Examining the relationship of cognitive impairment and driving following concussi

描述（由申请人提供）：脑震荡，有时被称为轻度创伤性脑损伤，是一个重大的公共卫生问题，在这个国家。患病率估计差异很大，从每年30万例运动相关脑震荡（CDC早期估计）到每年超过200万例运动和娱乐相关脑震荡（修订后的CDC估计）。在医学上，有各种各样的程序来评估脑震荡。尽管如此，研究一直记录了脑震荡导致的认知障碍的存在。研究结果可靠地表明，认知过程，包括注意力，信息处理速度和工作记忆都可能受损。值得注意的是，这些相同的认知领域已被确定为与其他临床人群的驾驶能力相关，但尚未研究脑震荡后认知障碍对驾驶的影响。本建议的总体目标是启动一个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，新的方法来评估驾驶能力的人与神经妥协。VR模拟允许呈现交互式的“真实的世界”驾驶场景，可用于以安全但具有挑战性的方式客观评估驾驶能力。目前的研究将使用VR驾驶模拟器来检查患有持续脑震荡的个人的驾驶相关技能。具体来说，50名被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，第二次VR驾驶评估将在个人获得医疗许可后48小时进行，以恢复日常活动。具体目标是：1）定义由脑震荡引起的认知障碍与由VR驾驶模拟器测量的驾驶技能之间的关系，2）比较认知和功能（即，驾驶）在脑震荡开始时（48小时内）和脑震荡后（体检合格后48小时）的表现。最后，一个探索性的目的是通过评估不同脑震荡严重程度（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是有据可查的，但其对驾驶能力的影响尚未得到研究。了解这一点可以帮助临床医生提出明确的临床建议，并可能最大限度地减少这一人群中驾驶受损的风险。

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.