頭部外傷後回復期における自動車運転再開評価の試み：当施設における現状と課題

抄録

This study investigated resumption of motor driving in recovery stage after traumatic brain injury (TBI) in our hospital.

We selected 12 cases based on certain inclusion criteria from 38 patients who had sent to our hospital and received rehabilitative training after TBI since February 2008 until December 2010. We evaluated motor driving skills by driving simulator (DS-2000^®, Mitsubishi Precision Incorporated Company), higher brain function by neuropsychological tests (WAIS-III, WMS-R, RBMT, TMT, FAB, BADS, kohs) and ADL by Functional Independence Measure (FIM). On admission driving simulation (DS) was performed, while DS and aptitude test (AT) was respectively performed on discharge. Each episode of dangerous driving was counted and totalized under 10 situations in DS, while capability of motor driving was evaluated from 5 points of view in AT.

Group was constituted by 11 men and 1 woman, 39 (mean) years old. Initial mean GCS was 9.3 (range 5 – 12), moderate (8 cases) – Severe (4 cases) injury. They were discharged 117.8 days after TBI. Episode of dangerous driving in DS on admission was 25.8 ± 5.9 (mean ± SD), while on discharge was 19.1 ± 4.6 (t-test, p<0.01). AT on discharge indicated two disqualified cases (17%). One of two had no remarkable abnormality in higher brain function but had sensory disturbance in right lower limb, therefore needed visual confirmation in AT. Another had abnormality in most of neuropsychological tests and it suggests certain correlation between motor driving and higher brain function. Eight of 10 qualified cases actually resumed motor driving and no obvious traffic accident was confirmed according to telephone interview 3 months later since discharge.

This study suggested that not a few patients with TBI could actually resume motor driving safely even in recovery stage after TBI under appropriate inclusion criteria, DS, and AT. Further various strategies, however, should be developed to guarantee safe resumption of motor driving.