Driving Simulation Methods for Assessing Post-Injury Driving Performance After Mild Traumatic Brain Injury: A Scoping Review.

Driving is a cognitively demanding task that involves the continuous integration of attention, executive control, visual processing, and motor coordination. Mild traumatic brain injury (mTBI) may disrupt these functions and affect driving performance during recovery. Driving simulation is increasingly used to examine post-mTBI driving performance, yet substantial heterogeneity exists in simulator platforms, task designs, and outcome selection. This scoping review characterized driving simulation methodologies used to assess post-mTBI driving performance and examined patterns of mTBI-related findings across reported outcomes. A systematic search of seven electronic databases identified 12 eligible publications between 2017 and 2026. Publications were synthesized by participant characteristics, time since injury, simulator platform, task demands, and outcomes. Across publications, mTBI-related findings were most frequently reported for vehicle control metrics, particularly lane position variability and speed regulation. mTBI-related differences were most often condition-specific, including differences during curves, hazard events, and manipulated cognitive load or dual-task conditions. Cognitive measures also demonstrated mTBI-related differences and associations to driving performance, particularly those assessing executive functioning and processing speed domains. Differences were observed across all post-injury intervals, including ≥ 15 days, with a small number of related publications reporting performance differences after symptom resolution. However, the predominantly cross-sectional evidence does not establish whether these differences persist over time within the same individuals. Findings suggest that driving simulation can provide a useful controlled method for examining functional driving performance following mTBI across varying road environments and task demands. Future work should prioritize standardizing simulator outcomes and validating simulator performance against on-road, naturalistic-driving, and crash-related outcomes.