The development of a simulator-based intervention to rehabilitate driving skills in people with acquired brain injury

Abstract

Purpose

With little to guide researchers and clinicians on how best to develop driving simulator interventions for ABI survivors, we aimed to describe the development process of a driving simulator intervention for ABI survivors in a rehabilitation setting.

Method

Intervention mapping methodology was used as a framework for the development of our driving simulator intervention. A qualitative synthesis of theoretical and empirical literature and stakeholder meetings enabled identification of factors affecting return to driving, selection of justifiable intervention goals, and identification of appropriate theoretically-informed techniques to facilitate change. These were used as a basis for design of intervention components and materials. A plan for delivery, implementation and evaluation was then developed.

Results

Determinants of driving ability, including knowledge and skills, self-efficacy, self-awareness of driving skills, awareness of risk and compensatory strategies were identified. These were applied to a range of tactical and operational driving behaviours to identify targets for change. Theoretically-informed strategies included direct instruction, repetition, graded difficulty, feedback and tailoring. An eight-session protocol, with a corresponding clinical manual, was developed for brain-injured patients who were referred for occupational therapy driving assessment. Protocols for recruitment, inclusion/exclusion criteria and facilitator training were developed, as well as a plan for evaluating feasibility, acceptability and effectiveness.

Conclusions

Intervention mapping was a useful approach to systematically develop an intervention tailored to the rehabilitation hospital context to complement existing driver rehabilitation. The feasibility and effectiveness of the simulator programme developed in this study will be evaluated in future studies.

IMPLICATIONS FOR REHABILITATION

• We were able to gather important information and provide recommendations to tailor a new driving simulator intervention for individuals with acquired brain injury within a rehabilitation service.

• The processes and methods described provide researchers and clinicians with a systematic process for the selection of driving simulator intervention components and delivery.

• This investigation can be used to educate rehabilitation clinicians and technicians to improve driver training and delivery to acquired brain injury survivors.

Keywords:

• Driving simulator
• rehabilitation
• brain injury
• intervention development
• intervention mapping

Acknowledgements

We would like to acknowledge the Driving Assessment and Rehabilitation team at Epworth Rehabilitation for their support and in-kind contribution to the intervention mapping project. The investigation team would sincerely like to thank the Royal Automobile Club of Victoria for supporting this research.

Disclosure statement

The authors declare that they have no potential conflict of interests.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This work is supported by the 2015 Royal Automobile Club of Victoria Sir Edmund Herring Memorial Scholarship awarded to the corresponding author.