Document Type

Critically Appraised Topic

Publication Date

2011

Clinical Scenario

One of the activities many TBI and stroke survivors wish to return to after receiving their injury is driving; however, their ability to drive has often been impaired. Safety has become the main issue in assessing driving ability as on-road tests may not always be feasible with this population due to cognitive impairments. Driving simulators are a safe way to assess and retrain driving skills in TBI and stroke survivors. In addition to safety, simulators are also able to provide a wide range of driving scenarios with varying traffic that an evaluator would not be able to control for on an on-road test.

Many of the TBI and stroke clients are physically fit to drive but lack the cognitive processing for safe driving. Because they are physically able to drive, many will continue to do so regardless of negative advice from professionals. A driving evaluation done with a simulator could add some weight to the clinician’s advice in discouraging unsafe clients from driving. On the other hand, if clients are so determined to drive contrary to clinical recommendations, a safe way to retrain and build their driving abilities is needed so that at least they have the skills to drive.

Clinical Question

How effective are driving simulator programs on driver assessment and retraining in comparison to other training programs and assessments with TBI/stroke survivors?

Clinical Bottom Line

In addition to being able to physically operate a car, driving also involves higher cognition and visual skills that may not be present after a person has received a stroke or TBI, thus making it a safety risk to assess stroke/TBI survivors who want to return to driving. These studies have shown that a driving simulator is a valid tool for evaluating and retraining clients with stroke or TBI.

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