高次脳機能障害者におけるドライビングシミュレーターを用いた運転評価の有効性の検討

The Effectiveness of Driving Evaluation Using a Driving Simulator in Patients with Higher Brain Dysfunction

要旨

はじめに：ドライビングシミュレーターの結果から運転再開許可となった群と不許可になった群を比較し，机上の高次脳機能評価結果との関係について検討した．

対象：2014年4月1日〜2018年12月31日に当院入院中または外来にて運転再開支援を行った脳損傷者203人を対象とした．

方法：診療録および運転再開支援結果より，性別，年齢，各種高次脳機能検査結果について調査し，ドライビングシミュレーターにて運転再開可能と判断された群と運転再開困難と判断された群の比較を行った．

結果：運転再開許可群は165人，机上の高次脳機能評価を通過したもののドライビングシミュレーターの結果で運転再開不可群は34人，机上の高次脳機能評価も通過せずドライビングシミュレーターの結果でも運転不可群は4人であった．FIMについては，3群に有意差を認めなかった．高次脳機能評価結果は，WMS-Rの視覚性再生以外の項目で運転再開許可群は運転再開不許可群に比し有意に良好であった．

結論：ドライビングシミュレーターなどによる実際の自動車運転の評価は重要であると考えられた．運転再開にはさまざまな高次脳機能が必要であり，安全運転にはより高いレベルの能力が要求されることが示唆された．

Introduction：The relationship between the results of a driving simulator test and a paper-based evaluation of higher brain function were examined.

Subjects：The subjects of this study were 203 patients with brain injury who received support to resume driving during hospitalization or outpatient treatment at our hospital between April 1, 2014 and December 31, 2018.

Methods：The sex, age, and results of various higher brain function tests of the patients were investigated using medical records and the outcomes of the driving resumption support. The performance on a driving simulator test was compared between patients judged able to and those judged unable to resume driving.

Results：In the group of 165 patients who passed the paper-based evaluation of higher brain function, 34 were judged unable to resume driving based on a driving simulator test. In the group that did not pass the paper-based evaluation of higher brain function, 4 patients were also judged unable to resume driving based on a driving simulator test. The results of the higher brain function evaluation were significantly better in the group permitted to resume driving compared with the group not permitted to resume driving in all items except for the Visual Reproduction subtest of the Wechsler Memory Scale-Revised.

Conclusions：Evaluations of actual automobile driving using driving simulators or other means are important in assessing driving resumption. Driving requires the use of various higher brain functions and the results of this study suggest that a higher level of ability is required for safe driving.