Examining simulated driving performance among athletes with a sport-related concussion

Many healthcare professionals have incorporated a return to play and return to learn strategies within their sport-related concussion (SRC) management protocol but may not have considered the effects of driving performance, which is a common activity of daily living for most athletes. By having severe signs and symptoms, and impairments from a SRC, it could influence the way concussed drivers think and act throughout their recovery process. Therefore, this could impair their acceptable decisions and make it harder to detect and avoid hazards on the road. PURPOSE: The specific aim of this project was to evaluate the test-retest reliability of the STISIM DriveRTM simulated driving software in a sample of healthy, college-aged students. The secondary purpose was to examine simulated driving performance in concussed and non-concussed match control athletes within 72 hours of sustained SRC, asymptomatic and return to sport participation (RTP) sessions. Lastly, the third purpose of this study was to explore the relationship between simulated driving performance and concussion tests in concussed athletes, over their SRC recovery. DESIGN: Repeated-measures study. INTERVENTION: There was a total of 59 collegiate students, who completed the test-retest reliability of three driving scenarios, with one week in between two test sessions. A total of 38 concussed and non-concussed athletes completed a series of SRC-based tools and simulated driving tasks within 72 hours, when they become asymptomatic and when they return to full participation. Lastly, the tools that were utilized in the study were the Sport Concussion Assessment Tool (SCAT5), Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), Balance Error Scoring System (BESS), Vestibular-Ocular Motor Screening (VOMS), and STISIM DriveRTM simulated driving tasks. RESULTS: The STISIM DriveRTM software reflected poor to moderate reliability (0.25--0.86) for the STISIM Drive driving tasks. Within the memory, planning and navigation scenario, there were no group (F1,28 = 1.56, p = 0.73) or group X time (F1,20 = 1.56, p = 0.79) interaction main effects, however there was a time (F1,20 = 1.56, p < 0.001) main effect. Within the car following with divided attention (DA) scenario, there were no group (F1,27 = 1.48, p = 0.20) or group X time (F1,18 = 1.09, p = 0.43) interaction main effects, however there was a time (F1,18 = 6.40, p < 0.001) main effect. Within the passing, gap judging and merging scenario, there were no group (F1,31 = 1.338, p = 0.27), time (F1,25 = 0.777, p = 0.67), or group X time (F1,18 = 1.09, p = 0.43) interaction main effects, however there was a time (F1,25 = 0.808, p = 0.64) main effect. However, nine concussed athletes (47.4%) collided with pedestrians and automobiles during the simulated driving scenarios over their SRC recovery. Lastly, we found four strong relationships between simulated driving performance (i.e. turn signal usage, car collisions, speeding) and SRC tools (i.e. ImPACT, BESS, VOMS). CONCLUSIONS: These preliminary findings may guide clinicians, educators, and researchers in developing a comprehensive driving evaluation for concussed individuals, due to the numerous pedestrian and car collisions displayed by concussed athletes. These results suggest that driving impairments may persist beyond when concussed athletes are returning back to full participation in sport and school.