State-of-the-art applications of driving simulators in neurorehabilitation: A scoping review

Objective This scoping review evaluates the current use of driving simulators in neurorehabilitation, focusing on diagnostic assessment and therapeutic training in neurological populations. Data Sources We searched nine major databases for studies published through September 2025, using broad terms related to simulated driving and neurorehabilitation. Review Methods Following PRISMA-ScR guidelines, we used ASReview software with active learning to identify relevant studies. Articles were grouped into diagnostic, therapeutic, review, and special interest categories, with data charted manually by two reviewers. Results Of 224 included articles, 124 addressed diagnostic use and 25 examined therapeutic interventions. Simulated driving was often evaluated for its predictive value in determining fitness-to-drive. Combined with neuropsychological tests, simulator outcomes reliably identified key cognitive predictors such as attention and executive function. Twenty-eight studies included on-road driving comparisons, supporting simulator validity. Simulator-based interventions showed benefits for patients with stroke, traumatic brain injury, or Parkinson's disease, particularly for improving tactical driving skills and awareness. Benefits were more pronounced in individuals with mild to moderate impairments. Simulators were generally well-accepted across patient populations. Conclusion Despite the heterogeneity of the literature, there is evidence to support the use of driving simulators as a promising tool for evaluating and improving fitness to drive in neurorehabilitation.