Potential driving issues in combat returnees

Defense and Veterans Brain Injury Center (DVBIC), Richmond, VA, USA.
Neurorehabilitation (Impact Factor: 1.12). 01/2010; 26(3):271-8. DOI: 10.3233/NRE-2010-0562
Source: PubMed


The driving abilities of service members returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) have not been well reported and are an important aspect of their return to normal life. This article reviews the unique risk factors for unsafe driving in this cohort. In particular, the cognitive and psychological symptoms of mild traumatic brain injury and postraumatic stress disorder, two of the most common diagnoses affecting these returning warriors, are specified, and their possible association with impaired driving is examined. The potential negative impact of the "battlemind driving tactics" (i.e., evasive driving skills) acquired by these service members as part of their military tours is also highlighted. The article concludes with comments about the functional consequences of impaired driving in this population, including limits to participation in rehabilitation and community reintegration, as well as recognition of the need for further research in this area.

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Available from: Melissa M Amick, May 20, 2014
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    • "According to Lew et al. (2010), deployed service members are taught " battle-mind " driving tactics to survive in war, and many retain that mindset postdeployment. Speeding, changing lanes suddenly, and avoiding certain objects (e.g., swerving around trash bags) are some of the tactics warranted in combat but potentially dangerous on civilian roads (Lew et al., 2010). Thus, even returning combat veterans without medical conditions can be unsafe drivers , but more empirical support for battle-mind driving is necessary to make this claim. "
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    ABSTRACT: Many combat veterans are injured in motor vehicle crashes shortly after returning to civilian life, yet little evidence exists on effective driving interventions. In this single-subject design study, we compared clinical test results and driving errors in a returning combat veteran before and after an occupational therapy driving intervention. A certified driving rehabilitation specialist administered baseline clinical and simulated driving assessments; conducted three intervention sessions that discussed driving errors, retrained visual search skills, and invited commentary on driving; and administered a postintervention evaluation in conditions resembling those at baseline. Clinical test results were similar pre- and postintervention. Baseline versus postintervention driving errors were as follows: lane maintenance, 23 versus 7; vehicle positioning, 5 versus 1; signaling, 2 versus 0; speed regulation, 1 versus 1; visual scanning, 1 versus 0; and gap acceptance, 1 versus 0. Although the intervention appeared efficacious for this participant, threats to validity must be recognized and controlled for in a follow-up study.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 07/2014; 68(4):405-11. DOI:10.5014/ajot.2014.010041 · 1.70 Impact Factor
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    • "Other authors have attributed postdeployment driving stress to the evasive or battlefield driving tactics taught to military personnel before deployment, including speeding, driving down the center of or off the road, swerving around objects in the road, ignoring traffic signals and signs (to avoid attack), and not wearing a seatbelt (to enable a quick escape; Lew et al., 2010; Stern et al., 2011). These driving behaviors, taught as life-saving techniques, are strongly reinforced during deployment to such a degree that they may become automatic driving habits (Stern et al., 2011). "
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    ABSTRACT: Difficulty in driving after deployment has emerged as an impediment for servicemembers returning from Operation Iraqi Freedom and Operation Enduring Freedom (OIF-OEF). This study explored postdeployment driving stress and related occupational limitations using two self-report instruments: the Driver's Stress Profile and the Driving and Occupational Limitations questionnaire. Data gathered from 103 OIF-OEF returnees confirmed that driving and related occupational issues occur postdeployment. Significant low to moderate correlations were found between postdeployment driving stress and limitations in community mobility, leisure, and social participation. The returnees who drove off base more frequently during deployment showed significantly higher levels of postdeployment driving stress than the returnees who drove off base less frequently. Moreover, the returnees who demonstrated higher levels of driving stress and occupational limitations required more time to resume normal driving postdeployment. Findings raise awareness about the need to design effective driver rehabilitation and community reintegration programs for this population.
    The American journal of occupational therapy.: official publication of the American Occupational Therapy Association 07/2014; 68(4):386-94. DOI:10.5014/ajot.2014.011668 · 1.70 Impact Factor
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    ABSTRACT: Individuals with brain injury often present with cognitive, physical and emotional impairments which impact their ability to resume independence in activities of daily living. Of those activities, the resumption of driving privileges is cited as one of the greatest concerns by survivors of brain injury. The integration of driving fundamentals within the hierarchical model proposed by Keskinen represents the complexity of skills and behaviors necessary for driving. This paper provides a brief review of specific considerations concerning the driver with TBI and highlights current vehicle technology which has been developed by the automotive industry and by manufacturers of adaptive driving equipment that may facilitate the driving task. Adaptive equipment technology allows for compensation of a variety of operational deficits, whereas technological advances within the automotive industry provide drivers with improved safety and information systems. However, research has not yet supported the use of such intelligent transportation systems or advanced driving systems for drivers with brain injury. Although technologies are intended to improve the safety of drivers within the general population, the potential of negative consequences for drivers with brain injury must be considered. Ultimately, a comprehensive driving evaluation and training by a driving rehabilitation specialist is recommended for individuals with brain injury. An understanding of the potential impact of TBI on driving-related skills and knowledge of current adaptive equipment and technology is imperative to determine whether return-to-driving is a realistic and achievable goal for the individual with TBI.
    Neurorehabilitation 01/2011; 28(3):221-9. DOI:10.3233/NRE-2011-0651 · 1.12 Impact Factor
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