Effects of upper-limb immobilisation on driving safety J.J. Gregory a, *, A.N. Stephens b , N.A. Steele a , J.A. Groeger b a Robert Jones and Agnes Hunt Orthopaedic & District General Hospital, Oswestry SY10 7AG, UK b Department of Psychology, University of Surrey, UK Introduction Doctors are frequently asked whether it is safe to drive a car with a limb fixed in a cast. Half of such patients when questioned admitted to driving at least once with an upper limb immobilised. 7 There have been surveys of doctors, insurance companies and the police, to try to obtain guidance on this point. 3,6,11,12,16 The majority of insurance companies refer policyholders back to their doctor for consideration of driving fitness. In the UK, if applying legislation strictly, the Driving and Vehicle Licensing Agency (DVLA) should be contacted by every driver who has any disability, the DVLA have stated that they need only be contacted if the disability may become permanent or if the car requires specialist adaptations. 11 Objective assessments of driving ability have been made following lower-limb surgery: total hip 9 and knee replacement, 13 knee arthroscopy, 5 anterior cruciate ligament reconstruction 10 and ankle fracture fixation. 2 The only aspect of driving assessed in these studies was the ability to apply the brakes, in terms of reaction times, force of brake application or brake travel time. All but one of these investigations involved the use of computers linked to pedals rather than formal driving simulators. Two studies have made subjective assessments of the ability to drive with the upper limb immobilised. 1,7 The author of one of these papers, wearing upper-limb plaster casts, was assessed by an occupational therapist and a driving instructor. 7 The second study consisted of the subjective assessment of one of the authors ability to drive a car while wearing different upper-limb plaster casts. 1 The ability to drive a vehicle safely is complex. The cognitive and motor requirements of driving vary depending on the circumstances encountered, and a broad range of brain systems are recruited to support performance. 13,14 Neither subjective reports of driving ability nor data on braking performance are adequate to assess the effects on driving of upper-limb immobi- lisation. Our aim was to investigate these effects more fully. Methods Eight volunteers, four men and four women, were selected. All were healthy, aged less than 25 years, and held full UK driving licences. Volunteers were screened with an Edinburgh handedness Injury, Int. J. Care Injured 40 (2009) 253–256 ARTICLE INFO Article history: Accepted 15 June 2008 Keywords: Driving Upper limb Immobilisation Safety Fracture ABSTRACT Doctors are frequently asked by patients whether it is safe to drive with an upper limb immobilised in a cast. In the literature there are no objective measurements of the effects of upper-limb immobilisation upon driving performance. Eight healthy volunteers performed four 20-min driving circuits in a driving simulator (STISIM 400 W), circuits 1 and 4 without immobilisation and circuits 2 and 3 with immobilisation. Immobilisation involved a lightweight below-elbow cast with the thumb left free. Volunteers were randomised to right or left immobilisation for circuit 2, and the contralateral wrist was immobilised for circuit 3. Circuits included urban and rural environments and specific hazards (pedestrians crossing, vehicles emerging from a concealed entrance, traffic lights changing suddenly, avoidance of an oncoming vehicle in the driver’s carriageway). Limb immobilisation led to more cautious rural and urban driving, with less adjustment of speed and lateral road position than when unrestricted. However when responding to hazards immobilisation caused less safe driving, with higher speeds, a greater proximity to the hazard before action was taken and less steering adjustment. The effects of restriction upon performance were more prevalent and severe with right-arm immobilisation. Upper-limb immobilisation appears to have little effect on the ability to drive a car unchallenged, but to adversely affect responses to routine hazards. Advice on ability to drive safely should be cautious, as the impact of immobilisation appears to be more subtle and wide ranging than previously thought. ß 2008 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +44 1743 284764; fax: +44 1691 404268. E-mail address: jjgregory@doctors.org.uk (J.J. Gregory). Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury 0020–1383/$ – see front matter ß 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.injury.2008.06.029