Training driving ability in a traumatic brain-injured individual using a driving simulator: a case report

International Medical Case Reports Journal Dovepress open access to scientific and medical research ORIGINAL International Medical Case Reports Journal downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Open Access Full Text Article RESEARCH Training driving ability in a traumatic brain-injured individual using a driving simulator: a case report This article was published in the following Dove Press journal: International Medical Case Reports Journal 10 February 2017 Number of times this article has been viewed Sarah Imhoff 1,2 Martin Lavallière 3,4 Mathieu GermainRobitaille 5 Normand Teasdale 5–7 Philippe Fait 1,2,8 1 Department of Human Kinetics, 2Research Group on Neuromusculoskeletal Dysfunctions (GRAN), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada; 3Massachusetts Institute of Technology AgeLab, Cambridge, MA, USA; 4Department of Health Sciences, Program of Kinesiology, Université du Québec à Chicoutimi, Chicoutimi, 5 Faculté de Médecine, Département de Kinésiologie, 6Groupe de recherche en analyse du mouvement et ergonomie, Université Laval, 7CHU de Québec – Université Laval, Centre d’excellence sur le vieillissement de Québec, 8Research Center in Neuropsychology and Cognition (CERNEC), Montréal, QC, Canada Background: Traumatic brain injury (TBI) causes functional deficits that may significantly interfere with numerous activities of daily living such as driving. We report the case of a 20-yearold woman having lost her driver’s license after sustaining a moderate TBI. Objective: We aimed to evaluate the effectiveness of an in-simulator training program with automated feedback on driving performance in a TBI individual. Methods: The participant underwent an initial and a final in-simulator driving assessment and 11 in-simulator training sessions with driving-specific automated feedbacks. Driving performance (simulation duration, speed regulation and lateral positioning) was measured in the driving simulator. Results: Speeding duration decreased during training sessions from 1.50 ± 0.80 min (4.16 ± 2.22%) to 0.45 ± 0.15 min (0.44 ± 0.42%) but returned to initial duration after removal of feedbacks for the final assessment. Proper lateral positioning improved with training and was maintained at the final assessment. Time spent in an incorrect lateral position decreased from 18.85 min (53.61%) in the initial assessment to 1.51 min (4.64%) on the final assessment. Conclusion: Driving simulators represent an interesting therapeutic avenue. Considerable research efforts are needed to confirm the effectiveness of this method for driving rehabilitation of individuals who have sustained a TBI. Keywords: traumatic brain injury, rehabilitation, driving, simulator, assessment Introduction Traumatic brain injury (TBI) causes functional deficits that may significantly interfere with numerous activities of daily living (ADL) such as driving,1–4 which is a strong symbol of autonomy.5,6 Since driving requires operational (basic driving skills such as lateral positioning and speed control), tactical (judgment and anticipation) and strategic level of control (route planning),2,7,8 resuming driving following TBI may be challenging. Thus, only 40%–60% of moderate-to-severe TBI individuals return to driving.3,6,9–15 Case report Correspondence: Philippe Fait Université du Québec à Trois-Rivières, 3351 Boulevard des Forges, C.P. 500, Trois-Rivières, QC, G9A 5H7, Canada Tel +1 819 376 5011ext3768 Fax +1 819 376 5092 Email 41 submit your manuscript | www.dovepress.com International Medical Case Reports Journal 2017:10 41–45 Dovepress © 2017 Imhoff et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). http://dx.doi.org/10.2147/IMCRJ.S120918 Powered by TCPDF (www.tcpdf.org) We report the case of a 20-year-old woman who lost her driver’s license after sustaining a moderate TBI in May 2013 after a car crash involving a deer. When transferred to intensive care, she presented a score of 10/15 on the Glasgow Coma Scale (GCS).16 Following the accident, she presented a posttraumatic amnesia, diffuse axonal injury with several bilateral petechiae, hemorrhagic contusions mostly located in the right frontal lobe, an infringement of the third right cranial nerve, mild right optic neuropathy, left hemiparesis, balance impairment (43/56 on Berg Balance Scale (BBS),17 Dovepress International Medical Case Reports Journal downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Imhoff et al difficulty in performing ADL and cognitive impairments, including memory impairment, decline in audioverbal and visual attention, decline in the ability of abstraction, reduced organizational capacity, decreased visuospatial abilities, cognitive fatigability and apathy. At the time of the accident, the participant held a Learner’s License – Passenger Vehicle (Class 5) and had very little driving experience. Having failed her first attempt to the Probationary License – Passenger Vehicle (Class 5), she was planning to perform her second attempt to the Société de l’Assurance Automobile du Québec (SAAQ) on-road test as required by Quebec’s provincial legislation. In order to regain her Learner’s License – Passenger Vehicle (Class 5), she had to obtain an evaluation certifying her functional capacity for driving. She underwent an in-clinic assessment, which revealed mild posttraumatic cognitive impairments (i.e., cognitive fatigability that interferes with the sustained attention span and vigilance weakness that generates a slow reaction time when stimuli appear slowly); sufficient muscle strength, range of motion and coordination; proper reaction time; sufficient overall perceptual-cognitive functions for driving and sufficient behavior. Following this assessment, she received a 10-hour on-road driving training with a driving instructor and a 3-hour in-simulator-specific road rules learning with a driving instructor. Driving ability of the posttrauma subject was assessed during an on-road evaluation conducted by an occupational therapist in May 2014 at the Quebec City Rehabilitation Institute (IRDPQ). During this test, the participant did not demonstrate the operational and tactical skills required to drive safely. The difficulties observed during the road test were consistent with cognitive sequelae observed in clinical setti (...truncated)