Driving After Concussion: Clinical Measures Associated with Post-concussion
Post-concussion driving assessment has been limited to driving simulators, which are not clinically feasible. There is a need to equip clinicians with tools that can assist in making recommendations on return to driving. To determine the association between clinical measures and driving simulator performance in college students within a week of a concussion. Cross-sectional. Laboratory. Forty-three college students with concussion and 46 controls. Clinical outcomes include: total symptom score, dual-task tandem gait completion time and dual-task cost (the percentage increase in completion under dual-task and single-task), Complex Figure performance, Useful Field of View performance, and Vestibular Ocular Motor Screening (VOMS) symptom provocation score. Driving simulator outcomes include: the number of collisions, speed exceedances, stop signs missed, centerline crossings, and road edge excursions. Within each of the drive segments, we collected standard deviation of speed (SDS) and lane position (SDLP). Separate models for each clinical assessment and driving outcome with negative binomial and linear regression models were used. Greater dual-task cost was associated with increased road edge excursions (p=.018) and SDS (p=.009). Higher VOMS symptom provocation was associated with less SDS (all p<.050). A higher Complex Figure copy score was associated with decreased centerline crossings (p=.001), road edge excursions (p<.001), SDS (p<.001), and SDLP (all p<.050). A slower Complex Figure copy completion time was associated with lower SDS (p=.010). A higher Complex Figure delayed score was associated with fewer road edge excursions and lower SDLP (all p<.050). Longer Complex Figure delayed completion time was associated with greater SDS (p=.03). Dual-task and Complex Figure might be useful when assessing post-concussion driving ability. Higher VOMS symptom provocation was associated with better driving performance, possibly indicating individuals experiencing vestibular-oculomotor symptoms may adopt more cautious strategies.ABSTRACT
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Contributor Notes
Conflicts of interest: No conflicts of interest.
Author contributions:
Conceptualization– Kumiko Hashida Lynall, Russell Gore, Hannes Devos, Kim Love, Julianne Schmidt
Methodology– Kumiko Hashida, Julianne Schmidt
Formal analysis and investigation– Kumiko Hashida, Kim Love, Julianne Schmidt
Writing – original draft preparation– Kumiko Hashida
Writing–review and editing- Julia Drattell, Robert Lynall, Russell Gore, Hannes Devos, Kim Love, Julianne Schmidt
Funding acquisition– Julianne Schmidt
Supervision– Julianne Schmidt