In-simulator training of driving abilities in a person with a traumatic brain injury

Aim: This study reports the case of a 23-year-old woman (MC) who sustained a severe traumatic brain injury in 2004. After her accident, her driving license was revoked. Despite recovering normal neuropsychological functions in the following years, MC was unable to renew her license, failing four on-road evaluations assessing her fitness to drive. Method: In hope of an eventual license renewal, MC went through an in-simulator training programme in the laboratory in 2009. The training programme aimed at improving features of MC's driving behaviour that were identified as being problematic in prior on-road evaluations. To do so, proper driving behaviour was reinforced via driving-specific feedback provided during the training sessions. Results: After 25 sessions in the simulator (over a period of 4 months), MC significantly improved various components of her driving. Notably, compared to early sessions, later ones were associated with a reduced cognitive load, less jerky speed profiles when stopping at intersections and better vehicle control and positioning. A 1-year retention test showed most of these improvements were consistent. Conclusions: The learning principles underlying well conducted simulator-based education programmes have a strong scientific basis. A simulator training programme like this one represents a promising avenue for driving rehabilitation. It allows individuals without a driving license to practice and improve their skills in a safe and realistic environment.

[1]  Dick de Waard,et al.  The measurement of drivers' mental workload , 1996 .

[2]  Donald L. Fisher,et al.  The Effect of Active Versus Passive Training Strategies on Improving Older Drivers’ Scanning in Intersections , 2009, Hum. Factors.

[3]  A. Scavarda,et al.  Muscles Testing and Function , 1984 .

[4]  N. Teasdale,et al.  Alternative Avenues in the Assessment of Driving Capacities in Older Drivers and Implications for Training , 2010 .

[5]  Normand Teasdale,et al.  Changing Lanes in a Simulator: Effects of Aging on the Control of the Vehicle and Visual Inspection of Mirrors and Blind Spot , 2011, Traffic injury prevention.

[6]  B. Johnstone,et al.  The clinical utility of the Rey Auditory-Verbal Learning Test in medical rehabilitation , 1994, Journal of Clinical Psychology in Medical Settings.

[7]  Elements of cognitive rehabilitation after right hemisphere stroke. , 1993, Neurologic clinics.

[8]  P A Hancock,et al.  Driver workload during differing driving maneuvers. , 1990, Accident; analysis and prevention.

[9]  Barbara J. Knowlton,et al.  Neural substrates of motor memory consolidation depend on practice structure , 2010, Nature Neuroscience.

[10]  H Alm,et al.  Changes in driver behaviour as a function of handsfree mobile phones--a simulator study. , 1994, Accident; analysis and prevention.

[11]  J. P. Miller,et al.  Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial. , 2006, JAMA.

[12]  Maria T. Schultheis,et al.  Driving, aging, and traumatic brain injury: Integrating findings from the literature. , 2008 .

[13]  J A Michon.  Dealing with danger , 1979 .

[14]  Normand Teasdale,et al.  Mental workload when driving in a simulator: effects of age and driving complexity. , 2009, Accident; analysis and prevention.

[15]  Normand Teasdale,et al.  Attentional demands while driving in a simulator: effects of driving straights on open roads , approaching intersections and doubling maneuvers , 2004 .

[16]  A. Lundqvist,et al.  Driving after brain injury: Self-awareness and coping at the tactical level of control , 2007, Brain injury.

[17]  Janine G. Walker,et al.  Cognitive, sensory and physical factors enabling driving safety in older adults. , 2005, Clinical psychology review.

[18]  Walter Schneider,et al.  Controlled and automatic human information processing: II. Perceptual learning, automatic attending and a general theory. , 1977 .

[19]  Timothy D. Lee,et al.  Motor Control and Learning: A Behavioral Emphasis , 1982 .