Driving Performance Deficits Despite Concussion Symptom Resolution: A Case Report

in International Journal of Athletic Therapy and Training
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Driving performance prior to concussion is not commonly available to help clinicians identify when deficits return to a preinjury status. This case report examines driving performance prior to and following concussion in a 20-year-old male college student. He initially volunteered as a control for a separate driving performance study. He sustained a concussion 18 months later, and was asked to complete the same driving tasks as previous testing once he was asymptomatic. Poor driving simulator performance and subtle cognitive deficits in complex attention and processing speed were evident despite being symptom-free. Our findings may be useful when considering readiness to drive postconcussion.

Hoffman and Schmidt are with the Department of Kinesiology, University of Georgia, Athens, GA. Devos is with the Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA; and with the University of Kansas Medical Center, Kansas City, KS. Megan N. Houston, PhD, ATC, Keller Army Community Hospital, is the report editor for this article.

Address author correspondence to Nicole L. Hoffman at nhoffman25@uga.edu.
  • 1.

    Broglio SP, Puetz TW. The effect of sport concussion on neurocognitive function, self-report symptoms and postural control: a meta-analysis. Sports Med. 2008;38(1):53–67. PubMed doi:10.2165/00007256-200838010-00005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2.

    McCrory P, Meeuwisse W, Dvorak J, et al. Consensus statement on concussion in sport-the 5th international conference on concussion in sport held in Berlin, October 2016. Br J Sports Med. 2017;51(11):838–847. PubMed doi:10.1136/bjsports-2017-097699

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 3.

    Baker A, Unsworth CA, Lannin NA. Fitness-to-drive after mild traumatic brain injury: mapping the time trajectory of recovery in the acute stages post injury. Accid Anal Prev. 2015;79:50–55. PubMed doi:10.1016/j.aap.2015.03.014

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Preece MH, Horswill MS, Geffen GM. Driving after concussion: the acute effect of mild traumatic brain injury on drivers’ hazard perception. Neuropsychology. 2010;24(4):493–503. PubMed doi:10.1037/a0018903

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Preece MH, Geffen GM, Horswill MS. Return-to-driving expectations following mild traumatic brain injury. Brain Inj. 2013;27(1):83–91. PubMed doi:10.3109/02699052.2012.722260

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    McCrea M, Barr WB, Guskiewicz K, et al. Standard regression-based methods for measuring recovery after sport-related concussion. J Int Neuropsychol Soc. 2005;11(1):58–69. PubMed doi:10.1017/S1355617705050083

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    McKay A, Liew C, Schönberger M, et al. Predictors of the on-road driving assessment after traumatic brain injury: comparing cognitive tests, injury factors, and demographics. J Head Trauma Rehabil. 2016;31(6):44. doi:10.1097/HTR.0000000000000209

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8.

    Baugh CM, Kroshus E, Stamm JM, et al. Clinical practices in collegiate concussion management. Am J Sports Med. 2016;44(6):1391–1399. PubMed doi:10.1177/0363546516635639

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    Kelly KC, Jordan EM, Joyner AB, et al. National Collegiate Athletic Association Division I Athletic Trainers’ concussion-management practice patterns. J Athl Train. 2014;49(5):665–673. doi:10.4085/1062-6050-49.3.25

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 10.

    Schmidt JD, Hoffman NL, Ranchet M, et al. Driving after concussion: is it safe to drive after symptoms resolve? J Neurotrauma. 2017;34:1571–1578. doi:10.1089/neu.2016.4668

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    McCrory P, Meeuwisse WH, Aubry M, et al. Consensus statement on concussion in sport: the 4th International Conference on Concussion in Sport held in Zurich, November 2012. J Am Coll Surg. 2013;216(5):e55–71. PubMed doi:10.1016/j.jamcollsurg.2013.02.020

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Gualtieri CT, Johnson LG. Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Arch Clin Neuropsychol. 2006;21(7):623–643. PubMed doi:10.1016/j.acn.2006.05.007

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Guskiewicz KM, Ross SE, Marshall SW. Postural stability and neuropsychological deficits after concussion in collegiate athletes. J Athl Train. 2001;36(3):263–273. PubMed

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    McCrea M, Kelly JP, Randolph C, et al. Standardized Assessment of Concussion (SAC): on-site mental status evaluation of the athlete. J Head Trauma Rehabil. 1998;13(2):27–35. doi:10.1097/00001199-199804000-00005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Schmidt JD, Register-Mihalik JK, Mihalik JP, et al. Identifying impairments after concussion: normative data versus individualized baselines. Med Sci Sports Exerc. 2012;44(9):1621–1628. PubMed doi:10.1249/MSS.0b013e318258a9fb

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 16.

    Kontos AP, Elbin RJ, Schatz P, et al. A revised factor structure for the post-concussion symptom scale: baseline and postconcussion factors. Am J Sports Med. 2012;40(10):2375–2384. PubMed doi:10.1177/0363546512455400

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Register-Mihalik JK, Guskiewicz KM, Mihalik JP, et al. Reliable change, sensitivity, and specificity of a multidimensional concussion assessment battery: implications for caution in clinical practice. J Head Trauma Rehabil. 2013;28(4):274–283. doi:10.1097/HTR.0b013e3182585d37

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Lange RT, Iverson GL, Zakrzewski MJ, et al. Interpreting the Trail Making Test following traumatic brain injury: comparison of traditional time scores and derived indices. J Clin Exp Neuropsychol. 2005;27(7):897–906. PubMed doi:10.1080/1380339049091290

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Smith A, Smith A. Symbol Digit Modalities Test. Los Angeles, CA: Western Psychological Services;1982.

  • 20.

    Meyers JE, Meyers KR, Meyers JE, et al. Rey Complex Figure Test and Recognition Trial. Bury St. Edmonds, UK: Thames Valley Test Company; 1995.

    • Search Google Scholar
    • Export Citation
  • 21.

    Cullen N, Krakowski A, Taggart C. Early neuropsychological tests as correlates of return to driving after traumatic brain injury. Brain Inj. 2014;28(1):38–43. PubMed doi:10.3109/02699052.2013.849005

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Devos H, Nieuwboer A, Vandenberghe W, et al. Validation of driving simulation to assess on-road performance in Huntington disease. Paper Presented at: Proceedings of the Seventh International Driving Symposium on Human Factors in Driver Assessment, Training, and Vehicle Design; 2013; Bolton Landing, NY.

    • Export Citation
  • 23.

    Sheridan LK, Fitzgerald HE, Adams KM, et al. Normative Symbol Digit Modalities Test performance in a community-based sample. Arch Clin Neuropsychol. 2006;21(1):23–28. PubMed doi:10.1016/j.acn.2005.07.003

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Tombaugh TN. Trail Making Test A and B: normative data stratified by age and education. Arch Clin Neuropsychol. 2004;19(2):203–214. PubMed doi:10.1016/S0887-6177(03)00039-8

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Hinton-Bayre AD, Geffen GM, Geffen LB, et al. Concussion in contact sports: reliable change indices of impairment and recovery. J Clin Exp Neuropsychol. 1999;21(1):70–86. PubMed doi:10.1076/jcen.21.1.70.945

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Moore RD, Hillman CH, Broglio SP. The persistent influence of concussive injuries on cognitive control and neuroelectric function. J Athl Train. 2014;49(1):24–35. PubMed doi:10.4085/1062-6050-49.1.01

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Ball K, Edwards JD, Ross LA. The impact of speed of processing training on cognitive and everyday functions. J Gerontol B Psychol Sci Soc Sci. 2007;62(special issue 1):19–31. PubMed

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Edwards JD, Myers C, Ross LA, et al. The longitudinal impact of cognitive speed of processing training on driving mobility. Gerontologist. 2009;49(4):485–494. PubMed doi:10.1093/geront/gnp042

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Ross LA, Edwards JD, O’Connor ML, et al. The transfer of cognitive speed of processing training to older adults’ driving mobility across 5 years. J Gerontol B Psychol Sci Soc Sci. 2016;71(1):87–97. PubMed doi:10.1093/geronb/gbv022

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Brouwer W, Busscher RB, Davidse RJ, et al. Traumatic brain injury: Tests in a driving simulator as part of the neuropsychological assessment of fitness to drive. In: Fisher DL, Rizzo M, Caird J, Lee J, eds. Handbook of Driving Simulation for Engineering, Medicine, and Psychology. Boca Raton, FL: CRC Press; 2011:1–11.

    • Search Google Scholar
    • Export Citation
  • 31.

    Marcotte TD, Rosenthal TJ, Roberts E, et al. The contribution of cognition and spasticity to driving performance in multiple sclerosis. Arch Phys Med Rehabil. 2008;89(9):1753–1758. PubMed doi:10.1016/j.apmr.2007.12.049

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32.

    Uc EY, Rizzo M, Anderson SW, et al. Driving under low-contrast visibility conditions in Parkinson disease. Neurology. 2009;73(14):1103–1110. PubMed doi:10.1212/WNL.0b013e3181bacf6e

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Oka N, Yoshino K, Yamamoto K, et al. Greater activity in the frontal cortex on left curves: a vector-based fNIRS study of left and right curve driving. PLoS ONE. 2015;10(5):e0127594. doi:10.1371/journal.pone.0127594

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34.

    Groom MJ, van Loon E, Daley D, et al. Driving behaviour in adults with attention deficit/hyperactivity disorder. BMC Psychiatry. 2015;15(1):1–11. doi:10.1186/s12888-015-0566-y

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Yeates KO, Armstrong K, Janusz J, et al. Long-term attention problems in children with traumatic brain injury. J Am Acad Child Adolesc Psychiatry. 2005;44(6):574–584. PubMed doi:10.1097/01.chi.0000159947.50523.64

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36.

    Verster JC, Roth T. Excursions out-of-lane versus standard deviation of lateral position as outcome measure of the on-the-road driving test. Hum Psychopharmacol. 2014;29(4):322–329. PubMed doi:10.1002/hup.2406

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
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