The signature injury of the wars in Iraq and Afghanistan is mild traumatic brain injury from roadside bomb blasts. Symptoms can significantly affect driving skills. Scripps Encinitas is one of the first hospitals in San Diego to assess if patients are still safe to be on the roads, by putting them in a driving simulator.
Farrell Sheffield, a driver rehab specialist at Scripps Health, flips a switch and a computer hums on. She turns to her patient, who’s sitting nervously at the controls in front of a small screen that shows a quiet suburban street.
“You’re going to follow the direction of the narrator to start the car and pull away from the curb,” says Sheffield.
The patient, David Tracey, grips the steering wheel.
“I hope I pass this!” he says.
The computer instructs him to start the engine and prepare to pull out.
Tracey is a civilian who suffered a stroke, but according to Dr. Michael Lobatz, head of the Neurology Center at Scripps Encinitas, more than 100 of the patients he’s treated are Marines referred from Camp Pendleton. He says the Center is the only comprehensive rehab facility for brain injury in North County. In 2006 the military turned to them to help treat active-duty service members suffering from TBI.
“We had a number of visits from high-ranking brass in the military,” Lobatz said, “like the chairman of the Joint Chiefs of Staff, various generals as well as admirals, who came through to really look and see what was going on in our facility.”
“Unfortunately,” he explained, “a lot of the Marines that come back from the conflicts get on their motorcycles or their cars and sometimes have accidents - and end up with other kinds of injuries, including brain injuries. We’re still seeing quite a few of those people.”
The Department of Defense acknowledges motor-vehicle crashes are one of the leading causes of death among combat veterans in the first years after they return home.
There are a variety of factors causing this. Service members suffering post traumatic stress disorder, or PTSD, are at risk. Plus, in some cases, they may be unaware how much even mild traumatic brain injury has affected their driving skills. And evasive driving techniques learned in war zones don’t translate well into suburban roads and freeways.
Back in the driving simulator, Farrell Sheffield is monitoring every move her patient makes. The computor instructs Tracey to turn at the next intersection, when the road is clear.
Each acceleration, brake and turn of the wheel is measured on the computer as he navigates his way through rural back roads. Sheffield says there are different programs and one of them is designed to monitor freeway driving.
When Tracey is done with the assessment he sits back in the chair with relief.
“I could see where somebody might think that they are ready to get back to driving, but not be ready,” he said. “Sometimes you think that everything’s there, but it might not be.”
“When I ask the question, ‘Well, are you safe to drive again?’ the patient is mostly, all the time going to say ‘yes’.” Lobatz said. “So the only way to really know if someone is really safe to drive or not after an injury is to put them in the car or the simulator with a occupational therapist who knows what they’re doing, and get them tested.”
The Naval Hospital in San Diego has recently acquired a driving simulator and has begun using it with patients in the past few months. It’s one of the two main hospitals in the region treating active-duty Marines and sailors. Lieutenant Tommy Neuens, an occupational therapist, says there is increasing evidence that risky driving among returning service members is a problem.
“There is a lot of research being done right now,” Neuens said, “trying to gauge exactly the percentage of incidents of driving recklessly returning from deployment, and so far the stats do show an increase in driving accidents.”
Neuens says so far the Naval Hospital is only using the simulator with service members suffering from mild TBI. He says there may be more people who would benefit from being tested, for example those with PTSD.
“The research is in progress for how we’re going to get these people to us sooner if they do not have trauma,” he said.
Meanwhile, the VA Medical Center in San Diego does not yet have a driving simulator among its assessment and treatment tools. That’s in spite of the fact that the VA treats veterans who have been discharged from active duty, and who are more likely to be suffering from significant symptoms that could affect their driving.
