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.

Download full-text


Available from: Melissa M Amick, May 20, 2014
1 Follower
38 Reads
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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
  • [Show abstract] [Hide abstract]
    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
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We studied the prevalence and characteristics of self-reported driving difficulties and examined their association with traumatic brain injury (TBI) and/or posttraumatic stress disorder (PTSD) in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans who were seen at a Department of Veterans Affairs outpatient polytrauma clinic. In this study, we used a brief driving questionnaire and chart reviews to assess the prevalence and characteristics of driving difficulties in the following four groups of patients: TBI only, PTSD only, TBI + PTSD, and Neither (neither TBI nor PTSD). Compared with before deployment, 93% of OIF/OEF veterans seen in the polytrauma clinic reported more difficulties with driving in at least one domain, with the most common areas of difficulty being (1) problems with anger or impatience (82%), (2) general driving difficulties (65%), and (3) experiences with near misses (57%). Patients with PTSD (with or without TBI) reported the most significant driving impairments, whereas respondents with a history of only TBI endorsed driving difficulties similar to veterans without either diagnosis. Qualitative analysis of veterans' comments also revealed similar patterns. Self-reported driving problems were common among OIF/OEF returnees. Respondents who had a diagnosis of PTSD (with or without TBI) reported the most severe driving difficulties since returning from deployment. The association between PTSD and driving problems warrants further investigation.
    The Journal of Rehabilitation Research and Development 01/2011; 48(8):913-25. DOI:10.1682/JRRD.2010.08.0140 · 1.43 Impact Factor
Show more