Neurocognitive Driving Rehabilitation in Virtual Environments (NeuroDRIVE): A pilot clinical trial for chronic traumatic brain injury.

The study was a pilot with a small number of participants, 11 in the NeuroDRIVE group and 6 in the wait-list group completing most procedures, so it cannot establish whether the treatment works. Drop-out was high, reported as 35% to 40%, and some withdrawals were due to VR simulation sickness. VR sickness caused 12.9% of participants to be withdrawn at the assessment stage and 11.8% of those remaining to be withdrawn during the intervention stage. The NeuroDRIVE package combined cognitive driving scenarios, composite driving practice, an open-ended race-track course, and examiner plus automated feedback, so this study cannot identify which component produced the cognitive changes. The wait-list group had higher estimated preinjury intellectual functioning than the NeuroDRIVE group, which may have affected the comparison. The NeuroDRIVE group already had average VR driving performance before treatment, so the study may not have captured room for improvement in driving. The comparison was against a wait list, not another active treatment, so the study cannot show NeuroDRIVE is better than other rehabilitation approaches. The number of participants analysed varied across outcome measures. MRI measurements were collected but their results are not reported in this paper.

The authors report no conflicts of interest in the conduct of this research.

Do not conclude that NeuroDRIVE improves driving after chronic TBI. The VR tactical and VR operational composite scores did not differ significantly between groups, and NeuroDRIVE combined cognitive driving scenarios, composite driving practice, an open-ended race-track course, and examiner plus automated feedback, so no single component can be credited for the cognitive changes.