Cognitive functions in drivers with brain injury : Anticipation and adaption

Abstract: The purpose of this thesis was to improve the understanding of what cognitive functions are important for driving performance, investigate the impact of impaired cognitive functions on drivers with brain injury, and study adaptation strategies relevant for driving performance after brain injury. Finally, the predictive value of a neuropsychological test battery was evaluated for driving performance.Main results can be summarized in the following conclusions: (a) Cognitive functions in terms of attentional and dynamic working memory-related functions are relevant for driving performance. (b) Neuropsychological impairments in information processing speed, divided and focused attention, requiring working memory, are associated to limitations in driving performance. In addition, qualitative aspects of driving problems especially impaired anticipatory attention appeared to constrain driving performance. (c) A neuropsychological test battery assessing speed of information processing and attention in terms of working memory predicted driving performance. In addition, cognitive factors are relevant for interpretation of driving problems qualitatively. (d) Driving speed adjustment and anticipatory attention were adaptive strategies for driving after brain injury. Interest in driving, motivation for driving safely, and driving experience appeared also relevant for driving after brain injury. (e) Collaboration between medical, neuropsychological and driving expertise is recommended for a total evaluation of driving performance after brain injury.Anticipatory attention was considered a working memory based attentional system, directing the processing resources flexibly and appropriately between the different information processing components. Thus, anticipatory attention demonstrated qualitatively that working memory is a prominent function in a real driving context.