The current study examined specific aspects of usability of a newly developed VR driver rehabilitation (VR-DR) system. Measures of user feedback and user comfort were examined among 54 participants: 33 individuals with acquired brain injury (20 with traumatic brain injury and 13 with cerebral vascular accident) and 21 healthy controls. All participants were administered the VR-DR and completed the VR-DR User Feedback Questionnaire. To examine group differences, a one-way analysis of variance was performed, comparing the user feedback total score between the three groups. The results indicated that the two clinical populations (traumatic brain injury and cerebral vascular accident) varied from the nonclinical population (healthy controls). A standard multiple regression analysis revealed that age was the only significant participant factor that contributed to the differences in user feedback ratings. Finally, consistent across the three groups, a distinct relationship was found between the self-reported user rating and the onset of simulation sickness. The current findings indicate that individuals with traumatic brain injury and cerebral vascular accident provided less favorable user feedback ratings than healthy controls in the use of a new VR-DR system. This difference was not accounted for by differences in gender, education, or cognitive status and was only slightly accounted for by age. Delineating these various aspects of user feedback can assist in identifying potential confounds in VR-DR performance and help refine the application of the VR-DR for clinical decision making.

The use of virtual environments with head-mounted displays (HMDs) offers unique assets to the evaluation and therapy of clinical populations. However, research examining the effects of this technology on clinical populations is sparse. Understanding how wearers interact with the HMD is vital. Discomfort leads to altered use of the HMD that could confound performance measures; the very measures which might be used as tools for clinical decision making. The current study is a post-hoc analysis of the relationship between HMD use and HMD comfort. The analysis was conducted to examine contributing factors for a high incidence of simulator sickness observed in an HMD-based driving simulator. Pearson correlation analysis was used to evaluate objective and subjective measures of HMD performance and self-reported user comfort ratings. The results indicated weak correlations between these variables, indicating the complexity of quantifying user discomfort and HMD performance. Comparison of two case studies detailing user behavior in the virtual environment demonstrates that selected variables may not capture how individuals use the HMD. The validity and usefulness of the HMD-based virtual environments must be understood to fully reap the benefits of virtual reality (VR) in rehabilitation medicine. 591

The driving privilege is a critical component of independent living for individuals who have acquired a brain injury. To date, measures of driving capacity following neurological compromise remain limited to gross performance measures, such as subjective behind the wheel evaluations. The current study demonstrates the use of a virtual reality (VR) driving simulator to provide objective and precise measures of driving behavior not previously available for clinical assessment. Driving performance related to Stop Sign (SS) intersections are compared between adults with and without acquired brain injury. The findings indicate that new driving performance measures can be calculated with VR driving simulations, and that these measures may have further implications for examining driving capacity following neurological compromise.

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