Longitudinal Assessment of Driving After Mild TBI in Teens

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PROJECT SUMMARY Returning to drive after an mild traumatic brain injury (mTBI) is an immediate goal for many individuals as they return to their daily activities. However, evidence-based guidance about when those with mTBI can safely return to drive is lacking. While an mTBI can lead to significant cognitive and functional impairments, little is known about how mTBI affects driving, especially among teen drivers who are at an increased risk of both mTBI and motor vehicle collisions compared to other age groups. The long-term goal of this research is to evaluate the effects of mTBI on teen's driving performance and inform clinical practice guidelines on when teens can safely return to drive post-mTBI and under what conditions. We will test the following specific aims: Aim1: Characterize the trajectory of driving from acutely post-injury to symptom resolution among teen drivers with mTBI compared to healthy controls. Aim 2: Examine the effect of cognitive load on driving performance from acutely post-injury to symptom resolution in teen drivers with mTBI compared to healthy controls. Aim 3: Examine the extent to which differences in driving performance between teen drivers with and without mTBI, especially under increased cognitive load, are mediated by acute post-injury neurocognitive function. We will enroll 200 teen drivers ages 16-19 years from two study sites to increase racial, geographic, and socioeconomic diversity. Participants will include 100 teen drivers (50 per site) with a physician-confirmed isolated mTBI and 100 (50 per site) healthy controls with no history of TBI matched for age, sex, driving experience, and athlete status. Primary driving outcomes will be assessed using two innovative, complementary approaches: 1) high-fidelity driving simulators will be used to assess driving performance under 4 experimental study conditions at up to 9 time points: acutely post-injury (≤ 96 hours of injury) and then weekly until symptom resolution or 8 weeks post-injury, whichever occurs first; 2) self-report surveys of real- world driving behaviors will be completed by all participants daily. This is the first study to longitudinally evaluate teen driving after mTBI from acutely post-injury to symptom resolution. The study will fill critical gaps by providing evidence on how increased cognitive load and underlying neurocognitive function post-injury may impact driving performance. Our results will have a significant impact on clinical practice and guidelines by providing evidence to inform the development of clinical return to drive guidelines, and to help healthcare providers make informed clinical recommendations regarding when a teen can safely return to drive after mTBI.