kerpape, France d UGECAM Tour-de-Gassies, France e Comete France, France f Ugecam centre He´lio-Marin, France *Corresponding author. E-mail address: [email protected] (J. M. Mazaux) Acquired brain damage such as stroke, traumatic brain injury (TBI), brain anoxia or encephalitis may impair fitness to drive in no less than 300,000 adults every year in France. Identifying peoples at risk and addressing the assessment methods were priority concerns in context of the guidelines developed on behalf of the French Rehabilitation Medicine Society SOFMER, the French Higher Health Authority (HHA) and other groups of interest. Objective To draw from the literature guidelines regarding who should benefit from an assessment of fitness to drive, and how this assessment should be conducted. Method Two hundred and nine studies were analyzed among 326 references from the literature and discussed by a multidisciplinary work group. A preliminary draft was drawn, then submitted to a reviewing group and improved according to recommendations. Then guidelines were submitted to HHA. Results Peoples with mild TBI are advised not to drive again within 24 hours after their TBI. Three processes were defined: – process A: medical examination aiming at detecting mild motor and/or cognitive impairments (Montreal Cognitive Assessment was recommended), and ensuring visual acuity and visual field; – process B: comprehensive fitness to drive assessment including medical examination, cognitive tests (attention, visual scanning, memory and executive functions) and a standardized on road assessment (a least 45 minutes, with different driving situations); – process C: medical advice from a designed general practitioner before a revalidation of the driving license by authorities. Peoples with transient ischemic attack or mild impairment after stroke, brain anoxia or encephalitis: 2 weeks delay before driving again and process A + C. Peoples with moderate to severe TBI, stroke, brain anoxia or encephalitis with significant impairments
1877-0657/
needing rehabilitation: process B + C. Peoples with persistent neglect are urged to refrain from driving. Seizures and/or hemianopia are legal exclusions from driving. Discussion-conclusion The committee emphasized the need for forthcoming studies providing French validated versions of international assessment battery such as: Stroke Driver Screening Assessment, as well as further information about driving simulators. Keywords Automobile driving; Acquired brain injury; Assessment Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.359 CO49-003-e
Return to drive after acquired brain damage: What support provided after assessment step? A.C. D’Apolito (Dr)a, J.M. Le Guiet (Dr)b,*, J.M. Mazaux (Prof)c, C. Rossignol d, M. Busnel (Dr)e, F. Lemoine (Dr)f a AP–HP, hoˆpital R.-Poincare´, Garches, France b Centre mutualiste de Kerpape, France c Universite´ et CHU de Bordeaux, Bordeaux, France d Ugecam Tour-de-Gassies, France e Comete France, France f Ugecam centre He´lio-Marin, France *Corresponding author. E-mail address: [email protected] (J. M. Le Guiet) A consensus exists about the need of assessing effects of unprogressive acquired brain injury (stroke, traumatic brain injury, brain anoxia and encephalitis) on recovery of driving. It is a dynamic process in which the assessment is only one step. It should be completed in terms of conclusion by an individual support focused on the person. Identifying the place of rehabilitation, the accompanying terms, and the place of the person were concerns in context of the guidelines developed on behalf of the French Rehabilitation Medicine Society SOFMER, the French Higher Health Authority (HHA) and other groups of interest. Aim With the aim of maintaining an optimal independence, to determine practical modalities of supporting people, whatever conclusions of the assessment (pass or fail). Method Seventy-seven studies from literature analyzed among 326 references allow the development of a preliminary draft by a multidisciplinary work group. A formal notice was based on a reading group’s recommendations then submitted to HHA. Result In case of successful assessment: information on the administrative and financial procedures for the regularization of driving license. If technical aids are needed, it is necessary to learn
e162
Driving / Annals of Physical and Rehabilitation Medicine 58S (2015) e161–e163
these control facilities, and useful information for their implementation (choice, cost, financing. . .) are made. In case of failed assessment: the person must be informed of his clinical case and his possible evolution, especially further improvement of driving abilities, and possibilities of cognitive rehabilitation would be considered. Without anosognosia, an on-road retraining of driving may be proposed, but the efficacy cannot be guaranteed. It should not exceed 10 hours, and should be stopped, after few sessions without progress. In case of permanent inability of driving recovery, the person, still supported by a trusted person if possible, should be informed of available driving alternatives, also of financial help mobilized in order to maintain the mobility and the social involvement. Discussion/conclusion The person’s place is central. The role of the information is essential with oral and writing modalities of transmission, with criteria of progressivity, considering experiences and feelings. Keywords Automobile driving; Acquired brain damage; Rehabilitation Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.360 CO49-005-e
Evaluation of driving resumption after acquired brain damage: Garches’s experiment C. Paillat a, A. Massonneau b,*, P. Azouvi (Prof)b, A.C. D’Apolito (Dr)b a Antenne UEROS-Ugecam, Garches, France b Hoˆpital R.-Poincare´, poˆle re´e´ducation-handicap, France *Corresponding author. E-mail address: [email protected] (A. Massonneau) Objective To describe the assessment of driving abilities practices after acquired brain damage, and the factors associated with driving resumption. Material and method Fifty-six traumatic brain injury (TBI) and stroke participants assessed, between 2010 and 2013, from the multidisciplinary consultation of R.-Poincare´ hospital (Garches), associating a medical evaluation, to eliminate possible contraindication of driving resumption and estimate the need of vehicle adaptation, a neuropsychologic assessment, and a road test. Study of personal (gender, age, level of studies, driving experience), medical (pathology, time since the accident, duration of coma or post-traumatic amnesia), functional (vehicle adaptation needed) and cognitive (results of neuropsychological tests) factors, being able to influence the ability of driving resumption. Results Of the 56 patients, 34 (61%) were found suitable to resume driving, at the end of their evaluation. This study advances the impact of several factors on the capacities of driving resumption after acquired brain damage: time since the cerebral accident; severity of the TBI; functional sequelae requiring vehicle adaptations; cognitive disorders. The patients found suitable after the road test, obtained performances significantly better during the neuropsychologic assessment, unless no test, individually considered, allows predicting, in an infallible way, the final result. The measures of time answers in the neuropsychologic tests are the most sensitive. Conclusion This study consolidates the importance of a global evaluation, associating a road test with the clinical, functional and cognitive evaluations, to appreciate the ability of driving resumption after acquired brain injury. Keywords Automobile driving; Brain injury; Cognitive disorders Disclosure of interest The authors have not supplied their declaration of conflict of interest. http://dx.doi.org/10.1016/j.rehab.2015.07.361
CO49-006-e
Two-year assessment of the activity of an evaluation unit of fitness to drive M. Tetard *, I. Hauret (Dr), S. Bardoux, E. Coudeyre (Prof) CHU Gabriel-Montpied, Clermont-Ferrand, France *Corresponding author. E-mail address: [email protected] (M. Tetard) Aim Driving is a complex and essential activity for patient autonomy. High Health Autority practice guidelines for the assessment of brain injury patient ability to drive are to be published in 2015 [1]. The main objective of this study is to analyze the activity of an evaluation unit of driving ability. The second one is to assess the compliance with clinical practice guidelines. Method Retrospective study concerning the relevance and the systematic nature of a medical assessment protocol ability to drive made by a PMR ward in tertiary university Hospital over a two year period. The protocol includes medical and ophthalmological evaluations, occupational therapy (OT) and neuropsychological assessment. Finally an on-road test with a suitable vehicle in the presence of a driving school instructor and an occupational therapist is made. Results A total of 77 patients were evaluated in our unit. We considered after evaluation that about half (23/52) of braindamaged patients assessed in our unit were able to drive. Fortytwo ophthalmologic assessments, 31 neuropsychological assessments and 25 reviews with OT coupled to a road test were performed. Practical analysis confirmed that the multidisciplinary assessment of visual, sensorimotor, cognitive and road test are consistent with the guidelines. However, the highlight of a neglect syndrome had not systematically dissuaded the driving capacity, that is not in line with the HAS guidelines. Discussion The assessment of ability to drive must be standardized, particularly concerning on-road test. Patient and family’s information on the need to make such an assessment must be systematized and made as early as possible. It seems necessary to better estimate driving habits after evaluation of patient, whatever they were validated or not. It is also necessary to analyze post validation risk for accident [2]. Finally, these guidelines should be disseminated and shared by all stakeholders (evaluation unit, licensed physician, Committee on driving license). Keywords Fitness to drive; Brain injury; Assessment Disclosure of interest The authors have not supplied their declaration of conflict of interest. References [1] D’Apolito AC, Massonneau A, Paillat C, Azouvi P. Impact of brain injury on driving skills. Ann Phys Rehabil Med 2013;56(1):63– 80. [2] Schanke AK, Rike PO, Mølmen A, Osten PE. Driving behavior after brain injury: a follow-up of accident rate and driving patterns 6– 9 years post-injury. J Rehabil Med 2008;40(9):733–6. http://dx.doi.org/10.1016/j.rehab.2015.07.362 CO49-007-e
Simulator-based driving assessment after stroke: Interest as a complement to cognitive evaluation C. Palayer a,*, J. Froger (Dr)b, H.Y. Bonnin Koang (Dr)b, S. Proia b, I. Laffont (Prof)a a CHU Lapeyronie, Montpellier, France b Centre hospitalier du Grau-du-Roi, France *Corresponding author. E-mail address: [email protected] (C. Palayer) Introduction Driving is a complex activity that requires motor, visuo-perceptual, behavioral and cognitive abilities, which all