Driving Simulator Training to Improve Driving Performance in Veteran Stroke Patients

About This Grant

Chronic disability following stroke is a significant problem for Veterans that affects a variety of daily activities. The impact of stroke on driving ability is of particular importance as it affects Veterans’ functional independence, quality of life, and ability to reintegrate into the community and social activities. Moreover, due to improvements in the timely detection and treatment of strokes, the VA is experiencing increasing numbers of Veteran stroke survivors. This coupled with the fact that the implementation of fully autonomous driving vehicles is still decades away, highlights a current gap in our healthcare system, namely that brain-injured Veterans are not routinely assessed for deficits that can impact their fitness to drive, nor are they provided with opportunities to improve driving skills prior to returning to the road. Driving simulators offer a low-cost method for both assessing driving vulnerabilities and rehabilitating specific driving skills following strokes or other brain injuries. Simulated driving conveys the primary advantage of being able to assess and retrain impaired drivers without having to be on real roadways, which could pose a safety risk to both the driver and others. In addition, simulated driving assessments have been shown to correlate highly with on-road testing. In our prior Merit project, we further established that Veteran stroke patients with a wide range of deficits can successfully complete simulated driving assessments and that strokes involving either the left or right cerebral hemisphere frequently result in significant driving impairments compared to age-matched controls. The most typical errors made by stroke patients included lane deviations, collisions, poor speed management, and difficulties dividing attention between car dashboard controls and the external driving environment. These findings make it imperative that we harness available technology to help our Veterans safely regain their driving skills following brain injury. The current project will address this need by investigating the usefulness/benefits of an active driver training intervention in Veteran stroke patients. Specifically, we will use our existing high-fidelity, interactive driving simulator to assess driving performance and to implement an active driver training intervention that will target critical driving skills that are frequently impaired in Veteran stroke patients (namely, lane positioning, accident avoidance, speed management, and divided attention). Using a crossover design, all participants will partake in both an active driver training intervention as well as a control intervention, with order of intervention counterbalanced across participants. In this way, all participants will receive the active driver training which will focus on driving skills that are most frequently impaired after stroke. Pre- and post-intervention driving assessments will be used to measure degree of improvement followingeach intervention condition. The targeted enrollment is 100 Veterans with history of stroke. We hypothesize that the active driver training will significantly improve driving performance and reduce driving errors compared to the control intervention. In addition, we predict that performance on driver training modules related to specific skills will correlate with the degree of error rate reductions pertaining to those skills (e.g. lane deviations, speed exceedances, collisions). Finally, we will also examine the durability of intervention-related improvements by conducting a 6-month follow-up assessment and by relating training-related improvements to neuroanatomical regions. This proposed clinical trial will provide evidence-based data and recommendations to the VA healthcare system as to the utility of simulated driver training interventions as a means of improving driving after acquired brain injury. It is our goal that this study will also be a first step toward the development of more individualized driver training programs at VA that can be implemented in a safe and low-cost simulated driving environment to assist brain injured Veterans safely return to driving.