Automated Vehicles: Future Initiatives for Occupational Therapy Practitioners and Driver Rehabilitation Specialists

This article addresses a critically important topic for the occupational therapy (OT) profession and driver rehabilitation specialists (DRS), related to the introduction and deployment of personal and public automated vehicles (AVs); and discusses the current and corresponding changing roles for these professionals. Within this commentary, we provide an overview of the relevant literature on AV regulations, policy, and legislation in North America, the various levels of AV technology, and inclusive and universal design principles to consider in AV deployment for people with disabilities. The role of the OT practitioner and DRS is described within the context of the person-environment-occupation-performance model, and within the guidelines of the Association for Driver Rehabilitation Specialists and the American Occupational Therapy Association. The article concludes with considerations for an extended clinical agenda, a new research agenda, and a call for action to OT practitioners and DRS, as well as to educators, certification bodies, professional organizations, and collaborators.

Should Steering Settings be Changed by the Driver or by the Vehicle Itself?

INTRODUCTION

Cars are increasingly computerized, and vehicle settings such as steering gain (SG) can now be altered during driving. However, it is unknown whether transitions in SG should be adaptable (i.e., triggered by driver input) or adaptive (i.e., triggered automatically). We examined this question for road segments expected to require different SG.

OBJECTIVE

This paper aimed to investigate whether SG mode changes should be made by the driver or automatically.

METHODS

Twenty-four participants drove under four conditions in a simulator: fixed low gain (FL), fixed high gain (FH), a machine-initiated steering system, which switched between the two SG levels at predetermined locations (MI), and a driver-initiated steering system, in which the SG level could be changed by pressing a button on the steering wheel (DI).

RESULTS

Participants showed poorer lane-keeping and reported higher effort for FH compared to FL on straights, while the opposite held true on curved roads. On curved roads, the MI condition yielded better lane-keeping and lower subjective effort than the DI condition. However, a substantial portion of the drivers gave low preference rankings to the MI system.

CONCLUSION

Drivers prefer and benefit from a steering system with a variable rather than fixed gain. Furthermore, although automatic SG transitions reduce effort, some drivers reject this concept.

APPLICATION

As the state of technology advances, MI transitions are becoming increasingly feasible, but whether drivers would want to delegate their decision-making authority to a machine remains a moot point.

Does in-vehicle automation help individuals with Parkinson's disease? A preliminary analysis

Introduction

PD is a progressive neurodegenerative disorder that affects, according to the ICF, body systems (cognitive, visual, and motor), and functions (e.g., decreased executive functions, decreased visual acuity, impaired contrast sensitivity, decreased coordination)-all which impact driving performance, an instrumental activity of daily living in the domain of "Activity" and "Participation" according to the ICF. Although there is strong evidence of impaired driving performance in PD, few studies have explored the real-world benefits of in-vehicle automation technologies, such as in-vehicle information systems (IVIS) and advanced driver assistance systems (ADAS), for drivers with PD. These technologies hold potential to alleviate driving impairments, reduce errors, and improve overall performance, allowing individuals with PD to maintain their mobility and independence more safely and for longer periods. This preliminary study aimed to fill the gap in the literature by examining the impact of IVIS and ADAS on driving safety, as indicated by the number of driving errors made by people with PD in an on-road study.

Methods

Forty-five adults with diagnosed PD drove a 2019 Toyota Camry equipped with IVIS and ADAS features (Toyota Safety Sense 2.0) on a route containing highway and suburban roads. Participants drove half of the route with the IVIS and ADAS systems activated and the other half with the systems deactivated.

Results

The results suggest that systems that assume control of the driving task, such as adaptive cruise control, were most effective in reducing driving errors. Furthermore, individual differences in cognitive abilities, particularly memory, were significantly correlated with the total number of driving errors when the systems were deactivated, but no significant correlations were present when the systems were activated. Physical capability factors, such as rigidity and bradykinesia, were not significantly correlated with driving error.

Discussion

Taken together, these results show that in-vehicle driver automation systems can benefit drivers with PD and diminish the impact of individual differences in driver cognitive ability.

Feasibility of automated in-vehicle technologies on volunteers' driving performance

BACKGROUND

Automated in-vehicle technologies, specifically in-vehicle information systems (IVIS) and advanced driver assistance systems (ADAS), are increasingly common in today's cars. Previous studies illustrate benefits of using IVIS and ADAS to improve safety, convenience, and comfort in healthy older drivers. However, research is sparse on the feasibility of such technologies for medically at-risk drivers, such as those with Parkinson's disease (PD).

OBJECTIVE

This study enrolled healthy volunteer drivers to examine the feasibility of the procedures and measures for evaluating the effects of IVIS and ADAS on their driving performance.

METHODS

During this feasibility study researchers compared drives completed with and without support of IVIS and ADAS, as participants drove a 2019 Toyota Camry XLE. The test vehicle was equipped with IVIS, ADAS, cameras, a telematics system, and sensors. Participants drove the road course supervised by a Driver Rehabilitation Specialist (DRS).

RESULTS

Overall study procedures and vehicle equipment were feasible and provided sufficient data collection for measuring the impact of IVIS and ADAS on driving performance. Data observation by the DRS combined with data captured from cameras and telematics, facilitated comparisons to increase data reliability and validity.

CONCLUSIONS

Feasibility study findings informed a randomized clinical trial, examining the use of IVIS and ADAS technologies as an intervention to support drivers with Parkinson's disease.

RCT protocol for driving performance in people with Parkinson's using autonomous in-vehicle technologies

Introduction

Driving is an essential facilitator of independence, community participation, and quality of life. Drivers with Parkinson's Disease (PD) make more driving errors and fail on-road evaluations more than healthy controls. In-vehicle technologies may mitigate PD-related driving impairments and associated driving errors. Establishing a rigorous study protocol will increase the internal validity and the transparency of the scientific work.

Methods

We present a protocol to assess the efficacy of autonomous in-vehicle technologies (Level 1) on the driving performance of drivers with PD via a randomized crossover design with random allocation. Drivers with a PD diagnosis based on established clinical criteria (N = 105), referred by neurologists, are exposed to two driving conditions (technology activated or not) on a standardized road course as they drove a 2019 Toyota Camry. The researchers collected demographic, clinical, on-road data observational and kinematic, and video data to understand several primary outcome variables, i.e., number of speeding, lane maintenance, signaling, and total driving errors.

Discussion

The protocol may enhance participant adherence, decrease attrition, provide early and accurate identification of eligible participants, ensure data integrity, and improve the study flow. One limitation is that the protocol may change due to unforeseen circumstances and assumptions upon implementation. A strength is that the protocol ensures the study team executes the planned research in a systematic and consistent way.

Following, adapting, and refining the protocol will enhance the scientific investigation to quantify the nuances of driving among those with PD in the era of automated in-vehicle technologies.

Trial registration

ClinicalTrials.gov NCT04660500.

Understanding Current and Future Transport Needs of Older Australian Drivers to Guide Development of Sustainable and Smart Initiatives to Support Safe Mobility of Older Adults

Access to adequate and appropriate transport options enables older people to continue as thriving community participants, to reach services and to maintain social connections. While transport needs are diverse, and tend to change over time, there is little information on current and future transport patterns, and the awareness, acceptance and adoption of new technologies. A national online survey was administered to current drivers in Australia. A sample of 705 drivers provided information on available travel modes and use of these modes, awareness of in-vehicle technologies and future use of vehicle technologies. The findings revealed high use of private vehicles, walking and taxis but little use of other travel modes (bicycles, motorcycles, rideshare, community services and public transport). Age, gender and residential location influenced the availability and use/potential use of some transport options. Overall awareness of in-vehicle technologies was generally low and particularly so amongst older and female participants. There was some appetite to use emerging technologies in the future. The findings inform the development of effective strategies and initiatives aligned with healthy ageing and wellbeing targets, increased sustainability, resilience and connectedness, creation of healthier travel choices and healthier environments to promote acceptance and use of a range of transport options and uptake of safer vehicles equipped with in-vehicle technologies to ultimately enhance safe and sustainable mobility of older road users.

Using Automated Vehicle Technologies With Older Adults: A Mixed-Methods Study

When older adults' driving abilities decline, automated driving technologies may improve community mobility, engagement, and independence. Most previous research has focused on older persons' attitudes rather than their use of automated driving technologies. This study examined older Australians' perceptions and experience of automated vehicle technologies before, during, and after a real-life driving experience, focusing on ease of use, usefulness, safety, acceptance, trust, and confidence. This mixed-methods study included observation of a 6-km test drive using a partially automated vehicle, pre- and post-drive questionnaires, and a post-drive semi-structured interview. Most participants reported positive perceptions and experiences before, during, and after the test drive. Visual analysis of pre/postresponses revealed divergent reactions to the test drive, consistent with the heterogeneity of the older population. Automated driving technologies have potential to contribute to mobility at older ages. Larger-scale studies including actual driving experiences are recommended.

Attitudes Toward Four Levels of Self-Driving Technology Among Elderly Drivers

Automatization and autonomous vehicles can drastically improve elderly drivers' safety and mobility, with lower costs to the driver and the environment. While autonomous vehicle technology is developing rapidly, much less attention and resources have been devoted to understanding the acceptance, attitudes, and preferences of vehicle automatization among driver groups, such as the elderly. In this study, 236 elderly drivers (≥65 years) evaluated four vehicles representing SAE levels 2–5 in terms of safety, trustworthiness, enjoyment, reliability, comfort, ease of use, and attractiveness, as well as reporting preferences for vehicles employing each of the four levels of automation. The results of a repeated-measures ANOVA showed that the elderly drivers rated the SAE level 2 vehicle highest and the fully automated vehicle (SAE 5) lowest across all attributes. The preference for the vehicle declined as a function of increasing automatization. The seven attributes formed an internally coherent “attitude to automatization” scale, a strong correlate of vehicle preference. Age or annual mileage were not related to attitudes or preferences for automated vehicles. The current study shows that elderly drivers' attitudes toward automatization should be studied further, and these results should be taken into account when developing automated vehicles. The full potential of automatization may not be realized if elderly drivers are ignored.

Construct Validity and Test-Retest Reliability of the Automated Vehicle User Perception Survey

Fully automated vehicles (AVs) hold promise toward providing numerous societal benefits including reducing road fatalities. However, we are uncertain about how individuals' perceptions will influence their ability to accept and adopt AVs. The 28-item Automated Vehicle User Perception Survey (AVUPS) is a visual analog scale that was previously constructed, with established face and content validity, to assess individuals' perceptions of AVs. In this study, we examined construct validity, via exploratory factor analysis and subsequent Mokken scale analyses. Next, internal consistency was assessed via Cronbach's alpha (α) and 2-week test-retest reliability was assessed via Spearman's rho (ρ) and intraclass correlation coefficient (ICC). The Mokken scale analyses resulted in a refined 20-item AVUPS and three Mokken subscales assessing specific domains of adults' perceptions of AVs: (a) Intention to use; (b) perceived barriers; and (c) well-being. The Mokken scale analysis showed that all item-coefficients of homogeneity (H) exceeded 0.3, indicating that the items reflect a single latent variable. The AVUPS indicated a strong Mokken scale (H scale = 0.51) with excellent internal consistency (α = 0.95) and test-retest reliability (ρ = 0.76, ICC = 0.95). Similarly, the three Mokken subscales ranged from moderate to strong (range H scale = 0.47-0.66) and had excellent internal consistency (range α = 0.84-0.94) and test-retest reliability (range ICC = 0.84-0.93). The AVUPS and three Mokken subscales of AV acceptance were validated in a moderate sample size (N = 312) of adults living in the United States. Two-week test-retest reliability was established using a subset of Amazon Mechanical Turk participants (N = 84). The AVUPS, or any combination of the three subscales, can be used to validly and reliably assess adults' perceptions before and after being exposed to AVs. The AVUPS can be used to quantify adults' acceptance of fully AVs.

The Drives for Driving Simulation: A Scientometric Analysis and a Selective Review of Reviews on Simulated Driving Research

Driving behaviors and fitness to drive have been assessed over time using different tools: standardized neuropsychological, on-road and driving simulation testing. Nowadays, the great variability of topics related to driving simulation has elicited a high number of reviews. The present work aims to perform a scientometric analysis on driving simulation reviews and to propose a selective review of reviews focusing on relevant aspects related to validity and fidelity. A scientometric analysis of driving simulation reviews published from 1988 to 2019 was conducted. Bibliographic data from 298 reviews were extracted from Scopus and WoS. Performance analysis was conducted to investigate most prolific Countries, Journals, Institutes and Authors. A cluster analysis on authors' keywords was performed to identify relevant associations between different research topics. Based on the reviews extracted from cluster analysis, a selective review of reviews was conducted to answer questions regarding validity, fidelity and critical issues. United States and Germany are the first two Countries for number of driving simulation reviews. United States is the leading Country with 5 Institutes in the top-ten. Top Authors wrote from 3 to 7 reviews each and belong to Institutes located in North America and Europe. Cluster analysis identified three clusters and eight keywords. The selective review of reviews showed a substantial agreement for supporting validity of driving simulation with respect to neuropsychological and on-road testing, while for fidelity with respect to real-world driving experience a blurred representation emerged. The most relevant critical issues were the a) lack of a common set of standards, b) phenomenon of simulation sickness, c) need for psychometric properties, lack of studies investigating d) predictive validity with respect to collision rates and e) ecological validity. Driving simulation represents a cross-cutting topic in scientific literature on driving, and there are several evidences for considering it as a valid alternative to neuropsychological and on-road testing. Further research efforts could be aimed at establishing a consensus statement for protocols assessing fitness to drive, in order to (a) use standardized systems, (b) compare systematically driving simulators with regard to their validity and fidelity, and (c) employ shared criteria for conducting studies in a given sub-topic.

Challenges to Human Drivers in Increasingly Automated Vehicles

OBJECTIVE

We examine the relationships between contemporary progress in on-road vehicle automation and its coherence with an envisioned "autopia" (automobile utopia) whereby the vehicle operation task is removed from all direct human control.

BACKGROUND

The progressive automation of on-road vehicles toward a completely driverless state is determined by the integration of technological advances into the private automobile market; improvements in transportation infrastructure and systems efficiencies; and the vision of future driving as a crash-free enterprise. While there are many challenges to address with respect to automated vehicles concerning the remaining driver role, a considerable amount of technology is already present in vehicles and is advancing rapidly.

METHODS

A multidisciplinary team of experts met to discuss the most critical challenges in the changing role of the driver, and associated safety issues, during the transitional phase of vehicle automation where human drivers continue to have an important but truncated role in monitoring and supervising vehicle operations.

RESULTS

The group endorsed that vehicle automation is an important application of information technology, not only because of its impact on transportation efficiency, but also because road transport is a life critical system in which failures result in deaths and injuries. Five critical challenges were identified: driver independence and mobility, driver acceptance and trust, failure management, third-party testing, and political support.

CONCLUSION

Vehicle automation is not technical innovation alone, but is a social as much as a technological revolution consisting of both attendant costs and concomitant benefits.