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

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.
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.
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.
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.

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.

目前尚无足够指南为研究人员与临床工作者提供针对获得性脑损伤（ABI, acquired brain injury）幸存者开发驾驶模拟器干预方案的最优路径，本研究旨在阐述康复场景下面向ABI幸存者的驾驶模拟器干预方案的开发流程。

本研究采用干预映射法（Intervention mapping）作为驾驶模拟器干预方案的开发框架。通过对理论与实证文献的定性综合分析，以及利益相关方会议，明确了影响幸存者重返驾驶的相关因素、选定合理的干预目标，并确定了具备理论支撑的行为改变技术。以上内容作为干预组件与配套材料的设计基础，随后进一步制定了干预方案的实施、落地与评估计划。

研究明确了驾驶能力的决定因素，包括知识与技能、自我效能感、驾驶技能自我认知、风险认知与代偿策略，并将其应用于一系列战术与操作驾驶行为，以确定行为改变的靶点。具备理论支撑的干预策略包括直接教学、重复练习、梯度难度设置、反馈与个性化定制。本研究为需接受作业治疗驾驶评估的脑损伤患者开发了包含8个疗程的干预方案及配套临床手册。同时制定了招募流程、纳入/排除标准与培训师培训方案，并搭建了可行性、可接受性与有效性的评估框架。

干预映射法是一套可靠的系统性开发框架，可针对康复医院场景定制适配现有驾驶康复服务的干预方案。本研究开发的模拟器干预方案的可行性与有效性，将在后续研究中进行验证。

【康复领域应用启示】
本研究收集了关键信息，并提出了针对康复服务中获得性脑损伤患者的个性化驾驶模拟器干预方案的优化建议。
本文所述流程与方法，为研究人员与临床工作者提供了一套系统化的驾驶模拟器干预组件选择与实施流程。
本研究成果可用于培训康复临床工作者与技术人员，以提升针对获得性脑损伤幸存者的驾驶培训与服务质量。

本研究收集了关键信息，并提出了针对康复服务中获得性脑损伤患者的个性化驾驶模拟器干预方案的优化建议。
本文所述流程与方法，为研究人员与临床工作者提供了一套系统化的驾驶模拟器干预组件选择与实施流程。
本研究成果可用于培训康复临床工作者与技术人员，以提升针对获得性脑损伤幸存者的驾驶培训与服务质量。