Predicting fitness-to-drive following stroke using the Occupational Therapy - Driver Off Road Assessment Battery

Effect of Fitness-To-Drive and Metacognition on Road Traffic Injury Among Older Taxi Drivers: Hierarchical Modeling

Age-related cognitive and somatic motor skills changes have been linked to impaired driving abilities. Taxi drivers play an important role in providing public transportation services and security. This study aimed to examine the level of fitness-to-drive (FTD) and identify the predictors of self-reported traffic injury among the older taxi drivers. Taxi drivers 60 years and older in Bangkok and the metropolitan area were enrolled. Hierarchical regression models were carried out to examine the effects of demographics, FTD, and metacognition towards self-reported road traffic injury. Totally, 46.1% of the respondents were classified as at-risk drivers. Drivers with alcohol consumption and low risk perception toward road safety were more likely to experience road traffic injury. Regular assessment of physical and psychometric capacity among older taxi drivers could provide another empirical basis to improve public safety transport.

Methods to evaluate driving competence for people with acquired brain injury (ABI): A systematic review

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.

Establishing the Predictive Validity of the ScanCourse for Assessing On-Road Driving Performance

IMPORTANCE

Scanning the environment is critical for driving safety. The ScanCourse is a functional assessment that assesses a person's ability to scan the environment for visual information while in motion. Measurement properties for the ScanCourse have been reported; however, its predictive validity is unknown.

OBJECTIVE

To determine the predictive validity of the ScanCourse for on-road driving performance and establish clinical cutoff scores.

DESIGN

Retrospective chart reviews were conducted over a 6-mo period.

SETTING

Four Canadian driver rehabilitation programs.

PARTICIPANTS

Charts from patients with neurological or vision conditions were eligible if they contained ScanCourse and on-road driving evaluation results between September 1, 2008, and August 30, 2018. Three hundred twenty-five charts were included for analysis.

OUTCOMES AND MEASURES

Area under the curve (AUC) analysis was used to determine the predictive validity of ScanCourse scores for on-road outcomes; cutoff scores were established by optimizing sensitivity and specificity.

RESULTS

The ScanCourse had an AUC of .702. The optimal cutoff score was 18/20 with a sensitivity of 76.7% and a specificity of 47.1%.

CONCLUSIONS AND RELEVANCE

Assessing the scanning abilities of at-risk drivers who intend to return to driving after sustaining an injury can help identify safety risks and inform interventions. The ScanCourse was found to have acceptable discriminatory ability for on-road driving performance. This study provides evidence supporting its continued use as a screening tool to assess driver fitness with an identified optimal cutoff score for clinical use.

WHAT THIS ARTICLE ADDS

Measuring the predictive ability of the ScanCourse assessment in relation to on-road driving performance provides occupational therapists with an evidence-based clinical tool to assist with screening fitness to drive among at-risk people.

Using Serial Trichotomization with Neuropsychological Measures to Inform Clinical Decisions on Fitness-to-Drive among Older Adults with Cognitive Impairment

Decisions related to driving safety and when to cease driving are complex and costly. There is an interest in developing an off-road driving test utilizing neuropsychological tests that could help assess fitness-to-drive. Serial trichotomization has demonstrated potential as it yields 100% sensitivity and specificity in retrospective test samples. The purpose of this study was to test serial trichotomization using four common neuropsychological tests (Trail Making Test Part A and B, Clock Drawing Test, and Modified Mini-Mental State Examination). Test scores from 105 patients who were seen in a memory clinic were abstracted. After applying the model, participants were classified as unfit, fit, or requiring further testing, 38.1%, 25.8%, and 36.1%, respectively. This study provides further evidence that trichotomization can facilitate the assessment of fitness-to-drive.

Maze test score time adjustments when using nondominant hand in fitness-to-drive assessments

Drivers with medical conditions may need to demonstrate their fitness by participating in clinical and on-road assessments. Scores from the clinic-based occupational therapy-drive home maze test (OT-DHMT) can contribute to fitness-to-drive recommendations. The OT-DHMT is a short, timed test that has previously been shown to be valid and reliable, and norms are available for completion with a driver's dominant hand. Following stroke or trauma, many drivers need to complete assessments and resume driving using their nondominant hand. The validity of a person's OT-DHMT score when completed with a nondominant hand is unknown. This study investigated if a person's OT-DHMT score time requires adjustment when completed with a nondominant hand. The OT-DHMT was administered with a convenience sample of 148 community-dwelling participants, aged 21-81 years (M = 48.6, SD = 19.38) using both their dominant and nondominant hands, in a random order. OT-DHMT score times were significantly faster when using dominant (M = 15.73) compared with nondominant (M = 17.64) hand, d = 1.91 [confidence interval (CI) 1.13, 2.69], t = 4.84, P < 0.01. Employing a generalized weighted least squares regression model indicated that multiplying a driver's nondominant hand time by 0.833 s for drivers aged ≤60, and by 0.929 s for drivers aged 61+ can approximate dominant hand completion times. The OT-DHMT has been validated for use with people using their nondominant hand. Time adjustments are required for people using their nondominant hand when completing the OT-DHMT, and a larger adjustment is required for people aged ≤60 reinforcing previous findings that younger people have faster OT-DHMT completion times.

An early warning system for diabetic automobile drivers with peripheral neuropathy

PURPOSE

People with Type 2 diabetes exhibit peripheral neuropathy that results in the progressive loss of sensation in their feet. This may adversely affect their ability to drive as there is the potential for their foot to slip off the accelerator or brake pedals, with unwanted consequences including traffic accidents. This research aimed to develop a prototype for an adaptive haptic foot device for diabetic drivers experiencing peripheral neuropathy that can serve as an early warning system for foot slip during driving.

METHODS

A prototype system was designed in the laboratory which consisted of four force sensing resistors, four light emitting diodes and an eccentric rotating mass all connected and programmed through an Arduino Uno. The prototype was tested under controlled conditions and validated against recommended specifications. The system was then installed in a Ford Falcon GT 2005 and tested under controlled road conditions.

RESULTS

The results indicated that the haptic device was effective in sensing foot locations and providing instant audio and video feedback to the driver.

CONCLUSION

This research has successfully designed and fabricated a haptic feedback device that can be used as an early warning system for diabetic automobile drivers with peripheral neuropathy.IMPLICATIONS FOR REHABILITATIONA haptic foot prototype device capable of generating warning signals to diabetic drivers whose foot could slip off the brake or accelerator pedals has been developed.The prototype includes force sensing receivers integrated with eccentric rotating mass system, a haptic controller breakout board, and Arduino software.The system is very easy to use and provides highly reliable audio and visual feedback which are good alerting mechanisms for older automobile drivers.