Date Presented 04/05/19
Primary Author and Speaker: Sara Stephenson
Additional Authors and Speakers: Alice Anderson-Tome, Sarah Fischer, William Meredith, Chandler Somers
Contributing Authors: Abby Guzman
BACKGROUND: The Federal Highway Administration reported in 2016 that there were 222 million licensed drivers in the United States. There are approximately 1.7 million people with traumatic brain injuries (TBI) and more than 7.9 million strokes, considered an acquired brain injury (ABI), that occur annually in the United States. Recent evidence estimates that 40-80% of individuals with ABI return to driving after their injury. Cessation of driving after ABI can decrease occupational engagement including access to employment, IADLs, and social participation. The Bioness Interactive Therapy System (BITS) is a software platform using touchscreen technology that focuses on visual motor, perceptual, and cognitive programs, all of which are intended to evaluate and improve abilities in individuals with neurological injuries. The purpose of this pilot study is to determine if performance on three subtests of the BITS correlates with passing an on-the-road driving evaluation (OTRDE) for clients with ABI. Showing a correlation will provide OTs an evidence-based foundation to inform clinical decisions regarding timing of return to driving activities.
DESIGN: This retrospective pilot study used a convenience sample of patients with ABI from the Center for Transitional Neurorehabilitation (CTN). Data was analyzed from a department designed BITS checklist and included three subtests. Inclusion criteria included being a client of CTN, diagnosis of ABI, completion of all the three BITS subtests, and an OTRDE. The final sample was seven participants ranging in age from 19-71 years (M=50.7 years, SD=19.02). Due to the small sample size, a non-parametric approach was required. Therefore Spearman’s correlations were calculated to evaluate correlation between the performance on BITS subtests and passing an OTRDE.
METHODS: All participants completed a BITS assessment administered by OTs and qualified participants completed an OTRDE within three weeks of the BITS evaluation. Three measures were evaluated using the BITS, each containing three potential attainment levels, progressing in difficulty at each level. The BITS measures include: 1) Visual Scanning Single Target (VSSTA) with levels for accuracy and reaction time. This program assesses visuomotor coordination, visual attention, peripheral awareness, hand speed, and reaction time with visual prompts; 2) Visual Scanning Complex Array Verbal (VSCAV) includes levels for accuracy and reaction time. This program evaluates visuomotor coordination, visual attention, peripheral awareness, hand speed, and reaction time with visual and auditory prompts; 3) Cognition/Memory (C/M) measures visual memory, auditory memory, and visual/auditory motor planning. Finally, a fourth measure, which is being correlated with VSSTA, VSCAV, and C/M levels, is an OTRDE. The OTRDE results indicate if an individual with an ABI passes or fails.
RESULTS: Data was analyzed using SPSS. Using a Spearman’s analysis, researchers found a high correlation (rs=.801) between VSSTA level II and passing the OTRDE. Additionally, a coefficient of determination (r2= .641) indicates VSSTA level II accounted for 64% variance and the remaining 46% was attributed to other factors and no causal relationship was identified.
CONCLUSION: The results of this pilot study carry the potential to promote more effective use of the BITS at CTN, with applications for all clinics that use the BITS with clients with ABI. Driving is an important part of integration into the community and is key component of regaining independence after an ABI. Future research will include a larger sample size with the intent to validate a definitive raw score that clinicians can use as a standard to substantiate their future recommendations when referring clients to OTRDE.
References
Aslaksen, P. M., Ørbo, M., Elvestad, R., Schäfer, C., & Anke, A. (2013). Prediction of on-road driving ability after traumatic brain injury and stroke. European Journal of Neurology, 20(9), 1227-1233.
Classen, S., Levy, C., McCarthy, D., Mann, W. C., Lanford, D., & Waid-Ebbs, J. K. (2009). Traumatic brain injury and driving assessment: an evidence-based literature review. American Journal of Occupational Therapy, 63(5).
Gibbons, C., Smith, N., Middleton, R., Clack, J., Weaver, B., Dubois, S., & Bédard, M. (2017). Using serial trichotomization with common cognitive tests to screen for fitness to drive. American Journal of Occupational Therapy, 71 (2).
