By Stephen Trapp, PhD
Objective (non-advertorial) review of product(s) or technology platforms designed to improve the rehabilitation, long-term care, or the quality of life of persons with brain injury. Driving following traumatic brain injury (TBI) is a highly valued functional skill linked to a range of important life outcomes. In fact, driving difficulties post-TBI are highly predictive of community participation and over all well-being (Erler et al., 2018; Winter, Moriarty, & Short, 2017). Even with alternative modes of transportation, individuals interested in driving following brain injury report a diminished sense of community integration in social and occupational domains when driving is restricted (Rapport, Bryer, &
Hanks, 2008). These domains are well-established predictors of a number of health-related quality of life indices. Accordingly, there is a need to examine the range of rehabilitative opportunities to remediate driving skills.
Simulator technology is an encouraging direction for driving assessment and rehabilitation (Imhoff, Lavallière, Teasdale, & Fait, 2016). Simulators offer a direct functional approach to rehabilitation in which the targeted performance is addressed with practice of pertinent activities, like driving (Giles, 2010). Further, simulators offer opportunities for objective assessment and ecologically relevant content. This approach is growing in value as digital technology becomes increasingly more cost-effective and easily adoptable by a range of end-users.
A recent advance in driving simulation interventions is the NeuroDRIVE (Ettenhofer et al., 2019). NeuroDRIVE is an immersive virtual reality (VR) intervention using a driving simulator to assess driving skills while an individual practice driving in a virtual environment. Virtual environments are often digitally constructed contexts that provide an immersive experience for an individual. Additionally, a virtual environment provides a safe opportunity to practice driving skills before on-road testing.
Dr. Mark Ettenhofer, a neuropsychologist and Director of Research Operations at the Defense and Veterans Brain Injury Center (DVBIC) at the Naval Medical Center San Diego (NMCSD), leads the team that developed NeuroDRIVE. The NeuroDRIVE system was initially designed from the perspective of assessment. Dr. Ettenhofer explained that although “the immersive aspect of the simulator itself added to the engagement for the patient,” he wanted a VR system to validly quantify driving skills. Further, he sought to “offer real life cognitive challenges,” that could “expand (an individual’s) driving skill capacity and expand their bandwidth to respond to unexpected events.” The latter being critical for driving safety, as numerous unforeseen events can occur while driving and tax the cognitive responsivity of individuals with brain injuries.
The NeuroDRIVE intervention involves six 90-minute sessions including a review of performance progress and virtual driving practice. Virtual driving practice includes performing component cognitive skills pertinent to driving (e.g., dual processing, response inhibition, working memory), performing composite driving skills featuring customary driving practices (e.g., road hazards, yielding), and an unassisted race-track course. The simulation apparatus used is the General Simulation Driver Guidance System (MBFARR, LLC; Moncrief, Behensky, Harkins, & Fuller, 2015), which both provides
the virtual reality experience and objectively assesses performance. Like many rehabilitation technologies, NeuroDRIVE is a product of science and industry partnerships. In this case, Dr. Ettenhofer’s intervention was propelled by technology development by Rick Moncrief (MBFARR, LLC), a video game developer who pioneered arcade driving simulator games. “Being able to draw on video game experience, was helpful even though this was very different application,” commented Dr. Ettenhofer.
Pilot data indicate promising directions for this intervention with regard to cognitive performance (Ettenhofer et al., 2019). Although no changes were found in VR driving performance within the small sample, an intervention group demonstrated significant improvements in working memory and selective attention / visual search. Pilot data ready the project for larger demonstration research and wider implications for VR simulator use in driving rehabilitation.
Disclosure. The author has no association with the research or technology reviewed in this article. NeuroDRIVE development and testing was sponsored by the Center for Neuroscience and Regenerative Medicine with institutional support from the Uniformed Services University of the Health Sciences and the Defense and Veterans Brain Injury Center.
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Ettenhofer, M. L., Guise, B., Brandler, B., Bittner, K., Gimbel, E. C., Sarah, I., … & Royand Leighton Chan, M. J.Neurocognitive driving rehabilitation in virtual environments (NeuroDRIVE): A pilot clinical trial for chronic traumatic brain injury. NeuroRehabilitation, (Preprint), 1-14.
Giles, G. M. (2010). Cognitive versus functional approaches to rehabilitation after traumatic brain injury: commentary on a randomized controlled trial. American Journal of Occupational Therapy, 64(1), 182-185.
Imhoff, S., Lavallière, M., Teasdale, N., & Fait, P. (2016). Driving assessment and rehabilitation using a driving simulator in individuals with traumatic brain injury: A scoping review. NeuroRehabilitation, 39(2), 239-251.
Moncrief, R. L., Behensky, M. L., Harkins, T. G., & Fuller, B. A. (2015). Driving assessment and training method and apparatus. In: Google Patents.
Rapport, L. J., Bryer, R. C., & Hanks, R. A. (2008). Driving and community integration after traumatic brain injury. Archives of physical medicine and rehabilitation, 89(5), 922-930.
Winter, L., Moriarty, H. J., & Short, T. H. (2017). Self-reported driving difficulty in veterans with traumatic brain injury: its central role in psychological well-being. PM&R, 9(9), 901-909.
Stephen K. Trapp, PhD, is on faculty with the Division of Physical Medicine and Rehabilitation at the University of Utah. His research focuses on rehabilitation technology and crosscultural rehabilitation. These areas are examined in order to address shared rehabilitation needs across cultures with unifying technology.