1
|
Fahmi A, Garon M, Ribon-Demars A, Dubois L, Caouette M, Lamontagne MÈ, Beaulieu-Bonneau S. Learning to drive with neurological conditions: profile of users of an adapted driver training program and cognitive factors associated with success. Disabil Rehabil 2024; 46:3869-3877. [PMID: 37728095 DOI: 10.1080/09638288.2023.2258332] [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: 05/25/2022] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To describe the sociodemographic and cognitive profile of participants enrolled in an adapted driving program for individuals with neurological conditions, to explore the association between cognitive functioning and driving program outcome, and to describe driving habits after program completion. METHODS This study combined retrospective chart review and cross-sectional data collection. RESULTS The sample included 71 participants with neurological disorders (aged 15-56 years, M = 22.2 ± 8.6; 39% women). Driving program was either successful (47%), failed (7%), discontinued (34%), or ongoing (13%). Among 35 participants with complete neuropsychological and driving program outcome data, those who successfully completed the program showed better attention functioning, and better performance relative to global functioning for attention, executive functions, and working memory, compared to those who discontinued/failed the program. Among 21 participants who completed a telephone questionnaire on average 3.7 years after program enrollment, 67% obtained their driver's license and drove regularly. Participants reported high levels of satisfaction with the program. CONCLUSION These results suggest that approximately half of the persons enrolled in a driver training program designed for learners with neurological conditions, obtain a driver's license; and that attention, and to a lesser extent executive functioning and working memory, are related to driving program success.IMPLICATIONS FOR REHABILITATIONIn individual with neurological conditions, learning how to drive can be challenging.An adapted driver training program, involving collaboration between driving instructors and healthcare professionals, simplification of theoretical learning, and increasing driving practice opportunities, can be effective, both in terms of licensing success and client satisfaction.Conducting a pre-driving program neuropsychological assessment, with identification of cognitive strengths and weaknesses, can provide valuable information for clinicians and driving instructors for optimizing training and predicting outcome.Better performance in attention, and better relative to global cognitive functioning in attention, executive functions, and working memory, are related to higher success rate of an adapted driving program.
Collapse
Affiliation(s)
- Adam Fahmi
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Mathieu Garon
- Centre intégré universitaire de santé et de services sociaux de l'Estrie, Centre hospitalier universitaire de Sherbrooke; Sherbrooke, QC, Canada
| | - Alexandra Ribon-Demars
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Laurie Dubois
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| | - Martin Caouette
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- Département de psychoéducation, Université du Québec à Trois-Rivières; Trois-Rivières, QC, Canada
| | - Marie-Ève Lamontagne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
- École des sciences de la réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Simon Beaulieu-Bonneau
- École de psychologie, Faculté des sciences sociales, Université Laval, Québec, QC, Canada
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (Cirris), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (CIUSSS-CN), Québec, QC, Canada
| |
Collapse
|
2
|
Tsuda Y, Yoshikawa R, Matsuda A, Fujii Y, Kobayashi Y, Harada R, Saji Y, Sakai Y. Evaluating the Effectiveness of the Driving Resumption Assessment in Brain Disorders: Insights From a Retrospective Observational Study. Cureus 2024; 16:e65304. [PMID: 39184726 PMCID: PMC11343641 DOI: 10.7759/cureus.65304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
Objectives For patients with brain disorders, regaining the ability to drive is crucial to their reintegration into society. Despite the existence of numerous assessment methods for determining the ability to resume driving, the most effective approach remains unclear. This study evaluated patients with brain disorders who had received support for driving resumption. We examined the factors influencing the acquisition of driving ability in this specific population. Methods This retrospective observational study was conducted from July 2019 to March 2022. Initially, a desk-based assessment was conducted using neuropsychological tests. Successful candidates subsequently underwent an on-road assessment at an affiliated driving school. Patients who passed both assessments were granted permission to resume driving. The participants were categorized into pass and fail groups based on their assessments, and a comparative analysis was conducted. Age, sex, type of brain disorder, functional independence measures (FIMs), assessments of higher cognitive skills, and physical function test results were evaluated. Results Forty-five patients (average age: 62±13 years) underwent evaluation. Logistic regression analysis for the desk-based assessment identified the Rey-Osterrieth complex figure test (ROCFT) (three-minute delayed recall) as the most influential factor (cutoff value: 21.5 points; sensitivity: 65%; specificity, 72.7%). In the on-road assessment, the 10-m walking test was significantly faster in the passing group than in the failing group (p<0.005). Conclusions We demonstrated that the ROCFT (three-minute delayed recall) was the most effective neuropsychological assessment tool for evaluating driving resumption. The assessment of walking speed may also be able to predict the resumption of driving in patients with brain disorders.
Collapse
Affiliation(s)
- Yuzo Tsuda
- Department of Rehabilitation Medicine, Ishikawa Hospital, Himeji, JPN
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital, Kobe, JPN
| | - Ryo Yoshikawa
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital, Kobe, JPN
| | - Atsuko Matsuda
- Department of Rehabilitation Medicine, Ishikawa Hospital, Himeji, JPN
| | - Yasumitsu Fujii
- Department of Rehabilitation Medicine, Ishikawa Hospital, Himeji, JPN
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, JPN
| | | | - Risa Harada
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, JPN
| | - Yoshiaki Saji
- Department of Surgery, Ishikawa Hospital, Himeji, JPN
| | - Yoshitada Sakai
- Division of Rehabilitation Medicine, Kobe University Graduate School of Medicine, Kobe, JPN
- Department of Physical Medicine and Rehabilitation, Kobe University Hospital, Kobe, JPN
| |
Collapse
|
3
|
Krasniuk S, Crizzle AM. Using Serial Trichotomization to Determine Fitness to Drive in Medically At-Risk Drivers. Am J Occup Ther 2024; 78:7801205020. [PMID: 38215305 DOI: 10.5014/ajot.2024.050134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024] Open
Abstract
IMPORTANCE Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs). OBJECTIVE To examine whether serial trichotomization of clinical tests predicts pass-fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE. DESIGN Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View® Subtests 1 to 3 and outcomes on the CDE (pass-fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass-fail and indeterminate outcomes. SETTING A driving assessment clinic. PARTICIPANTS Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate. OUTCOMES AND MEASURES On-road pass-fail outcomes. RESULTS Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI. CONCLUSIONS AND RELEVANCE Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments. Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.
Collapse
Affiliation(s)
- Sarah Krasniuk
- Sarah Krasniuk, PhD, MSc, is Postdoctoral Fellow, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alexander M Crizzle
- Alexander M. Crizzle, PhD, MPH, CE, is Associate Professor and Director, Driving Research and Simulation Laboratory, School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;
| |
Collapse
|
4
|
Müller Fiedler A, Almeida T, Vasconcellos FDN, Morell A, de Monaco BA, Anghinah R, Cordeiro JG. Fitness-to-drive after adult civilian traumatic brain injury: protocol for a systematic review and meta-analysis. Neurosurg Rev 2023; 46:324. [PMID: 38048009 DOI: 10.1007/s10143-023-02228-5] [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: 07/03/2023] [Revised: 11/06/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
Traumatic brain injury (TBI) poses significant challenges for assessing fitness-to-drive (FTD) and determining the appropriate timing for return-to-driving (RTD) in civilian adults. This systematic review and meta-analysis protocol is designed to offer a comprehensive assessment of RTD timelines post-TBI, examining the effects of injury severity as well as demographic and clinical factors that influence driving capabilities. In response to gaps identified in previous literature-namely, the absence of recent systematic search strategies and thorough quality assessments-this study employs rigorous methodologies for literature search, data extraction, and evaluation of study quality. Our approach aims to provide reliable estimates and detailed analyses of subgroups within the TBI population. The findings aim to support clinical decision-making, inform RTD readiness, and potentially impact policy and driving assessment protocols. Ultimately, this review seeks to contribute to public safety measures, reduce traffic-related harm, and improve life outcomes for individuals recovering from TBI, thereby filling a vital research niche in neurotrauma rehabilitation.
Collapse
Affiliation(s)
| | - Timoteo Almeida
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
- Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Fernando De Nigris Vasconcellos
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
- Department of Neurological Surgery, University of Texas Health Science, McGovern Medical School, Houston, TX, USA
| | - Alexis Morell
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
| | - Bernardo Assumpção de Monaco
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
- Department of Neurology, Neurosurgery Division, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Renato Anghinah
- Department of Neurological Surgery, University of Miami Hospital, Miami, FL, USA
- Department of Neurology, Clinics Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | | |
Collapse
|
5
|
Chanmas G, Taveekitworachai P, Paliyawan P, Thawonmas R, Thawonmas R, Nukoolkit C, Dajpratham P. Driving scenarios and environmental settings in simulator-based driving assessment systems for stroke: a systematic review. Top Stroke Rehabil 2023; 30:872-880. [PMID: 36617424 DOI: 10.1080/10749357.2023.2165273] [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: 09/11/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND Driving simulators are effective tools to evaluate the driving abilities of patients with stroke. They can introduce various driving scenarios which will greatly benefit both the assessors and drivers. However, there is still no guidelines by which driving scenarios should be introduced in the driving assessment. OBJECTIVES We conducted a systematic review to examine the utilization of driving scenarios and environments in the simulator-based driving assessment for patients with stroke. METHODS A systematic review was conducted following PRISMA. We searched PubMed, Web of Science, ScienceDirect, ACM Digital Library, and IEEE Xplore Digital Library databases in January and June 2022 to identify eligible articles published since 2010. RESULTS Our searches identified 1,614 articles. We included 12 studies that applied driving simulators to assess the driving performance of patients with stroke. The driving scenarios were categorized into three categories - vehicle controls scenarios, hazard perception scenarios, and trajectory planning scenarios - based on a certain set of driving abilities. The most common driving scenarios are simple navigation (n = 8) and emergency stop (n = 8). The most frequently used driving area is urban (n = 9), and a variety of roads and traffic conditions were found in the included studies. Only 2 studies applied weather conditions, such as the clear and sunny condition or the windy condition. CONCLUSION It is recommended for future research to consider covering scenarios from the aforementioned three categories and further investigate the benefits of introducing complex weather conditions and localized traffic conditions in the driving assessment.
Collapse
Affiliation(s)
- Gunt Chanmas
- Graduate School of Information Science and Engineering, Ritsumeikan University, Shiga, Japan
| | | | - Pujana Paliyawan
- Ritsumeikan Center for Game Studies, Ritsumeikan University, Kyoto, Japan
| | - Ramita Thawonmas
- Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ruck Thawonmas
- College of Information Science and Engineering, Ritsumeikan University, Shiga, Japan
| | - Chakarida Nukoolkit
- School of Information Technology, King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - Piyapat Dajpratham
- Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| |
Collapse
|
6
|
Waggestad TH, Kirsebom BE, Strobel C, Wallin A, Eckerström M, Fladby T, Egeland J. Improving validity of the trail making test with alphabet support. Front Psychol 2023; 14:1227578. [PMID: 37575421 PMCID: PMC10412809 DOI: 10.3389/fpsyg.2023.1227578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/07/2023] [Indexed: 08/15/2023] Open
Abstract
Objective The Trail Making Test (TMT) is commonly used worldwide to evaluate cognitive decline and car driving ability. However, it has received critique for its dependence on the Latin alphabet and thus, the risk of misclassifying some participants. Alphabet support potentially increases test validity by avoiding misclassification of executive dysfunction in participants with dyslexia and those with insufficient automatization of the Latin alphabet. However, Alphabet support might render the test less sensitive to set-shifting, thus compromising the validity of the test. This study compares two versions of the TMT: with and without alphabet support. Methods We compared the TMT-A, TMT-B, and TMT-B:A ratios in two independent normative samples with (n = 220) and without (n = 64) alphabet support using multiple regression analysis adjusted for age and education. The sample comprised Scandinavians aged 70-84 years. Alphabet support was included by adding the Latin alphabet A-L on top of the page on the TMT-B. We hypothesized that alphabet support would not change the TMT-B:A ratio. Results After adjusting for age and years of education, there were no significant differences between the two samples in the TMT-A, TMT-B, or the ratio score (TMT-B:A). Conclusion Our results suggest that the inclusion of alphabet support does not alter TMT's ability to measure set-shifting in a sample of older Scandinavian adults.
Collapse
Affiliation(s)
| | - Bjørn Eivind Kirsebom
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway
- Department of Psychology, The Arctic University of Norway, Tromsø, Norway
| | - Carsten Strobel
- Medical Department, Section of Geriatrics, Memory Clinic and Stroke Unit, Lovisenberg Diaconal Hospital, Oslo, Norway
| | - Anders Wallin
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Eckerström
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Tormod Fladby
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jens Egeland
- Vestfold Hospital Trust, Tønsberg, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| |
Collapse
|
7
|
Sanders G, Rapport LJ, Marwitz JH, Novack TA, Walker W, Tefertiller C, Watanabe TK, Kennedy R, Goldin Y, Bergquist T, Dreer LE, Bombardier CH, Zhang Y. Barriers to driving and psychosocial outcomes after traumatic brain injury. Brain Inj 2023; 37:412-421. [PMID: 36717959 DOI: 10.1080/02699052.2023.2172611] [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] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Examine considerations and perceived barriers to return to driving, and their association with psychosocial outcomes among adults with traumatic brain injury (TBI) who were not driving. METHODS 174 adults with moderate-to-severe TBI enrolled in the TBI Model System participated in this cross-sectional study. All participants were drivers prior to their TBI. Outcome measures included the Barriers to Driving Questionnaire, Disability Rating Scale, Patient Health Questionnaire-9, General Anxiety Disorder-7, and Satisfaction With Life Scale. Descriptive analyses examined considerations and barriers to driving, including differences associated with demographic characteristics. Moderation analyses investigated the extent to which disability moderated the relationship between barriers and psychosocial outcomes. RESULTS Social barriers were the most strongly endorsed domain, whereas physical barriers were endorsed least. The profile of endorsements differed for men and women, and for Black and White participants, on both theoretical considerations in returning to drive and experiences of barriers in doing so. Disability level moderated the relationship between barriers to driving and depression and life satisfaction, but not anxiety. CONCLUSION The experience of barriers to driving is differentially associated with psychosocial outcomes among nondriving adults with TBI. Adults with low disability appear to be at risk for distress, even compared to other nondrivers.
Collapse
Affiliation(s)
- Gavin Sanders
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Jenny H Marwitz
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thomas A Novack
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - William Walker
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Thomas K Watanabe
- Department of Physical Medicine and Rehabilitation, MossRehab at Elkins Park/Einstein Healthcare Network, Pennsylvania, USA
| | - Richard Kennedy
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Yelena Goldin
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey, USA
| | - Thomas Bergquist
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura E Dreer
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Charles H Bombardier
- Department of Physical Medicine and Rehabilitation, University of Washington, Seattle, Washington, USA
| | - Yue Zhang
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, Integrative Center for Aging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
8
|
Krasniuk S, Crizzle AM, Toxopeus R, Mychael D, Prince N. Clinical Tests Predicting On-Road Performance in Older Drivers with Cognitive Impairment. Can J Occup Ther 2023; 90:44-54. [PMID: 35950229 PMCID: PMC9923206 DOI: 10.1177/00084174221117708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The Trail Making Test Part B (Trails B) and Useful Field of View® (UFOV) can predict on-road outcomes in drivers with cognitive impairment (CI); however, studies have not included drivers referred for comprehensive driving evaluations (CDEs), who typically have more severe CI. Purpose. We determined the predictive ability of Trails B and UFOV on pass/fail on-road outcomes in drivers with CI (Montreal Cognitive Assessment <26) referred for CDEs. Method. Retrospective data collection from two driving assessments centers (N = 100, mean age = 76.2 ± 8.8 years). Findings. The Trails B (area under the curve [AUC] = .70) and UFOV subtests 2 (AUC = .73) and 3 (AUC = .76) predicted pass/fail outcomes. A cut-point ≥467 ms on UFOV subtest 3 better-predicted pass/fail outcomes with 78.9% sensitivity and 73.5% specificity. In comparison, a cut-point ≥3.58 min on Trails B had lower sensitivity (73.7%) and specificity (61.8%). Implications. The UFOV subtest 3 may be more useful than the Trails B for predicting pass/fail outcomes in drivers with more severe CI referred for CDEs.
Collapse
Affiliation(s)
| | - Alexander M. Crizzle
- Alexander Crizzle, School of Public Health,
University of Saskatchewan, Saskatoon, SK, Canada.
| | | | | | | |
Collapse
|
9
|
Alhashmi D, Lalor A, Fossey E. Methods to evaluate driving competence for people with acquired brain injury (ABI): A systematic review. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1020420. [PMID: 36684687 PMCID: PMC9846792 DOI: 10.3389/fresc.2022.1020420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023]
Abstract
Driving is essential for independence, community involvement and quality of life. Driving is the primary transportation method in Saudi Arabia. Despite the high rates of brain injuries and disability in Saudi Arabia, currently there are no guidelines regarding driver assessment and rehabilitation to facilitate people with brain injuries to resume driving. Therefore, this systematic review aimed to understand the assessment methods used internationally to evaluate driving competence for people with acquired brain injuries (ABI). A systematic search of six electronic databases was conducted by two authors and twenty-six studies were identified for review. Four main approaches to driver assessment: clinical assessments such as neuropsychological tests, off-road screening tools, simulator testing, and comprehensive driving assessment were identified. However, our findings revealed a lack of consistency in their use to assess driving competence after ABI. On-road driving performance tests were predominantly used to determine driving competence either independently or in combination with another method in over two-thirds of the reviewed studies. While clinical assessments of cognitive impairments showed some capacity to predict driving performance of people with ABI, they should be used with caution since they cannot replace on-road driving performance tests. Driver assessment should be part of rehabilitation following high prevalence conditions such as ABI. This systematic review offers guidance for Saudi clinicians, as well as policymakers, about providing rehabilitation services for people with ABI, and recommendations for further research and collaborations to improve this much-needed area of practice.
Collapse
Affiliation(s)
- Doha Alhashmi
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia,Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia,Correspondence: Doha Hassan Alhashmi
| | - Aislinn Lalor
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia,Rehabilitation, Ageing and Independent Living Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| |
Collapse
|
10
|
Rosenfeld M, Goverover Y, Weiss P. Self-awareness predicts fitness to drive among adults referred to occupational therapy evaluation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:1005025. [DOI: 10.3389/fresc.2022.1005025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/17/2022]
Abstract
BackgroundDriving is associated with independence, well-being, quality of life, and an active lifestyle. Driving requires cognitive, motor, and visual skills, including self-awareness and processing speed. This study examines whether driver self-awareness, motor processing speed, and cognitive processing speed can predict fitness to drive among individuals referred to occupational therapy evaluation due to concerns about their driving ability.MethodIn this cross-sectional study, 39 participants were referred to off- and on-road driving evaluation to determine their fitness to drive due to changes in health status, advanced age, license renewal requirement, or prior automobile accidents. A registered occupational therapist (OT) classified 23 of the participants as fit to drive and 16 as unfit to drive. Motor and cognitive processing speed were assessed by the Stationary Perception-Reaction Timer and the Color Trails Test, respectively. Driving self-awareness was assessed by comparing the DI and OT evaluations to the participants' estimation of their own on-road driving performance.ResultsThe fit-to-drive participants had a better motor and cognitive processing speed than those unfit-to-drive. The unfit-to-drive group overestimated their driving ability, whereas the fit-to-drive group accurately or almost accurately estimated their driving ability. Driving self-awareness was a significant predictor of participants' fitness to drive.ConclusionsThis study demonstrates the importance of self-awareness for predicting fitness to drive among people at risk for compromised driving skills. Thus, driving self-awareness should be addressed as part of fitness-to-drive evaluations and interventions.
Collapse
|
11
|
Ghawami H, Okhovvat A, Homaei Shoaa J, Sorkhavandi M, Yamola M, Moazenzadeh M, Rahimi-Movaghar V. Can executive functions of the brain predict official driving test success? APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-7. [PMID: 36369857 DOI: 10.1080/23279095.2022.2145479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Human factors, including the level of cognitive functioning, are the most influential factors in road traffic crashes. Among cognitive abilities, executive functions (EFs) of the brain play a pivotal role in driving performance and outcomes, including crash numbers. The current study was aimed to explore, for the first time, the ability of EF tests to predict success on the official driving tests in applicants of driving license in Iran. We administered a relevant set of commonly used EF tests, including a computerized Stroop test and six tests from the Delis-Kaplan Executive Function System (D-KEFS) and the Behavioral Assessment of the Dysexecutive Syndrome (BADS), to 87 healthy new drivers applying for a driver's license (Mage = 25.9 years, SD = 8.2; 43 female). We also administered a series of demographic and psychological questionnaires. The data regarding the participants' official driving tests were extracted from the official records. To determine the relations of the EF tests with success on the driving tests, several correlation and regression analyses were conducted. Most of the EF measures had significant correlations with the road test success, while having no significant relations with the theory test success. Moreover, in our regression analyses, The EF measures predicted success on the official driving road test, but not success on the driving theory test, even after controlling for the effects of previous unlicensed driving experience and stress symptoms. The results demonstrate the predictability of the driving road test success from executive functioning.
Collapse
Affiliation(s)
- Heshmatollah Ghawami
- Neuropsychology Division, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Atiyeh Okhovvat
- Department of Educational Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Jaleh Homaei Shoaa
- Department of Personality Psychology, Islamic Azad University Karaj Branch, Karaj, Iran
| | - Minoo Sorkhavandi
- Department of Psychology, Islamic Azad University Central Tehran Branch, Tehran, Iran
| | - Marjan Yamola
- Department of Clinical Psychology, Kharazmi University, Tehran, Iran
| | - Mona Moazenzadeh
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Ghawami H, Homaei Shoaa J, Moazenzadeh M, Sorkhavandi M, Okhovvat A, Hadizadeh N, Yamola M, Rahimi-Movaghar V. Ecological validity of executive function tests in predicting driving performance. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-13. [PMID: 36152341 DOI: 10.1080/23279095.2022.2126940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Almost all of our everyday activities depend on executive function (EF) skills. In line with the increasing attention to the ecological validation of neuropsychological assessment and intervention methods, this study aimed to explore the ecological validity of a relevant set of widely used EF tests, mostly from well-known paradigms of EF assessment, in predicting driving ability. Ninety-six healthy novice drivers (Mage = 26.2 years, SD = 8.4; 48 female) completed four stages of our data collection including psychological, EF, and driving assessments. For the psychological assessment, validated measures of sensation-seeking, risk-taking, personality traits, ADHD symptoms, depression, anxiety, and stress were administered. For the EF assessment, selected tests from the Delis-Kaplan Executive Function System (D-KEFS: Trail Making, Design Fluency, and Tower) and the Behavioral Assessment of the Dysexecutive Syndrome (BADS: Key Search, Zoo Map, and Modified Six Elements) along with a computerized Stroop test were administered. For the driving assessment, we used a simulated driving test comprising of 14 key dimensions of driving skills. Several correlations and multiple regression analyses were conducted. Significant correlations were found between all the EF measures and driving performance. Moreover, the EF measures predicted the driving ability over and above the effects of previous driving experience and the psychological variables. These results provide supporting evidence for the ecological validity of the EF tests in predicting driving performance. The incorporation of assessment and intervention targeting multiple domains of EF into driving rehabilitation and education programs could be a focus of future research.
Collapse
Affiliation(s)
- Heshmatollah Ghawami
- Neuropsychology Division, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Homaei Shoaa
- Department of Personality Psychology, Islamic Azad University Karaj Branch, Karaj, Iran
| | - Mona Moazenzadeh
- Department of Cognitive Psychology, Institute for Cognitive Science Studies, Tehran, Iran
| | - Minoo Sorkhavandi
- Department of Psychology, Islamic Azad University Central Tehran Branch, Tehran, Iran
| | - Atiyeh Okhovvat
- Department of Educational Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Neda Hadizadeh
- Department of Cognitive Rehabilitation, Institute for Cognitive Science Studies, Tehran, Iran
| | - Marjan Yamola
- Department of Clinical Psychology, Kharazmi University, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
13
|
Bäcker HC, Krüger D, Spies S, Perka C, Kirschbaum SM, Hardt S. Effect of total hip arthroplasty on brake reaction time and braking force. Hip Int 2022; 32:51-55. [PMID: 32573263 DOI: 10.1177/1120700020936635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The correct moment for return to driving after total hip arthroplasty (THA) remains unclear. Until today no uniform recommendation exists on the ability to perform an emergency brake.The aim of this prospective study was to investigate the braking ability of patients before and after THA implantation based on brake reaction time in milliseconds (BRT) and braking force in N (BF). METHODS In total, 25 patients (15 men, 10 women, mean age 51.3 ± 10.1 years) were treated with THA on the right side. Inclusion criteria consisted of a valid driving licence, frequent road participation and at least 2 years of driving experience. Exclusion criteria were underlying neurological disorders as well as severe complaints in the lumbar spine and the right knee joint. The brake ability was evaluated for emergency braking with a car simulator and a measuring sole. Measurements were performed preoperatively, 6 days, 2, 4 and 6 weeks after surgery. RESULTS Preoperatively, the mean BRT was 671.3 ± 123.5 ms and the BF 455.4 ± 185.0 N. Significant differences were observed at 6 days and 2 weeks after surgery, (BRT 836.4 ± 219.7 ms, respectively, BRT 735.0 ± 186.7 ms, and BF 302.6 ± 154.9 N, respectively, BF 375.5 ± 149.3 N, p < 0.05). Only 4 weeks after, no significant differences were seen compared to pre-operative with a BRT of 647.0 ± 91.9ms (p = 0.354) and BF of 435.9 ± 177.4 (p = 0.843). Furthermore, the BRT improved significantly after 6 weeks (607.4 ± 87.6; p = 0.005). CONCLUSIONS The braking force is significantly reduced, and the brake reaction time is prolonged directly after surgery for at least 2 weeks. After 4 weeks, no statistically significant differences were measured, although special care should still be taken during return to activity.
Collapse
Affiliation(s)
- Henrik C Bäcker
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - David Krüger
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - Sophie Spies
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - Stephanie M Kirschbaum
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité Berlin, University Hospital Berlin, Berlin, Germany
| |
Collapse
|
14
|
Samuelsson K, Lundqvist A, Selander H, Wressle E. Fitness to drive after acquired brain injury: Results from patient cognitive screening and on-road assessment compared to age-adjusted norm values. Scand J Psychol 2021; 63:55-63. [PMID: 34558073 DOI: 10.1111/sjop.12774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/16/2021] [Accepted: 08/10/2021] [Indexed: 01/13/2023]
Abstract
Fitness to drive after acquired brain injury or disease is a common question in rehabilitation settings. The aim of the study was to compare age-matched norms with patient cognitive test results used to predict fitness to drive. A second aim was to analyze the contribution from an on-road assessment to a final decision on resumption of driving after an acquired brain injury. Retrospective cognitive test results from four traffic medicine units (n = 333) were compared with results from a healthy norm population (n = 410) in Sweden. Patients were dichotomized according to the final decision as fit or unfit to drive made by the traffic medicine team. The norm group had significantly better results in all age groups for all cognitive tests compared with the patients considered unfit to drive and fit to drive. A binary regression analysis for the patient group showed an explained value for fit to drive/unfit to drive of 88%, including results for the Nordic Stroke Driver Screening Assessment total score, Useful Field of View total score and the final outcome from an on-road assessment. Results from the present study illustrate the importance of using several tests, methods and contexts for the final decision regarding fitness to drive.
Collapse
Affiliation(s)
- Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Lundqvist
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Helena Selander
- Department of Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Swedish National Transport Research Institute, Stockholm, Sweden
| | - Ewa Wressle
- Department of Geriatric Medicine and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
15
|
Perna R, Pundlik J, Arenivas A. Return-to-driving following acquired brain injury: A neuropsychological perspective. NeuroRehabilitation 2021; 49:279-292. [PMID: 34420988 DOI: 10.3233/nre-218026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Return to driving after an acquired brain injury (ABI) has been positively associated with return to employment, maintenance of social relationships, and engagement in recreational and other community activities. Safe driving involves multiple cognitive abilities in a dynamic environment, and cognitive dysfunction resulting from ABI can negatively impact driving performance. OBJECTIVE This manuscript examines the post-injury return-to-driving process, including performances on the in-office and on-road assessments, and the role of a rehabilitation neuropsychologist in helping patients resume driving. METHOD In this study, 39 of 200 individuals (approximately 20%) treated at an outpatient neurorehabilitation facility, who performed satisfactorily on a pre-driving cognitive screening, completed a behind-the-wheel driving test. RESULTS Of the 200 individuals, 34 (87%) passed the road test. Among the remaining five individuals who did not pass the road test, primary reasons for their failure included inability to follow or retain examiner directions primarily about lane position, speed, and vehicle control. The errors were attributable to cognitive difficulties with information processing, memory, attention regulation, and dual tasking.CONCLUSIONThe rehabilitation neuropsychologist contributed to the process by assessing cognition, facilitating self-awareness and error minimization, providing education about driving regulations and safety standards, and preparing for the road test and its outcomes.
Collapse
Affiliation(s)
| | | | - Ana Arenivas
- The Institute of Rehabilitation Research (TIRR), Memorial Hermann, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
16
|
Kanser R, O'Rourke J, Silva MA. Performance validity testing via telehealth and failure rate in veterans with moderate-to-severe traumatic brain injury: A veterans affairs TBI model systems study. NeuroRehabilitation 2021; 49:169-177. [PMID: 34397429 DOI: 10.3233/nre-218019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic has led to increased utilization of teleneuropsychology (TeleNP) services. Unfortunately, investigations of performance validity tests (PVT) delivered via TeleNP are sparse. OBJECTIVE The purpose of this study was to examine the specificity of the Reliable Digit Span (RDS) and 21-item test administered via telephoneMETHOD:Participants were 51 veterans with moderate-to-severe traumatic brain injury (TBI). All participants completed the RDS and 21-item test in the context of a larger TeleNP battery. Specificity rates were examined across multiple cutoffs for both PVTs. RESULTS Consistent with research employing traditional face-to-face neuropsychological evaluations, both PVTs maintained adequate specificity (i.e., > 90%) across previously established cutoffs. Specifically, defining performance invalidity as RDS < 7 or 21-item test forced choice total correct < 11 led to < 10%false positive classification errors. CONCLUSIONS Findings add to the limited body of research examining and provide preliminary support for the use of the RDS and 21-item test in TeleNP via telephone. Both measures maintained adequate specificity in veterans with moderate-to-severe TBI. Future investigations including clinical or experimental "feigners" in a counter-balanced cross-over design (i.e., face-to-face vs. TeleNP) are recommended.
Collapse
Affiliation(s)
- Robert Kanser
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA
| | - Justin O'Rourke
- Polytrauma Section, Audie L. Murphy Memorial Veterans' Hospital, San Antonio, TX, USA
| | - Marc A Silva
- Mental Health & Behavioral Sciences Section (MHBSS), James A. Haley Veterans' Hospital, Tampa, FL, USA.,Department of Internal Medicine, University of South Florida, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA.,Department of Psychology, University of South Florida, Tampa, FL, USA
| |
Collapse
|
17
|
Katsuki M, Yasuda I, Narita N, Ozaki D, Sato Y, Kato Y, Jia W, Nishizawa T, Kochi R, Sato K, Kawamura K, Ishida N, Watanabe O, Cai S, Shimabukuro S, Yokota K. Chronic subdural hematoma in patients over 65 years old: Results of using a postoperative cognitive evaluation to determine whether to permit return to driving. Surg Neurol Int 2021; 12:212. [PMID: 34084639 PMCID: PMC8168661 DOI: 10.25259/sni_186_2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Chronic subdural hematoma (CSDH) is usually associated with good recovery with burr hole irrigation and postoperative drainage under local anesthesia. In Japan, traffic accidents by the elderly drivers over 65 years old are severely increasing, and there is no consensus on whether or not to return to driving after CSDH treatment. We perform a postoperative cognitive assessment. We retrospectively investigated the return-to-driving rate and associated factors. Methods: Of the 45 patients over 65 y.o. and who had usually driven, 30 patients wished to drive again. We performed tests composed of Mini-Mental State Examination (MMSE), line cancellation and line bisection task, Kohs block design test, trail making test (TMT)-A and B, Kana-hiroi test, Rey-Osterrieth complex figure test, and behavioral assessment of the dysexecutive syndrome, in order. When all tests’ scores were better than the cutoff values, we let patients drive again. When some of the scores were worse than the cutoff values, we reevaluated the patients at the outpatient every month. If the patients’ scores could not improve at the outpatient, we recommended them to stop driving. Results: Nineteen of 30 patients could return to driving. Worse MMSE, Kohs block design test, TMT-A, TMT-B scores, higher age, dementia, or consciousness disturbance as chief complaints were associated with driving disability. Conclusion: CSDH is known as treatable dementia. However, we should perform an objective cognitive assessment before discharge because only 63% of the patients over 65 y.o. who wished to drive could return to driving.
Collapse
Affiliation(s)
- Masahito Katsuki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Iori Yasuda
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Norio Narita
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Dan Ozaki
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Yoshimichi Sato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Yuya Kato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Wenting Jia
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Taketo Nishizawa
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Ryuzaburo Kochi
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Kanako Sato
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Kokoro Kawamura
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Naoya Ishida
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Ohmi Watanabe
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Siqi Cai
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Shinya Shimabukuro
- Department of Neurosurgery, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| | - Kenichi Yokota
- Department of Rehabilitation, Kesennuma City Hospital, Kesennuma, Miyagi, Japan
| |
Collapse
|
18
|
Gouse H, Masson CJ, Henry M, Thomas KGF, Robbins RN, Kew G, London L, Joska JA, Marcotte TD. The Impact of HIV-Associated Neurocognitive Impairment on Driving Performance in Commercial Truck Drivers. AIDS Behav 2021; 25:689-698. [PMID: 32910354 DOI: 10.1007/s10461-020-03033-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Driving ability can be diminished amongst people with HIV with associated neurocognitive impairment (NCI). We explore the relationship between HIV status, NCI and driving ability in professional truck drivers. Forty male professional drivers (20 HIV-positive; mean age = 39.20 ± 7.05) completed a neuropsychological test battery, two driving simulator tasks that assessed driving ability, and a driving history and habits questionnaire. A higher proportion of HIV-positive drivers exhibited impaired overall cognitive performance (p ≤ 0.001). Overall, drivers with NCI (defined as z ≤ 1.00) were more likely than those without NCI to crash (p = 0.002). There were no significant between-group (HIV-positive versus HIV-negative) differences with regard to self-reported on-road driving events. Professional drivers with NCI, as measured on a driving simulator, are at increased risk of making driving errors under high-risk conditions compared to their neurocognitively normal counterparts. These data should inform driver health management with regard to annual medical screening and surveillance.
Collapse
Affiliation(s)
- H Gouse
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - C J Masson
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Henry
- Centre for Higher Education Development, University of Cape Town, Cape Town, South Africa
| | - K G F Thomas
- ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - R N Robbins
- HIV Center for Clinical and Behavioral Science, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - G Kew
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - L London
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J A Joska
- HIV Mental Health Research Unit and Neurosciences Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - T D Marcotte
- HIV Neurovehavioral Research Program, Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| |
Collapse
|
19
|
De Tanti A, Baldari F, Pedrazzi G, Inzaghi MG, Benoldi R, Abbati P, Malangone G, Martini C, Saviola D. Role of vehicle assistive devices for safe return to driving after severe acquired brain injury. Eur J Phys Rehabil Med 2020; 56:386-393. [PMID: 32434312 DOI: 10.23736/s1973-9087.20.06098-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Driving is a complex activity that requires a wide range of cognitive, behavioral, sensory and motor competences that are often impaired in cases of severe acquired brain injury (sABI). A safe return to driving is an objective significantly correlated with recovery of personal independence and social-occupational role. AIM The study investigated elements predictive of the possibility of a safe return to driving after sABI, concentrating on motor disability and the need to prescribe vehicle assistive devices. DESIGN Retrospective study. SETTING Out-patients of a rehabilitation center for sABI. POPULATION A series of 217 patients with stable sABI, well reintegrated at family and social level, were enrolled between January 2006 and June 2019. METHODS The subjects were assessed for residual competences. Those who passed assessment of cognitive-behavioral and visual impairment were assessed for motor disability and the need for vehicle assistive devices to enable a safe return to driving. RESULTS About 79% of the population were judged suitable for a return to driving. More than 50% of the latter were only able to return to driving with the aid of vehicle assistive devices. Etiological and demographic variables were not predictive of assessment outcome, whereas the various Griffith motor disability categories were correlated with need for vehicle assistive devices, which are most needed in non-traumatic subjects. CONCLUSIONS Although the literature on return to driving after brain injury focuses mainly on cognitive-behavioral impairment, in a significant percentage of cases it is also necessary to carefully analyse and manage motor disabilities that may result from sABI. CLINICAL REHABILITATION IMPACT Evaluation of the competences necessary for a return to driving after sABI requires a multiprofessional team that must also assess motor disability and know the possible vehicle assistive devices that can enable most candidates to overcome the limits imposed by their disability.
Collapse
Affiliation(s)
- Antonio De Tanti
- Centro Cardinal Ferrari - Santo Stefano Riabilitazione, Fontanellato, Parma, Italy -
| | | | - Giuseppe Pedrazzi
- Unit of Neurosciences, Center of Robust Statistics (Ro.S.A.), Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Maria G Inzaghi
- Laboratory of Neuropsychology, Quarenghi Clinical Institute, S. Pellegrino, Bergamo, Italy
| | - Raffaella Benoldi
- Centro Cardinal Ferrari - Santo Stefano Riabilitazione, Fontanellato, Parma, Italy
| | - Paola Abbati
- Centro Cardinal Ferrari - Santo Stefano Riabilitazione, Fontanellato, Parma, Italy
| | | | | | - Donatella Saviola
- Centro Cardinal Ferrari - Santo Stefano Riabilitazione, Fontanellato, Parma, Italy
| |
Collapse
|