Driving Simulator Performance After Acquired Brain Injury: A Comparative Study of Neuropsychological Predictors

Acquired brain injury (ABI) often results in cognitive and motor impairments that can compromise driving ability, an essential aspect of independence and social participation. This study utilized a custom-designed driving simulator to compare driving performance between individuals with ABI and controls, and to examine the relationship between cognitive performance and driving behavior within the control group. All participants completed a series of standardized driving simulation tasks of varying complexity. The control group also completed a neuropsychological battery that assessed attention, processing speed, executive function, and visuospatial abilities. Simulator data were analyzed using generalized linear mixed models to evaluate group differences and, for the control group, cognitive predictors of performance. Results showed that individuals with ABI performed comparably to controls in basic operational tasks but demonstrated reduced performance in cognitively demanding scenarios requiring sustained attention, visuospatial monitoring, and adaptive control, such as rural driving, vehicle following, and parking. In the control group, strong associations were found between simulator outcomes and measures of attention, processing speed, and spatial orientation. The findings support the use of simulator-based assessment as an objective tool sensitive to post-injury impairments and highlight its links to cognitive domains relevant to driving.