Assessing ability to drive following an acute neurological event: are we on the right road?

Effectiveness of a time to fixate for fitness to drive evaluation in neurological patients

We present a method to automatically calculate time to fixate (TTF) from the eye-tracker data in subjects with neurological impairment using a driving simulator. TTF presents the time interval for a person to notice the stimulus from its first occurrence. Precisely, we measured the time since the children started to cross the street until the drivers directed their look to the children. From 108 neurological patients recruited for the study, the analysis of TTF was performed in 56 patients to assess fit-, unfit-, and conditionally-fit-to-drive patients. The results showed that the proposed method based on the YOLO (you only look once) object detector is efficient for computing TTFs from the eye-tracker data. We obtained discriminative results for fit-to-drive patients by application of Tukey's honest significant difference post hoc test (p < 0.01), while no difference was observed between conditionally-fit and unfit-to-drive groups (p = 0.542). Moreover, we show that time-to-collision (TTC), initial gaze distance (IGD) from pedestrians, and speed at the hazard onset did not influence the result, while the only significant interaction is among fitness, IGD, and TTC on TTF. Obtained TTFs are also compared with the perception response times (PRT) calculated independently from eye-tracker data and YOLO. Although we reached statistically significant results that speak in favor of possible method application for assessment of fitness to drive, we provide detailed directions for future driving simulation-based evaluation and propose processing workflow to secure reliable TTF calculation and its possible application in for example psychology and neuroscience.

Driving and cognitive function in people with stroke and healthy age-matched controls

The decision to return to driving is both complex and difficult. It is often made with clinician support, perhaps on the basis of results from standardized paper and pencil tests, and less frequently an assessment of on-road driving. However, the resources required and inherent reliability and validity challenges suggest that greater use of computerization and driving simulation may play a useful role in the assessment process. In this study, thirty-six age-matched healthy and post-stroke drivers completed standard psychometric assessments (including NART, MMSE, BADS, IADL), computer delivered cognitive assessments (including SART, N-Back, Simple Reaction Time), as well as simulated and on-road assessments of driving. While significantly different in terms of psychometric and computer-based assessments, the healthy and post-stroke drivers who completed the on-road test did not differ. In contrast, driving in the portable simulator showed impaired driving, on some but not all driving manoeuvres, for those who failed the on-road test or had voluntarily ceased to drive. These results are discussed in terms of the implications they have for the multi-faceted nature of driving as a skill, and the need to involve simulation when assessing fitness to drive.

Investigating the driving performance of drivers with and without autism spectrum disorders under complex driving conditions

PURPOSE

The aim of this study was to investigate the driving performance of drivers with autism spectrum disorders under complex driving conditions.

METHOD

Seventeen drivers with autism spectrum disorders and 18 typically developed drivers participated in a driving simulator trial. Prior to the assessment, participants completed the Driving Behaviour Questionnaire and measurements of cognitive and visual-motor ability. The driving simulation involved driving in an urban area with dense traffic and unpredictable events.

RESULTS

In comparison with the typically developed group, drivers with autism spectrum disorders reported significantly more lapses in driving, committed more mistakes on the driving simulator, and were slower to react in challenging situations, such as driving through intersections with abrupt changes in traffic lights. However, they were also less likely to tailgate other vehicles, as measured by time-to-collision between vehicles, on the driving simulator.

CONCLUSIONS

The performances of licensed drivers with autism spectrum disorders appeared to be safer in respect to car-following distance but were poorer in their response to challenging traffic situations. Driver education for individuals with autism spectrum disorders should focus on quick identification of hazards, prompt execution of responses, and effective allocation of attention to reduce lapses in driving. Implications for rehabilitation Drivers with autism spectrum disorders reported significantly more lapses during driving. Drivers with autism spectrum disorders were observed to be poorer in traffic scenarios requiring critical response. Driver education for individuals with autism spectrum disorders should focus on managing anxiety and effective attention allocation while driving. Driving simulators can be used as a safe means for training critical response to challenging traffic scenarios.

Loss of Ability to Drive following a Stroke: The Early Experiences of Three Elderly People on Discharge from Hospital

A qualitative study employing a phenomenological approach was undertaken in South Australia to explore how three elderly people who had been hospitalised with stroke experienced the initial impact of the 1055 of their ability to drive following discharge. In-depth interviews were the primary form of data collection.

The main themes emerging from the data were expectation of the 1055, acceptance of the loss, lack of acceptable transport alternatives, lack of control over the loss, an altered lifestyle and loss of independence. Many of the reported assumptions in the literature that loss of ability to drive has negative psychological, social and functional implications were supported by the results of this study. However, the findings from this study that the expectation of the losswas variable and that the participants felt that they lacked control over the loss had not previously been reported.

The results have several implications for clinical practice, including consideration of the time at which the loss is discussed with older people and the need to prepare them for the loss. Whilst the study has produced data that shed light on the concept of loss of ability to drive, further research is needed using a larger population to check the constructs of the phenomenon.

The effect of neurofeedback on a brain wave and visual perception in stroke: a randomized control trial

[Purpose] This study investigated a brain wave and visual perception changes in stroke subjects using neurofeedback (NFB) training. [Subjects] Twenty-seven stroke subjects were randomly allocated to the NFB (n = 13) group and the control group (n=14). [Methods] Two expert therapists provided the NFB and CON groups with traditional rehabilitation therapy in 30 thirst-minute sessions over the course of 6 weeks. NFB training was provided only to the NFB group. The CON group received traditional rehabilitation therapy only. Before and after the 6-week intervention, a brain wave test and motor free visual perception test (MVPT) were performed. [Results] Both groups showed significant differences in their relative beta wave values and attention concentration quotients. Moreover, the NFB group showed a significant difference in MVPT visual discrimination, form constancy, visual memory, visual closure, spatial relation, raw score, and processing time. [Conclusion] This study demonstrated that NFB training is more effective for increasing concentration and visual perception changes than traditional rehabilitation. In further studies, detailed and diverse investigations should be performed considering the number and characteristics of subjects, and the NFB training period.

Does personality predict driving performance in middle and older age? An evidence-based literature review

OBJECTIVE

To conduct a literature review of the relationship between personality and driving performance among middle-aged and older adults.

METHODS

We searched for relevant literature using Web of Science, PsycInfo, and PubMed and consulted with experts for recently published literature not yet catalogued in those databases. Using the American Academy of Neurology's classification criteria, we extracted data from 13 studies and assigned a class (I-IV) to each study. We grouped primary studies into 3 main categories of driving assessment (behavioral assessment: comprehensive driving evaluations, alternative on-road driving evaluations, driving simulations; automobile crashes: state-recorded crashes, self-reported crashes; self-report measures: self-reported driving behaviors). In all, we synthesized the relationship between personality and driving performance for middle-aged and older adults.

RESULTS

To assist clinicians and researchers in future considerations of the relationship between personality and driving performance, we provide specific evidence-based recommendations for several driving assessments: on-road driving evaluations (Level B), driving simulations (Level U), state-recorded crashes (Level C), self-reported crashes (Level C), and self-reported driving behaviors (Level C).

CONCLUSIONS

Overall, we found evidence for personality as a reliable predictor of driving performance among older drivers. However, 2 caveats qualify our conclusions: the research considered only a limited number of personality variables and largely consisted of less valid tests of driving performance. Therefore, to truly understand the relationship between personality and driving performance, future research must consider a wider range of individual differences and employ more stringent tests and methodological designs to measure driving performance.

Development of a standardised Occupational Therapy--Driver Off-Road Assessment Battery to assess older and/or functionally impaired drivers

INTRODUCTION

Research has been conducted over several years to develop a new off-road assessment battery referred to as the Occupational Therapy - Driver Off-Road Assessment Battery. This article documents the development of the Battery, and provides preliminary research evidence to support its content and predictive validity.

METHODS

Literature reviews and a focus group with nine driver assessor occupational therapists were undertaken, as well as data collection using the Occupational Therapy - Driver Off-Road Assessment Battery with 246 clients. A Classification and Regression Tree model was constructed to ascertain the predictive validity of the Battery, with fitness-to-drive as the outcome.

RESULTS

Twenty-one physical, 13 sensory and seven assessments of cognition/perception were identified as being reflective of the skills required for driving. Following rating of their psychometric properties, the best assessments were presented to focus group members. The driver assessors supported the inclusion of several assessments and encouraged the development of new assessments. A draft version of the Occupational Therapy - Driver Off-Road Assessment Battery was tested and found to have excellent predictive validity for client on-road performance of 82.6%. The Classification and Regression Tree model showed that client performance on tests included in the Battery should be used together, rather than in isolation, to support fitness-to-drive recommendations.

CONCLUSION

This research identified the most suitable physical, sensory and cognitive assessments to include in the Occupational Therapy - Driver Off-Road Assessment Battery, and provided support for its validity. The development of this standardised battery assists driver assessors to accurately and consistently assess and report the off-road driving capacity of clients.

Normative data, preliminary inter-rater reliability and predictive validity of the Drive Home Maze Test

OBJECTIVE

The Drive Home Maze Test has been developed as part of a clinic-based driver assessment battery. This article reports normative data and preliminary inter-rater reliability for this test together with predictive validity for a clinical sample.

SUBJECTS AND SETTING

223 individuals contributed to the normative data. Of these, data from 42 clients undergoing driver assessment as part of their rehabilitation or health care plan were used to ascertain the predictive validity of the Drive Home Maze Test for on-road driving performance (Pass/ Fail).

MAIN MEASURE

The Drive Home Maze Test was developed for occupational therapy driver assessors to use with all older and/ or functionally impaired drivers prior to on-road testing. The test assesses a person s executive function, attention and visuoconstructive skills.

RESULTS

The normative data indicated that time taken and number of errors on the maze increases with age. Performance on this test was strongly indicative of driver assessment outcome using the regression model: ln(Odds of failing on road) = 5.9451 + 2.7047 (log10 time taken to complete the maze). Excellent preliminary inter-rater reliability was also found using Ordinary Least Products linear regression analysis to test for bias between two raters for time taken and number of errors on the maze, with values ranging from r = 0.858 to 0.999.

CONCLUSIONS

The Drive Home Maze Test provides useful information concerning a person's cognitive skills prior to undertaking an on-road assessment. Time taken to complete this test is indicative of the outcome of an on-road driver assessment.

Australian Occupational Therapy Driver Assessors’ Opinions on Improving On-Road Driver Assessment Procedures

OBJECTIVE. We collected practitioner opinions to improve the validity and reliability of the on-road driver assessment procedures used in Australia.

METHOD. We used focus groups to document the views of experienced occupational therapy driver assessors using a purposive sampling method.

RESULTS. Eight focus groups were conducted with 55 clinicians practicing in urban and rural regions. There was strong support for greater standardization of procedures for all tests. For drivers seeking unrestricted (open) licenses, use of standard routes with predetermined assessment points was important where practicable. Where use of a nonstandard route for this purpose was unavoidable, it was important to specify a minimum set of requirements related to route characteristics and assessment items.

CONCLUSION. Australian occupational therapy driver assessors support greater standardization of test routes and procedures to improve reliability and validity. However, the extent to which standardization can be achieved is limited by variable road traffic environments where assessments are conducted.

Validation of a Test of Road Law and Road Craft Knowledge With Older or Functionally Impaired Drivers

OBJECTIVE. The number of functionally impaired drivers being assessed is increasing the urgency to develop a standardized off-road driver assessment battery. We examined the validity of the Road Law and Road Craft Test (RLRCT) and a version of the Melbourne Slide Test to determine whether they should be included in the Occupational Therapy Driver Off-Road Assessment (OT–DORA) battery, which is under development.

METHOD. We conducted a file audit of 118 data sets with individual item scores for the RLRCT and Melbourne Slide Test.

RESULTS. The RLRCT test with one item removed provides clinicians with a valid indication of clients’ off-road driving skills. The Melbourne Slide Test added no new information over that provided by the RLRCT and can be excluded from the battery.

CONCLUSION. The revised 14-item RLRCT should be included in the OT–DORA battery. Further research is required to develop the OT–DORA battery as a valid and reliable measure of off-road driver skill.

Comparison of driving errors between on-the-road and simulated driving assessment: a validation study

OBJECTIVE

Driving simulation provides a convenient and safe method for assessing driving behaviors. Many authors, however, agree that validation is a key component of any study that utilizes simulators to assess driving performance. The purpose of this study was to test driver response validity by discerning whether behavioral responses of drivers, as expressed by type and number of errors, are similar on the road and in the simulator.

METHODS

We replicated real-world intersections in our driving simulator (STISIM M500W; Systems Technology Inc.) and assessed the number and type of driving errors committed by the same 39 participants while negotiating a right and a left turn both on the road and in the simulator.

RESULTS

We found no significant interactions between the type of vehicle (road vs. simulator) and the type of turn (right versus left) for any of the driving errors, indicating that the same trends exist between driving errors made on the road and in the simulator and thus suggesting relative validity of the simulator. We also found no significant differences between the road and the simulator for lane maintenance, adjustment to stimuli, and visual scanning errors, indicating absolute validity for these types of errors.

CONCLUSIONS

The findings suggest early support for external validity for our driving simulator, indicating that the results of assessing driving errors when negotiating turns in the simulator can be generalized or transferred to the road under the same testing conditions. A follow-up study with larger sample size is needed to establish whether driving performance in the simulator is predictive of driving performance on the road.

Étude rétrospective d'une pratique d'évaluation de la conduite automobile en santé mentale adulte

Contexte. En santé mentale adulte, peu de données probantes guident la pratique de l'ergothérapeute lors de l'évaluation des capacités à conduire un véhicule. Objectif. Cet article vise à décrire une pratique d'évaluation de la conduite d'un véhicule, en santé mentale adulte. Méthodologie. Une étude rétrospective a été menée à partir de dossiers de clients suivis en ergothérapie entre 1999 et 2004 à la clinique externe de psychiatrie d'un hôpital universitaire. Résultats. Les ergothérapeutes n'utilisent pas le test sur route, mais les résultats aux épreuves suivantes distinguent les conducteurs jugés sécuritaires ou non-sécuritaires: « Tracé A » (p=0,0004), « Tracé B » (p=0,0005), « Cognitive Behavioral Driver's Inventory » (p=0.006), « Continuous Performance Test » (p=0,001). Conséquences. Les résultats à certaines épreuves métrologiques guident les recommandations de l'ergothérapeute lors de l'évaluation des capacités à conduire. Cependant, d'autres études devraient inclure la performance sur route pour une clientèle en santé mentale adulte.

An exploratory study on the predictive elements of passing on-the-road tests for disabled persons

OBJECTIVES

Driving evaluations are performed by Occupational Therapists to evaluate drivers with disability. They include both off-road and on-road assessments. Many aspects of driving are examined during the on-road assessment. The main objective of this study is to identify the elements of the Occupational Therapy on-road driving assessment that are most predictive of the overall driving evaluation.

METHODS

This retrospective cohort study took place at a provincially approved Driving Assessment Program. Records of 700 participants with various disabilities who completed a driving assessment between 1995 and 2003 were reviewed. Only clients who completed the on-road assessment were included in the study. At our center, 11 driving elements comprised of 34 items were used as independent variables and rated as pass (acceptable or good) or fail (borderline or poor). Analysis was completed with descriptive statistics and use of logistic regression to identify elements that contributed most significantly to the overall driving evaluation.

RESULTS

A total of 628 clients completed the on-road assessment with an overall pass rate of 50%. Logistic regression modeling identified poor anticipation of road hazards, observation of environment, improper stopping position, poor visual scanning, poor knowledge of the rules of the road, and increasing age as predictive of failure for all participants. Further analysis grouped subjects according to disability to identify similarities and differences between pass/fail predictors. Both similarities and differences in predictive elements were found between cognitive and physical diagnostic groupings. Most notably, the physical diagnostic grouping showed that cognitive, not physical elements of the on-road test, predicted failure of the overall driving evaluation.

CONCLUSIONS

Of the 11 elements considered in the on-road evaluation, specific cognitive ones such as anticipates potential hazards, scanning, observes for pedestrians, and proper stopping position tend to contribute more to the prediction of pass or fail than others. These elements should be considered as components of on-road assessments by other Driving Assessment Programs.

Perceptions of power mobility use and safety within residential facilities

BACKGROUND

Power wheelchairs enhance quality of life by enabling occupation, improving self-esteem and facilitating social interaction. Despite these benefits, the risks associated with power mobility use raise serious concerns in residential facilities.

PURPOSE

As there is no gold standard to assess when a client is unsafe, a two-phase study was conducted to develop client-centred guidelines for power mobility use.

METHOD

In the first phase of the study, presented here, 18 in-depth, qualitative interviews were conducted with a variety of stakeholders, including power mobility users, other residents, staff and family members.

RESULTS

A thematic analysis of the interviews revealed four main themes: 1) the meaning of power mobility, 2) learning the rules of the road, 3) red flags: concerns about safety, and 4) solutions.

PRACTICE IMPLICATIONS

Given the importance of power mobility, safety measures need to address issues of mobility and safety for power mobility drivers and those around them.

Evaluation and management of the driver with dementia

BACKGROUND

The number of older adult drivers with dementia is expected to increase over the next few decades. This increase raises public and personal safety concerns given the higher crash rates of drivers with a dementing illness. However, the identification of drivers with a dementia who may be at risk for a crash is difficult, particularly for those in the early stages of dementia.

REVIEW SUMMARY

Studies examining the correlation of dementia with driving outcomes such as motor vehicle crashes are reviewed. The strengths and weaknesses of recent consensus statements, published to assist clinicians in evaluating drivers with a dementia, are discussed. The authors also review common practices currently in use by physicians to identify at-risk drivers, including mental status examinations, global dementia rating scales, specialist referral, medical evaluations, and the use of caregiver reports and other proxy measures. Legal issues, based on the role of the physician, are reviewed along with suggestions for driving cessation and education for the caregiver and family.

CONCLUSIONS

In patients with mild to moderate dementia, the literature indicates that physicians would have difficulty in identifying which individuals should not drive. Performance-based measures of driving skills, such as on-road driving tests, are recommended as a means of assessing driving competency.

Driving skills in elderly persons with stroke: comparison of two new assessment options

OBJECTIVE

To compare the effectiveness of two methods of assessing off-road driving skills that claim to predict on-road driving fitness of persons with stroke.

METHOD

Fifty-six persons with stroke (age 44 to 82 yrs; mean, 60.2 yrs) completed the 2 off-road driving assessments along with standard clinical and on-road driving tests.

MAIN OUTCOME MEASURES

Linear stepwise regression on 4 variables of the Dynavision Performance Assessment Battery (DPAB), the Cognitive Behavioral Driver's Inventory (CBDI) variable (composite score), and the variables of age, gender, and lesion side.

RESULTS

A 4-minute endurance subtest from the DPAB was superior to the CBDI in predicting success/failure in the on-road driving test (75%). However, success on both the 4-minute endurance subtest from the DPAB and the CBDI tests significantly improved the prediction of on-road success. If participants passed the CBDI and the endurance test from the DPAB, they also passed the on-road assessment.

CONCLUSION

Driving fitness of elderly persons with stroke can be assessed with reasonable accuracy using off-road tests, minimizing the expense and risk associated with on-road assessments in this population.

A review of a major driver rehabilitation centre: a ten-year client profile

Driver Rehabilitation Services at Bloorview MacMillan Centre in Toronto provide important assessment and rehabilitation services for persons with various physical, neurological, and medical disabilities. Each year, the programme sees approximately 700 to 800 clients. Since 1985, the earliest year for which records are currently available, the program has seen approximately 7300 clients. The client information filing system consists predominantly of paper reports filed alphabetically by hand. A comprehensive computer database program was implemented in 1996 to organize and analyze client-driver records more efficiently. A systematic random sample consisting of 364 records (5% of the total population) was examined to describe the characteristics of the population within five major study categories: demographics, administration, medical information, visual and perceptual abilities and driving record.