Principal Investigators: Henry L. Lew, MD, PhD and David L. Jaffe, MS Project Staff: Edward Brodd, MS; John H. Poole, PhD; and Jill Storms, PT Project Category: Stroke - 2003 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: With the simulator, TBI patients exhibited greater variability in driving speed (p<0.001), reduced divided attention responses (p<0.001), and more collisions (p<0.05) than controls. Simulator and on-road performance showed significant correlation in this second preliminary study (R2=0.782, p<0.05). These results suggest that a driving simulator might be used to screen patients with driving problems before an in-car assessment. Expected Outcome: A VISN equipment grant has been awarded for the purchase of a new high-quality interactive driving simulator. In addition, a VA Merit Review proposal has been approved to investigate the effectiveness of this simulator to safely assess, and through training, improve the driving abilities and quality of life of individuals following stroke and traumatic brain injury. Funding Source: VA RR&D Merit Review Funding Status: Funded 04/2004 - 03/2007
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