The relationship of cognitive retraining to neurological patients' driving status: The role of process variables and compensation training

Primary objective: To explore the relationship of cognitive retraining performance to discharge driving status. Methods and procedures: One hundred and three brain-injured patients from a holistic milieu-oriented work/school re-entry programme. Experimental interventions: Initial, last, mean, and best cognitive retraining scores; Behavioural Checklist ratings; Working Alliance (WA) scores. Main outcomes and results: At the time of discharge, 50.5% of the sample were cleared to drive. Better performance on a cognitive retraining task addressing information processing and motor speed, focused attention, visual scanning and memory was associated with clearance to drive. Patients' behavioural approach to cognitive retraining tasks (use of compensations, organizational and procedural skills) and higher mean and discharge WA scores with staff were associated with driving clearance. Higher mean WA scores were also related to an enhanced behavioural approach to cognitive retraining tasks, including timeliness to sessions, compensation use, better communication pragmatics, decreased distractibility and the ability to apply the 'big picture' benefits of cognitive retraining to the 'real world'. Conclusions: Cognitive retraining exercises that incorporate skill remediation, 'process' variables and metacognitive skills, as well as a better WA with patients, positively related to clearance to drive at the time of discharge from a holistic milieu-oriented programme.