Principal Investigators: Henry L. Lew, MD, PhD and David L. Jaffe, MS Project Staff: Hsiu-Chen Huang, MD, PhD and Peter D. Fredericks Project Categories: Stroke and Other Objective: This pilot study investigated the use of a driving simulator to assess the driving performance of patients after stroke, traumatic brain injury, and spinal cord injury. We studied (1) whether on-road evaluation correlates with evaluation on a driving simulator and (2) whether computerized data from the simulator are useful to determine a subject's driving ability and predicting overall on-road driving performance, including safety. Research Plan: For this study, a low-cost driving simulator from Systems Technology Incorporated (Hawthorne, CA) was employed. Subjects were recruited from the VA's Driving Rehabilitation Program and the Comprehensive Rehabilitation Center (CRC) within the Physical Medicine and Rehabilitation Service at the Palo Alto HCS. The protocol consisted of three items: pre & post-test questionnaires, a driving simulator assessment, and an in-car assessment. A brief questionnaire was administered before and after driving the simulator and after the on-the-road evaluation. The driving simulator assessment consisted of three courses modeling typical driving environments: hospital grounds driving (15-25 mph), residential areas (35-45 mph), and commercial and freeway settings (55-65 mph). The subject's driving performance on the simulator was scored by one investigator using a form that itemized various driving aspects, including speed, obeying traffic signs and signals, safety, lane tracking, lane changes, turns, steering control, following distance, brake reaction time, throttle/brake coordination, merging into traffic, and speed/accuracy of decisions. Work Accomplished: A control group showed significantly better overall simulator performance than brain injury subjects (p<0.05). For the small number of subjects, no significant statistical differences were noted between the TBI and CVA groups. When broken down by the three course levels, brain injury subjects showed a significant performance difference (p<0.05) from control subjects in the two more difficult courses where higher driving speeds, more cars, more pedestrians, and sharper curves were presented. Simulator and on-road performance showed significant correlation (R2=0.804, p<0.05). This preliminary study suggested that a driving simulator might be used to screen patients with driving problems before an in-car assessment. Expected Outcome: A Merit Review proposal has been submitted to the VA to investigate the effectiveness of a high-quality interactive driving simulator to safely assess and improve the driving abilities and quality of life of individuals following stroke and traumatic brain injury. Funding Source: PVA Funding Status: Funded 6/2002 - 8/2002
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