Driving after Concussion: Examination of the Adolescent Brain and Behaviors

每年有超过190万儿童遭受脑震荡，其中青少年占50%以上 轻微创伤性脑损伤。脑震荡会影响认知、注意力、处理速度和 眼球运动功能。驾驶需要集成这些功能，包括视觉场景评估， 处理环境风险，快速连续地执行复杂的技能。青少年的年龄在 机动车碰撞(MVC)的最大风险，以及脑震荡造成的神经功能减退 安全驾驶不可或缺的能力。然而，对于返回驾驶，没有基于证据的指导方针 对青少年的建议，很少有研究专门研究过后重新开车 青少年脑震荡。R01的长期目标是为返回驾驶建立证据基础 对脑震荡后青少年的建议。目的是检查神经生理学。 恢复中的脑震荡青少年大脑在管理驾驶任务时的功能，协会 神经生理功能和临床评估之间的关系，以及脑震荡的性质 青少年参与危险驾驶行为。这款R01的创新之处包括1)发现，2) 翻译和3)真实世界的评估。在三个目标的协同下，这款R01将采用驾驶 模拟、fNIRS和瞳孔测量法作为神经生理功能的测量；检查 这些客观测量与临床评估相结合；并前瞻性地量化脑震荡患者的驾驶行为 对青少年进行客观的道路车内监测和生态瞬时监测 脑震荡症状。综合起来，这些目标构成了证据所需的基础科学-- 基于脑震荡后恢复驾驶的建议。在目标1(发现)的驾驶模拟研究中， 用功能近红外光谱和自主神经功能测量认知工作负荷 将对脑震荡和非脑震荡青少年的斜视测量进行比较。在目标2(翻译)中，我们 将客观神经生理学测量结果与采集到的模拟数据进行相关性分析 在临床环境中使用标准脑震荡评估的驾驶研究。在《目标3》(真实世界 评估)，实时、道路上、驾驶行为的数据将客观地衡量危险驾驶行为 脑震荡和非脑震荡青少年，同时整合脑震荡症状的EMA评估。 每个目标都有助于描述青少年脑震荡后恢复驾驶的重要方面，包括什么 发生在脑震荡的青少年大脑中，它如何与临床评估相关，以及脑震荡如何 青少年从事的驾驶行为将他们置于MVC的最大风险。在这三个目标中，这 创新的方法将为建立基于证据的临床指南提供科学基础， 可以促进健康和健康，因为青少年脑震荡后恢复驾驶。

Each year, over 1.9 million children sustain a concussion, with adolescents accounting for over 50% of these mild traumatic brain injuries. A concussion can affect cognition, concentration, processing speed, and oculomotor function. Driving requires integration of these functions, including assessment of the visual scene, processing of environmental risks, and execution of complex skills in rapid succession. Adolescents are at greatest risk for a motor vehicle crash (MVC), and the neurofunctional decrements due to concussion impairs abilities integral to safe driving. However, there are no evidence-based guidelines for return to drive recommendations for adolescents, and little research has specifically examined returning to drive after a concussion in adolescents. The long-term goal of this R01 is to establish the evidence base for return to drive recommendations for adolescents after a concussion. The objective is to examine the neurophysiological functioning of the recovering concussed adolescent brain while managing driving tasks, the association between their neurophysiological functioning and clinical assessments, and the nature of concussed adolescents' engagement in risky driving behaviors. The innovation of this R01 includes 1) Discovery, 2) Translation and 3) Real-world Assessment. In the synergy of the three Aims, this R01 will employ driving simulation, fNIRS, and pupillometry as measures of neurophysiological function; examine the association of these objective measures with clinical assessments; and prospectively quantify driving behaviors of concussed adolescents with objective on-road in-vehicle monitoring and ecological momentary monitoring (EMA) of concussion symptoms. Taken together these aims form the foundational science necessary for evidence- based recommendations for return to drive after concussion. In a driving simulated study for Aim 1 (Discovery), cognitive workload measured with functional near-infrared spectroscopy and autonomic function measured with pupillometry will be compared for concussed and non-concussed adolescents. In Aim 2 (Translation), we will evaluate the relationship between the objective measures of neurophysiology collected the simulated driving study with standard concussion assessments used in the clinical setting. In Aim 3 (Real-world Assessment), data on real-time, on-road, driving behaviors will objectively measure risky driving behaviors of concussed and non-concussed adolescents, while integrating EMA assessment of concussion symptoms. Each aim helps delineate important facets of returning to drive after concussion for adolescents, including what is happening in the concussed adolescent brain, how it relates to clinical assessments, and how concussed adolescents engage in driving behaviors that place them at most risk for an MVC. Across the three aims, this innovative approach will provide the scientific foundation to establish evidence-based clinical guidelines that can promote health and wellness as adolescents return to drive after concussion.