UGA Concussion Research Laboratory, Department of Kinesiology, University of Georgia, Athens, GA 30602, USA.
School of Kinesiology and Recreation, Illinois State University, Normal, IL 61790, USA.
J Sport Health Sci. 2021 Mar;10(2):145-153. doi: 10.1016/j.jshs.2020.09.005. Epub 2020 Sep 19.
Concussed patients have impaired reaction time (RT) and cognition following injury that may linger and impair driving performance. Limited research has used direct methods to assess driving-RT post-concussion. Our study compared driving RT during simulated scenarios between concussed and control individuals and examined driving-RT's relationship with traditional computerized neurocognitive testing (CNT) domains.
We employed a cross-sectional study among 14 concussed (15.9 ± 9.8 days post-concussion, mean ± SD) individuals and 14 healthy controls matched for age, sex, and driving experience. Participants completed a driving simulator and CNT (CNS Vital Signs) assessment within 48 h of symptom resolution. A driving-RT composite (ms) was derived from 3 simulated driving scenarios: stoplight (green to yellow), evasion (avoiding approaching vehicle), and pedestrian (person running in front of vehicle). The CNT domains included verbal and visual memory; CNT-RT (simple-, complex-, Stroop-RT individually); simple and complex attention; motor, psychomotor, and processing speed; executive function; and cognitive flexibility. Independent t tests and Hedge d effect sizes assessed driving-RT differences between groups, Pearson correlations (r) examined driving RT and CNT domain relationships among cohorts separately, and p values were controlled for false discovery rate via Benjamini-Hochberg procedures (α = 0.05).
Concussed participants demonstrated slower driving-RT composite scores than controls (mean difference = 292.86 ms; 95% confidence interval (95%CI): 70.18-515.54; p = 0.023; d = 0.992). Evasion-RT (p = 0.054; d = 0.806), pedestrian-RT (p = 0.258; d = 0.312), and stoplight-RT (p = 0.292; d = 0.585) outcomes were not statistically significant after false-discovery rate corrections but demonstrated medium to large effect sizes for concussed deficits. Among concussed individuals, driving-RT outcomes did not significantly correlate with CNT domains (r-range: -0.51 to 0.55; p > 0.05). No correlations existed between driving-RT outcomes and CNT domains among control participants either (r-range: -0.52 to 0.72; p > 0.05).
Slowed driving-RT composite scores and large effect sizes among concussed individuals when asymptomatic signify lingering impairment and raise driving-safety concerns. Driving-RT and CNT-RT measures correlated moderately but not statistically, which indicates that CNT-RT is not an optimal surrogate for driving RT.
脑震荡患者在受伤后会出现反应时间（RT）和认知能力受损，这些问题可能会持续存在并影响驾驶表现。有限的研究使用直接方法评估脑震荡后的驾驶 RT。我们的研究比较了脑震荡患者和对照组个体在模拟场景中的驾驶 RT，并研究了驾驶 RT 与传统计算机神经认知测试（CNT）领域的关系。
我们采用了一项横断面研究，共纳入 14 名脑震荡患者（脑震荡后 15.9±9.8 天，平均值±标准差）和 14 名年龄、性别和驾驶经验匹配的健康对照组。参与者在症状缓解后 48 小时内完成驾驶模拟器和 CNT（CNS 生命体征）评估。从 3 个模拟驾驶场景中得出驾驶 RT 综合得分：信号灯（从绿灯变为黄灯）、回避（避开接近的车辆）和行人（车辆前方奔跑的行人）。CNT 领域包括言语和视觉记忆；CNT-RT（简单、复杂、Stroop-RT 分别）；简单和复杂注意力；运动、心理运动和处理速度；执行功能；和认知灵活性。独立 t 检验和 Hedge d 效应量评估了两组之间的驾驶 RT 差异，Pearson 相关系数（r）分别评估了队列中驾驶 RT 和 CNT 领域之间的关系，p 值通过 Benjamini-Hochberg 程序（α=0.05）进行了假发现率校正。
与对照组相比，脑震荡组的驾驶 RT 综合得分较慢（平均差异=292.86 毫秒；95%置信区间（95%CI）：70.18-515.54；p=0.023；d=0.992）。回避-RT（p=0.054；d=0.806）、行人-RT（p=0.258；d=0.312）和信号灯-RT（p=0.292；d=0.585）结果在进行假发现率校正后无统计学意义，但脑震荡组的缺陷仍具有中到大的效应量。在脑震荡患者中，驾驶 RT 结果与 CNT 领域无显著相关性（r 范围：-0.51 至 0.55；p>0.05）。对照组中也不存在驾驶 RT 结果与 CNT 领域之间的相关性（r 范围：-0.52 至 0.72；p>0.05）。
无症状的脑震荡患者的驾驶 RT 综合得分较慢且具有较大的效应量，这表明存在持续的损伤并引起驾驶安全问题。驾驶 RT 和 CNT-RT 测量中度相关但无统计学意义，这表明 CNT-RT 不是驾驶 RT 的理想替代指标。
