We’ve heard a lot about traumatic brain injury (TBI) in the media in recent years.

Soldiers returned home from America’s most recent wars in Iraq and Afghanistan with lasting symptoms ¬that they could not understand. As we now know, many of these brave warriors were suffering from the long-term effects of exposure to roadside improvised explosive devices (IED) blasts.

But TBI didn’t only impact soldiers. It also impacted athletes.

The 2015 film “Concussion” earned actor Will Smith accolades for his cinematic depiction of Dr. Bennet Omalu – and also resurfaced discussions about sports-related brain injuries.

Blast-related and sports-related TBI research has increased awareness on the lasting effects of brain injury. Although families are finally getting long-awaited answers to their questions, even more questions remain about TBI rehabilitation.

The Long-Term Effects of TBI

Soldiers and athletes, like average Americans, place a high value on their independence. The debilitating symptoms caused by TBI steal much of that freedom.

The long list of side effects can range from acute symptoms in mild TBI cases (e.g., headache, difficulty thinking, memory problems, attention deficits, mood swings, frustration) to more lasting side effects.

Severe brain injury, which is associated with a loss of consciousness for more than 30 minutes, memory loss after the injury, or penetrating skull injury longer than 24 hours, can result in symptoms such as:

• Limited function of arms or legs.
• Abnormal speech or language.
• Loss of thinking ability.
• Emotional instability.

In severe cases, TBI can lead to coma or death.

TBI Diagnosis & Rehabilitation

The range of injuries and degree of recovery varies from person to person, making both diagnosis and rehabilitation considerably difficult.

Many people who suffer a mild TBI do not even seek medical attention and thus may not make the connection to lingering symptoms. Mild TBI accounts for 80% 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.
• 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 last effects of TBI, according to the Centers for Disease Control and Prevention.

The prevalence of TBI, and the varying recovery needs that depend on patient history and severity of the injury, make it difficult for practitioners to develop a rehabilitation plan.

Driving Rehabilitation for TBI Survivors

Regaining complete independence is of the utmost importance to many TBI survivors. 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 affect on a person’s ability to safely operate a vehicle. These include:

• Headache.
• Dizziness (vertigo).
• Poor balance.
• Forgetfulness.
• Slowed thinking.
• Impaired concentration.
• Decreased executive function.
• Fatigue.
• Irritability.
• Visual impairment.
• Sensitivity to light or noise.

Similar symptoms create limitations for individuals affected by other neurological issues, such as stroke, Alzheimer’s disease, multiple sclerosis, and dementia. (See our recent article on how driving rehabilitation helps stroke survivors regain independence.)

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.

TBI, however, can wreak havoc on the functions necessary to independently and safely drive. Symptoms can linger into the future or re-emerge after an initial injury is thought to have been resolved.

“People with TBI often lack insight into their deficits and, therefore, fail to accommodate for them, whether by restricting their driving or ceasing driving,” according to a 2009 paper published in The American Journal of Occupational Therapy. “Approximately 80% of TBI survivors return to driving, even though many have been told not to do so.”

This paper was an evidence-based literature review for driving assessments for TBI survivors and came to the following conclusions:

“TBI survivors frequently received advice about driving from family members, physicians, or nonphysician health care professionals, but more than half (63%) had not been professionally evaluated for driving competency,” the paper stated. “Many family members or caregivers believe assessing fitness to drive is the responsibility of physicians. Physicians, however, are generally not prepared to make such a determination because they lack specialized training in driving assessment and do not have the time to complete thorough assessments.”

This is Where Virtual Simulators Can Make the Difference

Utilizing a virtual simulator to safely identify driving fitness in TBI survivors can mean the difference between a lifetime of dependence or driving independence and the difference between safely and unsafely operating a motor vehicle.

The previously mentioned paper reviewed studies describing five approaches used in assessing fitness to drive:

1. Clinical Tests: Neuropsychological and Psychosocial Tests.
2. Simulator Testing.
3. Off-Road Screenings.
4. Self-Report, Significant Others, and Post-injury Disability Status.
5. Comprehensive Driving Evaluation.

While Comprehensive Driving Evaluations (which include a clinical assessment followed by closely-monitored on-road assessments) was identified as the “gold standard” in driving assessments, this tool remains controversial because of the lack of standardization amongst practitioners. This tool proved “expensive, not widely available, and possibly intimidating.”

Simulator testing, on the other hand, was found to provide benefits related to safety and cost in measuring driving performance. “One study has shown ecological validity between simulator testing and real-world driving performance for people with brain injury.”

The ability to predict on-the-road performance utilizing virtual driving simulators continues to be researched for survivors of brain injury.

DriveSafety’s clinical simulators have proven a safe and effective way for survivors to serve as active participants in their recovery in a comfortable environment. For those patients that may self-identify as fully capable of safely and independently driving, a virtual simulator can highlight key areas of concern or raise awareness of functions that need additional rehabilitation before a survivor is fit to drive.

Virtual driving simulators offer an objective look at driving fitness and provide survivors with consistent practice and repeatable steps to perfect a skill and establish confidence.

Summary

As further research is conducted on rehabilitation standards for TBI survivors, driving fitness should be a central part of the overall recovery plan and return to normal activities of daily life.

Trained technicians are available to work with practitioners and survivors to incorporate virtual driving simulation into the driving rehabilitation process with DriveSafety.
The use of simulators as a strategic tool is a reliable method to evaluate TBI survivors.

Certified specialists can answer any questions about whether virtual driving simulators are a viable option. Contact us today to learn more.