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Wallace HE, Gullo HL, Copland DA, Rotherham A, Wallace SJ. Does aphasia impact on return to driving after stroke? A scoping review. Disabil Rehabil 2024:1-24. [PMID: 38415619 DOI: 10.1080/09638288.2024.2317989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Stroke can affect driving, an important activity of daily living. Little is known about whether aphasia (language impairment) impacts driving post-stroke. This scoping review explores impacts and perceived impacts of aphasia on driving performance, and the process of returning to driving post-stroke. MATERIALS AND METHODS Scoping review using Arksey and O'Malley's framework, reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Bibliographic databases were searched and international clinical practice guidelines were sourced online. Full-text articles were independently assessed by two reviewers. Results were tabulated and summarised using narrative synthesis. RESULTS Forty-three literature sources and 17 clinical practice guidelines were identified. Six studies investigated return to driving with aphasia post-stroke; 37 sources from the broader literature contributed to objectives. It remains unclear whether aphasia impacts fitness-to-drive; however, people with aphasia face barriers in returning to driving due to: (1) uncertainty regarding the role of language in driving; (2) poor awareness and knowledge of aphasia, and (3) communication demands in the patient-journey and assessment. CONCLUSIONS The current evidence base is limited, inconsistent, and lacking in quality and recency and there is a lack of guidelines to support clinical practice. People with aphasia face barriers in returning to driving; however, it is unclear if aphasia affects fitness-to-drive post-stroke. Implications for rehabilitationPeople with aphasia, their caregivers and clinicians have identified return to driving as a top 10 research priority.We do not know if aphasia affects fitness-to-drive post-stroke, but communication difficulties can make the process of returning to driving more difficult.Speech pathologists have an important role in ensuring that driving is discussed with people with aphasia post-stroke.Speech pathologists should support the multidisciplinary team to understand and meet the communication needs of people with aphasia throughout the driving evaluation process.
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Affiliation(s)
- Helen E Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Hannah L Gullo
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Metro North Health, Brisbane, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Annette Rotherham
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
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Tsiakiri A, Christidi F, Tsiptsios D, Vlotinou P, Kitmeridou S, Bebeletsi P, Kokkotis C, Serdari A, Tsamakis K, Aggelousis N, Vadikolias K. Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies. Neurol Int 2024; 16:210-225. [PMID: 38392955 PMCID: PMC10893544 DOI: 10.3390/neurolint16010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
The Trail Making Test (TMT) is one of the most commonly administered tests in clinical and research neuropsychological settings. The two parts of the test (part A (TMT-A) and part B (TMT-B)) enable the evaluation of visuoperceptual tracking and processing speed (TMT-A), as well as divided attention, set-shifting and cognitive flexibility (TMT-B). The main cognitive processes that are assessed using TMT, i.e., processing speed, divided attention, and cognitive flexibility, are often affected in patients with stroke. Considering the wide use of TMT in research and clinical settings since its introduction in neuropsychological practice, the purpose of our review was to provide a comprehensive overview of the use of TMT in stroke patients. We present the most representative studies assessing processing speed and attentional shift/mental flexibility in stroke settings using TMT and applying scoring methods relying on conventional TMT scores (e.g., time-to-complete part A and part B), as well as derived measures (e.g., TMT-(B-A) difference score, TMT-(B/A) ratio score, errors in part A and part B). We summarize the cognitive processes commonly associated with TMT performance in stroke patients (e.g., executive functions), lesion characteristics and neuroanatomical underpinning of TMT performance post-stroke, the association between TMT performance and patients' instrumental activities of daily living, motor difficulties, speech difficulties, and mood statue, as well as their driving ability. We also highlight how TMT can serve as an objective marker of post-stroke cognitive recovery following the implementation of interventions. Our comprehensive review underscores that the TMT stands as an invaluable asset in the stroke assessment toolkit, contributing nuanced insights into diverse cognitive, functional, and emotional dimensions. As research progresses, continued exploration of the TMT potential across these domains is encouraged, fostering a deeper comprehension of post-stroke dynamics and enhancing patient-centered care across hospitals, rehabilitation centers, research institutions, and community health settings. Its integration into both research and clinical practice reaffirms TMT status as an indispensable instrument in stroke-related evaluations, enabling holistic insights that extend beyond traditional neurological assessments.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Pinelopi Vlotinou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Paschalina Bebeletsi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
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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 2023:1-9. [PMID: 37728095 DOI: 10.1080/09638288.2023.2258332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [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.
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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
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Park K, Renge K, Nakagawa Y, Yamashita F, Tada M, Kumagai Y. Aging Brains Degrade Driving Safety Performances of the Healthy Elderly. Front Aging Neurosci 2022; 13:783717. [PMID: 35145391 PMCID: PMC8822331 DOI: 10.3389/fnagi.2021.783717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/27/2021] [Indexed: 11/19/2022] Open
Abstract
The relationship between aging brains and driving safety performances (DSPs) of elderly drivers was studied. A total of 90 dementia-free participants (63 men and 27 women, mean age 75.31 ± 4.795 years) were recruited and their DSPs were analyzed on actual vehicles running through a closed-circuit course. DSPs were comprehensively evaluated on the basis of driving instructors' scores (DIS). Signaling and visual research behaviors, part of DSPs, were measured to supplement the DIS evaluation by driving recorders (DR) and wearable wireless sensors (WS), respectively. Aging brains were evaluated via magnetic resonance imaging (MRI) findings and experimentally assigned to two grades (high vs. low) of brain atrophy (BA) and leukoaraiosis (LA). Regression analyses on DIS and DR data, and logistic analysis on WS scores showed significant correlations of aging brains with degradation of DSPs. The participant group with more advanced BAs and LAs showed lower DIS, DR data, and WS scores representing degraded DSP regardless of age. These results suggest that MRI examinations from both volumetric and pathological perspectives of brains have the potential to help identify elderly drivers with dangerous driving behaviors. Brain healthcare, lifestyle improvements and medical treatments to suppress BA and LA, may contribute to preventing DSP degradation of elderly drivers with aging brains.
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Affiliation(s)
- Kaechang Park
- Traffic Medicine Laboratory, Research Organization for Regional Alliance, Kochi University of Technology, Kami, Japan
- *Correspondence: Kaechang Park
| | - Kazumi Renge
- Faculty of Psychology, Tezukayama University, Nara, Japan
| | | | - Fumio Yamashita
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Morioka, Japan
| | - Masahiro Tada
- Faculty of Science and Engineering, Kindai University, Higashiosaka, Japan
| | - Yasuhiko Kumagai
- Traffic Medicine Laboratory, Research Organization for Regional Alliance, Kochi University of Technology, Kami, Japan
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Hiraoka T, Metani H, Yasunaga M, Yoine T, Yagi M, Yamamoto S, Arai N, Tsubahara A, Hanayama K. Foundational Study on the Simple Detection of Impairment Resulting in Dangerous Driving in Patients with Higher Brain Dysfunction. Prog Rehabil Med 2021; 6:20210040. [PMID: 34722946 PMCID: PMC8530780 DOI: 10.2490/prm.20210040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/29/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES We performed a survey of medical records to reveal the cognitive deficits behind dangerous driving in patients with higher brain dysfunction. METHODS Thirty-four patients with higher brain dysfunction were included in this study. Patients' basic characteristics, neuropsychological test results, scores on two types of driving aptitude tests, and accident/near miss data from a driving simulator were extracted from medical records. We conducted χ2 tests for independence between comprehensive driving aptitude scores and "traffic accidents" / "being prohibited from driving as defined by the number of traffic accidents and near misses." Backward logistic regression analysis was carried out to assess correlations of "traffic accidents" and "being prohibited from driving as defined by the number of traffic accidents and near misses" with neuropsychological test scores. RESULTS No significant correlation was observed between the comprehensive driving aptitude score and "traffic accidents" / "being prohibited from driving as defined by the number of traffic accidents and near misses." The score on the Raven's Colored Progressive Matrices test was the only factor identified as a significant predictor of "being prohibited from driving as defined by the number of traffic accidents and near misses." CONCLUSIONS The results of this study suggest that it is important to focus on the decline in problem-solving ability as a predictor of "being prohibited from driving as defined by the number of traffic accidents and near misses."
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Affiliation(s)
- Takashi Hiraoka
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Okayama, Japan
- Faculty of Rehabilitation, Kawasaki University of Medical
Welfare, Okayama, Japan
- Department of Rehabilitation Medicine, Kawasaki Medical
School Hospital, Okayama, Japan
| | - Hiromichi Metani
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Okayama, Japan
- Department of Rehabilitation Medicine, Kawasaki Medical
School Hospital, Okayama, Japan
| | - Masashi Yasunaga
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Okayama, Japan
- Department of Rehabilitation Medicine, Kawasaki Medical
School Hospital, Okayama, Japan
| | - Taketo Yoine
- Faculty of Rehabilitation, Kawasaki University of Medical
Welfare, Okayama, Japan
- Department of Rehabilitation Medicine, Kawasaki Medical
School Hospital, Okayama, Japan
| | - Masami Yagi
- Department of Rehabilitation Medicine, Kawasaki Medical
School Hospital, Okayama, Japan
| | - Sayako Yamamoto
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Okayama, Japan
- Department of Rehabilitation Medicine, Kawasaki Medical
School Hospital, Okayama, Japan
| | - Nobuyuki Arai
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Okayama, Japan
- Department of Rehabilitation Medicine, Kawasaki Medical
School Hospital, Okayama, Japan
| | - Akio Tsubahara
- Faculty of Rehabilitation, Kawasaki University of Medical
Welfare, Okayama, Japan
| | - Kozo Hanayama
- Department of Rehabilitation Medicine, Kawasaki Medical
School, Okayama, Japan
- Department of Rehabilitation Medicine, Kawasaki Medical
School Hospital, Okayama, Japan
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Stamatelos P, Economou A, Stefanis L, Yannis G, Papageorgiou SG. Driving and Alzheimer's dementia or mild cognitive impairment: a systematic review of the existing guidelines emphasizing on the neurologist's role. Neurol Sci 2021; 42:4953-4963. [PMID: 34581880 DOI: 10.1007/s10072-021-05610-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Driving is a complex task requiring the integrity and the cooperation of cognition, motor, and somatosensory skills, all of which are impacted by neurological diseases. OBJECTIVE Identification of neurologist's role when assessing fitness to drive of cognitively impaired individuals. METHODS We performed a systematic review of the guidelines/recommendations (G/Rs) regarding the evaluation of driving fitness of patients with mild cognitive impairment (MCI) and/or dementia. Emphasis was put on the neurological and neuropsychological aspects of the evaluation. RESULTS Eighteen G/Rs were included in the review (9 national guidelines, 5 recommendation papers, 3 consensus statements, and 1 position paper). All G/Rs referred to drivers with dementia and 9/18 referred to drivers with MCI. A common approach among G/Rs is the initial trichotomization of patients in safe to drive, unsafe to drive, and undetermined cases, which are referred to a second-line evaluator. First-line evaluators are general practitioners in 10/18 G/Rs; second-line evaluators are neurologists in 7/18 G/Rs. Specific neuropsychological tests are proposed in 11/18 G/Rs and relative cut-off values in 7/18. The most commonly used tests are the MMSE, TMT, and CDT. A thorough neurological examination is proposed in only 1/18 G/R. CONCLUSION Although extensive multi-disciplinary research has provided useful information for driving behavior of cognitively impaired individuals, we are still far from a widely accepted approach of driving ability evaluation in this increasing population. A comprehensive assessment from a multi-disciplinary team in which the neurologist plays a critical role seems to be required, although this has not yet been implemented in any G/Rs.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - Alexandra Economou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece
| | - George Yannis
- School of Civil Engineering, Department of Transportation Planning and Engineering, National Technical University of Athens, Athens, Greece
| | - Sokratis G Papageorgiou
- 1st Department of Neurology, National and Kapodistrian University of Athens, Eginition Hospital, 72 Vas. Sofias Ave, 11528, Athens, Greece.
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Protocol for the conceptualization and evaluation of a screening-tool for fitness-to-drive assessment in older people with cognitive impairment. PLoS One 2021; 16:e0256262. [PMID: 34469443 PMCID: PMC8409688 DOI: 10.1371/journal.pone.0256262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Due to aging and health status people may be subjected to a decrease of cognitive ability and subsequently also a decline of driving safety. On the other hand there is a lack of valid and economically applicable instruments to assess driving performance. Objective The study is designed to develop a valid screening-tool for fitness-to-drive assessment in older people with cognitive impairment externally validated on the basis of on-road driving performance. Methods In a single-centre, non-randomized cross-sectional trial cognitive functioning and on-road-driving-behavior of older drivers will be assessed. Forty participants with cognitive impairment of different etiology and 40 healthy controls will undergo an extensive neuropsychological assessment. Additionally, an on-road driving assessment for external validation of fitness to drive will be carried out. Primary outcome measures will be performance in attention, executive functions and visuospatial tasks that will be validated with respect to performance on the on-road-driving-test. Secondary outcome measures will be sociodemographic, clinical- and driving characteristics to systematically examine their influence on the prediction of driving behavior. Discussion In clinical practice counselling patients with respect to driving safety is of great relevance. Thus, having valid, reliable, time economical and easily interpretable screening-tools on hand to counsel patients is of great relevance for practitioners. Ethics and dissemination Ethics approval was obtained from the Ethics Committee at the Ludwig-Maximilians-University Munich. The trial results will be disseminated through peer-reviewed publications and various conferences. Trial registration 18–640. Trial registration: German Clinical Trials Register. Registration number: DRKS00023549.
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Todate K, Takami A, Makino M. Verification of spatial recognition ability of stroke patients required to resume automobile driving. J Phys Ther Sci 2021; 33:455-459. [PMID: 34177108 PMCID: PMC8219603 DOI: 10.1589/jpts.33.455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 03/17/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To help patients who had a stroke resume automobile driving, we evaluated their ability to recognize three-dimensional space like that experienced in actual driving situations, with a focus on sensing car width. [Participants and Methods] Seven patients who had a stroke and 29 healthy adults participated in the study. Three 50-cm-wide chairs and 2 panels, 3 m apart, were placed 9 m from the chair in which the participant sat. One panel was fixed and the other panel could be moved toward the fixed panel in a horizontal direction. The participants were asked to signal when they believed that the width of the chair was the same as the space between the panels. [Results] In the simulation of driving a real car, the mean error in judging distance was 13.2 ± 10.4 cm for the Healthy group and that of the Stroke group was two times greater than that of the Healthy group. [Conclusion] These findings show that spatial recognition cannot be evaluated using paper-based two-dimensional higher brain function tests. To help patients who had a stroke resume driving requires evaluation of three-dimensional spatial recognition ability under circumstances that simulate actual driving situations.
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Affiliation(s)
- Kouhei Todate
- Mihono Hospital: 31-2 Oyama, Okubo, Hachinohe-shi, Aomori 031-0833, Japan.,Hirosaki University Graduate School of Health Sciences, Japan
| | - Akiyoshi Takami
- Hirosaki University Graduate School of Health Sciences, Japan
| | - Misato Makino
- Hirosaki University Graduate School of Health Sciences, Japan
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Lodha N, Patel P, Shad JM, Casamento-Moran A, Christou EA. Cognitive and motor deficits contribute to longer braking time in stroke. J Neuroeng Rehabil 2021; 18:7. [PMID: 33436005 PMCID: PMC7805062 DOI: 10.1186/s12984-020-00802-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/20/2020] [Indexed: 01/13/2023] Open
Abstract
Background Braking is a critical determinant of safe driving that depends on the integrity of cognitive and motor processes. Following stroke, both cognitive and motor capabilities are impaired to varying degrees. The current study examines the combined impact of cognitive and motor impairments on braking time in chronic stroke. Methods Twenty stroke survivors and 20 aged-matched healthy controls performed cognitive, motor, and simulator driving assessments. Cognitive abilities were assessed with processing speed, divided attention, and selective attention. Motor abilities were assessed with maximum voluntary contraction (MVC) and motor accuracy of the paretic ankle. Driving performance was examined with the braking time in a driving simulator and self-reported driving behavior. Results Braking time was 16% longer in the stroke group compared with the control group. The self-reported driving behavior in stroke group was correlated with braking time (r = − 0.53, p = 0.02). The stroke group required significantly longer time for divided and selective attention tasks and showed significant decrease in motor accuracy. Together, selective attention time and motor accuracy contributed to braking time (R2 = 0.40, p = 0.01) in stroke survivors. Conclusions This study provides novel evidence that decline in selective attention and motor accuracy together contribute to slowed braking in stroke survivors. Driving rehabilitation after stroke may benefit from the assessment and training of attentional and motor skills to improve braking during driving.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA.
| | - Prakruti Patel
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA
| | - Joanna M Shad
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA
| | | | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
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Chau E, Nishi A, Kristalovich L, Holowaychuk A, Mortenson WB. Establishing the Predictive Validity of the ScanCourse for Assessing On-Road Driving Performance. Am J Occup Ther 2021; 75:7501205120p1-7501205120p8. [PMID: 33399060 DOI: 10.5014/ajot.2021.041608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Eric Chau
- Eric Chau, BKin, MOT, OT, is Occupational Therapist, Private Practice, Vancouver, British Columbia, Canada. At the time of the research, Chau was Graduate Student, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Nishi
- Adam Nishi, BKin, MOT, OT, is Occupational Therapist, Private Practice, Vancouver, British Columbia, Canada. At the time of the research, Nishi was Graduate Student, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lisa Kristalovich
- Lisa Kristalovich, BMR(OT), MRSc, OT, is Clinical Instructor, Department of Occupational Science and Occupational Therapy, University of British Columbia, and Occupational Therapist, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
| | - Ana Holowaychuk
- Ana Holowaychuk, MScOT (C), is Occupational Therapist, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
| | - W Ben Mortenson
- W. Ben Mortenson, BScOT, MSc, PhD, OT, is Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Principal Investigator, International Collaboration on Repair Discoveries, Blusson Spinal Cord Centre at Vancouver General Hospital, Vancouver, British Columbia, Canada; and Principal Investigator, Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada;
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Falkenstein M, Karthaus M, Brüne-Cohrs U. Age-Related Diseases and Driving Safety. Geriatrics (Basel) 2020; 5:E80. [PMID: 33086572 PMCID: PMC7709672 DOI: 10.3390/geriatrics5040080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/13/2020] [Accepted: 10/16/2020] [Indexed: 11/16/2022] Open
Abstract
Due to demographic changes, the number of older drivers is steadily increasing. Mobility is highly relevant for leading an independent life in the elderly. It largely depends on car driving, which is a complex task requiring a multitude of cognitive and motor skills vulnerable to age- related functional deterioration. The almost inevitable effects of senescence may be potentiated by age-related diseases, such as stroke or diabetes mellitus. Respective pharmacological treatment may cause side effects, additionally affecting driving safety. The present article reviews the impact of age-related diseases and drug treatment of these conditions on driving fitness in elderly drivers. In essence, we focus on diseases of the visual and auditory systems, diseases of the central nervous system (i.e., stroke, depression, dementia and mild cognitive disorder, and Parkinson's disease), sleep disorders, as well as cardiovascular diseases, diabetes mellitus, musculoskeletal disorders, and frailty. We will outline the role of functional tests and the assessment of driving behavior (by a driving simulator or in real traffic), as well as the clinical interview including questions about frequency of (near) accidents, etc. in the evaluation of driving fitness of the elderly. We also address the impact of polypharmacy on driving fitness and end up with recommendations for physicians caring for older patients.
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Affiliation(s)
- Michael Falkenstein
- Institute for Work Learning and Aging (ALA), Hiltroper Landwehr 136, 44805 Bochum, Germany
| | - Melanie Karthaus
- Leibniz Institute for Working Environment and Human Factors (IfADo), 44139 Dortmund, Germany;
| | - Ute Brüne-Cohrs
- LWL University Hospital, Clinic for Psychiatry, Psychotherapy and Preventive Medicine, 44791 Bochum, Germany;
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12
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Racheva R, Totkova Z. Reliability and Validity of a Method for Assessment of Executive Functions in Drivers. Behav Sci (Basel) 2020; 10:bs10010037. [PMID: 31963798 PMCID: PMC7017126 DOI: 10.3390/bs10010037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 11/16/2022] Open
Abstract
The quality of drivers’ performance is one of the crucial components related to road safety. One of the key cognitive characteristics related to the ability to drive safely are executive functions. The main goal of the presented research is to propose a new method (Trace-route task) for assessment of executive functions in drivers. The present article discusses the results of two consecutive studies. Study one aims to determine the validity and reliability of the method used and includes 134 participants, equally divided in two groups—people with disturbances in executive functions and people from the general population. Study two aims to assess the ability of the method to distinguish drivers with risky behavior. It includes 1440 participants divided in two groups—people with and without actual risky driving behavior. The results from the studies show that people with different neurological or psychiatric diseases and drivers with different road violations demonstrate worse planning ability, working memory, decision making, and cognitive flexibility. This data show that the trace-route task method is a valid and reliable instrument for assessing executive functions and has the ability to distinguish people with risky driving behavior from those who drive safely. This study reveals that the proposed method can be used for implementation in the area of traffic psychology.
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13
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Bernstein JP, Calamia M. Assessing the Longer-Term Effects of Mild Traumatic Brain Injury on Self-Reported Driving Ability. PM R 2018; 10:1153-1163. [PMID: 29777771 DOI: 10.1016/j.pmrj.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 10/16/2022]
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14
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Vickers KL, Schultheis MT, Manning KJ. Driving after brain injury: Does dual-task modality matter? NeuroRehabilitation 2018; 42:213-222. [PMID: 29562565 DOI: 10.3233/nre-172301] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Virtual reality technology allows neuropsychologists to examine complex, real-world behaviors with high ecological validity and can provide an understanding of the impact of demanding dual-tasks on driving performance. OBJECTIVE We hypothesized that a task imposing high cognitive and physical demands (coin-sorting) would result in the greatest reduction in driving maintenance performance. METHODS Twenty participants with acquired brain injury and 28 healthy controls were included in the current study. All participants were licensed and drove regularly. Participants completed two standardized VRDS drives: (1) a baseline drive with no distractions, and (2) the same route with three, counterbalanced dual-tasks representing differing demands. RESULTS A series of 3 (Task)×2 (Group) ANOVAs revealed that the ABI group tended to go slower than the HC group in the presence of a dual-task, F (1, 111) = 6.24, p = 0.01. Importantly, the ABI group also showed greater variability in speed, F (1, 110) = 10.97, p < 0.01, and lane position, F (1, 108) = 7.81, p < 0.01, an effect driven by dual-tasks with both a cognitive and motor demand. CONCLUSIONS These results indicate that long-term driving difficulties following ABI are subtle and likely due to reduced cognitive resources.
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Affiliation(s)
- Kayci L Vickers
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | - Kevin J Manning
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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15
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Kato N, Saeki S, Okazaki T, Matsunaga K, Hachisuka K. Development of a simple driving simulator and determination of the reference range of normative performance. Brain Inj 2018; 32:644-651. [PMID: 29388857 DOI: 10.1080/02699052.2018.1432889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To establish the reference range for assessment items of the 'Simple Driving Simulator' (SiDS) in a normative population and to compare performance of age-matched young adults with a traumatic brain injury (TBI) to this reference data. METHODS AND PROCEDURES Normative ranges were calculated from the data of 445 participants in the control group. Three performance ranges were established: 'normal', 'borderline' and 'impaired' defined using standard deviation cutoff values in the control group. The performance of 28 patients with a TBI, aged 18-35 years, was evaluated. The performance score for the TBI group in the 'impaired range' was calculated for each test item and used to make a synthetic judgment regarding the clinical value of the SiDS. MAIN OUTCOMES AND RESULTS In the control group, only 0.6% of the participants exhibited a performance in the impaired range on >2 items, compared to 33.2% for the TBI group. CONCLUSIONS We provide evidence that impaired performance on ≤2 items of the SiDS provides a sensitive criterion of 'driving fitness' in young adults after a TBI.
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Affiliation(s)
- Noriaki Kato
- a Department of Rehabilitation Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Satoru Saeki
- a Department of Rehabilitation Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Tetsuya Okazaki
- b Department of Rehabilitation Medicine , Wakamatsu Hospital of the University of Occupational and Environmental Health , Kitakyushu , Japan
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16
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Stolwyk RJ, Charlton JL, Ross PE, Bédard M, Marshall S, Gagnon S, Gooden JR, Ponsford JL. Characterizing on-road driving performance in individuals with traumatic brain injury who pass or fail an on-road driving assessment. Disabil Rehabil 2018; 41:1313-1320. [DOI: 10.1080/09638288.2018.1424955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Renerus J. Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Judith L. Charlton
- Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | | | - Michel Bédard
- Centre for Research and Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Shawn Marshall
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - James R. Gooden
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Jennie L. Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
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17
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Rodseth J, Washabaugh EP, Al Haddad A, Kartje P, Tate DG, Krishnan C. A novel low-cost solution for driving assessment in individuals with and without disabilities. APPLIED ERGONOMICS 2017; 65:335-344. [PMID: 28802454 PMCID: PMC5568672 DOI: 10.1016/j.apergo.2017.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/16/2017] [Accepted: 07/17/2017] [Indexed: 05/29/2023]
Abstract
Brake reaction time is a key component to studying driving performance and evaluating fitness to drive. Although commercial simulators can measure brake reaction time, their cost remains a major barrier to clinical access. Therefore, we developed open-source software written in C-sharp (C#) for measuring driving related reaction times, which includes a subject-controlled vehicle with straight-line dynamics and several testing scenarios. The software measures both simple and cognitive load based reaction times and can use any human interface device compliant steering wheel and pedals. Measures from the software were validated against a commercial simulator and tested for reproducibility. Further, experiments were performed using hand controls in both able-bodied and spinal cord injured patients to determine clinical feasibility for disabled populations. The software demonstrated high validity when measuring brake reaction times, showed excellent test-retest reliability, and was sensitive enough to determine significant brake reaction time differences between able-bodied and spinal cord injured subjects. These results indicate that the proposed simulator is a simple and feasible low-cost solution to perform brake reaction time tests and evaluate fitness to drive.
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Affiliation(s)
- Jakob Rodseth
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Edward P Washabaugh
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Ali Al Haddad
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Paula Kartje
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Chandramouli Krishnan
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA; School of Kinesiology, University of Michigan, Ann Arbor, MI, USA; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
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18
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Jawi ZM, Deros BM, Rashid AAA, Isa MHM, Awang A. The Roles and Performance of Professional Driving Instructors in Novice Driver Education. Sultan Qaboos Univ Med J 2017; 17:e277-e285. [PMID: 29062549 DOI: 10.18295/squmj.2017.17.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/11/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022] Open
Abstract
This review article aimed to analyse existing literature regarding the roles and performance of professional driving instructors (PDIs) in novice driver education (DE). A systematic classification scheme was adopted to analyse identified articles to determine the study context of PDIs in novice DE, the competency level of PDIs in relation to experienced and learner drivers and the contributions of PDIs to the novice driver learning process. A total of 14 original research articles were identified, with no systematic reviews or meta-analyses available. Overall, all of the articles were found to be inadequate in providing an in-depth understanding of the roles and performance of PDIs in novice DE. There is an urgent need to improve current understanding of the roles of PDIs in novice DE and to work towards an internationally recognised PDI management approach.
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Affiliation(s)
- Zulhaidi M Jawi
- Department of Vehicle Safety & Biomechanics, Malaysian Institute of Road Safety Research, Kajang, Selangor, Malaysia
| | - Baba M Deros
- Centre for Automotive Research, Faculty of Engineering & Built Environment, Universiti Kebangsaan Malaysia, Bangi, Selangor, Malaysia
| | - Ahmad A A Rashid
- Department of Vehicle Safety & Biomechanics, Malaysian Institute of Road Safety Research, Kajang, Selangor, Malaysia
| | - Mohd H M Isa
- Department of Vehicle Safety & Biomechanics, Malaysian Institute of Road Safety Research, Kajang, Selangor, Malaysia
| | - Azmi Awang
- Road Transport Department, Akademi Pengangkutan Jalan Malaysia, Melaka, Malaysia
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19
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D’apolito AC, Leguiet JL, Enjalbert M, Lemoine F, Mazaux JM. Return to drive after non-evolutive brain damage: French recommendations. Ann Phys Rehabil Med 2017; 60:263-269. [DOI: 10.1016/j.rehab.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 04/13/2017] [Accepted: 04/15/2017] [Indexed: 11/26/2022]
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20
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Gibbons C, Smith N, Middleton R, Clack J, Weaver B, Dubois S, Bédard M. Using Serial Trichotomization With Common Cognitive Tests to Screen for Fitness to Drive. Am J Occup Ther 2017; 71:7102260010p1-7102260010p8. [PMID: 28218592 DOI: 10.5014/ajot.2017.019695] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive. METHOD We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either "Pass," "Fail," or "Indeterminate." RESULTS Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants. CONCLUSION A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.
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Affiliation(s)
- Carrie Gibbons
- Carrie Gibbons, MPH, is Research Coordinator, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Nathan Smith
- Nathan Smith, MPH, is Research Assistant, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| | - Randy Middleton
- Randy Middleton, MScOT, is Occupational Therapist, St. Joseph's Hospital, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - John Clack
- John Clack, MScOT, is Occupational Therapist, St. Joseph's Hospital, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Bruce Weaver
- Bruce Weaver, MSc, is Research Associate, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada, and Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Sacha Dubois
- Sacha Dubois, MPH, is Research Statistician, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada; Adjunct Professor, Lakehead University, Thunder Bay, ON, Canada; and Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michel Bédard
- Michel Bédard, PhD, is Professor, Lakehead University and Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Director, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada; and Scientific Director, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada;
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Self-Reported Driving Difficulty in Veterans With Traumatic Brain Injury: Its Central Role in Psychological Well-Being. PM R 2017; 9:901-909. [PMID: 28167305 DOI: 10.1016/j.pmrj.2017.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 01/06/2017] [Accepted: 01/16/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The ability to drive is a core function supporting independent living. Traumatic brain injury (TBI) may impair driving capacity in numerous ways. Previous research has documented that individuals with TBI have more driving-related problems than other people and has identified predictors of driving status or capacity, mostly among civilians; however, no research has examined the implications of driving limitations for the well-being of individuals with TBI. OBJECTIVE To examine the association between self-reported difficulty in driving with important domains of psychological well-being in veterans with TBI, with adjustment for posttraumatic stress disorder (PTSD) and years since most recent TBI. DESIGN Cross-sectional. SETTING Veterans' homes. PARTICIPANTS A total of 61 veterans of the Global Wars on Terrorism diagnosed with TBI, all outpatients at a Veterans Affairs medical center rehabilitation service. METHODS Home interviews as a baseline assessment for a larger randomized controlled trial. MAIN OUTCOME MEASURES Community reintegration (extent of social participation), depressive symptomatology, and role limitations due to physical health problems and those due to emotional problems. Self-rated competence in driving was the predictor, and sociodemographic characteristics, diagnosis of PTSD, severity of TBI, and time since most recent TBI were covariates. RESULTS Self-rated driving difficulty was associated with decreased community reintegration (β = .280, P =.028), greater depressive symptomatology (β = -.402, P < .001), and greater role limitations due to physical problems (β = -.312, P =.011) and to emotional problems (β = -.324, P = .006), after we adjusted for PTSD and other variables. DISCUSSION The self-reported ability to drive seems to be central to psychological well-being in veterans with TBI, showing clear associations with depression, community reintegration, and health-related role limitations. These associations cannot be attributed to comorbid PTSD. CONCLUSION Rehabilitation specialists should view driving difficulty as a risk factor for poor psychosocial outcomes in veterans with TBI and seek ways to compensate for the veteran's loss of driving if it is no longer advisable. LEVEL OF EVIDENCE II.
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22
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Salmon JP, Jones SAH, Wright CP, Butler BC, Klein RM, Eskes GA. Methods for validating chronometry of computerized tests. J Clin Exp Neuropsychol 2016; 39:190-210. [PMID: 27532256 DOI: 10.1080/13803395.2016.1215411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Determining the speed at which a task is performed (i.e., reaction time) can be a valuable tool in both research and clinical assessments. However, standard computer hardware employed for measuring reaction times (e.g., computer monitor, keyboard, or mouse) can add nonrepresentative noise to the data, potentially compromising the accuracy of measurements and the conclusions drawn from the data. Therefore, an assessment of the accuracy and precision of measurement should be included along with the development of computerized tests and assessment batteries that rely on reaction times as the dependent variable. This manuscript outlines three methods for assessing the temporal accuracy of reaction time data (one employing external chronometry). Using example data collected from the Dalhousie Computerized Attention Battery (DalCAB) we discuss the detection, measurement, and correction of nonrepresentative noise in reaction time measurement. The details presented in this manuscript should act as a cautionary tale to any researchers or clinicians gathering reaction time data, but who have not yet considered methods for verifying the internal chronometry of the software and or hardware being used.
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Affiliation(s)
- Joshua P Salmon
- a Department of Psychiatry , Dalhousie University , Halifax , NS , Canada
| | | | - Chris P Wright
- b Department of Psychology and Neuroscience , Dalhousie University , Halifax , NS , Canada
| | - Beverly C Butler
- a Department of Psychiatry , Dalhousie University , Halifax , NS , Canada.,c Research Services, Capital District Health Authority , Halifax , NS , Canada
| | - Raymond M Klein
- b Department of Psychology and Neuroscience , Dalhousie University , Halifax , NS , Canada
| | - Gail A Eskes
- a Department of Psychiatry , Dalhousie University , Halifax , NS , Canada.,b Department of Psychology and Neuroscience , Dalhousie University , Halifax , NS , Canada
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23
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Evidence Based Review of Fitness-to-Drive and Return-to-Driving Following Traumatic Brain Injury. Geriatrics (Basel) 2016; 1:geriatrics1030017. [PMID: 31022811 PMCID: PMC6371138 DOI: 10.3390/geriatrics1030017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to conduct an evidence-based review to determine predictors of fitness to drive and return to driving in persons with traumatic brain injury (TBI). Relevant databases (MEDLINE/PubMed, CINAHL, Cochrane Library, and SCOPUS) were searched for primary articles published before June 2016 using MeSH search terms. Using the American Academy of Neurology’s classification criteria, 24 articles were included after reviewing 1998 articles. Studies were rated by class (I–IV), with I being the highest level of evidence. Articles were classified according to TBI severity, as well as types of assessments (on-road, simulator and surveys). There were no Class I studies. Based on Class II studies, only Post-traumatic amnesia (PTA) duration was found to be probably predictive of on-road driving performance. There is limited evidence concerning predictors of return to driving. The findings suggest further evidence is needed to identify predictors of on-road driving performance in persons with TBI. Class I studies reporting Level A recommendations for definitive predictors of driving performance in drivers with TBI are needed by policy makers and clinicians to develop evidence-based guidelines.
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Liang P, Gustafsson L, Liddle J, Fleming J. Family members' needs and experiences of driving disruption over time following an acquired brain injury: an evolving issue. Disabil Rehabil 2016; 39:1398-1407. [PMID: 27347745 DOI: 10.1080/09638288.2016.1196397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Family members often assume the role of driver for individuals who are not driving post-acquired brain injury (ABI). Given that return to driving can be unpredictable and uncertain, the impact of driving disruption on family members may vary at different stages post-injury. This study aims to understand the needs and experiences of family members over time during driving disruption following an ABI. METHOD A qualitative prospective longitudinal research design was used with semi-structured interviews at recruitment to study, 3 and 6 months later. RESULTS Fourteen family members completed 41 interviews. The longitudinal data revealed four phases of driving disruption: (1) Wait and see, (2) Holding onto a quick fix, (3) No way out, and (4) Resolution and adjustment. The phases described a process of building tension and a need for support and resolution over time. CONCLUSIONS Holding onto a quick fix is a pivotal phase whereby supports, such as engagement in realistic goal setting, are essential to facilitate family members' resolution of driving disruption issues. Family members who see no way out might not actively seek help and these points to a need for long-term and regular follow-ups. Future research can explore ways to support family members at these key times. Implications for rehabilitation Health professionals need to facilitate the process of fostering hope in family members to set realistic expectations of return to driving and the duration of driving disruption. It is necessary to follow-up with family members even years after ABI as the issue of driving disruption could escalate to be a crisis and family members might not actively seek help. Health professionals can consider both practical support for facilitating transport and emotional support when addressing the issue of driving disruption with family members.
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Affiliation(s)
- Phyllis Liang
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia
| | - Louise Gustafsson
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia
| | - Jacki Liddle
- b Queensland Brain Institute, The University of Queensland , Brisbane , Queensland , Australia
| | - Jennifer Fleming
- a Division of Occupational Therapy, School of Health and Rehabilitation Sciences , The University of Queensland , Brisbane , Queensland , Australia.,c Occupational Therapy Department , Princess Alexandra Hospital , Brisbane , Queensland , Australia
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Ranchet M, Akinwuntan AE, Tant M, Salch A, Neal E, Devos H. Fitness-to-drive agreements after stroke: medical versus practical recommendations. Eur J Neurol 2016; 23:1408-14. [DOI: 10.1111/ene.13050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 01/25/2023]
Affiliation(s)
- M. Ranchet
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - A. E. Akinwuntan
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
- Dean's Office; School of Health Professions; The University of Kansas Medical Center; Kansas City KS USA
| | - M. Tant
- CARA; Belgian Road Safety Institute; Brussels Belgium
| | - A. Salch
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - E. Neal
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - H. Devos
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
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Esser P, Dent S, Jones C, Sheridan BJ, Bradley A, Wade DT, Dawes H. Utility of the MOCA as a cognitive predictor for fitness to drive. J Neurol Neurosurg Psychiatry 2016; 87:567-8. [PMID: 25986364 DOI: 10.1136/jnnp-2015-310921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/22/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Patrick Esser
- Movement Science Group, Oxford Brookes University, Oxford, UK
| | - Stephen Dent
- Regional Driving Assessment Centre, Birmingham, UK
| | - Clare Jones
- Regional Driving Assessment Centre, Birmingham, UK
| | | | - Andrew Bradley
- Department of Mechanical Engineering & Mathematics, Oxford Brookes University, Oxford, UK
| | - Derick Treharne Wade
- Movement Science Group, Oxford Brookes University, Oxford, UK Oxford Centre for Enablement, Oxford University Hospital NHS Trust, Oxford, UK
| | - Helen Dawes
- Movement Science Group, Oxford Brookes University, Oxford, UK Department of Clinical Neurology, University of Oxford, Oxford, UK
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Abstract
OBJECTIVE Motor vehicle collisions (MVCs) are one of the leading causes of injury and death for adolescents. Driving is a complex activity that is highly reliant on executive function (EF) to safely navigate through the environment. Little research has examined the efficacy of using self-reported EF measures for assessing adolescent driving risk. This study examined the Behavior Rating Inventory of Executive Function (BRIEF) questionnaire and performance-based EF tasks as potential predictors of problematic driving outcomes in adolescents. METHODS Forty-six adolescent drivers completed the (1) BRIEF, (2) Trail Making Test, (3) Backwards Digit Span, and (4) self-report on 3 problematic driving outcomes: the number of times of having been pulled over by a police officer, the number of tickets issued, and the number of MVCs. RESULTS Greater self-reported difficulty with planning and organization was associated with greater odds of having a MVC, whereas inhibition difficulties were associated with greater odds of receiving a ticket. Greater self-reported difficulty across multiple BRIEF subscales was associated with greater odds of being pulled over. CONCLUSION Overall findings indicated that the BRIEF, an ecological measure of EF, showed significant association with self-reported problematic driving outcomes in adolescents. No relationship was found between performance-based EF measures and self-reported driving outcomes. The BRIEF could offer unique and quick insight into problematic driving behavior and potentially be an indicator of driving risk in adolescent drivers during clinical evaluations.
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de Guise E, Bélanger S, Tinawi S, Anderson K, LeBlanc J, Lamoureux J, Audrit H, Feyz M. Usefulness of the rivermead postconcussion symptoms questionnaire and the trail-making test for outcome prediction in patients with mild traumatic brain injury. APPLIED NEUROPSYCHOLOGY-ADULT 2015; 23:213-22. [DOI: 10.1080/23279095.2015.1038747] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Elaine de Guise
- Psychology Department, University of Montreal, Montreal, Quebec, Canada
- Neurology and Neurosurgery Department, McGill University, Montreal, Quebec, Canada
| | - Sara Bélanger
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada
| | - Simon Tinawi
- Rehabilitation Medicine Department, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada
| | - Kirsten Anderson
- Psychology Department, University of Montreal, Montreal, Quebec, Canada
| | - Joanne LeBlanc
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada
| | - Julie Lamoureux
- Social and Preventive Medicine Department, University of Montreal, Montreal, Quebec, Canada
| | - Hélène Audrit
- Psychology Department, University of Montreal, Montreal, Quebec, Canada
| | - Mitra Feyz
- Traumatic Brain Injury Program, McGill University Health Centre-Montreal General Hospital, Montreal, Quebec, Canada
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Heyer EJ, Mallon KA, Mergeche JL, Stern Y, Connolly ES. Deficits of hand coordination and laterality of carotid endarterectomy. J Neurosurg 2015; 122:101-6. [DOI: 10.3171/2014.8.jns1459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
Neurocognitive performance is used to assess multiple cognitive domains, including motor coordination, before and after carotid endarterectomy (CEA). Although gross motor strength is impaired with ischemia of large cortical areas or of the internal capsule, the authors hypothesize that patients undergoing CEA demonstrate significant motor deficits of hand coordination contralateral to the operative side, which is more clearly manifest in the nondominant hand than in the dominant hand with ischemia of smaller cortical areas.
METHODS
The neurocognitive performance of 374 patients was evaluated with a battery of neuropsychometric tests. Both asymptomatic and symptomatic patients undergoing CEA were included. The authors evaluated the patients' dominant and nondominant hand performance on the Grooved Pegboard test, a test of hand coordination, to demonstrate their functional laterality. Neurocognitive dysfunction was evaluated as the difference in performance before and after CEA according to group-rate and event-rate analyses. The z scores were generated for all tests using a reference group of patients who were having simple spine surgery. Dominant and nondominant motor coordination functions were evaluated as raw scores and as calculated z scores.
RESULTS
According to event-rate analysis, significantly more patients undergoing CEA of the opposite carotid artery demonstrated nondominant than dominant hand deficits of coordination (41.2% vs 26.4%, respectively, p = 0.02). Similarly, according to group-rate analysis, in patients undergoing CEA of the opposite carotid artery, raw difference scores from the Grooved Pegboard test reflected greater nondominant than dominant hand deficits of coordination (21.0 ± 54.4 vs 9.7 ± 37.0, respectively, p = 0.02).
CONCLUSIONS
Patients undergoing CEA of the opposite carotid artery are more likely to demonstrate nondominant than dominant hand deficits of coordination because of greater dexterity in the dominant hand before surgery.
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Affiliation(s)
| | | | | | | | - E. Sander Connolly
- 2Neurology and
- 3Neurological Surgery, Columbia University, New York, New York
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30
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Affiliation(s)
- A H V Schapira
- Department of Clinical Neurosciences, UCL Institute of Neurology, London, UK.
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31
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Devos H, Tant M, Akinwuntan AE. On-Road Driving Impairments and Associated Cognitive Deficits After Stroke. Cerebrovasc Dis 2014; 38:226-32. [DOI: 10.1159/000368219] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/09/2014] [Indexed: 11/19/2022] Open
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32
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Nakano K, Park K, Zheng R, Fang F, Ohori M, Nakamura H, Kumagai Y, Okada H, Teramura K, Nakayama S, Irimajiri A, Taoka H, Okada S. Leukoaraiosis significantly worsens driving performance of ordinary older drivers. PLoS One 2014; 9:e108333. [PMID: 25295736 PMCID: PMC4189976 DOI: 10.1371/journal.pone.0108333] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Accepted: 08/26/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Leukoaraiosis is defined as extracellular space caused mainly by atherosclerotic or demyelinated changes in the brain tissue and is commonly found in the brains of healthy older people. A significant association between leukoaraiosis and traffic crashes was reported in our previous study; however, the reason for this is still unclear. METHOD This paper presents a comprehensive evaluation of driving performance in ordinary older drivers with leukoaraiosis. First, the degree of leukoaraiosis was examined in 33 participants, who underwent an actual-vehicle driving examination on a standard driving course, and a driver skill rating was also collected while the driver carried out a paced auditory serial addition test, which is a calculating task given verbally. At the same time, a steering entropy method was used to estimate steering operation performance. RESULTS The experimental results indicated that a normal older driver with leukoaraiosis was readily affected by external disturbances and made more operation errors and steered less smoothly than one without leukoaraiosis during driving; at the same time, their steering skill significantly deteriorated. CONCLUSIONS Leukoaraiosis worsens the driving performance of older drivers because of their increased vulnerability to distraction.
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Affiliation(s)
- Kimihiko Nakano
- Interfaculty Initiative in Information Studies, The University of Tokyo, Tokyo, Japan
| | - Kaechang Park
- Traffic Medicine Laboratory, Research Organization for Regional Alliances, Kochi University of Technology, Kami-shi, Kochi, Japan
- The Brain Checkup Center, Kochi Kenshin Clinic, Kochi-shi, Kochi, Japan
| | - Rencheng Zheng
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Fang Fang
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Masanori Ohori
- Institute of Industrial Science, The University of Tokyo, Tokyo, Japan
| | - Hiroki Nakamura
- Faculty of Engineering, Kanagawa University, Yokohama, Japan
| | - Yasuhiho Kumagai
- Regional ITS Research Laboratory, Research Organization for Regional Alliances, Kochi University of Technology, Kami-shi, Kochi, Japan
| | - Hiroshi Okada
- Driver's License Center, Kochi Prefectural Police Department, Ino-cho, Kochi, Japan
| | - Kazuhiko Teramura
- Driver's License Center, Kochi Prefectural Police Department, Ino-cho, Kochi, Japan
| | - Satoshi Nakayama
- Driver's License Center, Kochi Prefectural Police Department, Ino-cho, Kochi, Japan
| | - Akinori Irimajiri
- Driver's License Center, Kochi Prefectural Police Department, Ino-cho, Kochi, Japan
| | - Hiroshi Taoka
- Driver's License Center, Kochi Prefectural Police Department, Ino-cho, Kochi, Japan
| | - Satoshi Okada
- Driver's License Center, Kochi Prefectural Police Department, Ino-cho, Kochi, Japan
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Neuropsychological Performance, Brain Imaging, and Driving Violations in Multiple Sclerosis. Arch Phys Med Rehabil 2014; 95:1818-23. [DOI: 10.1016/j.apmr.2014.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/14/2014] [Accepted: 05/27/2014] [Indexed: 01/13/2023]
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Devos H, Hawley CA. Screening tools for fitness to drive after traumatic brain injury and stroke. Eur J Neurol 2013; 20:1225-6. [PMID: 23560549 DOI: 10.1111/ene.12168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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