Simulators Facilitate TBI Recovery for Military Personnel

Simulators Facilitate TBI Recovery for Military Personnel

The Department of Defense and Department of Veterans Affairs are leading a web campaign aimed at addressing the high incidence of motor vehicle crashes for veterans in the early years after returning from deployment. This issue has become a top priority considering motor vehicle crashes are the leading cause of death for these veterans.

Discoveries regarding long-term effects of traumatic brain injury (TBI) have begun to surface following America’s most recent wars in Iraq and Afghanistan where roadside improvised explosive devices changed the shape of war and left many returning soldiers with lasting symptoms they could not understand.

Soldiers, like average American counterparts, place a high value on independence, much of which can be lost due to debilitating symptoms caused by TBI. The long list of side effects can range from acute symptoms in mild TBI cases like headaches, difficulty thinking, memory problems, attention deficits, mood swings, and frustration to more lasting side effects. The range of injuries and degree of recovery vary from person to person, making both diagnosis and rehabilitation considerably difficult.

Mild TBI accounts for 80 percent of all cases. Close to 1.4 million people sustain TBI each year. Statistically, of those cases, 50,000 do not survive the initial injury, 235,000 require hospitalization, and 1.1 million are treated and released from emergency departments. An estimated 5.3 million people require long-term assistance with activities of daily living because of the last effects of TBI, according to the Centers for Disease Control and Prevention. Over the last 9 years, the incidence rate of TBI-related hospitalizations was 22 percent higher during post-deployment compared to pre-deployment services for veterans.

The prevalence of TBI and the varying recovery needs depending on patient history and severity of the injury can create struggles for practitioners in developing a plan for rehabilitation. Of utmost importance to many—regaining complete independence. In the U.S., a large part of independence is linked to mobility and the ability to drive. Lingering symptoms, even those associated with mild TBI, can have a drastic effect on one’s ability to safely operate a vehicle including headache, dizziness (vertigo), poor balance, forgetfulness, slowed thinking, impaired concentration, decreased executive function, fatigue, irritability, visual impairment, or sensitivity to light or noise.

Driving is a complex task requiring a full range of cognitive, sensory, and motor functions, but it is also a key component of independence. Driving allows individuals to remain connected to society, participate in social activities, maintain stable employment, and carry out basic life tasks. A TBI, however, can wreak havoc on the functions necessary to independently and safely drive, and symptoms can linger into the future or re-emerge after an initial injury is thought to have been resolved.

Individuals recovering from a TBI who do resume driving typically recognize their shortcomings associated with driving fitness but do not make accommodations such as avoiding high traffic or night driving. Survivors of TBI have 2.5 more collisions per mile than the general population.

“High quality and engaging driving rehabilitation techniques that focus on improving such driving impairments could hasten and maximize recovery of driving skills in TBI patients. Given the extensive use of simulation in training military personnel, it is surprising that simulation has not been applied routinely for purposes of driving rehabilitation in the military,” one study published in Military Medicine argued.

Virtual driving simulators offer a safe, comfortable environment for TBI survivors to practice and improve driving skills and obtain objective feedback. The study mentioned above showed significant improvement in driving functions for TBI patients who participated in virtual driving simulator training.

The purpose of the study was to determine whether using virtual driving simulation in rehabilitation training with military personnel recovering from TBI was feasible. Research participants completed a Road Rage Questionnaire and the Cox Assessment of Risky Driving Scale. All subjects then completed a road test on the driving simulator. The subjects were split into a research group and a control group. The two groups completed identical pre and post assessments. Before the post-assessment, the research group was provided training in the simulator with an administrator. Training sessions lasting 60 to 90 minutes and allowed patients to rehearse and practice progressively more demanding skills associated with safe driving.

Early training sessions allowed subjects to practice maintaining lane position and speed control, appropriate application of brakes, use of turn signals, and use of side and rearview mirrors. More complex tasks were introduced as the training sessions progressed allowing patients to practice skills associated with decision-making, managing distractions, and handling complex driving maneuvers such as passing a slow-moving vehicle or merging onto a highway.

Training participants were provided immediate feedback and reviewed goals with the administrator before each new scenario. The number of training sessions required for each subject was based on individual progress and identified areas for improvement. At the end of the training, subjects rated the utility of the road course in improving their driving skills at the highest level. “They also felt that providing virtual driving simulator training as a routine clinical service would promote a positive attitude toward the military,” according to the study.

At post-test, virtual simulator training participants showed significant improvements in their driving performance compared to the control group, which received no training. Training participants also showed marked improvements in road rage and risky driving behavior measures.

It is the hope of the researchers that these findings encourage and facilitate future research and funding in driving rehabilitation. Specifically, for military personnel recovering from wartime injuries like TBI, driving simulators can help these valiant men and women regain their independence associated with driving.

Citation: Cox, Daniel J, et al. “Driving Rehabilitation for Military Personnel Recovering From Traumatic Brain Injury Using Virtual Reality Driving Simulation: A Feasibility Study.” Military Medicine, vol. 175, June 2010, pp. 411–416.

DriveSafety’s clinical simulators can serve as an effective and objective tool for patients recovering from a TBI. If the goal is a return to safe driving independence, studies have shown that training and practice on a driving simulator can result in significant improvements in the physical and mental aspects of driving. Certified technicians can work with patients and care teams to determine the most appropriate options available and help develop individualized programs. Appointments can be scheduled by calling DriveSafety today.