Driving after Concussion: Is it Safe To Drive after Symptoms Resolve?
Schmidt JD, Hoffman NL, Ranchet M, Miller LS, Tomporowski PD, Akinwuntan AE, Devos H. Neurotruama. 2017; 34:1-8.
Take Home Message: Asymptomatic concussed patients exhibited poor vehicle control, which suggests that driving impairments persists after signs and symptoms resolve.
Concussion consensus statements address return to sport and return to school, but few address return to daily activities such as driving. Often patients are unaware that deficits, such as those with reaction time and executive function, persist even after concussive symptoms resolve. These impairments create an unsafe condition if a patient gets behind the wheel prior to full recovery. Unfortunately, there is little research examining when is it safe for a patient to drive after a concussion. Therefore, the authors compared the neuropsychological tests and driving performance using a desktop simulator between 14 participants with a concussion (~48 hours following symptoms resolution) and 14 matched (age, sex, years driving experience) healthy participants. The authors also explored the relationships between neuropsychological and driving performance. All participants were of driving age (~20 years old) and reported no more than 3 previous concussions. All participants completed a 20.5km driving simulation task involving daily-life traffic in urban, suburban, and rural areas and the authors calculated total number of crashes, tickets, and lane excursions. During the neuropsychological assessment participants completed the Trail Making Test, symbol digit modalities test, Rey Osterrieth Complex Figure, Mental Rotation Task, and CNS Vital Signs. Concussed participants committed more frequent lane excursions, and exhibited greater side-to-side deviation during the first and final curve compared with controls. There were no differences in the neuropsychological assessment between groups. Poorer performance on symbol digit modalities, Rey Osterrieth Complex Figure verbal memory, and motor speed were related with more frequent lane excursions in the concussed group, but not in the control group.
The authors of this study found that despite the participants reporting that they were asymptomatic the concussed participants exhibited poorer driving performance compared to their matched counterparts. Hence, impairments persisted beyond when the participant feels they are ready to fasten a seatbelt and drive. Specifically, the concussed participants had trouble staying centered in a lane. Though, the participants seemed to cross over to the shoulder instead of the center lane there is still an increased risk for vehicle accidents. Additionally, the authors reported that performing poorly on neuropsychological tests was related with poor driving performance. These results provide preliminary data that may guide future developments of a comprehensive driving evaluation following a concussion. This is an important study as it brings to light some of the activities of daily life that medical professionals often fail to specifically address in the return to play of an athlete. Return to driving needs to be considered since it is a complicated task, and we need to start addressing this in our concussion education and return to play plans.
Question for Discussion: Do you feel driving should be restricted following a concussion? If so, when should readiness to return to driving be determined?
Written by: Jane McDevitt, PhD
Reviewed by: Jeff Driban
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