Driving after Concussion: Examination of the Adolescent Brain and Behaviors

脑震荡后驾驶：青少年大脑和行为的检查

• 批准号: 9886884
• 负责人: Catherine Claire McDonald
• 金额: $ 61.5万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-04-03 至 2024-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9886884
• 关键词: Accounting; Activities of Daily Living; Address; Adolescence; Adolescent; Adolescent Development; Affect; Automobile Driving; Autonomic Dysfunction; Brain; Brain Concussion; Cellular Phone; Cessation of life; Child; Clinical; Clinical assessments; Cognition; Cognitive; Complex; Data; Ecological momentary assessment; Enrollment; Environmental Risk Factor; Event; Foundations; G Forces; Gait; Goals; Guidelines; Health Promotion; Impairment; Measures; Methods; Monitor; Nature; Near-Infrared Spectroscopy; Neurocognitive; Neurocognitive Deficit; Patient Self-Report; Physical activity; Physiology; Plant Roots; Prefrontal Cortex; Public Health; Pupil light reflex; Recommendation; Research; Research Personnel; Risk; Risk Behaviors; Safety; Schools; Science; Speed; Symptoms; Technology; Testing; Time; Translating; Translations; Vehicle crash; Visual; Workload; brain behavior; clinical practice; cognitive function; cohort; concussive symptom; driving behavior; driving safety; evidence base; evidence based guidelines; hemodynamics; innovation; mild traumatic brain injury; multidisciplinary; neurophysiology; novel; oculomotor; peer; processing speed; prospective; response; simulation; skills; synergism

Each year, over 1.9 million children sustain a concussion, with adolescents accounting for over 50% of these mild traumatic brain injuries. A concussion can affect cognition, concentration, processing speed, and oculomotor function. Driving requires integration of these functions, including assessment of the visual scene, processing of environmental risks, and execution of complex skills in rapid succession. Adolescents are at greatest risk for a motor vehicle crash (MVC), and the neurofunctional decrements due to concussion impairs abilities integral to safe driving. However, there are no evidence-based guidelines for return to drive recommendations for adolescents, and little research has specifically examined returning to drive after a concussion in adolescents. The long-term goal of this R01 is to establish the evidence base for return to drive recommendations for adolescents after a concussion. The objective is to examine the neurophysiological functioning of the recovering concussed adolescent brain while managing driving tasks, the association between their neurophysiological functioning and clinical assessments, and the nature of concussed adolescents' engagement in risky driving behaviors. The innovation of this R01 includes 1) Discovery, 2) Translation and 3) Real-world Assessment. In the synergy of the three Aims, this R01 will employ driving simulation, fNIRS, and pupillometry as measures of neurophysiological function; examine the association of these objective measures with clinical assessments; and prospectively quantify driving behaviors of concussed adolescents with objective on-road in-vehicle monitoring and ecological momentary monitoring (EMA) of concussion symptoms. Taken together these aims form the foundational science necessary for evidence- based recommendations for return to drive after concussion. In a driving simulated study for Aim 1 (Discovery), cognitive workload measured with functional near-infrared spectroscopy and autonomic function measured with pupillometry will be compared for concussed and non-concussed adolescents. In Aim 2 (Translation), we will evaluate the relationship between the objective measures of neurophysiology collected the simulated driving study with standard concussion assessments used in the clinical setting. In Aim 3 (Real-world Assessment), data on real-time, on-road, driving behaviors will objectively measure risky driving behaviors of concussed and non-concussed adolescents, while integrating EMA assessment of concussion symptoms. Each aim helps delineate important facets of returning to drive after concussion for adolescents, including what is happening in the concussed adolescent brain, how it relates to clinical assessments, and how concussed adolescents engage in driving behaviors that place them at most risk for an MVC. Across the three aims, this innovative approach will provide the scientific foundation to establish evidence-based clinical guidelines that can promote health and wellness as adolescents return to drive after concussion.

每年有超过 190 万儿童遭受脑震荡，其中青少年占 50% 以上 轻度脑外伤。脑震荡会影响认知、注意力、处理速度和 动眼神经功能。驾驶需要整合这些功能，包括视觉场景的评估、 处理环境风险并快速连续执行复杂的技能。青少年正处于 机动车碰撞 (MVC) 的最大风险，以及脑震荡造成的神经功能减退 安全驾驶不可或缺的能力。然而，目前还没有关于重返驾驶的循证指南 对青少年的建议，并且很少有研究专门研究在 青少年脑震荡。 R01的长期目标是为重返驾驶建立证据基础 对脑震荡后青少年的建议。目的是检查神经生理学 恢复中的脑震荡青少年大脑在管理驾驶任务时的功能，该协会 他们的神经生理功能和临床评估以及脑震荡的性质之间 青少年参与危险驾驶行为。这款R01的创新包括1）Discovery，2） 翻译和 3) 现实世界评估。在这三个目标的协同作用下，这款R01将采用驾驶 模拟、fNIRS 和瞳孔测量作为神经生理功能的测量；检查关联性 这些客观措施与临床评估；并前瞻性地量化脑震荡患者的驾驶行为 具有客观道路车载监测和生态瞬时监测（EMA）的青少年 脑震荡症状。这些目标共同构成了证据所需的基础科学—— 基于脑震荡后恢复驾驶的建议。在目标 1（发现）的驾驶模拟研究中， 通过功能性近红外光谱测量认知负荷并测量自主神经功能 将使用瞳孔测量法对脑震荡和非脑震荡青少年进行比较。在目标 2（翻译）中，我们 将评估收集的模拟神经生理学客观测量之间的关系 驾驶研究与临床环境中使用的标准脑震荡评估。目标 3（现实世界 评估），实时的道路驾驶行为数据将客观地衡量危险驾驶行为 脑震荡和非脑震荡青少年，同时整合 EMA 对脑震荡症状的评估。 每个目标都有助于描绘青少年脑震荡后恢复驾驶的重要方面，包括哪些内容 脑震荡发生在青少年大脑中，它与临床评估有何关系，以及脑震荡是如何发生的 青少年的驾驶行为使他们面临 MVC 的风险最大。跨越这三个目标， 创新方法将为建立循证临床指南提供科学基础， 可以促进青少年在脑震荡后恢复驾驶时的健康。