Driving Simulator Assessment of Fitness-to-Drive Following Traumatic Brain Injury

Returning to driving is a major goal for individuals recovering from a traumatic brain injury (TBI). Clinicians have a variety of tools to assess the ability to return to driving for TBI patients, including cognitive assessments, but on-road instrumented vehicle driving assessments have been considered the gold standard. However, these on-road assessments are limited in the ability to ethically expose drivers to certain driving situations or environments. The purpose of this study was to examine the ability of a high-fidelity driving simulator to assess driving performance in individuals who have sustained a moderate-to-severe TBI, as well as associate cognitive measures commonly used in this population with simulated driving outcomes. Fourteen participants from a TBI clinic were recruited to drive in a simulator through a series of increasingly complex diving modules: 1) basic vehicle operation; 2) secondary task engagement while driving; 3) car following; 4) divided attention; and 5) navigating left hand turns across oncoming traffic. Half (n = 7) had been released to return to drive and half (n = 7) were considered to never be able to return to driving. Although general trends suggest non-drivers exhibit slower driving and increased lane position variation, group differences driving were not shown likely due to small sample sizes. Differences in patterns of cognitive correlates with driving were found, with higher order cognitive processes, like working memory, being more associated with driving outcomes in active drivers. Suggestions for driving scenario development in this population are discussed

Correction: Bishop, H.; Boe, L.; Stavrinos, D.; Mirman, J. Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder. <em>Safety</em> 2018, <em>4</em>, 40

The published version of the paper [...

Driving among Adolescents with Autism Spectrum Disorder and Attention-Deficit Hyperactivity Disorder

Over the past several decades there has been a surge of research on the contextual, biological, and psychological factors associated with transportation safety in adolescence. However, we know much less about the factors contributing to transportation safety among adolescents who do not follow a typical developmental trajectory. Adolescents with developmental disabilities (DD) such as Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) have a wide range of behavioral and psychological deficits that may make the complex task of driving even more challenging. Because these adolescents often retain characteristic symptoms of their disorder into adulthood, it may impede their ability to achieve important milestones during the developmental transition from adolescent to adult. As the motivating force behind autonomous living and employment, the capacity for independent transportation is paramount to an adolescent&rsquo;s overall success. This critical review will draw from the current body of literature on adolescent drivers with developmental disabilities to determine (1) areas of impairment; (2) safety risk factors; and (3) effective interventions for improving driving safety in this vulnerable population of adolescent drivers between the ages of 15&ndash;22. This review will also identify important unanswered research questions, and summarize the current state of the literature

Driving Simulator Performance in the Acute Post-Injury Phase Following a Mild Traumatic Brain Injury Among Young Drivers

While mild traumatic brain injury (mTBI) can lead to cognitive and functional impairments, little is known about how mTBI may affect driving, especially among young drivers who are at an increased risk of mTBI and motor vehicle collisions compared to other age groups. The objective of this multisite, pilot study was to examine the feasibility of assessing driving performance acutely post-injury (i.e., mTBI sustained < 2 weeks at assessment) among young drivers with and without mTBIs (N=42; nmTBI= 21; ncontrol=21) using high-fidelity driving simulators. Driving performance was hypothesized to be significantly degraded, especially under conditions of high cognitive load, among drivers with mTBI compared to matched controls. Neurocognitive measures used in clinical assessment of mTBI (i.e., Cogstate Brief Battery) were hypothesized to correlate with driving simulator performance metrics. Risk management protocols were successful (i.e., no participants withdrew due to simulator sickness) and no significant increase in post-concussion symptoms was found from pre-assessment to immediately following driving assessment. Group differences on key driving variables did not emerge; however, drivers with mTBI showed a differential pattern of driving under high cognitive load. Neurocognitive correlates of simulated driving performance suggested processing speed, attention, and working memory are important functions for driving. Implications and future directions discussed

Moderate-to-Vigorous Physical Activity and Response Inhibition Predict Balance in Adults with Attention Deficit/Hyperactivity Disorder

Background: Some evidence indicates that adults with attention deficit hyperactivity disorder (ADHD) may have balance impairments. This study examined the associations between moderate-to-vigorous physical activity (MVPA), response inhibition (RI), and static balance in this population while off and on psychostimulant medication (PS). Methods: Participants (n = 40; 30 females; M age = 29.0; SD = 6.3 years) wore an ActiGraph GT9X–link around their waist to estimate MVPA levels (minutes/day). To assess RI, participants completed the Delis–Kaplan Executive Function System (D–KEFS) subtests Trail-Making Test (TMT) and Color–Word Interference Test (CWIT). To evaluate static balance, participants completed postural sway area (cm2) assessments in four conditions: feet-apart eyes-open (FAEO), feet-apart eyes-closed (FAEC), feet-together eyes-open (FTEO), and feet-together eyes-closed (FTEC). Participants also completed the single-leg standing tests (seconds) with eyes open (SLEO) and with eyes closed (SLEC). Results: When off medication, MVPA significantly predicted SLEC (β = 0.30; p = 0.017). MVPA and TMT significantly predicted FTEO, explaining ~19% of the variance in FTEO; both MVPA and TMT were significant predictors (β = –0.33, p = 0.027 and β = –0.31, p = 0.039, respectively). When on medication, TMT significantly predicted FAEC (β = 0.17; p = 0.047). Conclusions: MVPA and RI may be effective parameters in predicting static balance in adults with ADHD when off medication only