after Concussion: Is it Safe To Drive after Symptoms Resolve?

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.

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

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.

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
by: Jeff Driban

Related Posts:

Inter-association Guidelines: Independent Medical Care for College Student-Athletes, Diagnosis and Management of Sport-Related Concussion, and Year-Round Football Practice Contact

Schmidt JD, Hoffman NL, Ranchet M, Miller LS, Tomporowski PD, Akinwuntan AE, & Devos H (2017). Driving after Concussion: Is It Safe To Drive after Symptoms Resolve? Journal of neurotrauma PMID: 27959745