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EUROPEAN JOURNAL OF PHYSICAL AND REHABILITATION MEDICINE

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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

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

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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