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 轻度脑外伤脑震荡会影响认知、注意力、处理速度， 眼功能驾驶需要整合这些功能，包括评估视觉场景， 处理环境风险，并快速连续地执行复杂的技能。青少年面临 机动车碰撞（MVC）的最大风险，以及由于脑震荡损伤导致的神经功能减退 安全驾驶必备的能力。然而，没有证据为基础的指导方针， 青少年的建议，很少有研究专门研究后返回驾驶 青少年脑震荡本R 01的长期目标是为恢复驾驶建立证据基础 青少年脑震荡后的建议。目的是检查神经生理学 恢复脑震荡青少年大脑的功能，同时管理驾驶任务，协会 他们的神经生理功能和临床评估之间的关系，以及脑震荡的性质， 青少年的危险驾驶行为。这款R 01的创新包括1）发现，2） （3）真实世界的评价。在这三个目标的协同作用下，R 01将采用驱动 模拟，fNIRS和瞳孔测量作为神经生理功能的措施;检查 这些客观的措施与临床评估;并前瞻性量化脑震荡的驾驶行为 对青少年进行客观的道路车载监测和生态瞬时监测（EMA）， 脑震荡症状这些目标合在一起构成了证据所必需的基础科学- 基于脑震荡后恢复驾驶的建议。在Aim 1（发现）的驾驶模拟研究中， 用功能性近红外光谱和自主神经功能测量认知负荷 将比较脑震荡和非脑震荡青少年的瞳孔测量。在目标2（翻译）中，我们 将评估神经生理学的客观测量之间的关系， 驾驶研究与临床环境中使用的标准脑震荡评估。在Aim 3中（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的驾驶行为， 脑震荡和非脑震荡青少年，同时整合脑震荡症状的EMA评估。 每一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 发生在青少年脑震荡中，它如何与临床评估相关，以及脑震荡如何 青少年从事驾驶行为，使他们处于最危险的MVC。在这三个目标中， 创新的方法将为建立循证临床指南提供科学基础， 可以促进青少年在脑震荡后恢复驾驶时的健康和健康。

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.