Should an individual who recently suffered a concussion drive an automobile?
That’s a question one Spartanburg County physician hopes to answer with the findings of a new research project he is conducting in partnership with Clemson University’s International Center for Automotive Research (CU-ICAR).
“About one-tenth of the cases I see are concussions,” said Dr. John Lucas, head of the Spartanburg Regional Healthcare System (SRHS) Sports Medicine Institute at the Upward Sports Star Center at 9678 Warren H. Abernathy Highway in Spartanburg.
“The No. 1 killer of teenagers in the U.S. is motor vehicle crashes,” Lucas added. “We know the presentation [of concussions] can vary. We want to find out if there are deficits. When should they go back behind the wheel? There’s next to no literature out there about this.”
Lucas earned his medical degree from the University of Alabama at Birmingham’s School of Medicine. He completed his residency at the Wake Forest Family Medicine program in Winston-Salem, N.C.
As a third-year resident, he received one of four national research grants from the American Medical Society for Sports Medicine to investigate the effects of progesterone on concussions, according to SRHS.
Concussion research has attracted hundreds of millions of dollars during the past few years.
Efforts by the National Football League and other sports organizations to raise awareness for the short- and long-term impacts of brain injuries, particularly among young athletes, have sparked a range of studies.
Lucas said he noticed a gap in those investigations a few years ago.
“We have intensive protocols for when [student athletes] should return to play, or return to the classroom, but nothing for this,” he said. “They leave the office, get behind the wheel of a car, and drive home. … It all falls back on the shoulders of the physician. I still don’t have protocols to go off of. I’m hoping to at least raise the question.”
Lucas said his initial research led him to poll other physicians in his field. He found out that they too were uncertain about protocol for driving after a concussion.
In 2014, he was part of a group of Spartanburg Regional physicians that visited CU-ICAR’s facility in Greenville.
It was there he met Johnell Brooks, an associate professor who, for several years, has been working with an interdisciplinary team to develop driving simulators focused on rehabilitation in a clinical setting in partnership with Utah-based DriveSafety.
Lucas described his research to Brooks, and the two quickly realized they could help each other.
“We’re really excited to work with Dr. Lucas and Spartanburg Regional,” Brooks said. “We think this is going to provide invaluable research that may one day have a real-world impact, which is what CU-ICAR was created to do.”
Brooks and Lucas said CU-ICAR had already collected some data from a group of students at Christ Church Episcopal School in Greenville, CU-ICAR students, and other seniors in the community.
In 2016, the Spartanburg Regional Foundation awarded a $75,000 grant to support the purchase of two driving simulators.
One of the simulators was placed at Lucas’ office and the other at the SRHS Rehabilitation Services facility at the Thomas E. Hannah Family YMCA in downtown Spartanburg.
Travis Dewyea, rehabilitation manager for SRHS’s Rehabilitation Services, said the simulator at the YMCA will be used to study the impacts of a variety of factors, such as cerebrovascular disease, chemotherapy, neuropathy, and musculoskeletal injuries, on driving.
“CU-ICAR is one of the world leaders in automotive research,” Dewyea said. “We’re truly grateful to have them as a partner. … For us, one of the most exciting things about this is that it’s leveraging technology to help manage someone’s rehabilitation.”
Brooks said designers worked closely with Lucas and his team to tailor the driving simulators to meet their needs.
“It’s about finding tools that make sense in a clinical setting,” she said. “In a research setting, we have all of the time in the world. But in a clinical setting, Dr. Lucas has a limited amount of time to spend with a patient. Many of the tools and tasks we have with the simulators make sense for research like this. We went through and looked at how we could maximize [the simulators] for his research.”
Brooks said CU-ICAR has about 50 simulators “out in the world.” The focus of those simulators is to shed more light on the importance of mobility in the community.
“You have to establish that there is a problem and then provide lots of numbers,” Lucas said. “I think that what comes out of the Upstate during the next few years has the potential to have a global impact.”
Lucas said the research takes into consideration the age and driving experience of subjects. He said the optimal age range for his study is 15 to 22 years old, and all subjects must have their driver’s license or restricted driver’s license.
The simulator puts patients through a variety of basic tests that measure reaction times, response to visual cues, and other cognitive aspects of driving.
He has already put several patients through the simulator and said the results show promise for his research.
“The typical reaction time [for a healthy driver to put on the brakes] is about a half second,” Lucas said. “I had one girl that it took 2.5 seconds. And the scariest part about it was she said, ‘I thought I was doing good.’”
Brooks said a simulator will be placed at Dorman High School in Spartanburg during the spring semester, which will enable researchers to collect more data on the topic.
Lucas said he hopes his research will lead to protocol that helps doctors determine when a patient should return to driving after a concussion. He also doesn’t want to unnecessarily restrict anyone based on knee-jerk reactions that aren’t based on facts.
“As far as I know, we’re the first to do this,” Lucas said. “The sky is the limit.”