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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.
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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
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Grant JG, Rapport LJ, Darling R, Waldron-Perrine B, Bernitsas E. Incremental validity of brief and abbreviated neuropsychological tests toward predicting functional outcomes in multiple sclerosis. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-11. [PMID: 36773023 DOI: 10.1080/23279095.2023.2176766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE This study examined the relationships among functional outcomes and performance on standard-length and abbreviated cognitive screening measures for multiple sclerosis (MS). METHOD 72 adults with MS underwent neurological examination and cognitive screening. They completed standard-length and abbreviated versions of tests from the Minimal Assessment of Cognitive Function in MS (MACFIMS), the abbreviated aMACFIMS, and the Brief International Cognitive Assessment for MS (BICAMS). Functional outcomes included neurological disability, physical and psychological dysfunction, and employment status. RESULTS Concordance of impairment classifications was examined between standard-length and abbreviated tests using logistic regression and ROC curve analyses. Overall, the abbreviated test versions showed a broad range of concordance with impairment classifications made using the full-length tests. Processing speed was the strongest correlate of neurological disability and employment status; immediate recall was the strongest predictor of subjective physical dysfunction. Test performance provided unique value toward predicting neurological disability and employment status, but not physical and psychological dysfunction. CONCLUSIONS The findings replicate some support for abbreviated tests in MS assessment, although caveats regarding loss of validity associated with abbreviation remain. The findings extend prior research showing that abbreviated tests of processing speed and immediate recall can provide unique predictive information regarding objective functional outcomes.
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Affiliation(s)
- Jeremy G Grant
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Lisa J Rapport
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Rachel Darling
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Brigid Waldron-Perrine
- Department of Physical Medicine & Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - Eva Bernitsas
- Department of Neurology, Wayne State University School of Medicine, Detroit, MI, USA
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Maeta M, Mizuno M, Okubo S, Ogasawara M, Terauchi T, Suzuki M, Akasaka H, Sato Y, Ohi K, Maeda T. Symbol digit modalities test predicts decline of off-road driving ability in Japanese patients with multiple sclerosis. Mult Scler Relat Disord 2022; 68:104150. [PMID: 36055114 DOI: 10.1016/j.msard.2022.104150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 07/31/2022] [Accepted: 08/26/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic progressing neurological disease with exacerbations and remissions. Patients with MS can show a variety of neurological symptoms. Cognitive decline is noticed as one of them and is related with deterioration of daily life quality in a clinical practice. Driving a car is one of the common activities required in daily life and is also an important issue in MS patients. METHODS To clarify the relationship between cognitive function and driving ability in MS patients, the symbol digit modalities test (SDMT) and a driving simulator were evaluated. We enrolled 24 patients with MS (5 males, 19 females, 39.04 ± 8.27 years old) and age- and sex-matched 24 healthy controls (5 males, 19 females, 40.54 ± 9.78 years old) in this study. They underwent the SDMT and also used a driving simulator to measure a total of 12 response values related to driving ability. In order to evaluate the relationship between SDMT and driving ability, MS patients were divided into two groups according to the median SDMT score: group A (SDMT 51 or more) and group B (SDMT less than 51). The data were statistically analyzed among control group, MS group A, and MS group B using Jonkheere-Terpstra trend test and Bonferroni's multiple comparison test. RESULTS The group with higher scores on the SDMT tended to have significantly higher driving performance. Multiple comparison analysis among three groups showed that the reaction values for speed of response behavior were significantly higher in MS group B than control group. CONCLUSION This study revealed a relationship between driving abilities and SDMT scores. Clinical evaluation using the SDMT may help to detect cognitive decline and to make a decision on driving a car in patients with MS.
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Affiliation(s)
- Manami Maeta
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate 0283694, Japan
| | - Masanori Mizuno
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate 0283694, Japan
| | - Satoru Okubo
- Department of Occupational Therapy, Iwate Rehabilitation Center, 16-243 Nanatsumori, Shizukuishi, Iwate 0200503, Japan
| | - Miku Ogasawara
- Department of Occupational Therapy, Iwate Rehabilitation Center, 16-243 Nanatsumori, Shizukuishi, Iwate 0200503, Japan
| | - Takahiro Terauchi
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate 0283694, Japan
| | - Masako Suzuki
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate 0283694, Japan
| | - Hiroshi Akasaka
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate 0283694, Japan
| | - Yoshitomo Sato
- Department of Neurology, Iwate Rehabilitation Center, 16-243 Nanatsumori, Shizukuishi, Iwate 0200503, Japan
| | - Kiyohumi Ohi
- Department of Neurology, Iwate Rehabilitation Center, 16-243 Nanatsumori, Shizukuishi, Iwate 0200503, Japan
| | - Tetsuya Maeda
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba, Shiwa, Iwate 0283694, Japan.
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Chen MH, Goverover Y. Self-awareness in multiple sclerosis: Relationships with executive functions and affect. Eur J Neurol 2021; 28:1627-1635. [PMID: 33527564 DOI: 10.1111/ene.14762] [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: 11/18/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Deficits in self-awareness can be observed in persons with multiple sclerosis (pwMS). The present study aimed to investigate two types of self-awareness (intellectual and online) among pwMS, which will inform clinical care. Intellectual awareness refers to knowledge of one's own abilities; online awareness refers to real-time monitoring and regulation of one's performance. METHODS The study sample consisted of 95 pwMS and 65 healthy controls (HCs). Intellectual awareness was defined as discrepancy between participant's and informant's reports of participant's functioning. Online awareness was operationalized by change in self-assessment of performance after engaging in a functional task. RESULTS PwMS had significantly worse intellectual awareness than HCs regarding money management (confidence interval [CI] 0.44 to 1.99), task performance (CI -0.01 to 2.5), social interaction (CI 0.29 to 2.45), and problem solving (CI 0.87 to 2.8) abilities, but not sensory symptoms. Executive functioning was positively associated with intellectual awareness in HCs, while depressive and anxiety symptoms were negatively related to intellectual awareness in pwMS. In contrast, online awareness was not significantly different between groups; both groups were able accurately to assess their performance after engaging in a functional task. CONCLUSIONS Intellectual awareness, but not online awareness, is impaired in pwMS. Among pwMS, affective symptomatology may distort their perception of functional status. Persons with MS may benefit from actually performing a functional task during the assessment and treatment process, which may lead to a more accurate estimate of their own abilities.
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Affiliation(s)
- Michelle H Chen
- Kessler Foundation, East Hanover, New Jersey, USA.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Rutgers University, Newark, New Jersey, USA
| | - Yael Goverover
- Kessler Foundation, East Hanover, New Jersey, USA.,Department of Occupational Therapy, Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York, USA
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Real-time assessment of daytime sleepiness in drivers with multiple sclerosis. Mult Scler Relat Disord 2020; 47:102607. [PMID: 33160140 DOI: 10.1016/j.msard.2020.102607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/06/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Daytime sleepiness is a common symptom of multiple sclerosis (MS) that may jeopardize safe driving. Our aim was to compare daytime sleepiness, recorded in real-time through eyelid tracking, in a simulated drive between individuals with MS (iwMS) and healthy controls. METHODS Fifteen iwMS (age = median (Q1 - Q3), 55 (50 - 55); EDSS = 2.5 (2 - 3.5); 12 (80%) female) were matched for age, sex, education, and cognitive status with 15 controls. Participants completed self-reported fatigue and sleepiness scales including the Modified Fatigue Impact Scale (MFIS), Pittsburg Sleep Quality Inventory (PSQI), and Epworth Sleepiness Scale (ESS). Percentage of eyelid closure (PERCLOS) was extracted from a remote eye tracker while completing a simulated drive of 25 min. RESULTS Although iwMS reported more symptoms of fatigue (MFIS, p = 0.003) and poorer sleep quality (PSQI, p = 0.008), they did not report more daytime sleepiness (ESS, p = 0.45). Likewise, there were no differences between groups in real-time daytime sleepiness, indexed by PERCLOS (p = 0.82). Both groups exhibited more real-time daytime sleepiness as they progressed through the drive (time effect, p < 0.0001). The interaction effect of group*time (p = 0.05) demonstrated increased symptoms of daytime sleepiness towards the end of the drive in iwMS compared to controls. PERCLOS correlated strongly (Spearman ρ = 0.76, p = 0.001) with distance out of lane in iwMS. CONCLUSION IwMS show exacerbated symptoms of daytime sleepiness during a monotonous, simulate drive. Future studies should investigate the effect of MS on daytime sleepiness during real-world driving.
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Messinis L, Kosmidis MH, Nasios G, Konitsiotis S, Ntoskou A, Bakirtzis C, Grigoriadis N, Patrikelis P, Panagiotopoulos E, Gourzis P, Malefaki S, Papathanasopoulos P. Do Secondary Progressive Multiple Sclerosis patients benefit from Computer- based cognitive neurorehabilitation? A randomized sham controlled trial. Mult Scler Relat Disord 2020; 39:101932. [PMID: 31927200 DOI: 10.1016/j.msard.2020.101932] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/21/2019] [Accepted: 01/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Cognitive impairment is common in multiple sclerosis (MS), but deficits tend to be more pronounced in progressive MS, negatively impacting daily functional capacity. Despite this, most cognitive rehabilitation (CR) interventions to date have focused on relapsing-remitting MS (RRMS). Moreover, information on the efficacy of CR in progressive MS is limited and controversial. The present study investigated the efficacy of a home based, computer assisted cognitive rehabilitation (HBCACR) intervention (RehaComTM software) exclusively in a Secondary Progressive Multiple Sclerosis (SPMS) sample. METHODS This was a randomized, multi site, sham controlled trial. Thirty six (36) individuals with SPMS, naïve to the RehaCom software, with cognitive deficits were randomized to the treatment (IG; n= 19) or control group condition (CG; n=17). Treatment with the RehaCom modules consisted of 24 domain and task specific, 45 minute session's over an 8-week period, three sessions per week, applied by each patient at home. The CG completed non specific computer based activities at home with the same frequency and duration. Primary cognitive outcome measures included the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery, and secondary outcome measures for depression (BDI-FS), fatigue (MFIS), and quality of life (EuroQol EQ-5D) visual analogue scale (VAS). RESULTS The two groups were well matched on demographic and clinical characteristics, cognitive reserve and severity of cognitive deficits at baseline assessment. At post treatment assessment the IG group showed significant improvements with large effect sizes; in verbal learning [z = -4.759, p <.0005, g = 2.898], visuospatial memory [z = -3.940, p <.0005, g = 1.699] and information processing speed [z= -4.792, p <.0005, g = 2.980], compared with the sham control group. We also found significant between group differences on physical [z=-3.308, p = .001, g= -.604], cognitive [z = -4.011, p <.0005, g = -1.654], psychosocial [z= 3.308, p = .010, g = -.940], and general fatigue impact [z= -2.623, p = .008, g = -.519], depression severity [z = -2.730, p = .006, g = -.519], and quality of life [z= -4.239, p <.0005, g = -1.885] in favor of the treated group. CONCLUSION These data provide the first evidence supporting the efficacy of computer based restorative cognitive rehabilitation applied at home exclusively in SPMS patients, suggesting that adaptive neuroplasticity may occur after functional cognitive training in progressive MS. Improved cognitive functioning in combination with mood augmentation appear to have ameliorated fatigue, which impacted daily functioning activity and culminated in improved health related quality of life.
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Affiliation(s)
- Lambros Messinis
- Neuropsychology Section, Departments of Neurology and Psychiatry, University Hospital of Patras and University of Patras Medical School.
| | - Mary H Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, Greece
| | - Grigorios Nasios
- Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina
| | | | - Aikaterini Ntoskou
- Rehabilitation Unit for patients with Spinal Cord Injury, "Demetrios and Vera Sfikas" Department of Medicine, University of Patras Medical School
| | - Christos Bakirtzis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Nikolaos Grigoriadis
- B'Department of Neurology and the MS Center, AHEPA University Hospital, Central Macedonia, Thessaloniki, Greece
| | - Panayiotis Patrikelis
- First Department of Neurosurgery, Medical School, National and Kapodistrian University of Athens, Greece
| | - Elias Panagiotopoulos
- Rehabilitation Unit for patients with Spinal Cord Injury, "Demetrios and Vera Sfikas" Department of Medicine, University of Patras Medical School
| | | | - Sonia Malefaki
- Department of Mechanical Engineering & Aeronautics, University of Patras (statistics)
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Independent outdoor mobility of persons with multiple sclerosis - A systematic review. Mult Scler Relat Disord 2019; 37:101463. [PMID: 31678858 DOI: 10.1016/j.msard.2019.101463] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Multiple sclerosis (MS) can manifest itself in many ways, all of which can affect the independent outdoor mobility of persons with MS (pwMS). In most studies, mobility of pwMS is defined by the ability to walk. However, mobility comprises more than walking alone. This systematic review provides an overview of the literature on several types of independent outdoor mobility of pwMS. We aimed to identify which specific factors may influence outdoor mobility and how the lives of pwMS may be affected by a reduced mobility. METHODS A systematic literature search was performed, using three databases (PubMed, PsychInfo and Web of Science). Studies had to describe a group of pwMS sclerosis and had to concern some type of mobility other than walking. RESULTS The 57 studies that fulfilled the criteria included in total 10,394 pwMS and in addition, 95,300 pwMS in separate prevalence study. These studies showed that pwMS as a group have a decreased fitness to drive, make use of a wheelchair or mobility scooter more often and have difficulties making use of public transport. Mobility problems especially occur in patients with cognitive problems, secondary progressive MS or high disability scores. CONCLUSIONS The reduced mobility may prevent pwMS participating in society. However, few studies investigating interventions or rehabilitation options to improve mobility were found in the existing literature, highlighting an until now under recognised unmet need.
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Harand C, Mondou A, Chevanne D, Bocca ML, Defer G. Evidence of attentional impairments using virtual driving simulation in multiple sclerosis. Mult Scler Relat Disord 2018; 25:251-257. [PMID: 30144695 DOI: 10.1016/j.msard.2018.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Detection of attentional disorders in complex situation related to daily life activities in multiple sclerosis patients needs better adapted tools than traditional cognitive assessment. OBJECTIVE To investigate the usefulness of virtual reality assessment of attention in multiple sclerosis, especially to evaluate alertness and divided attention using driving simulation. METHODS In this preliminary study, 11 relapsing-remitting patients (median EDSS: 2; mean disease duration of 10.3 years) and 11 healthy matched controls performed a driving simulation under three conditions (monotonous driving, divided attention driving and urban driving) where Standard Deviation of Lateral position (SDLP) was the main evaluated criteria. In comparison, traditional cognitive assessment of attentional functions was administered (SDMT, alertness and divided attention of TAP battery). Statistical non-parametric Mann-Whitney U tests were used to compare performances between groups in the two types of assessments. Exploratory correlational analyses were further conducted. RESULTS No significant difference was observed between groups for traditional attentional assessment except for information processing speed (SDMT; p < 0.01). Considering virtual reality, patients were less efficient than controls on the primary parameter of safe driving (SDLP; p < 0.05). They also committed more errors and omissions (p < 0.01) and speed fluctuations (p < 0.01) during the divided-attention driving condition. Urban driving did not reveal difference between groups. Lack of significant correlations between traditional and virtual reality attentional assessment suggested that they do not evaluate the same cognitive processes. CONCLUSION Patients experienced difficulties in maintaining the trajectory and the speed of the simulated vehicle which may be indicative of attentional difficulties, especially alertness and divided attention. These impairments were not revealed by the traditional cognitive assessment. Results of this preliminary study shed new light about the usefulness of virtual reality techniques and their future interest as a part of cognitive rehabilitation programs. They also highlights the need to develop driving preventive measures in MS.
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Affiliation(s)
- C Harand
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France.
| | - A Mondou
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France
| | - D Chevanne
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France
| | - M L Bocca
- Normandie University, UNICAEN, INSERM, U1075, COMETE, 14000 Caen, France
| | - G Defer
- Department of Neurology, Caen University Hospital Centre, Avenue de la Côte de Nacre, CS 30001, 14033 Caen Cedex 9, France; Centre de Ressources et de Compétences SEP, 14000 Caen, France; Réseau Bas-Normand Pour la Prise en Charge de la SEP, 14000 Caen, France
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Celius EG, Vila C. The influence of THC:CBD oromucosal spray on driving ability in patients with multiple sclerosis-related spasticity. Brain Behav 2018; 8:e00962. [PMID: 29761015 PMCID: PMC5943754 DOI: 10.1002/brb3.962] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/09/2018] [Accepted: 02/18/2018] [Indexed: 01/24/2023] Open
Abstract
Background Driving ability is a key function for the majority of patients with multiple sclerosis (MS) to help maintain daily interactions. Both physical and cognitive disability, as well as treatments, may affect the ability to drive. Spasticity is a common symptom associated with MS, and it may affect driving performance either directly or via the medications used to treat it. In this article, we review the evidence relating the antispasticity medicine, Δ9-tetrahydrocannabinol:cannabidiol (THC:CBD) oromucosal spray (Sativex®), and its potential impact on driving performance. Methods Articles were identified by searching PubMed from 1/1/2000 to 30/6/2017 using a specified list of search terms. The articles identified using these search terms were augmented with relevant references from these papers and other articles known to the authors. Results The results from THC:CBD oromucosal spray driving studies and real-world registries did not show any evidence of an increase in motor vehicle accidents associated with THC:CBD oromucosal spray. The majority of patients reported an improvement in driving ability after starting THC:CBD oromucosal spray, and it was speculated that this may be related to reduced spasticity and/or better cognitive function. It should be noted that THC blood levels are significantly lower than the levels associated with recreational use of herbal cannabis. Conclusions THC:CBD oromucosal spray was shown not to impair driving performance. However, periodic assessment of patients with MS driving ability is recommended, especially after relapses and changes in treatment. Blood THC measurements might be above authorized thresholds for some countries following administration of THC:CBD oromucosal spray, thus specific knowledge of each country's driving regulations and a medical certificate are recommended.
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Affiliation(s)
- Elisabeth G. Celius
- Department of NeurologyOslo University Hospital, and Institute of Health and SocietyUniversity of OsloOsloNorway
| | - Carlos Vila
- Almirall Neurology Global Medical AffairsBarcelonaSpain
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Devos H, Ranchet M, Backus D, Abisamra M, Anschutz J, Allison CD, Mathur S, Akinwuntan AE. Determinants of On-Road Driving in Multiple Sclerosis. Arch Phys Med Rehabil 2016; 98:1332-1338.e2. [PMID: 27840131 DOI: 10.1016/j.apmr.2016.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/18/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the cognitive, visual, and motor deficits underlying poor performance on different dimensions of on-road driving in individuals with multiple sclerosis (MS). DESIGN Prospective cross-sectional study. SETTING MS clinic and driving simulator lab. PARTICIPANTS Active drivers (N=102) with various types of MS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Off-road cognitive, visual, and motor functions, as well as 13 specific driving skills. These skills were categorized into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving. Stepwise regression analysis was used to determine the off-road functions influencing performance on the on-road test and each cluster. RESULTS Visuospatial function (P=.002), inhibition (P=.008), binocular acuity (P=.04), vertical visual field (P=.02), and stereopsis (P=.03) best determined variance in total on-road score (unadjusted R2=.37). Attentional shift (P=.0004), stereopsis (P=.007), glare recovery (P=.047), and use of assistive devices (P=.03) best predicted the operational cluster (unadjusted R2=.28). Visuospatial function (P=.002), inhibition (P=.002), reasoning (P=.003), binocular acuity (P=.04), and stereopsis (P=.005) best determined the tactical cluster (unadjusted R2=.41). The visuo-integrative model (unadjusted R2=.12) comprised binocular acuity (P=.007) and stereopsis (P=.045). Inhibition (P=.0001) and binocular acuity (P=.001) provided the best model of the mixed cluster (unadjusted R2=.25). CONCLUSIONS Our results provide more insights into the specific impairments that influence different dimensions of on-road driving and may be used as a framework for targeted driving intervention programs in MS.
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Affiliation(s)
- Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS; Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA.
| | - Maud Ranchet
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA; French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), Laboratory of Ergonomic and Cognitive Sciences for Transports (TS2-LESCOT), Bron, France
| | | | | | | | | | - Sunil Mathur
- Biostatistics Department, Medical College of Georgia, Augusta University, Augusta, GA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA; Dean's Office, School of Health Professions, University of Kansas Medical Center, Kansas City, KS
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McKay C, Rapport LJ, Coleman Bryer R, Casey J. Self-Evaluation of Driving Simulator Performance After Stroke. Top Stroke Rehabil 2015; 18:549-61. [DOI: 10.1310/tsr1805-549] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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12
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Driving competences and neuropsychological factors associated to driving counseling in multiple sclerosis. J Int Neuropsychol Soc 2014; 20:555-65. [PMID: 24867442 DOI: 10.1017/s1355617714000368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Multiple Sclerosis (MS) significantly impacts daily living activities, including car driving. To investigate driving difficulties experienced with MS, we compared 50 MS patients with minor or moderate disability and 50 healthy controls (HC) using computerized driving tests (the ASDE driver test and the Useful Field of View (UFOV) test) and neuropsychological tests. Inclusion criteria included being active drivers. We evaluated whether cognitive deterioration in MS is associated with the results of driving tests by comparing MS patients without cognitive deterioration with HC. The results indicated that the MS patients performed worse than the HCs in attention, information processing, working memory and visuomotor coordination tasks. Furthermore, MS patients with cognitive impairments experienced more difficulties in the driving tests than did the non-impaired MS patients. Motor dysfunction associated with MS also played an important role in this activity. The results of this study suggest that MS should be assessed carefully and that special emphasis should be placed on visuomotor coordination and executive functions because patients with minor motor disability and subtle cognitive impairments can pass measures predictive of driving safety.
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Devos H, Brijs T, Alders G, Wets G, Feys P. Driving performance in persons with mild to moderate symptoms of multiple sclerosis. Disabil Rehabil 2013; 35:1387-93. [DOI: 10.3109/09638288.2012.731468] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Phonological fluency strategy of switching differentiates relapsing-remitting and secondary progressive multiple sclerosis patients. ISRN NEUROLOGY 2013; 2013:451429. [PMID: 23401793 PMCID: PMC3562673 DOI: 10.1155/2013/451429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/19/2012] [Indexed: 11/30/2022]
Abstract
The strategies used to perform a verbal fluency task appear to be reflective of cognitive abilities necessary for successful daily functioning. In the present study, we explored potential differences in verbal fluency strategies (switching and clustering) used to maximize word production by patients with relapsing-remitting multiple sclerosis (RRMS) versus patients with secondary progressive multiple sclerosis (SPMS). We further assessed impairment rates and potential differences in the sensitivity and specificity of phonological versus semantic verbal fluency tasks in discriminating between those with a diagnosis of MS and healthy adults. We found that the overall rate of impaired verbal fluency in our MS sample was consistent with that in other studies. However, we found no differences between types of MS (SPMS, RRMS), on semantic or phonological fluency word production, or the strategies used to maximize semantic fluency. In contrast, we found that the number of switches differed significantly in the phonological fluency task between the SPMS and RRMS subtypes. The clinical utility of semantic versus phonological fluency in discriminating MS patients from healthy controls did not indicate any significant differences. Further, the strategies used to maximize performance did not differentiate MS subgroups or MS patients from healthy controls.
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Griffen JA, Rapport LJ, Bryer RC, Bieliauskas LA, Burt C. Awareness of Deficits and On-Road Driving Performance. Clin Neuropsychol 2011; 25:1158-78. [DOI: 10.1080/13854046.2011.609841] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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