Return to drive after acquired brain damage: what support provided after assessment step ?
Dr Anne-Claire D'APOLITOa, Dr Jean-Michel LE GUIETb, Prof Jean-Michel MAZAUXc, Mr Catherine ROSSIGNOLd, Dr Michel BUSNELe, Dr Francis LEMOINEf
a AP-HP - Hôpital R.Poincaré, b Centre mutualiste de Kerpape, c Université et CHU de Bordeaux, d UGECAM Tour de Gassies, e Comete France, f Ugecam Centre Hélio Marin
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. 77 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 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