All ETDs from UAB

Advisory Committee Chair

Richard Kennedy

Advisory Committee Members

Michael Crowe

Laura Dreer

Thomas Novak

Despina Stavrinos

Document Type


Date of Award


Degree Name by School

Doctor of Philosophy (PhD) College of Arts and Sciences


Moderate-to-severe traumatic brain injury (TBI) often results in cognitive deficits in learning/memory, executive functions, and self-awareness. Cognitive impairments and unawareness of those impairments hinder driving capacity, yet a large proportion of survivors return to driving after injury. Given that many survivors are driving, it is essential to understand how cognition and self-awareness impact driving practices. To date, studies in this area are limited. This dissertation aimed to (1) create a normative sample for the Brief Test of Adult Cognition by Telephone (BTACT), a short cognitive battery adapted for telephone administration and validated for the TBI population; (2) examine the relationship between cognitive function (memory and executive function) and return to driving after TBI; (3) examine the influence of cognition and self-awareness on driving patterns (frequency and restriction) following TBI. Normative data for the BTACT were derived from a national sample of 6,747 English-speaking healthy adults aged 23–84 years (aim 1). For aims two and three, participants were 585 adults with moderate-to-severe TBI enrolled in the TBI Model System multi-center program. Cross-sectional driving and cognitive outcomes were collected via structured interview and telephone-administered cognitive battery (BTACT) across the recovery trajectory, ranging from 1–30 years after injury. Cognitive impairment was defined as z score ≤ -1.0, and participants were classified as having iv impaired self-awareness when there was objective cognitive impairment but no selfreported cognitive impairment. The BTACT normative data were created based on age, sex, and education. Memory and executive function impacted return to driving after TBI, but these effects washed out when family income and motor function were taken into account. Thirty-nine percent of survivors had impaired self-awareness. The majority drove numerous times weekly, but survivors were not driving in all situations. Survivors with more cognitive impairment were more likely to have impaired self-awareness and also restricted their driving more. Driving after moderate-to-severe TBI is multifaceted. Survivors with memory and executive function impairments, lower income, and less motor function are at greater risk for not driving after injury. Among those who return to driving, most survivors drive frequently but the situations they drive in differ based on their cognition.



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