2010 BC Guide in Determining Fitness to Drive

Chapter 25: Traumatic Brain InjuryBACKGROUND25.1 About traumatic brain injuryTraumatic brain injury (TBI) is a nondegenerative, noncongenital insult to the brain from anexternal mechanical force, possibly leading to permanent or temporary impairment of cognitive,physical, and psychosocial functions, with an associated diminished or altered state ofconsciousness. The leading causes of TBI are falls and motor vehicle crashes.Descriptions of the severity of a TBI reflect the length of time a person is unconscious or lacksawareness of their environment. Mild TBI indicates only a brief change in mental status orconsciousness, while severe TBI describes an extended period of unconsciousness or amnesiaafter the injury.TBI can result in a wide range of impairments, which will vary depending on the severity andlocation of the injury, and the age and general health of the injured person. Possible sensoryimpairments include: visual field deficits visual neglect diplopia, and loss of sensation or hearing.Possible motor impairments include paralysis, paresis (partial loss of movement or impairedmovement) and slowed reaction times. Cognitive impairments include impaired: attention memory executive functioning processing speed, and visuo-spatial abilities, including visual memory.Behavioural impairments are common including disorders affecting mood and impulse control.Sleep disturbances, sleep apnea and fatigue are also commonly reported. TBI is also associatedwith epilepsy.Anosognosia (unawareness of impairment) is common in individuals with TBI, particularly inthose with moderate to severe TBI, and is of particular concern for driving. Research suggeststhat anosognosia is more frequently associated with cognitive and behavioural impairments thanwith physical deficits.324