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Indexed/Abstracted in: CINAHL, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 2,063
Online ISSN 1973-9095
RETURN TO DRIVING AFTER TRAUMATIC BRAIN INJURY - Part I
Guest Editors: Bruno Gradenigo, Anna Mazzucchi
Huchler S. 1,2, Jörg A. 1,2, Golz D. 1,2, Küst J. 1, Netz J. 2, Hömberg V. 2, Karbe H. 1
1 Neurological Rehabilitation Center Godeshöhe
2 Neurological Therapy Center, Düsseldorf, Germany
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.