1
|
Penna V, Dickerson A, Wu Q. Visual-Motor Processing Speed and Reaction Time Differences between Medically-At-Risk Drivers and Healthy Controls. Occup Ther Health Care 2023; 38:42-58. [PMID: 36786776 DOI: 10.1080/07380577.2023.2177790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/03/2023] [Indexed: 02/15/2023]
Abstract
This cross-sectional study compared visual-motor processing speed and reaction times between medically-at-risk drivers and normal controls to determine if the time in seconds distinguished between drivers who pass, fail, or need restrictions based on a road test. The medically-at-risk drivers' data (N = 35, 28-89 years) were collected as part of a comprehensive driving evaluation and coded by diagnosis (e.g., cognitive, neurological, medical) and driving outcome. The healthy control (N = 121, 21-79 years) data were collected in previous studies. The Vision Coach™ Full Field 60 task was used to collect reaction times in seconds between the two groups. Independent t-tests showed a significant difference (p < .001) in trial times between healthy controls and medically-at-risk adults. No significant difference (p = .141) was found between the three diagnoses groups. The resulting scores from the Vision Coach™ demonstrated a significant different (p < .001) between those who were determined fit to drive without restrictions and those who were determined not fit to drive after a comprehensive driving evaluation, showing the potential to be used as a screening tool for determining driving risk.
Collapse
Affiliation(s)
- Victoria Penna
- Department of Occupational Therapy, East Carolina University, Greenville, NC, USA
| | - Anne Dickerson
- Department of Occupational Therapy, East Carolina University, Greenville, NC, USA
| | - Qiang Wu
- Department of Public Health, East Carolina University, Greenville, NC, USA
| |
Collapse
|
2
|
Crizzle AM, Mullen N, Mychael D, Meger N, Toxopeus R, Gibbons C, Ostap S, Dubois S, Bédard M. The SIMARD-MD is not an Effective Driver Screening Tool for Determining Fitness-To-Drive. Can Geriatr J 2021; 24:14-21. [PMID: 33680259 PMCID: PMC7904326 DOI: 10.5770/cgj.24.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Studies have reported poor sensitivity and specificity of the Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers, a modification of the DemTech (SIMARD-MD) to screen for drivers with cognitive impairment. The purpose of this study was to determine whether the SIMARD-MD can accurately predict pass/fail on a road test in drivers with cognitive impairment (CI) and healthy drivers. Methods Data from drivers with CI were collected from two comprehensive driving assessment centres (n=86) and compared with healthy drivers (n=30). All participants completed demographic measures, clinical measures, and a road rest (pass/fail). Analyses consisted of correlations between the SIMARD-MD and the other clinical measures, and a receiver-operating-characteristic (ROC) curve to determine the predictive ability of the SIMARD-MD. Results All healthy drivers passed the road test compared with 44.2% of the CI sample. On the SIMARD-MD, the CI sample scored significantly worse than healthy drivers (p < .001). The ROC curve showed the SIMARD-MD, regardless of any cut-point, misclassified a large number of CI individuals (AUC=.692; 95% CI = 0.578, 0.806). Conclusions Given the high level of misclassification, the SIMARD-MD should not be used with either healthy drivers or those with cognitive impairment for making decisions about driving.
Collapse
Affiliation(s)
- Alexander M Crizzle
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada.,School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Nadia Mullen
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| | - Diane Mychael
- St. Joseph's Health Centre Guelph, Guelph, ON, Canada
| | - Natasha Meger
- Saskatchewan Health Authority, Saskatoon, SK, Canada
| | - Ryan Toxopeus
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carrie Gibbons
- Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Simeon Ostap
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| | - Sacha Dubois
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada.,Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada.,Human Sciences Division, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michel Bédard
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada.,Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada.,Human Sciences Division, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| |
Collapse
|
3
|
Yamin S, Ranger V, Stinchcombe A, Knoefel F, Gagnon S, Bédard M. Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness-to-Drive among Older Adults with Cognitive Impairment. Occup Ther Health Care 2020; 38:5-25. [PMID: 33249934 DOI: 10.1080/07380577.2020.1843750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 10/25/2020] [Indexed: 10/22/2022]
Abstract
Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples. The purpose of this study was to test serial trichotomization using four common neuropsychological tests (Trail Making Test Part A and B, Clock Drawing Test, and Modified Mini-Mental State Examination). Test scores from 105 patients who were seen in a memory clinic were abstracted. After applying the model, participants were classified as unfit, fit, or requiring further testing, 38.1%, 25.8%, and 36.1%, respectively. This study provides further evidence that trichotomization can facilitate the assessment of fitness-to-drive.
Collapse
Affiliation(s)
- Stephanie Yamin
- Faculty of Human Sciences, Saint Paul University (Ottawa), Ottawa, ON, Canada
- Bruyere Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada
| | - Valerie Ranger
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Arne Stinchcombe
- Department of Recreation and Leisure Studies, Brock University, Saint Catharines, ON, Canada
| | - Frank Knoefel
- Bruyere Research Institute, Bruyère Continuing Care, Ottawa, ON, Canada
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Michel Bédard
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| |
Collapse
|
4
|
Where the Rubber Hits the Road: What Home Healthcare Professionals Need to Know About Driving Safety for Persons With Dementia. Home Healthc Now 2018; 35:26-32. [PMID: 27922996 DOI: 10.1097/nhh.0000000000000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Driving cessation for people with dementia is a significant personal safety and public health issue. Home healthcare professionals frequently encounter situations where patients/clients should not continue to drive, and family members are unaware of how to approach the issue. This article will inform readers of the current state of the healthcare driving assessment process, measures and instruments used to assess, and effective strategies and resources when working with families facing the dilemma of how and when to proceed with a driving cessation plan.
Collapse
|
5
|
Stinchcombe A, Dickerson A, Weaver B, Bédard M. Response to "Motor Output Variability Impairs Driving Ability in Older Adults". J Gerontol A Biol Sci Med Sci 2018. [PMID: 28633396 DOI: 10.1093/gerona/glx078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arne Stinchcombe
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Canada.,Department of Health Sciences, Lakehead University, Thunder Bay, Canada
| | - Anne Dickerson
- Department of Occupational Therapy, East Carolina University, Greenville, South Carolina
| | - Bruce Weaver
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Canada.,Northern Ontario School of Medicine, Thunder Bay, Canada
| | - Michel Bédard
- Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Canada.,Department of Health Sciences, Lakehead University, Thunder Bay, Canada.,Northern Ontario School of Medicine, Thunder Bay, Canada
| |
Collapse
|
6
|
Stinchcombe A, Paquet S, Yamin S, Gagnon S. Assessment of Drivers with Alzheimer's Disease in High Demand Driving Situations: Coping with Intersections in a Driving Simulator. Geriatrics (Basel) 2016; 1:E21. [PMID: 31022814 PMCID: PMC6371174 DOI: 10.3390/geriatrics1030021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 08/05/2016] [Accepted: 08/17/2016] [Indexed: 12/04/2022] Open
Abstract
Intersections are one of the most complex and cognitively demanding driving situations. Individuals with dementia and, more precisely, Alzheimer's disease (AD), may face additional challenges negotiating intersections given the nature of their cognitive decline, which often includes deficits of attention. We developed a comprehensive evaluation scheme to assess simulated driving performance at intersections. The evaluation scheme captured all types of errors that could occur during preparation (i.e., prior to the intersection), execution (i.e., during the intersection), and recovery (i.e., after the intersection). Using the evaluation scheme, intersection behaviour in a driving simulator among 17 drivers with mild AD was compared to that of 21 healthy controls. The results indicated that across all types of intersections, mild AD drivers exhibited a greater number of errors relative to controls. Drivers with mild AD made the most errors during the preparation period leading up to the intersection. These findings present a novel approach to analyzing intersection behaviour and contribute to the growing body of research on dementia and driving.
Collapse
Affiliation(s)
- Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Stephanie Paquet
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Stephanie Yamin
- Faculty of Human Sciences, Saint Paul University, Ottawa, ON K1S 1C4, Canada.
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| |
Collapse
|
7
|
CIHR Candrive Cohort Comparison with Canadian Household Population Holding Valid Driver's Licenses. Can J Aging 2016; 35 Suppl 1:99-109. [PMID: 27256820 DOI: 10.1017/s0714980816000052] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We investigated whether convenience sampling is a suitable method to generate a sample of older drivers representative of the older-Canadian driver population. Using equivalence testing, we compared a large convenience sample of older drivers (Candrive II prospective cohort study) to a similarly aged population of older Canadian drivers. The Candrive sample consists of 928 community-dwelling older drivers from seven metropolitan areas of Canada. The population data was obtained from the Canadian Community Health Survey - Healthy Aging (CCHS-HA), which is a representative sample of older Canadians. The data for drivers aged 70 and older were extracted from the CCHS-HA database, for a total of 3,899 older Canadian drivers. Two samples were demonstrated as equivalent on socio-demographic, health, and driving variables that we compared, but not on driving frequency. We conclude that convenience sampling used in the Candrive study created a fairly representative sample of Canadian older drivers, with a few exceptions.
Collapse
|
8
|
Yamin S, Stinchcombe A, Gagnon S. Deficits in Attention and Visual Processing but not Global Cognition Predict Simulated Driving Errors in Drivers Diagnosed With Mild Alzheimer's Disease. Am J Alzheimers Dis Other Demen 2016; 31:351-60. [PMID: 26655744 PMCID: PMC10852565 DOI: 10.1177/1533317515618898] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study sought to predict driving performance of drivers with Alzheimer's disease (AD) using measures of attention, visual processing, and global cognition. Simulated driving performance of individuals with mild AD (n = 20) was contrasted with performance of a group of healthy controls (n = 21). Performance on measures of global cognitive function and specific tests of attention and visual processing were examined in relation to simulated driving performance. Strong associations were observed between measures of attention, notably the Test of Everyday Attention (sustained attention; r = -.651, P = .002) and the Useful Field of View (r = .563, P = .010), and driving performance among drivers with mild AD. The Visual Object and Space Perception Test-object was significantly correlated with the occurrence of crashes (r = .652, P = .002). Tests of global cognition did not correlate with simulated driving outcomes. The results suggest that professionals exercise caution when extrapolating driving performance based on global cognitive indicators.
Collapse
Affiliation(s)
- Stephanie Yamin
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada Faculty of Human Sciences, Saint Paul University, Ottawa, Ontario, Canada
| | - Arne Stinchcombe
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
9
|
Abstract
Occupational therapists, both generalists and specialists, have a critical role in providing services to senior drivers. These services include evaluating fitness-to-drive, developing interventions to support community mobility, and facilitating the transition from driving to non-driving when necessary for personal and community safety. The evaluation component and decision-making process about fitness-to-drive are highly dependent on the use of screening and assessment tools. The purpose of this paper is to briefly present the rationale and context for 12 consensus statements about the usefulness and appropriateness of screening and assessment tools to determine fitness-to-drive, within the occupational therapy clinical setting, and their implications on community mobility.
Collapse
Affiliation(s)
- Michel Bédard
- 1Centre for Research on Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | | | | | | |
Collapse
|
10
|
Greve JMD, Santos L, Alonso AC, Tate DG. Driving evaluation methods for able-bodied persons and individuals with lower extremity disabilities: a review of assessment modalities. Clinics (Sao Paulo) 2015; 70:638-47. [PMID: 26375567 PMCID: PMC4557573 DOI: 10.6061/clinics/2015(09)08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/30/2015] [Accepted: 05/19/2015] [Indexed: 11/29/2022] Open
Abstract
Assessing the driving abilities of individuals with disabilities is often a very challenging task because each medical condition is accompanied by physical impairments and because relative individual functional performance may vary depending on personal characteristics.We identified existing driving evaluation modalities for able-bodied and lower extremity-impaired subjects (spinal cord injury patients and amputees) and evaluated the potential relationships between driving performance and the motor component of driving.An extensive scoping review of the literature was conducted to identify driving assessment tools that are currently used for able-bodied individuals and for those with spinal cord injury or lower extremity amputation. The literature search focused on the assessment of the motor component of driving. References were electronically obtained via Medline from the PubMed, Ovid, Web of Science and Google Scholar databases.This article compares the current assessments of driving performance for those with lower extremity impairments with the assessments used for able-bodied persons. Very few articles were found concerning "Lower Extremity Disabilities," thus confirming the need for further studies that can provide evidence and guidance for such assessments in the future. Little is known about the motor component of driving and its association with the other driving domains, such as vision and cognition. The available research demonstrates the need for a more evidenced-based understanding of how to best evaluate persons with lower extremity impairment.
Collapse
Affiliation(s)
- Julia Maria D'Andréa Greve
- Faculdade de Medicina da Universidade de São Paulo, Department of Orthopedics and Traumatology, São Paulo/SP, Brazil
| | - Luciana Santos
- University of Michigan Medical School, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Angelica Castilho Alonso
- Faculdade de Medicina da Universidade de São Paulo, Department of Orthopedics and Traumatology, São Paulo/SP, Brazil
| | - Denise G Tate
- University of Michigan Medical School, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| |
Collapse
|
11
|
Wernham M, Jarrett PG, Stewart C, MacDonald E, MacNeil D, Hobbs C. Comparison of the SIMARD MD to Clinical Impression in Assessing Fitness to Drive in Patients with Cognitive Impairment. Can Geriatr J 2014; 17:63-9. [PMID: 24883164 PMCID: PMC4038537 DOI: 10.5770/cgj.17.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The assessment of fitness to drive in patients with cognitive impairment is complex. The SIMARD MD was developed to assist with assessing fitness to drive. This study compares the clinical decision made by a geriatrician regarding driving with the SIMARD MD score. METHODS Patients with a diagnosis of mild dementia or mild cognitive impairment, who had a SIMARD MD test, were included in the sample. A retrospective chart review was completed to gather diagnosis, driving status, and cognitive and functional information. RESULTS Sixty-three patients were identified and 57 met the inclusion criteria. The mean age was 77.1 years (SD 8.9). The most common diagnosis was Alzheimer's disease in 22 (38.6%) patients. The mean MMSE score was 24.9 (SD 3.34) and the mean MoCA was 19.9 (SD 3.58). The mean SIMARD MD score was 37.2 (SD 19.54). Twenty-four patients had a SIMARD MD score ≤ 30, twenty-eight between 31-70, and five scored > 70. The SIMARD MD scores did not differ significantly compared to the clinical decision (ANOVA p value = 0.14). CONCLUSIONS There was no association between the SIMARD MD scores and the geriatricians' clinical decision regarding fitness to drive in persons with mild dementia or mild cognitive impairment.
Collapse
Affiliation(s)
| | - Pamela G Jarrett
- Department Geriatric Medicine, Horizon Health Network, Saint John, NB
| | - Connie Stewart
- Department of Computer Science & Applied Statistics, University of New Brunswick, Saint John, NB
| | | | - Donna MacNeil
- Department Geriatric Medicine, Horizon Health Network, Saint John, NB
| | - Cynthia Hobbs
- Department Geriatric Medicine, Horizon Health Network, Saint John, NB
| |
Collapse
|