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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

A Journal on Physical Medicine and Rehabilitation after Pathological Events


Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
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  RETURN TO DRIVING AFTER TRAUMATIC BRAIN INJURY - Part I
Guest Editors: Bruno Gradenigo, Anna Mazzucchi


Europa Medicophysica 2001 December;37(4):283-9

language: English

Evaluation of driving simulation

Huchler S. 1,2, Jörg A. 1,2, Golz D. 1,2, Küst J. 1, Netz J. 2, Hömberg V. 2, Karbe H. 1

From the
1 Neu­ro­log­ical Reha­bil­i­ta­tion ­Center ­Godeshöhe
2 Neu­ro­log­ical ­Therapy ­Center, ­Düsseldorf, Germany


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Back­ground. The ­driving ­ability of ­patients ­today is ­extremely impor­tant, as is ­mobility in gen­eral. The eco­log­ical ­validity of the ­methods ­most ­widely ­used in neu­ro­log­ical reha­bil­i­ta­tion and neu­ro­psy­cho­log­ical ­tests is insuf­fi­cient. The ­driving sim­u­lator is a ­method ­based on vir­tual ­reality ­which ­closely resem­bles sit­u­a­tions in ­everyday ­life. The aim of ­this ­study was to ­examine ­whether the ­driving sim­u­lator is a suit­able diag­nostic and ther­a­peutic ­device.
­Methods. The ­study exam­ined ­patients ­with cere­bral ­damage, ­caused by ­either cereb­ro­vas­cular epi­sodes or ­traumatic brain injury, and ­also ­resulting ­from the ­removal of ­brain ­tumours. The ­patients ­were ­given ­driving les­sons ­using a sim­u­lator, fol­lowed by a stan­dard ­driving ­test ­again ­using the sim­u­lator, a prac­tical ­driving ­lesson and a prac­tical ­driving ­test. A neu­ro­psy­chol­o­gist was ­asked to eval­uate the ­test on the sim­u­lator ­using an obser­va­tion ­sheet. The prac­tical ­driving ­test was eval­u­ated sep­ar­ately by a neu­ro­psy­chol­o­gist and a ­driving ­instructor, ­using the ­same obser­va­tion ­sheet.
­Results. ­Patients ­tended to ­have a ­more pos­i­tive impres­sion of ­their ­tests ­than the ­observers, in par­tic­ular the prac­tical ­driving ­test. The assess­ments ­made by the neu­ro­psy­chol­o­gist and ­driving ­instructor ­were not con­sis­tent. The out­come, ­pass or ­fail, of the prac­tical ­test ­could be pre­dicted by the ­results of the sim­u­lator ­driving ­test, ­with an accu­racy of 84.8%. The ­results sug­gest ­that the ­patients’ ­self-assess­ment is inad­e­quate ­because ­they ­tend to over­es­ti­mate ­their ­driving com­pe­tence. ­Intense ­training ­focused on ­both ­driving ­skills and ­self-crit­ical ­capacity is essen­tial in neu­ro­log­ical ­patients. More­over, the ­study ­shows ­that the ­result of the prac­tical ­driving ­test can be pre­dicted by the sim­u­lator ­driving ­test if ­rated by an objec­tive ­observer, ­like a neu­ro­psy­chol­o­gist. ­Given ­that neu­ro­psy­cho­log­ical ­tests ­often ­lack suf­fi­cient eco­log­ical ­validity, the sim­u­lator ­becomes a ­useful addi­tional diag­nostic instru­ment.
Con­clu­sions. The sim­u­lator ­offers ­extremely inter­esting diag­nostic oppor­tu­nities and it is an instru­ment ­that ­will ­enhance the ther­a­peutic ­methods ­used for the reha­bil­i­ta­tion of ­patients ­with neu­ro­log­ical ­damage. Fur­ther ­research ­using ­this ­modern ­device ­must be encour­aged.

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