Driving simulator scenarios and measures to faithfully evaluate risky driving behavior: A comparative study of different driver age groups

Older adult driving performance assessed under simulated and on-road conditions

Simulated driving offers a convenient test of driving ability for older drivers, although the viability of using simulated driving with this population is mixed. The relative weighting of the relevant perceptual, cognitive, and physical factors may vary between simulated and on-road driving. The current study was designed to assess this possibility. We conducted simulated and on-road driving tests of 61 older adults aged 66-92 years. To ensure that the driving performance was measured similarly between the two driving modalities, we employed the Record of Driving Errors (RODE) driving assessment system during both driving tests. Correlation and random weights analysis (RWA) results indicated only modest evidence of correspondence between the simulated and on-road driving performances. The primary factors operative in both simulated and on-road driving was Useful Field of View and a measure of basic cognition. Unique factors for simulated driving included a measure of physical mobility (Time-Up-and-Go) and spatial reasoning (Line), and for on-road driving included chronological age and sensorimotor processing (Trail-Making Task A). Chronological age was correlated primarily the on-road rather than simulated test, was greatly reduced with the inclusion of additional explanatory factors, and likely reflects driving efficiency rather than driving safety. We conclude that simulated driving in healthy older drivers can be beneficial for research purposes to assess cognitive and perceptual factors that underly driving effectiveness, although it cannot serve as a clear proxy for on-road driving.

About the Predictive Value of a 3D Multiple Object Tracking Device for Talent Identification in Elite Ice Hockey Players

Purpose: The aim of this study is to verify if a single session on the NeuroTracker has predictive value in talent identification in ice hockey. Methods: Thirty-five male ice hockey players (aged 16-20) from the highest Canadian competition level for that age group participated in the study. A battery of tests (attention, working memory, time reproduction, pattern recognition, temporal equivalence, technical ability, and decision-making) was administered to verify the relation between various cognitive abilities, on-ice performance, and the baseline score on the NeuroTracker, which is claimed to solicit multiple cognitive functions. On-ice performance indicators were game-related statistics: games played, points (mean per game), on-ice goals differential, and draft rank. Results: Results show that the baseline score on the NeuroTracker is not associated with draft ranking, nor is it able to predict which players will perform best based on game-related statistics. However, the NeuroTracker baseline score does correlate with various tests involving working memory and attention. Conclusion: Currently, NeuroTracker is not specific enough to allow talent identification among same-level elite athletes in ice hockey.

Gender comparison of perceptual-cognitive learning in young athletes

Elite athletes demonstrate higher perceptual cognitive abilities compared to non-athletes and those capacities can be trained. A recent study showed that differences were observed between male and female athletes in their cognitive abilities whereby male athletes showed superior perceptual abilities compared to female athletes. The purpose of this study was to investigate whether there were gender differences in athletes' perceptual cognitive learning using a 3D-MOT tracking task. The study was performed on 72 young people from 16 to 22 years of age; athlete males and females and non-athlete males and females were distributed in four distinct groups. Five sessions comprised of three thresholds were performed with each participant. Results indicated that all participants benefited from training and significantly increased their speed thresholds. Initial scores showed that male athletes achieved higher speed thresholds than any other groups. Furthermore, after 5 weeks, female athletes obtained higher speed thresholds in comparison to their non-athlete counterparts. In conclusion, engaging in sporting activity is associated with improved perceptual-cognitive abilities and learning. The results support the notion that competitive sport-related activity is beneficial for perceptual-cognitive functions and emphasizes the benefits of participating in sport-related activities for improved brain function with an even greater impact for females.

Self-Regulation of Driving Behavior Under the Influence of Cannabis: The Role of Driving Complexity and Driver Vision

OBJECTIVE

This study analyzed the self-regulation behaviors of drivers under the influence of cannabis and its relationship with road complexity and some driver traits, including visual deterioration.

BACKGROUND

Cannabis is the illicit drug most often detected in drivers; its use results in significant negative effects in terms of visual function. Self-regulation behaviors involve the mechanisms used by drivers to maintain or reduce the risk resulting from different circumstances or the driving environment.

METHODS

Thirty-one young, occasional cannabis users were assessed both in a baseline session and after smoking cannabis. We evaluated the visual function (visual acuity and contrast sensitivity) and driver self-regulation variables of both longitudinal and lateral control as the speed adaptation and standard deviation of lateral position (SDLP).

RESULTS

Visual function was significantly impaired after cannabis use. Recreational cannabis use did not result in self-regulation, although some road features such as curved roads did determine self-regulation. Male participants adopted mean faster driving speeds with respect to the speed limit. Driver age also determined better lateral control with lower SDLPs. In addition, visual impairment resulting from cannabis use (contrast sensitivity) was linked with self-regulation by changes in longitudinal and lateral control.

CONCLUSION

Contrast sensitivity could be a good indicator of individual visual status to help determine how drivers self-regulate their driving both in normal conditions and while under the influence of cannabis.

APPLICATION

The findings provide new insights about driver self-regulation under cannabis effects and are useful for policy making and awareness campaigns.

Analysis of factors affecting crash under risk scenarios based on driver homogenous clustering

Research on road safety has focused on analyzing the factors that affect crashes. However, previous studies have often neglected differences in crash causation among heterogeneous clusters of drivers. In particular, the differences in the combined effect mechanisms of the factors in the risk scenarios have not been completely explained. Therefore, this study used the K-means algorithm to perform multidimensional feature homogeneous clustering for drivers involved in crashes and near-crashes. Structural equation modeling involving mediating effects was introduced to explore the direct and indirect effects of each influencing factor on vehicle crashes under risk scenarios and compare the differences in crash causation among different driver clusters. The results indicate that the drivers who experienced the risk scenarios can be classified into two homogeneous driver clusters. Significant differences exist in the demographic characteristics, intrinsic driving characteristics, and crash rates between them. In the risk scenario, traffic factors, distraction state, crash avoidance reaction, and maneuver judgment directly affect the crash outcomes of the two cluster drivers. Demographic characteristics and environmental factors have fewer direct influence on the crash outcomes of two-cluster drivers, but produce more complex mediating effects. Analysis of the differences in the influence of factors between clusters indicates that the fundamental cause of crashes for cluster 1 drivers includes poor driving skills. In contrast, cluster 2 drivers' crashes were more influenced by traffic conditions and their safety awareness. The analysis method of this study can be used to develop more targeted road safety policies to reduce the occurrence of vehicle crashes.

The effect of Real-Time feedback and incentives on speeding behaviors using Telematics: A randomized controlled trial

Speeding behaviour of drivers is highly correlated to their tangible consequence. Therefore, this study aimed to evaluate the effectiveness of telematics-based feedback and financial incentives in reducing speeding behaviors through a randomized controlled field trial. This randomized controlled trial included four groups of (1) control, (2) information-only, (3) gain-of-reward, and (4) loss-of-reward. While drivers of the control group were unobtrusively monitored using telematics devices, drivers of the information-only group received real-time, weekly, and monthly feedback via text message. In both groups with financial incentives, in addition to receiving feedback, drivers could receive payments at the end of each month based on observed speeding. The primary outcome was the distance traveled at speeds more than 10% (S10 + ) above the posted speed limit as a proportion of the total traveled distance. A total of 397 male taxi drivers consented to participate in the study. After the stratified randomization, the mean age of the participant was 46.0 (95% Confidence Interval: 43.8 to 48.2), 47.0 (44.7 to 49.3), 46.1 (43.7 to 48.5), and 48.8 (46.5 to 51.1) years for the control, the information-only, the gain-of-reward, and the loss-of-reward groups, respectively. The mean S10 + rate per 100 km was 0.9 (0.5 to 1.2) for the control, 0.8 (0.4 to 1.1) for the information-only, 0.7 (0.3 to 1.1) for the gain-of-reward, and 1.3 (0.4 to 2.2) for the loss-of-reward group at the start of intervention. During the intervention phase, the loss-of-reward group with 0.6 (0.5 to 0.7) had the lowest mean of S10 + rate, followed by the gain-of-reward group with 0.8 (0.7 to 0.8). The loss-of-reward and gain-of-reward groups were the most influenced groups by the intervention, with 38.0% (13.2 to 55.7; p-value < 0.01) and 29.4% (2.0 to 49.2; p-value = 0.04) less S10 + rate than the control group, respectively. It was figured out that providing information regarding drivers' behavior without appropriating motives or penalties would have a minuscule impact.In addition, the group of drivers who were treated with instant punishment was the most influenced group by the intervention.

A Protocol for Remote Cognitive Training Developed for Use in Clinical Populations During the COVID-19 Pandemic

Many traumatic brain injury (TBI) survivors face scheduling and transportation challenges when seeking therapeutic interventions. The COVID-19 pandemic created a shift in the use of at-home spaces for work, play, and research, inspiring the development of online therapeutic options. In the current study, we determined the feasibility of an at-home cognitive training tool (NeuroTrackerX) that uses anaglyph three-dimensional (3D) glasses and three-dimensional multiple object tracking (3D-MOT) software. We recruited 20 adults (10 female; mean age = 68.3 years, standard deviation [SD] = 6.75) as the at-home training group. We assessed cognitive health status for participants using a self-report questionnaire and the Mini-Mental State Examination (MMSE), and all participants were deemed cognitively healthy (MMSE >26). At-home participants loaned the necessary equipment (e.g., 3D glasses, computer equipment) from the research facilities and engaged in 10 training sessions over 5 weeks (two times per week). Participant recruitment, retention, adherence, and experience were used as markers of feasibility. For program validation, 20 participants (10 female; mean age = 63.39 years, SD = 12.22), who had previously completed at least eight sessions of the in-lab 3D-MOT program, were randomly selected as the control group. We assessed individual session scores, overall improvement, and learning rates between groups. Program feasibility is supported by high recruitment and retention, 90% participant adherence, and participants' ease of use of the program. Validation of the program is supported. Groups showed no differences in session scores (p > 0.05) and percentage improvement (p > 0.05) despite the differences in screen size and 3D technology. Participants in both groups showed significant improvements in task performance across the training sessions (p < 0.001). NeuroTrackerX provides a promising at-home option for cognitive training in cognitively healthy adults and may be a promising avenue as an at-home therapeutic for TBI survivors. This abstract was previously published on clinicaltrials.gov and can be found at: https://www.clinicaltrials.gov/ct2/show/NCT05278273.

Vehicle crash simulations for safety: Introduction of connected and automated vehicles on the roadways

Traffic accidents are one main cause of human fatalities in modern society. With the fast development of connected and autonomous vehicles (CAVs), there comes both challenges and opportunities in improving traffic safety on the roads. While on-road tests are limited due to their high cost and hardware requirements, simulation has been widely used to study traffic safety. To make the simulation as realistic as possible, real-world crash data such as crash reports could be leveraged in the creation of the simulation. In addition, to enable such simulations to capture the complexity of traffic, especially when both CAVs and human-driven vehicles co-exist on the road, careful consideration needs to be given to the depiction of human behaviors and control algorithms of CAVs and their interactions. In this paper, the authors reviewed literature that is closely related to crash analysis based on crash reports and to simulation of mixed traffic when CAVs and human-driven vehicles co-exist, for studying traffic safety. Three main aspects are examined based on our literature review: data source, simulation methods, and human factors. It was found that there is an abundance of research in the respective areas, namely, crash report analysis, crash simulation studies (including vehicle simulation, traffic simulation, and driving simulation), and human factors. However, there is a lack of integration between them. Future research is recommended to integrate and leverage different state-of-the-art transportation-related technologies to contribute to road safety by developing an all-in-one-step crash analysis system.

Can Three-Dimensional Multiple Object Tracking Training Be Used to Improve Simulated Driving Performance? A Pilot Study in Young and Older Adults

Driving ability has been shown to be dependent on perceptual-cognitive abilities such as visual attention and speed of processing. There is mixed evidence suggesting that training these abilities may improve aspects of driving performance. This preliminary study investigated the feasibility of training three-dimensional multiple object tracking (3D-MOT)-a dynamic, speeded tracking task soliciting selective, sustained and divided attention as well as speed of processing-to improve measures of simulated driving performance in older and younger adults. A sample of 20 young adults (23-33 years old) and 14 older adults (65-76 years old) were randomly assigned to either a 3D-MOT training group or an active control group trained on a perceptual discrimination task as well as 2048. Participants were tested on a driving scenario with skill-testing events previously identified as optimal for cross-sectional comparisons of driving ability. Results replicated previously identified differences in driving behaviour between age groups. A possible trend was observed for the 3D-MOT trained group, especially younger adults, to increase the distance at which they applied their maximum amount of braking in response to dangerous events. This measure was associated with less extreme braking during events, implying that these drivers may have been making more controlled stops. Limitations of sample size and task realism notwithstanding, the present experiment offers preliminary evidence that 3D-MOT training might transfer to driving performance through quicker detection of or reaction to dangerous events and provides a rationale for replication with a larger sample size.

Fit for purpose of on-the-road driving and simulated driving: A randomised crossover study using the effect of sleep deprivation

INTRODUCTION

Drivers should be aware of possible impairing effects of alcohol, medicinal substance, or fatigue on driving performance. Such effects are assessed in clinical trials, including a driving task or related psychomotor tasks. However, a choice between predicting tasks must be made. Here, we compare driving performance with on-the-road driving, simulator driving, and psychomotor tasks using the effect of sleep deprivation.

METHOD

This two-way cross over study included 24 healthy men with a minimum driving experience of 3000km per year. Psychomotor tasks, simulated driving, and on-the-road driving were assessed in the morning and the afternoon after a well-rested night and in the morning after a sleep-deprived night. Driving behaviour was examined by calculating the Standard Deviation of Lateral Position (SDLP).

RESULTS

SDLP increased after sleep deprivation for simulated (10cm, 95%CI:6.7-13.3) and on-the-road driving (2.8cm, 95%CI:1.9-3.7). The psychomotor test battery detected effects of sleep deprivation in almost all tasks. Correlation between on-the-road tests and simulator SDLP after a well-rested night (0.63, p < .001) was not present after a night of sleep deprivation (0.31, p = .18). Regarding the effect of sleep deprivation on the psychomotor test battery, only adaptive tracking correlated with the SDLP of the driving simulator (-0.50, p = .02). Other significant correlations were related to subjective VAS scores.

DISCUSSION

The lack of apparent correlations and difference in sensitivity of performance of the psychomotor tasks, simulated driving and, on-the-road driving indicates that the tasks may not be interchangeable and may assess different aspects of driving behaviour.

The effectiveness of fixed speed cameras on Iranian taxi drivers: An evaluation of the influential factors

Background

The adherence to speed limits can reduce deaths associated with road traffic injuries (RTIs) by more than a quarter. This study aimed to evaluate the effective factors on the speeding behavior of Iranian taxi drivers around fixed speed cameras.

Method

Telematics devices used in this study collected the location and speed of the vehicles. The units of analysis in this study were trips per camera, including 2.5 km before and after each camera. Linear regression analysis was used to identify kangaroo driving (KD), defined as trips with a significant V-shape in speed distribution around the camera. In the clustered camera zones, cameras were placed at regular intervals of approximately 3.5 km.

Findings

A total of 93,160 trips were recorded from 13,857,443 data points. There was an inverse association between drivers' age and KD with an odds ratio (OR) of 0.98 (95% confidence interval: 0.98-0.98). The intercity trips had a substantially higher probability of KD than urban trips (OR: 4.94 [4.73-5.16]). The tendency of drivers toward KD during the daylight hours vs. nighttime was significant for both urban (OR: 1.15 [1.06-1.25]) and intercity (OR: 1.18 [1.14-1.22]) trips. The 4 -8 a.m. period had the highest chance of KD in both urban (10.71% [7.41-14.53]) and intercity (44.13% [41.18-47.09]) trips. There was a significant decrease in the odds of KD inside the clustered camera zones (OR: 0.22 [0.20-0.25]).

Conclusion

The heterogeneous occurrence of KD in different locations and times indicates the necessity of evidence-based decision-making in urban planning to improve safe driving behaviors. The lower occurrence of KD in clustered camera zones could be a practical key to the effective control of speeding behaviors by helping in the efficient placement of cameras through sustainable development of cities and roads.

Three-dimensional multiple object tracking improves young adult cognitive abilities associated with driving: evidence for transfer to the useful field of view

OBJECTIVES

3-dimensional multiple object tracking (3D-MOT) and the useful field of view (UFOV) both claim to measure and train cognitive abilities, such as selective and divided attention implicated in driving safety. 3D-MOT is claimed to improve even young adult cognitive ability. If true, one would expect to observe the transfer of 3D-MOT training to UFOV performance mediated by way of shared underlying cognitive mechanisms.

METHODS

We test this notion by assessing whether ten 30-min sessions of 3D-MOT training spread across 5 weeks improves UFOV performance relative to an active control group trained on a visual task and a challenging puzzle game (participants aged between 23 and 33 years old).

RESULTS

The 3D-MOT training group exhibited significantly improved UFOV performance whereas the active control group exhibited only a small, statistically nonsignificant improvement in the task.

CONCLUSIONS

This suggests that 3D-MOT and UFOV performance are likely dependent on overlapping cognitive abilities and helps support the assertion that these abilities can be trained and measured even in young adults. Such training could have implications for improving driver safety in both young and older adults.

Speed management across road environments of varying complexities and self-regulation behaviors in drivers with cataract

Evidence suggests that drivers with cataract self-regulate their driving, but there is a lack of objective information. This study compared speed behavior in older drivers with and without cataract and how the parameter is influenced by road traffic complexity and driver characteristics. The study included 15 drivers with cataract and a control group of 20 drivers. Visual status was assessed using visual acuity, contrast sensitivity, and intraocular straylight. Speed management was studied using a driving simulator. Driving difficulty and self-regulation patterns were evaluated by means of the Driver Habits Questionnaire (DHQ). The cataract group showed a significant decrease in visual function in all the parameters evaluated (p < 0.05). These drivers tended to drive at lower speeds than the control group. Road characteristics, gender, and intraocular straylight in the better eye were identified as significant predictors of speed management. Drivers with cataract experience greater driving difficulty, particularly when driving at night (p < 0.05). Drivers with cataract reduce their driving speed more than older drivers without visual impairment. The straylight parameter may be a good indicator of each driver's subjective perception of their own visual ability to drive. This work helps shed light on the mechanisms through which age-related visual impairment influences driving behavior.

The prevalence of alcohol-involved crashes across high and low complexity road environments: Does knowing where drinking drivers crash help explain why they crash?

Objective

Alcohol use has been linked to impairment of cognitive and psychomotor driving skills, yet the extent to which skill impairment contributes to actual crashes is unknown. A reasonable assumption is that some driving situations have higher skill demands than others. We contend that intersections, the presence of other vehicles or moving objects, and work zones are examples of common situations with higher skill demands. Accordingly, if skill deficits are largely responsible for alcohol-involved crashes, crashes involving a drinking driver (versus only sober drivers) should be overrepresented in these driving situations.

Method

Publicly available FARS data from 2010 to 2017 were collected. Fatal crashes were coded as alcohol-involved (1+ driver with a blood alcohol concentration [BAC] ≥ .05 g/dl) or having no impaired driver (BACs = .000). Drug-positive crashes were excluded. Crashes were also coded as involving moving versus stationary objects, occurring at versus away from intersections, being multivehicle versus single vehicle, occurring at or away from work zones.

Results

Across multiple models, controlling for time of day and type of road, alcohol-involved crashes were significantly underrepresented in crashes at intersections, with moving objects, and other vehicles. Most strikingly, alcohol-involved crashes were 24 percentage points more likely to be with a stationary object than a moving object.

Conclusions

No evidence supported the idea that skill reductions are a primary contributor to alcohol-involved crashes. Alternative explanations and limitations are discussed.

Age-related effects of executive function on takeover performance in automated driving

The development of highly automated vehicles can meet elderly drivers' mobility needs; however, worse driving performance after a takeover request (TOR) is frequently found, especially regarding non-driving related tasks (NDRTs). This study aims to detect the correlation between takeover performance and underlying cognitive factors comprising a set of higher order cognitive processes including executive functions. Thirty-five young and 35 elderly participants were tested by computerized cognitive tasks and simulated driving tasks to evaluate their executive functions and takeover performance. Performance of n-back tasks, Simon tasks, and task switching were used to evaluate updating, inhibition, and shifting components of executive functions by principal component analysis. The performance of lane changing after TOR was measured using the standard deviation of the steering wheel angle and minimum time-to-collision (TTC). Differences between age groups and NDRT engagement were assessed by two-way mixed analysis of variance. Older participants had significantly lower executive function ability and were less stable and more conservative when engaged in NDRT. Furthermore, a significant correlation between executive function and lateral driving stability was found. These findings highlight the interaction between age-related differences in executive functions and takeover performance; thus, provide implications for designing driver screening tests or human-machine interfaces.

The Multiple Object Avoidance (MOA) task measures attention for action: Evidence from driving and sport

Performance in everyday tasks, such as driving and sport, requires allocation of attention to task-relevant information and the ability to inhibit task-irrelevant information. Yet there are individual differences in this attentional function ability. This research investigates a novel task for measuring attention for action, called the Multiple Object Avoidance task (MOA), in its relation to the everyday tasks of driving and sport. The aim in Study 1 was to explore the efficacy of the MOA task to predict simulated driving behaviour and hazard perception. Whilst also investigating its test-retest reliability and how it correlates to self-report driving measures. We found that superior performance in the MOA task predicted simulated driving performance in complex environments and was superior at predicting performance compared to the Useful Field of View task. We found a moderate test-retest reliability and a correlation between the attentional lapses subscale of the Driving Behaviour Questionnaire. Study 2 investigated the discriminative power of the MOA in sport by exploring performance differences in those that do and do not play sports. We also investigated if the MOA shared attentional elements with other measures of visual attention commonly attributed to sporting expertise: Multiple Object Tracking (MOT) and cognitive processing speed. We found that those that played sports exhibited superior MOA performance and found a positive relationship between MOA performance and Multiple Object Tracking performance and cognitive processing speed. Collectively, this research highlights the utility of the MOA when investigating visual attention in everyday contexts.

Impact of antiepileptic drugs on simulated driving in patients with epilepsy

OBJECTIVE

Results of observational investigations have demonstrated that the risk of a traffic accident is independent of use of AEDs. However, no reports of driving tests conducted with patients administered AEDs have been presented. This study examined this scenario in a simulated driving setting.

METHODS

Driving performance of 43 patients with epilepsy (PWE) and prescribed an AED, who were licensed to drive and drove regularly (subject group), was assessed, with the results compared to 40 age- and gender-matched healthy volunteers (control group). Daily driving skills associated with a traffic accident were examined using two different tests provided by a driving simulator software package, road-tracking and car-following. Standard deviation of lateral position (SDLP) and distance coefficient of variation (DCV) were determined as primary and exploratory outcomes, respectively.

RESULTS

There was no statistically significant difference for primary outcome shown by SDLP between the subject and control groups (p = 0.906), nor for exploratory outcome shown by DCV (p = 0.063). Multiple regression analysis revealed that age (ß=0.967, p = 0.001), female gender (ß=0.469, p<0.001), and duration of driving experience (ß=-0.583, p = 0.038) were correlated with SDLP.

SIGNIFICANCE

The present results demonstrated that the driving performance of PWE taking AEDs was not different from that of healthy volunteers.

Topical Review: The Top Five Peripheral Vision Tools in Sport

SIGNIFICANCE

This study summarizes the empirical evidence on the use of peripheral vision for the most-researched peripheral vision tools in sports.

The objective of this review was to explain if and how the tools can be used to investigate peripheral vision usage and how empirical findings with these vision tools might be transferred to sports situations. The data sources used in this study were Scopus, ScienceDirect, and PubMed. We additionally searched the manufacturers' Web pages and used Google Scholar to find full texts that were not available elsewhere. Studies were included if they were published in a peer-reviewed journal, were written in English language, and were conducted in a sports context. From the 10 searched tools, we included the 5 tools with most published studies. In our topical search, we identified 93 studies for the five most-used peripheral vision tools. Surprisingly, none of these studies used eye-tracking methods to control for the use of peripheral vision. Best "passive" control is achieved by tools using (foveal) secondary tasks (Dynavision D2 and Vienna Test System). Best transfer to sports tasks is expected for tools demanding action responses (FitLight, Dynavision D2). Tools are likely to train peripheral monitoring (NeuroTracker), peripheral reaction time (Dynavision D2, Vienna Test System), or peripheral preview (FitLight), whereas one tool did not show any link to peripheral vision processes (Nike SPARQ Vapor Strobe).

Onge J, Robinson J, Eguakun O, Feinstein A, Dorsch K, Kakar RS, Abdulhakim R, Rehman Z, Shawush M, Pillay V. Effectiveness of Three-Dimensional Multiple-Object Tracking in Patients with Multiple Sclerosis: A Pilot Trial

BACKGROUND

Computerized cognitive training remains an attractive supplemental modality to enhance rehabilitation in multiple sclerosis (MS). The objective of the present study was to assess the usability of three-dimensional multiple-object tracking (3D-MOT) in patients with MS.

METHODS

In this pilot study, 16 patients with relapsing-remitting MS and nine age-matched controls participated in four 30-minute training sessions of 3D-MOT. Computerized neuropsychological tests, including driving readiness (ie, Useful Field of View) and cognitive function (ie, Stroop Color and Word Test, Paced Visual Serial Addition Test, Symbol Digit Modalities Test) were conducted at baseline and at the conclusion of training.

RESULTS

Although scoring lower in 3D-MOT, the MS group improved their 3D-MOT scores in similar magnitude as the control group. The 3D-MOT training led to significant improvements in driving readiness in the MS group. Taken together, 3D-MOT training showed similar effectiveness in patients with MS as in age-matched controls.

CONCLUSIONS

Training with 3D-MOT may be an accessible and remotely administrable supplement to cognitive rehabilitation protocols for patients with MS.

Benefits of Higher Cardiovascular and Motor Coordinative Fitness on Driving Behavior Are Mediated by Cognitive Functioning: A Path Analysis

Driving is an important skill for older adults to maintain an independent lifestyle, and to preserve the quality of life. However, the ability to drive safely in older adults can be compromised by age-related cognitive decline. Performing an additional task during driving (e.g., adjusting the radio) increases cognitive demands and thus might additionally impair driving performance. Cognitive functioning has been shown to be positively related to physical activity/fitness such as cardiovascular and motor coordinative fitness. As such, a higher fitness level might be associated with higher cognitive resources and may therefore benefit driving performance under dual-task conditions. For the first time, the present study investigated whether this association of physical fitness and cognitive functioning causes an indirect relationship between physical fitness and dual-task driving performance through cognitive functions. Data from 120 healthy older adults (age: 69.56 ± 3.62, 53 female) were analyzed. Participants completed tests on cardiovascular fitness (cardiorespiratory capacity), motor coordinative fitness (composite score: static balance, psychomotor speed, bimanual dexterity), and cognitive functions (updating, inhibition, shifting, cognitive processing speed). Further, they performed a virtual car driving scenario where they additionally engaged in cognitively demanding tasks that were modeled after typical real-life activities during driving (typing or reasoning). Structural equation modeling (path analysis) was used to investigate whether cardiovascular and motor coordinative fitness were indirectly associated with lane keeping (i.e., variability in lateral position) and speed control (i.e., average velocity) while dual-task driving via cognitive functions. Both cardiovascular and motor coordinative fitness demonstrated the hypothesized indirect effects on dual-task driving. Motor coordinative fitness showed a significant indirect effect on lane keeping, while cardiovascular fitness demonstrated a trend-level indirect effect on speed control. Moreover, both fitness domains were positively related to different cognitive functions (processing speed and/or updating), and cognitive functions (updating or inhibition), in turn, were related to dual-task driving. These findings indicate that cognitive benefits associated with higher fitness may facilitate driving performance. Given that driving with lower cognitive capacity can result in serious consequences, this study emphasizes the importance for older adults to engage in a physically active lifestyle as it might serve as a preventive measure for driving safety.

A critical systematic review of the Neurotracker perceptual-cognitive training tool

In this systematic review, we evaluate the scientific evidence behind “Neurotracker,” one of the most popular perceptual-cognitive training tools in sports. The tool, which is also used in rehabilitation and aging research to examine cognitive abilities, uses a 3D multiple object-tracking (MOT) task. In this review, we examine Neurotracker from both a sport science and a basic science perspective. We first summarize the sport science debate regarding the value of general cognitive skill training, based on tools such as Neurotracker, versus sport-specific skill training. We then consider the several hundred MOT publications in cognitive and vision science from the last 30 years that have investigated cognitive functions and object tracking processes. This literature suggests that the abilities underlying object tracking are not those advertised by the Neurotracker manufacturers. With a systematic literature search, we scrutinize the evidence for whether general cognitive skills can be tested and trained with Neurotracker and whether these trained skills transfer to other domains. The literature has major limitations, for example a total absence of preregistered studies, which makes the evidence for improvements for working memory and sustained attention very weak. For other skills as well, the effects are mixed. Only three studies investigated far transfer to ecologically valid tasks, two of which did not find any effect. We provide recommendations for future Neurotracker research to improve the evidence base and for making better use of sport and basic science findings.

Predicting the Coping Skills of Older Drivers in the Face of Unexpected Situation

In recent years, when an older driver who cannot immediately recognize, judge, and operate properly faces an unexpected situation, they often panic, which may cause a traffic accident. However, there has not yet been enough discussion about the coping skills of older drivers in the face of this unexpected situation. Therefore, this study discusses the coping skills of older drivers in the face of unexpected situations. Moreover, we propose a coping skills prediction system (CP system). The CP system predicts coping skills from the tilt angle and angular velocity of the left foot when an older driver is driving or preparing to start a car. The experiment carried out two phases, a phase of driving a car and a phase of preparing to start the car. In the driving phase, the young and older driver drive the car in a driving simulator. The average age of the young driver group was ± standard deviation = 20.6 ± 0.7 years, and the age of the older driver group was 78.5 ± 5.1 years. The driving route included 15 cases in which collision accidents are likely to occur. We analyzed the experimental results of the driving phase and clarified the predictors of coping skills. Moreover, we analyzed the correlation between the left foot movement in driving and the left foot movement during preparing to start the car. As a result of the experiment, there was a 0.84 correlation between the tilt angle of the left foot of the older driver in driving and the tilt angle of the left foot of the older driver in preparing to start the car. The result shows that the coping skills can be predicted from the tilt angle of the left foot of the older driver during preparing to start the car. We showed that the coping skill can be predicted with an accuracy of 92% or 94% on average from the tilt angle and the angular velocity of the left foot while driving or preparing to start the car. Moreover, we clarified that the tilt angle of the left foot of a driver without coping skills is perpendicular to the ground compared to a driver with coping skills. This study is expected to contribute to the prevention of traffic accidents that occur in the face of an unexpected situation.

Increased visual and cognitive demands emphasize the importance of meeting visual needs at all distances while driving

Having an optimal quality of vision as well as adequate cognitive capacities is known to be essential for driving safety. However, the interaction between vision and cognitive mechanisms while driving remains unclear. We hypothesized that, in a context of high cognitive load, reduced visual acuity would have a negative impact on driving behavior, even when the acuity corresponds to the legal threshold for obtaining a driving license in Canada, and that the impact observed on driving performance would be greater with the increase in the threshold of degradation of visual acuity. In order to investigate this relationship, we examined driving behavior in a driving simulator under optimal and reduced vision conditions through two scenarios involving different levels of cognitive demand. These were: 1. a simple rural driving scenario with some pre-programmed events and 2. a highway driving scenario accompanied by a concurrent task involving the use of a navigation device. Two groups of visual quality degradation (lower/ higher) were evaluated according to their driving behavior. The results support the hypothesis: A dual task effect was indeed observed provoking less stable driving behavior, but in addition to this, by statistically controlling the impact of cognitive load, the effect of visual load emerged in this dual task context. These results support the idea that visual quality degradation impacts driving behavior when combined with a high mental workload driving environment while specifying that this impact is not present in the context of low cognitive load driving condition.

The short-term effects of artificially-impaired binocular vision on driving performance

Appropriate visual function is paramount to ensuring adequate driving performance and road safety. Here, we examined the influence of sudden artificially-impaired binocular vision on driving performance using a car simulator. Twenty-four young drivers (mean age 22.42 ± 3.19 years) drove under three different visual conditions (natural driving, monocular blur, and monocular occlusion) through three different traffic environments with low, medium, and high levels of complexity (highway, rural, and city, respectively). We assessed their driving performance, perceived level of task complexity, and subjectively-experienced road safety. Furthermore, as a manipulation check, we also evaluated the drivers' cardiac vagal responses, as a well-known index of task complexity. The sudden deterioration of binocular vision caused unsafe driving behaviours (distance out of the road and maximum breaking intensity) in the most complex traffic environments. Specific self-regulatory strategies (i.e. increased cardiac vagal responses) and subjective responses corroborated these results. Practitioner summary: This study provides evidence that the sudden deterioration of binocular vision has a detrimental effect on simulated driving performance. Our analysis of cardiovascular functioning shows that drivers adopt self-regulatory strategies when their binocular vision functioning is compromised. Abbreviations: VA: visual acuity; BV: binocular vision; HRV: heart rate variability; NASA: TLX: NASA-Task Load Index; SSS: Stanford Sleepiness scale; RMSSD: root mean square of successive difference; HF: high-frequency.

Eye-head coordination and dynamic visual scanning as indicators of visuo-cognitive demands in driving simulator

Driving is an everyday task involving a complex interaction between visual and cognitive processes. As such, an increase in the cognitive and/or visual demands can lead to a mental overload which can be detrimental for driving safety. Compiling evidence suggest that eye and head movements are relevant indicators of visuo-cognitive demands and attention allocation. This study aims to investigate the effects of visual degradation on eye-head coordination as well as visual scanning behavior during a highly demanding task in a driving simulator. A total of 21 emmetropic participants (21 to 34 years old) performed dual-task driving in which they were asked to maintain a constant speed on a highway while completing a visual search and detection task on a navigation device. Participants did the experiment with optimal vision and with contact lenses that introduced a visual perturbation (myopic defocus). The results indicate modifications of eye-head coordination and the dynamics of visual scanning in response to the visual perturbation induced. More specifically, the head was more involved in horizontal gaze shifts when the visual needs were not met. Furthermore, the evaluation of visual scanning dynamics, based on time-based entropy which measures the complexity and randomness of scanpaths, revealed that eye and gaze movements became less explorative and more stereotyped when vision was not optimal. These results provide evidence for a reorganization of both eye and head movements in response to increasing visual-cognitive demands during a driving task. Altogether, these findings suggest that eye and head movements can provide relevant information about visuo-cognitive demands associated with complex tasks. Ultimately, eye-head coordination and visual scanning dynamics may be good candidates to estimate drivers' workload and better characterize risky driving behavior.

Hazard Perception and Prediction test for walking, riding a bike and driving a car: "Understanding of the global traffic situation"

To "put oneself in the place of other road users" may improve understanding of the global traffic situation. It should be useful enabling drivers to anticipate and detect obstacles in time to prevent accidents to other road users, especially those most vulnerable. We created a pioneering Hazard Perception and Prediction test to explore this skill in different road users (pedestrians, cyclists and drivers), with videos recorded in naturalistic scenarios: walking, riding a bicycle and driving a car. There were 79 participants (30 pedestrians, 14 cyclists, 13 novice drivers and 22 experienced drivers). Sixty videos of hazardous traffic situations were presented, divided into 2 blocks of 30 videos each: 10 walking, 10 riding a bicycle, 10 driving a car. In each situation presented, we evaluated the performance of the participants carrying out the task of predicting the hazard and estimating the risk. In the second block, after they had carried out the task, we gave them feedback on their performance and let them see the whole video (i.e., checking what happened next). The results showed that the holistic test had acceptable psychometric properties (Cronbach's alpha = .846). The test was able to discriminate between the different conditions manipulated: a) between traffic hazards recorded from different perspectives: walking, riding a bicycle and driving a car; b) between participants with different user profiles: pedestrians, cyclists and drivers; c) between the two test blocks: the first evaluation only and the second combining evaluation with this complex intervention. We found modal bias effects in both Hazard Perception and Prediction; and in Risk Estimation.

Factors determining speed management during distracted driving (WhatsApp messaging)

The objective of this work was to investigate self-regulation behaviours, particularly speed management, under distracted conditions due to WhatsApp use. We also studied the influence of different environments and driver characteristics, introducing visual status as one of them. Seventy-five drivers were evaluated in a simulator study involving two test sessions under baseline and texting conditions. A cluster analysis was used to identify two groups with different visual capacity .Lastly, possible predictors of speed management were studied developing a generalised linear mixed model. Our results show that drivers reduced their speeds in the presence of more demanding driving conditions; while replying to a WhatsApp message, on curved road segments and when parked cars are present. Driving speed also correlated with driver characteristics such as age or dual task experience and human factors such as self-perceived risk. Finally, although there were significant differences in visual capacity between the two groups identified, the model did not identify visual capacity membership as a significant predictor of speed management. This study could provide a better understanding of the mechanisms drivers use when WhatsApp messaging and which environments and driver conditions influence how speed is managed.

Class-imbalanced crash prediction based on real-time traffic and weather data: A driving simulator study

Objective: Crash occurrence prediction has been of major importance in proactively improving traffic safety and reducing potential inconveniences to road users. Conventional statistical crash prediction models frequently suffer from severe data quality issues and require a significant amount of historical data. On the other hand, even though machine learning (ML) based algorithms have proven to be powerful in predicting future outcomes in different fields of applications, they likely fail to provide satisfactory results unless a tuning parameter approach is conducted. The main objective of this article is to develop real-time crash prediction models that will potentially be employed within traffic management systems.Methods: In this study, two highly optimized data-driven models for crash occurrence prediction have been designed based on the popular machine learning techniques, Support Vector Machine (SVM) and deep neural network Multilayer Perceptron (MLP). To ensure that the proposed algorithms produce robust and stable performance, the optimal scheme for models' construction has been thoroughly examined and discussed. Additionally, the further boost of models' performance requires the systemic assessment of crash strongest precursors within the driver-vehicle-environment triptych. Therefore, three categories of features, including driver input responses, vehicle kinematics and weather conditions, were measured during the execution of various driving tasks performed on a desktop driving simulator. Moreover, since crash events typically occur in rare instances tending to be underrepresented in the dataset, an imbalance-aware strategy to overcome the issue was adopted using the Synthetic Minority Oversampling TEchnique (SMOTE).Results: The results show that MLP exhibited the best performing prediction results, most particularly, in clear, overcast and snow conditions, in which MLP recall values were above 94%. Higher F1-score values were achieved in overcast and rain weather by MLP and snow conditions by SVM; whereas over 90% of G-mean levels were obtained under fog and rain conditions for MLP and snow condition for SVM.Conclusion: The findings provide new insights into crash events forecasting and may be used to promote enforcement efforts related to designing crash avoidance/warning systems that enhance the effectiveness of the system's application based on driver input and vehicle kinematics under various weather conditions.

Effects of aging on foot pedal responses to visual stimuli

BACKGROUND

Car accidents due to unexpected forward or backward runaway by older drivers are a serious social problem. Although the cause of these accidents is often attributed to stepping on the accelerator instead of the brake, it is difficult to induce such pedal application errors systematically with usual drive simulators. We developed a simple personal computer system that induces the pedal errors, and investigate the effects of age on the error behaviors.

METHODS

The system consisted of a laptop computer and a three-pedal foot mouse. It measured response time, accuracy, and flexibility of pedal operation to visual stimuli. The system displayed two open circles on the computer display, lighting one of the circles in a random order and interval. Subjects were instructed to press the foot pedal with their right foot as quickly as possible when the circle was lit; the ipsilateral pedal to the lit circle in a parallel mode and the contralateral pedal in a cross mode. When the correct pedal was pressed, the light went off immediately, but when the wrong pedal was pressed, the buzzer sounded and the light remained on until the correct pedal was pressed. During a 6-min trial, the mode was switched between parallel and cross every 2 min. During the cross mode, a cross mark appears on the display. The pedal responses were evaluated in 52 subjects divided into young (20-29 years), middle-aged (30-64 years), and older (65-84 years) groups. Additionally, the repeatability of the pedal response characteristic indicators was examined in 14 subjects who performed this test twice.

RESULTS

The mean response time was 95 ms (17%) longer in the older group than in the young group. More characteristically, however, the older group showed 2.1 times more frequent pedal errors, fell into long hesitations (response freezing > 3 s) 16 times more often, and took 1.8 times longer period to correct the wrong pedal than the young groups. The indicators of pedal response characteristics showed within-individual repeatability to the extent that can identify the age-dependent changes.

CONCLUSIONS

Hesitations and extended error correction time can be associated with increased crash risk due to unexpected runaway by older drivers. The system we have developed may help to uncover and evaluate physiological characteristics related to crash risk in the elderly population.

Combining 3D-MOT With Sport Decision-Making for Perceptual-Cognitive Training in Virtual Reality

This study introduces a virtual life-sized perceptual-cognitive training paradigm that combines three-dimensional multiple object tracking (3D-MOT) with motor (Experiment 1) or perceptual (Experiment 2) sport decision-making tasks. We sought to assess the impact of training on task performance and determine optimal training conditions for improvement and learning. Fifty-seven participants were randomly assigned to one of four training conditions (isolated 3D-MOT, 3D-MOT combined with a decision-making task, consolidated 3D-MOT later combined with a decision-making task, and isolated decision-making task). We evaluated task performance using speed thresholds, success rate (%), and reaction time (s). Findings were that the dual-task paradigm was associated with performance beyond chance level on both 3D-MOT and decision-making tasks despite an important dual-task cost. Interestingly, the results seemed to favor consolidated 3D-MOT training over simultaneous 3D-MOT training when combined with a motor decision-making task but not when combined with a perceptual decision-making task. The number of shared attentional resources in the nature of the additional task (i.e., perceptual or motor decision-making) seems to be key in interpreting the dual-task interference. These findings must be considered when designing representative multitask perceptual-cognitive training.

Inattentional Blindness During Driving in Younger and Older Adults

Age-related changes to perceptual and cognitive abilities have been implicated in an increased risk of collision in older adults. This may be due, in part, to their reduced ability to attend to potentially relevant aspects of their driving environment. An associated general phenomenon of inattentional blindness involves a failure to notice visually presented objects or events when attention is directed elsewhere. Previous studies of inattentional blindness using computer paradigms report higher incidence of this effect in older compared to younger adults. However, little is known about whether these age-related effects are observed during more complex, realistic, everyday tasks, such as driving. Therefore, the goal of this study was to explore whether younger and older adults differ in their awareness of objects in their driving environment when their attention is directed toward another primary driving task. This study took place in a high-fidelity, full field of view, driving simulator. Thirty-two younger (M age = 25.41) and 32 older (M age = 73.41) adults drove through 19 short scenarios and were asked to first judge whether their vehicle could fit between two rows of vehicles parked on either side of the road and then to perform the associated driving maneuver (i.e., drive through or drive around). On four critical trials, objects were placed on the side of the road that differed in terms of animacy. Specifically, animate objects consisted of 3D humans standing by a bus shelter and inanimate objects consisted of photographs of the same individuals on a bus shelter advertisement. Inattentional blindness was measured via a post-drive, tablet-based recognition task immediately following the critical trials. Results revealed high rates of inattentional blindness across both age groups, with significantly lower levels of awareness for inanimate objects compared to animate objects. Further, whereas younger adults demonstrated reduced inattentional blindness following the first critical trial, older adults did not show this immediate improvement in recognition performance. Overall, this study provides unique insights into the factors associated with age-related changes to attention and how they may affect important driving-related outcomes.

Effects of scheduled manual driving on drowsiness and response to take over request: A simulator study towards understanding drivers in automated driving

Because current automated vehicles have operational limitations, it is important to ensure that the fallback-ready driver is able to perform appropriately when required to take over control of the vehicle. However, time-related increase in driver drowsiness is well-known, and drowsy driving can affect response to take-over request (TOR). It was previously reported that a scheduled period of manual driving during automated driving was beneficial in maintaining driver arousal level. The present driving simulator study investigates the effects of scheduled manual driving on driver drowsiness and performance, as well as age differences therein. A total of 115 participants, whose gender was balanced and age was distributed uniformly from 20 to 70 years, drove an automated vehicle for 31 min, and a TOR was prompted before a collision event. A between-subjects design comprised two conditions: with versus without a scheduled 10-min interval of manual driving that ended 10 min before TOR. The Karolinska Sleepiness Scale and eyeblink durations estimated from electrooculograms (EOG) were used to subjectively and objectively measure participant's drowsiness. Reaction time, standard deviation of steering wheel angle, and minimum Time-to-Collison (TTC) were extracted to measure driver performance in response to TOR. The alleviating effect on drowsiness of 10-min scheduled manual driving became non-significant after another 10-min period of automated driving. Although the scheduled manual driving had no significant effect for younger drivers, older drivers reacted significantly more slowly in both steering and braking at the critical event. These findings provide essential insights for human-vehicle interactions: Scheduled manual driving cannot maintain drivers' arousal level for 10 min afterwards, and for older drivers, it would be better to avoid unnecessary task-switching between manual and automated driving.

Altered driving performance of symptomatic Huntington's disease gene carriers in simulated road conditions

OBJECTIVE

In clinical practice, patients with Huntington's disease (HD) often decide to solely drive in their own familiar neighborhoods and not on a motorway or in an unknown area. The aim of the study was to identify differences in driving performance between HD gene carriers and healthy individuals in simulated urban and motorway environments.

METHODS

This cross-sectional study included 87 participants (28 premanifest HD, 30 manifest HD, 29 controls). All participants were active drivers and were assessed using a driving simulator, a driving history questionnaire, and the Unified Huntington's Disease Rating Scale. The driving simulator session included urban and motorway scenarios. Analysis of variance and Kruskal-Wallis tests were used to compare urban and motorway driving across all 3 groups.

RESULTS

Manifest HD drove slower compared to controls and premanifest HD when speed limits increased (80 and 100 km/h) and they had a less steady speed compared to premanifest HD on the motorway and in a 30 km/h zone. Manifest HD also had a larger standard deviation of the lateral position (i.e., more weaving of the car/less vehicle control) compared to controls and premanifest HD on the motorway.

CONCLUSIONS

Manifest HD drive more cautious in a driving simulator when speed limits increase compared to premanifest HD and controls and they have less vehicle control on the motorway. The driving simulator parameters are able to discriminate between manifest HD and healthy individuals, so a driving simulator seems a feasible tool to use when investigating changes in driving in manifest HD.

Perceptual-cognitive three-dimensional multiple-object tracking task can help the monitoring of sport-related concussion

Objectives

While the rate of sport-related concussion is increasing, more effective tools are needed to help monitor the diagnosis and return to play of athletes. The three-dimensional multiple-object tracking (3D-MOT) exercise is a perceptual-cognitive task that has shown predictive power towards the dynamic requirements of real-world activities such as sport. This study introduced the use of the 3D-MOT task, along with the Standardized Assessment of Concussion (SAC) and Modified Balance Error Scoring System (M-BESS) tests, for diagnosis and return to play in professional sports.

Methods

Fifty-nine professional athletes were tested with the 3D-MOT, SAC and M-BESS tests at 48 hours following the injury. The same measures were employed to evaluate the return to play following the standard concussion management protocol. The SAC and M-BESS tests were also performed in pre-season (baseline) in 32 out of the 59 athletes.

Results

The injured athletes exhibited poor performance on 3D-MOT at 48 hours post injury compared with return to play (p<0.001) as well as compared with healthy professionals' performance scores (p<0.001). Importantly, learning rate, which participants are thought to have an expert advantage on this perceptual-cognitive task, was totally disrupted at 48 hours post injury compared with healthy professionals (p<0.001). The 3D-MOT performance was also correlated to the total number of symptoms (p=0.020), SAC (p=0.031) and M-BESS (p=0.004) scores at 48 hours. Not surprisingly, SAC and M-BESS tests' usefulness for monitoring concussion was found to be weak, particularly when test performance following the injury was compared to baseline (p=0.056 and 0.349 for SAC and M-BESS, respectively).

Conclusion

3D-MOT could help monitor sport-related concussion in professional athletes. The discussion also covers the critical importance of perceptual-cognitive assessment following concussion in the athletic population.

A Systematic Review of Commercial Cognitive Training Devices: Implications for Use in Sport

Background: Cognitive training (CT) aims to develop a range of skills, like attention and decision-making, through targeted training of core cognitive functions. While CT can target context specific skills, like movement anticipation, much CT is domain general, focusing on core abilities (e.g., selective attention) for transfer to a range of real-world tasks, such as spotting opponents. Commercial CT (CCT) devices are highly appealing for athletes and coaches due to their ease of use and eye-catching marketing claims. The extent to which this training transfers to performance in the sporting arena is, however, unclear. Therefore, this paper sought to provide a systematic review of evidence for beneficial training effects of CCT devices and evaluate their application to sport. Methods: An extensive search of electronic databases (PubMed, PsychInfo, GoogleScholar, and SportDiscus) was conducted to identify peer-reviewed evidence of training interventions with commercially available CT devices. Forty-three studies met the inclusion criteria and were retained for quality assessment and synthesis of results. Seventeen studies assessed transfer effects beyond laboratory cognitive tests, but only 1 directly assessed transfer to a sporting task. Results: The review of evidence showed limited support for far transfer benefits from CCT devices to sporting tasks, mainly because studies did not target the sporting environment. Additionally, a number of methodological issues with the CCT literature were identified, including small sample sizes, lack of retention tests, and limited replication of findings by researchers independent of the commercial product. Therefore, evidence for sporting benefits is currently limited by the paucity of representative transfer tests and a focus on populations with health conditions. Conclusions: Currently there is little direct evidence that the use of CCT devices can transfer to benefits for sporting performance. This conclusion, however, stems more from a lack of experimental studies in the sporting field and a lack of experimental rigor, rather than convincing null effects. Subsequently, there is an opportunity for researchers to develop more reliable findings in this area through systematic assessment in athletic populations and major methodological improvements.