Driving simulation in the clinical setting: utility for testing and treatment

Driving simulation has the potential to be useful in the clinical setting for testing and treating impairments of visual perception, cognitive functioning and driver safety across a wide variety of conditions and age ranges. It also may be used alone, or adjunctively with pharmacologic intervention, as a treatment to improve visual (e.g. visual search, kinetic depth), cognitive (e.g. attention, situational awareness, learning) and driving skills (avoidance of hazardous situations and conditions). Driving simulation offers the advantages of testing performance, rather than function alone, because it integrates perceptual input, cognitive processing and behavioral output into a single dynamic, feed-forward and feed-back iterative loop. It can reveal impaired performance when visual acuity is good and cognitive impairment is mild. Validation, reliability and generalizability studies will need to be done before driving simulation is widely used in clinical settings. Future research is needed to develop open standards for driving simulation tests (e.g. attention, time to crash, car following, hazard avoidance) and to validate these tests against other tests of visual perception, cognition and learning, as well as, on-road driving performance (testing) and experience (driving habits, tickets, crashes). For testing and treatment, issues of practice effect and required levels of fidelity relative to visual perception and cognitive functioning (e.g. attention) will need further clarification. Ways of avoiding simulation sickness will also need to be addressed. Lastly, research is needed to develop diagnostic and treatment protocols to determine which battery (profile) of driving simulation capabilities is best suited for which conditions.