Concussion And Driving: Key Factors Associated With Post-concussion Driving

Current post-concussion driving assessments are restricted to laboratory settings, limiting their practical application in clinical settings. There is a need for tools that enable clinicians to make recommendations on return to driving. PURPOSE: To determine the association between clinical assessments and simulated driving performance in college students within a week of concussion. METHODS: Forty-three college students within a week of concussion (19.5 ± 1.4 years, Female: 60.5%) and 46 controls (19.5 ± 1.5 years, Female: 76.1%) participated in the study. Clinical outcome measures included: dual-task (DT) tandem gait completion time and DT cost, Vestibular Ocular Motor Screening (VOMS) symptom change score for each test, and total symptom severity. Driving simulator outcomes included number of collisions, speed exceedances, stop signs missed, centerline crossings, and road edge excursions. Within each of the 11 drive segments, we collected standard deviation of speed and lane position. Separate generalized linear mixed effects regression models for each assessment and driving outcome were conducted using a negative binomial outcome distribution. This abstract focuses on interaction effects. A significant interaction indicates the relationship between clinical assessment and driving outcome differs across groups. RESULTS: Slower DT tandem gait associated with greater speed variability while navigating around incoming vehicle in concussion group (B: -0.37, p = .009). Greater DT cost associated with more frequent road edge excursions (B: 0.01, p < .001) and greater speed variability during the residential left curve (B: 0.71, p = .009). Increased symptoms with smooth pursuits, horizontal saccades, vertical saccades, and horizontal vestibular/ocular reflex were associated with lower speed variability during navigating around car crash (p < .050). Higher smooth pursuit symptom provocation was associated with lower speed variability in the crosswalk (B: -0.35, p < .001). CONCLUSIONS: DT tandem gait might be useful when assessing post-concussion driving ability. Contrary to hypothesis, better VOMS outcomes were associated with worse driving outcomes, indicating that individuals experiencing vestibular or oculomotor symptoms may adopt more cautious driving strategies. Supported by: Research reported in this abstract was supported by Andee’s Army Foundation and the National Center for Advancing Translational Sciences of The National Institutes of Health under Award Number UL1TR002378. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.