Nicole L. Hoffman

Driving after Concussion: Is It Safe To Drive after Symptoms Resolve?

Post-concussion impairments may result in unsafe driving performance, but little research is available to guide consensus on when concussed individuals should return to driving. The purpose of this study was to compare driving performance between individuals with and without a concussion and to explore relationships between neuropsychological and driving performance. Fourteen participants with concussion (age 20.2 ± 0.9 years old) and 14 non-concussed age- and driving experience-matched controls (age 20.4 ± 1.1 years old) completed a graded symptom checklist, a brief neuropsychological exam, and a 20.5 km driving simulation task. Participants with a concussion completed driving simulation within 48 h of becoming asymptomatic (15.9 ± 9.0 days post-concussion). One-way analyses of variance were used to compare total number of crashes, tickets, and lane excursions, as well as standard deviation of lateral position (SDLP) and standard deviation of speed. Pearsons correlations were conducted to explore the relationship between the neuropsychological and driving performance separately by group (α = 0.05). Participants with a concussion committed more frequent lane excursions (concussed 10.9 ± 4.5; controls 7.4 ± 2.4; p = 0.017) and exhibited greater SDLP, compared with controls, during the first curve (concussed 45.7 ± 21.3 cm, controls 27.4 ± 6.1 cm; p = 0.030) and final curve (concussed 39.6 ± 24.4 cm; controls 33.5 ± 21.3 cm; p = 0.036). Poorer performance on symbol digit modalities (r = -0.54), Rey Osterrieth Complex Figure (r = -0.53), verbal memory (r = -0.77), and motor speed (r = -0.54) were correlated with more frequent lane excursions in the concussed group, but not in the control group. Despite being asymptomatic, concussed participants exhibited poorer vehicle control, especially when navigating curves. Driving impairments may persist beyond when individuals with a concussion have returned to driving. Our study provides preliminary guidance regarding which neuropsychological functions may best indicate driving impairment following concussion.

Influences of Mental Illness, Current Psychological State, and Concussion History on Baseline Concussion Assessment Performance:

Background: A student-athlete’s mental state, including history of trait anxiety and depression, or current psychological state may affect baseline concussion assessment performance. Purpose: (1) To determine if mental illness (anxiety, depression, anxiety with depression) influences baseline scores, (2) to determine if psychological state correlates with baseline performance, and (3) to determine if history of concussion affects Brief Symptom Inventory–18 (BSI-18) subscores of state anxiety, depression, and somatization. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A sample of 8652 collegiate student-athletes (54.5% males, 45.5% females) participated in the Concussion Assessment, Research and Education (CARE) Consortium. Baseline assessments included a demographic form, a symptom evaluation, Standardized Assessment of Concussion, Balance Error Scoring System, a psychological state assessment (BSI-18), and Immediate Post-concussion Assessment and Cognitive Test. Baseline scores were compared between individuals with a history of anxiety (n = 59), depression (n = 283), and anxiety with depression (n = 68) and individuals without a history of those conditions (n = 8242). Spearman’s rho correlations were conducted to assess the relationship between baseline and psychological state subscores (anxiety, depression, somatization) (α = .05). Psychological state subscores were compared between individuals with a self-reported history of concussions (0, 1, 2, 3, 4+) using Kruskal-Wallis tests (α = .05). Results: Student-athletes with anxiety, depression, and anxiety with depression demonstrated higher scores in number of symptoms reported (anxiety, 4.3 ± 4.2; depression, 5.2 ± 4.8; anxiety with depression, 5.4 ± 3.9; no anxiety/depression, 2.5 ± 3.4), symptom severity (anxiety, 8.1 ± 9.8; depression, 10.4 ± 12.4; anxiety with depression, 12.4 ± 10.7; no anxiety/depression, 4.1 ± 6.9), and psychological distress in state anxiety (anxiety, 3.7 ± 4.7; depression, 2.5 ± 3.6; anxiety with depression, 3.8 ± 4.2; no anxiety/depression, 0.8 ± 1.8), depression (anxiety, 2.4 ± 4.0; depression, 3.2 ± 4.5; anxiety with depression, 3.8 ± 4.8; no anxiety/depression, 0.8 ± 1.8), and somatization (anxiety, 2.3 ± 2.9; depression, 1.8 ± 2.8; anxiety with depression, 2.2 ± 2.4; no anxiety/depression, 0.9 ± 1.7). A moderate positive relationship existed between all BSI-18 subscores and total symptom number (n = 8377; anxiety: rs = 0.43, P < .001; depression: rs = 0.42, P < .001; somatization: rs = 0.45, P < .001), as well as total symptom severity (anxiety: rs = 0.43, P < .001; depression: rs = 0.41, P < .001; somatization: rs = 0.45, P < .001). Anxiety, depression, and somatization subscores were greater among student-athletes that self-reported more concussions. Conclusion: Clinicians should be cognizant that student-athletes with a history of trait anxiety, depression, and anxiety with depression may report higher symptom score and severity at baseline. Individuals with extensive concussion history may experience greater state anxiety, depression, and somatization.