Examining the relationship of cognitive impairment and driving following concussi

描述(申请人提供)：脑震荡，有时被称为轻度创伤性脑损伤，在这个国家是一个重要的公共卫生问题。患病率估计差异很大，从每年30万次与运动有关的脑震荡(疾控中心早先的估计)到每年超过200万次与运动和娱乐有关的脑震荡(修订后的疾控中心当前估计)。在医学上，评估脑震荡的程序有很大的多样性。尽管如此，研究一直证明脑震荡导致认知障碍的存在。研究结果可靠地表明，包括注意力、信息处理速度和工作记忆在内的认知过程都会受到损害。值得注意的是，在其他临床人群中，这些相同的认知域已被确定为与驾驶能力相关，但认知障碍对脑震荡后驾驶的影响尚未得到检验。这项建议的首要目标是启动一种系统的方法来审查这一关系。 使用虚拟现实(VR)驾驶模拟是一种很有前途的新方法，可以用来评估有神经损害的人的驾驶能力。VR模拟允许以一种安全但具有挑战性的方式呈现可用于客观评估驾驶能力的交互式“真实世界”驾驶场景。目前的研究将使用VR驾驶模拟器来检查持续脑震荡的个人的驾驶相关技能。具体地说，50名经医学诊断为脑震荡的人将在脑震荡后48小时内接受认知、视觉和VR驾驶评估。此外，在体检合格后48小时，将进行第二次VR驾驶评估，以恢复日常活动。具体目标是：1)定义脑震荡引起的认知障碍与虚拟现实驾驶模拟器测量的驾驶技能之间的关系；2)比较脑震荡开始时(48小时内)和脑震荡后(医疗许可后48小时)的认知和功能(即驾驶)表现。最后，探索性目标是通过评估具有不同程度脑震荡严重程度(临床定义)的个体的表现来确定潜在的临床风险分层结果。 公共卫生相关性：脑震荡后认知障碍的存在已经有了很好的记录，但它对驾驶能力的影响还没有被研究。了解这一点可以帮助临床医生做出明确的临床建议，并潜在地将这一人群中驾驶受损的风险降至最低。

DESCRIPTION (provided by applicant): Concussions, sometimes referred to as mild traumatic brain injuries, are a significant public health issue in this country. Prevalence estimates vary widely, ranging from 300,000 sports related concussions annually (a CDC earlier estimate) to over 2 million sports and recreation related concussions annually (revised current CDC estimate). Medically, there is great variety in procedures for evaluating concussion. Despite this, research has consistently documented the presence of cognitive impairment resulting from concussion. Findings have reliably shown that cognitive processes, including attention, information processing speed and working memory can all be impaired. It is remarkable that these same cognitive domains have been identified as relevant to driving capacity in other clinical populations, yet the impact of cognitive impairment on driving following a concussion has not been examined. The overarching objective of this proposal is to initiate a systematic approach to examining this relationship. The use of virtual reality (VR) driving simulation is a promising, novel approach for evaluating driving capacity among persons with neurological compromise. VR simulation allows the presentation of interactive, "real world" driving scenarios that can be used to objectively assess driving capacity, in a safe but challenging manner. The current study will employ the use a VR driving simulator to examine driving related skills in individuals who have sustained concussions. Specifically, 50 individuals with medically diagnosed concussion will be administered a cognitive, visual and VR driving evaluation within 48 hours of an individual sustaining a concussion. In addition, a second VR driving evaluation will be conducted 48 hours after the individual has been medically cleared to return to everyday activities. The specific aims are: 1) define the relationship between cognitive impairment resulting from concussion and driving skills as measured by a VR driving simulator, 2) to compare both cognitive and functional (i.e., driving) performance at the initiation of a concussion (within 48 hours) and at post- concussion (48 hours after medical clearance). Finally, an exploratory aim is to identify potential clinical risk stratification findings by evaluating performance of individuals with varying levels of concussion severity (defined clinically). PUBLIC HEALTH RELEVANCE: The presence of cognitive impairment following concussion is well documented, but its impact on driving capacity has not been examined. Understanding this could help clinicians make clear clinical recommendations and potentially minimize risk of impaired driving in this population.