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Stamatelos P, Economou A, Yannis G, Stefanis L, Papageorgiou SG. Parkinson's Disease and Driving Fitness: A Systematic Review of the Existing Guidelines. Mov Disord Clin Pract 2024; 11:198-208. [PMID: 38164044 PMCID: PMC10928339 DOI: 10.1002/mdc3.13942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 09/21/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Motor/nonmotor symptomatology and antiparkinsonian drugs deteriorate the driving ability of Parkinson's disease (PD) patients. OBJECTIVES Treating neurologists are frequently asked to evaluate driving fitness of their patients and provide evidence-based consultation. Although several guidelines have been published, the exact procedure along with the neurologist's role in this procedure remains obscure. METHODS We systematically reviewed the existing guidelines, regarding driving fitness evaluation of PD patients. We searched MEDLINE and Google Scholar and identified 109 articles. After specified inclusion criteria were applied, 15 articles were included (nine national guidelines, five recommendation papers, and one consensus statement). RESULTS The treating physician is proposed as the initial evaluator in 8 of 15 articles (neurologist in 2 articles) and may refer patients for a second-line evaluation. The evaluation should include motor, cognitive, and visual assessment (proposed in 15, 13, and 8 articles, respectively). Specific motor tests are proposed in eight articles (cutoff values in four), whereas specific neuropsychological and visual tests are proposed in seven articles each (cutoff values in four and three articles, respectively). Conditional licenses are proposed in 11 of 15 articles, to facilitate driving for PD patients. We summarized our findings on a graphic of the procedure for driving fitness evaluation of PD patients. CONCLUSIONS Neurological aspects of driving fitness evaluation of PD patients are recognized in most of the guidelines. Motor, neuropsychological, visual, and sleep assessment and medication review are key components. Clear-cut instructions regarding motor, neuropsychological, and visual tests and relative cutoff values are lacking. Conditional licenses and periodical reevaluation of driving fitness are important safety measures.
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Affiliation(s)
- Petros Stamatelos
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
| | - Alexandra Economou
- Department of PsychologyNational and Kapodistrian University of AthensAthensGreece
| | - George Yannis
- Department of Transportation Planning and EngineeringSchool of Civil Engineering, National Technical University of AthensAthensGreece
| | - Leonidas Stefanis
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
| | - Sokratis G. Papageorgiou
- 1st Department of NeurologyMedical School, National and Kapodistrian University of Athens, Eginition HospitalAthensGreece
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Bastos MSC, Nickel R, Camargo CHF, Teive HAG. Patients with Cervical Dystonia Demonstrated Decreased Cognitive Abilities and Visual Planning Compared to Controls. Mov Disord Clin Pract 2021; 8:904-910. [PMID: 34405098 DOI: 10.1002/mdc3.13259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 05/06/2021] [Accepted: 05/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background Cervical dystonia (CD) involves clinical and motor manifestations, and visual and cognitive dysfunctions may also be frequent. Objective To evaluate functional vision, visual attention, and cognitive aspects in patients with CD compared with a control group. Methods Fifty patients with CD were assessed using the Useful Field of View Test (UFOV), the Mini Mental State Examination (MMSE), and the Trail Making Tests (TMT-A and TMT-B), and compared with an identical number of health controls matched by sex, age, and educational level. Results No differences were seen between the groups in terms of MMSE score (P = 0.481), but the CD patient group had poorer scores for the TMA-A (P = 0.004) and TMT-B (P = 0.004). For the UFOV subtests, a decrease was found for visual processing speed (P < 0.001), divided attention (P < 0.001), and selective attention (P = 0.001), as well as higher frequency in the categories with higher risk index in the UFOV test (P < 0.001). Conclusion Patients with CD may exhibit decreased functional vision and visual attention, as well as higher risk in performing complex activities.
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Affiliation(s)
- Marina S C Bastos
- Neurological Diseases Group, Graduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil.,Occupational Therapy Department Federal University of Paraná Curitiba Brazil
| | - Renato Nickel
- Occupational Therapy Department Federal University of Paraná Curitiba Brazil
| | - Carlos H F Camargo
- Neurological Diseases Group, Graduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil
| | - Hélio A G Teive
- Neurological Diseases Group, Graduate Program in Internal Medicine, Internal Medicine Department, Hospital de Clínicas Federal University of Paraná Curitiba Brazil.,Movement Disorders Unit, Neurology Service, Internal Medicine Department Hospital de Clínicas, Federal University of Paraná Curitiba Brazil
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Lajoie AC, Lafontaine AL, Kaminska M. The Spectrum of Sleep Disorders in Parkinson Disease: A Review. Chest 2020; 159:818-827. [PMID: 32956712 DOI: 10.1016/j.chest.2020.09.099] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 09/02/2020] [Accepted: 09/11/2020] [Indexed: 12/23/2022] Open
Abstract
There is increasing interest in the effects of sleep and sleep disturbances on the brain, particularly in relation to aging and neurodegenerative processes. Parkinson disease (PD) is the second most common neurodegenerative disorder, with growing prevalence worldwide. Sleep disorders, including sleep-disordered breathing (SDB), are among the most frequent non-motor manifestations of PD. They can substantially impair quality of life and possibly affect the course of the disease. This article reviews the etiology, implications, and management of sleep disturbances in PD, such as excessive daytime sleepiness, insomnia, restless legs syndrome, rapid eye movement sleep behavior disorder, and SDB. Also briefly explored is the potential role of sleep disorders, including SDB, in the progression of neurodegeneration.
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Affiliation(s)
- Annie C Lajoie
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Canada
| | | | - Marta Kaminska
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Canada; Respiratory Division & Sleep Laboratory, McGill University Health Centre, Montreal, Canada.
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Abstract
Driving is impaired in most patients with Parkinson disease because of motor, cognitive, and visual dysfunction. Driving impairments in Parkinson disease may increase the risk of crashes and result in early driving cessation with loss of independence. Drivers with Parkinson disease should undergo comprehensive evaluations to determine fitness to drive with periodic follow-up evaluations as needed. Research in rehabilitation of driving and automation to maintain independence of patients with Parkinson disease is in progress.
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Affiliation(s)
- Maud Ranchet
- Laboratoire Ergonomie Sciences Cognitives pour les Transports (LESCOT), IFSTTAR (Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux), 25, Avenue François Mitterrand, Case 24, Cité des Mobilités, Lyon, Bron F-69675, France
| | - Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, Kansas University, KU Medical Center, 3901 Rainbow Boulevard/MS2002, Kansas City, KS 66160, USA
| | - Ergun Y Uc
- Department of Neurology, University of Iowa, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA; Neurology Service, Veterans Affairs Medical Center, 601 Highway 6 W, Iowa City, IA 52246, USA.
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Joshi CN, Vossler DG, Spanaki M, Draszowki JF, Towne AR. "Chance Takers Are Accident Makers": Are Patients With Epilepsy Really Taking a Chance When They Drive? Epilepsy Curr 2019; 19:221-226. [PMID: 31328536 PMCID: PMC6891831 DOI: 10.1177/1535759719858647] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
This review compiles scientific data about the real dangers faced by people with
epilepsy (PWE) who drive. Those include risks of motor vehicle accidents (MVA)
in PWE as compared with controls (individuals without epilepsy) and as compared
with persons with other medical conditions that impact fitness to drive. Data
regarding Accident rates as related to seizure free intervals (SFI), single vs.
multiple seizure events, and/or antiseizure drug (ASD) taper and reintroduction
are discussed. Variation in state, national, and international laws and guidance
for non-commercial and commercial drivers is highlighted, along with some
related reasons for driving restrictions. The review concludes by emphasizing
the importance of physicians educating patients about local driving laws and
about risks of ASD non-adherence. The need for a broader, multi-stakeholder
re-examination of driving regulations for PWE is noted.
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Affiliation(s)
- Charuta N Joshi
- 1 Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Denver, CO, USA
| | - David G Vossler
- 2 UW Medicine
- Valley Medical Center and University of Washington, Seattle, WA, USA
| | - Marianne Spanaki
- 3 Department of Neurology, Wayne State University, Detroit, MI, USA
| | | | - Alan R Towne
- 5 Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
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Classen S, Brumback B, Crawford K, Jenniex S. Visual Attention Cut Points for Driver Fitness in Parkinson's Disease. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 39:257-265. [PMID: 30907280 DOI: 10.1177/1539449219836689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study determined whether the Useful Field of View™ Risk Index (UFOV RI) adds value as a predictor of on-road outcomes in drivers with Parkinson's disease (PD) when considered with age, gender, and disease severity and compared with community-dwelling older drivers (Controls). A total of 101 PD drivers and 138 Controls underwent a comprehensive driving evaluation, including an on-road assessment. Logistic regression analyses determined the associations of age, gender, visual attention, and disease severity to on-road outcomes. Receiver operating characteristic curve analyses determined the optimal UFOV RI cut points to predict on-road outcomes. Above adding age and gender, the UFOV RI alone predicted on-road outcomes in PD, while the UFOV RI and age predicted on-road outcomes in Controls. Regardless of disease severity, visual attention was more impaired in PD than in Controls. The UFOV RI cut point of 3 provided the fewest misclassifications (n = 25) in PD. The UFOV RI is a valid screening predictor of on-road outcomes across PD drivers of different disease severity, but has moderate sensitivity and specificity.
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Affiliation(s)
- Sherrilene Classen
- University of Florida, Gainesville, USA.,University of Western Ontario, London, Canada
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Driving with Parkinson’s Disease: Exploring Lived Experience. PARKINSON'S DISEASE 2019; 2019:3169679. [PMID: 30854186 PMCID: PMC6378012 DOI: 10.1155/2019/3169679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022]
Abstract
A growing body of literature has explored the impact of Parkinson's disease (PD) on fitness to drive. As such, evidence now supports the use of specific clinical tests for screening purposes, the predictive validity of risk impressions, and the critical driving errors that predict on-road pass/fail outcomes in this population. However, little is known about the lived experiences of persons with PD as they navigate driving-related concerns such as driving impairments, cessation, potential threats to independence, and community mobility. This qualitative secondary data analysis aimed to explore the driving-related lived experiences of persons with PD. We utilized summative content analysis to identify themes related to driving from transcribed interviews with nineteen community-dwelling individuals with PD who participated in the primary study. Five themes emerged within the analysis: (1) the meaning and significance of driving; (2) driving cessation; (3) modified driving behaviors; (4) factors affecting driving; and (5) accessibility. Participants identified driving as an activity that holds significant importance—both directly (i.e., as a primary activity) and as a means for enabling other activities. This study lays the foundation for the development of client-centred and evidence-informed driving interventions for individuals with PD, as well as the development of driving retirement programs.
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Guo L, Normando EM, Shah PA, De Groef L, Cordeiro MF. Oculo-visual abnormalities in Parkinson's disease: Possible value as biomarkers. Mov Disord 2018; 33:1390-1406. [DOI: 10.1002/mds.27454] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 05/16/2018] [Accepted: 05/18/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Li Guo
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Eduardo M. Normando
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
| | - Parth Arvind Shah
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
| | - Lies De Groef
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Neural Circuit Development and Regeneration Research Group, Department of Biology; University of Leuven; Leuven Belgium
| | - M. Francesca Cordeiro
- Glaucoma and Retinal Degenerative Disease Research Group, Institute of Ophthalmology; University College London; London UK
- Western Eye Hospital, Imperial College Healthcare National Health Service Trust; London UK
- Imperial College Ophthalmology Research Group, Department of Surgery and Cancer, Imperial College London; London UK
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Ueno T, Kon T, Haga R, Nishijima H, Tomiyama M. Motor vehicle accidents in Parkinson's disease: A questionnaire study. Acta Neurol Scand 2018; 137:218-223. [PMID: 28948617 DOI: 10.1111/ane.12849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Few studies have investigated the risk factors for motor vehicle accidents (MVA) in individuals with Parkinson's disease (PD) in Japan. MATERIALS AND METHODS We sent an anonymous questionnaire to 1417 patients with PD who had received medical care certificates for Intractable Diseases during the 2014 fiscal year from the Aomori Prefectural Government in Japan. Data from patients with PD who previously or currently held a driving license at the time of the survey were analyzed. RESULTS Complete datasets were obtained from 384 patients with PD who were either past or present driving license holders. Fifty-seven patients had caused at least one MVA in the last 5 years before the survey. Logistic regression analyses revealed that ergot-dopamine agonist (DA) use and excessive daytime sleepiness (Epworth Sleepiness Scale score ≥ 10) were the best predictors of MVAs. Patients having caused non-sleep-related MVAs had significantly longer disease durations, more frequent ergot-DA use, and higher cognition and communication subscores on the Parkinson's Disease Questionnaire-39 than those without non-sleep-related MVAs (P < .05). The Epworth Sleepiness Scale scores of PD patients with sleep-related MVAs were significantly higher than those of patients without sleep-related MVAs (P < .01). CONCLUSIONS Excessive daytime sleepiness and ergot-DA use may be important predictive risk factors for MVAs in PD. Daytime sleepiness appears to be related to sleep-related MVAs in PD, whereas disease progression and ergot-DA use may contribute to non-sleep-related MVAs.
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Affiliation(s)
- T. Ueno
- Department of Neurology Aomori Prefectural Central Hospital Aomori Japan
| | - T. Kon
- Department of Neurology Aomori Prefectural Central Hospital Aomori Japan
| | - R. Haga
- Department of Neurology Aomori Prefectural Central Hospital Aomori Japan
| | - H. Nishijima
- Department of Neurology Aomori Prefectural Central Hospital Aomori Japan
| | - M. Tomiyama
- Department of Neurology Aomori Prefectural Central Hospital Aomori Japan
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Uc EY, Rizzo M, O'Shea AMJ, Anderson SW, Dawson JD. Longitudinal decline of driving safety in Parkinson disease. Neurology 2017; 89:1951-1958. [PMID: 29021353 DOI: 10.1212/wnl.0000000000004629] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/23/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To longitudinally assess and predict on-road driving safety in Parkinson disease (PD). METHODS Drivers with PD (n = 67) and healthy controls (n = 110) drove a standardized route in an instrumented vehicle and were invited to return 2 years later. A professional driving expert reviewed drive data and videos to score safety errors. RESULTS At baseline, drivers with PD performed worse on visual, cognitive, and motor tests, and committed more road safety errors compared to controls (median PD 38.0 vs controls 30.5; p < 0.001). A smaller proportion of drivers with PD returned for repeat testing (42.8% vs 62.7%; p < 0.01). At baseline, returnees with PD made fewer errors than nonreturnees with PD (median 34.5 vs 40.0; p < 0.05) and performed similar to control returnees (median 33). Baseline global cognitive performance of returnees with PD was better than that of nonreturnees with PD, but worse than for control returnees (p < 0.05). After 2 years, returnees with PD showed greater cognitive decline and larger increase in error counts than control returnees (median increase PD 13.5 vs controls 3.0; p < 0.001). Driving error count increase in the returnees with PD was predicted by greater error count and worse visual acuity at baseline, and by greater interval worsening of global cognition, Unified Parkinson's Disease Rating Scale activities of daily living score, executive functions, visual processing speed, and attention. CONCLUSIONS Despite drop out of the more impaired drivers within the PD cohort, returning drivers with PD, who drove like controls without PD at baseline, showed many more driving safety errors than controls after 2 years. Driving decline in PD was predicted by baseline driving performance and deterioration of cognitive, visual, and functional abnormalities on follow-up.
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Affiliation(s)
- Ergun Y Uc
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha.
| | - Matthew Rizzo
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Amy M J O'Shea
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Steven W Anderson
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
| | - Jeffrey D Dawson
- From the Departments of Neurology (E.Y.U., M.R., S.W.A.) and Biostatistics (A.M.J.O., J.D.D.), University of Iowa; Neurology Service (E.Y.U.) and Comprehensive Access and Delivery Research & Evaluation (A.M.J.O.), Veterans Affairs Medical Center, Iowa City, IA; and Department of Neurology (M.R.), University of Nebraska, Omaha
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Abstract
OBJECTIVES In addition to the motor and cognitive symptoms that people with Parkinson's disease (PD) typically experience, psychiatric symptoms such as anxiety are also commonly experienced by people with PD. The overall purpose of the current study was to explore driving and driving cessation for people with PD and their families. METHODS A descriptive phenomenological approach was employed using semi-structured interviews and 34 interviews were conducted overall (22 participants with PD and 12 family members). RESULTS Experiences of anxiety and worry that had an impact on driving and driving cessation arose from the data, and this article specifically captured the lived experience of anxiety with driving and driving cessation for people with PD and their families. CONCLUSIONS Findings reveal that the experience of anxiety while driving, as well as anticipatory anxiety and/or worry related to driving cessation, affect the driving experiences and wellbeing of people with PD. CLINICAL IMPLICATIONS Implications of the study findings are outlined and aim to provide information about the needs to enable future clinical directions to be developed.
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Affiliation(s)
| | - Jacki Liddle
- a The University of Queensland , Brisbane , Australia
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Jitkritsadakul O, Bhidayasiri R. Physicians' role in the determination of fitness to drive in patients with Parkinson's disease: systematic review of the assessment tools and a call for national guidelines. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2016; 3:14. [PMID: 27729986 PMCID: PMC5048693 DOI: 10.1186/s40734-016-0043-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 09/06/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Physicians are usually at the forefront when the issue of driving ability is raised by Parkinson's disease (PD) patients or their family members, even though few have been formally trained in this area. OBJECTIVES AND METHODS To identify relevant literature on driving assessment tools in patients with PD by performing a systematic review on this subject in order to provide background information for physicians on what types of driving assessment are available, and to delineate the role of physicians in providing fitness to drive recommendations. RESULTS Of 1,490 abstracts screened, 55 articles fulfilled the selection criteria that investigated assessment of driving ability in PD patients with questionnaires, off-road testing battery, driving simulators, and driving skill tests (on-road tests and naturalistic driving test). Despite different methodology across studies, PD patients were observed to commit more driving errors than controls. Poor driving performance correlated with motor, visual, and cognitive severity. Excessive daytime somnolence was common in PD drivers and the presence of falling asleep while driving was identified to be a significant predictor of car accidents. CONCLUSION Although the evidence indicated more driving errors among PD drivers as identified by various assessment tools, the extent on how physicians should be involved in the evaluation process and make related recommendations remain unclear. Driving safety is an important public health issue in PD that needs better-defined specific legal and medical guidelines. National guidelines that establish risk assessment protocols involving multidisciplinary assessments are needed to assist physicians in making appropriate referrals for additional evaluations and recommendations when patients are deemed to be unsafe drivers.
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Affiliation(s)
- Onanong Jitkritsadakul
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330 Thailand
| | - Roongroj Bhidayasiri
- Chulalongkorn Center of Excellence for Parkinson Disease & Related Disorders, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama 4 Road, Bangkok, 10330 Thailand
- Department of Rehabilitation Medicine, Juntendo University, Tokyo, Japan
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Classen S, Alvarez L. Caregivers' Impressions Predicting Fitness to Drive in Persons With Parkinson's. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2016; 36:5-13. [PMID: 27504688 DOI: 10.1177/1539449215601117] [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: 11/16/2022]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disease, increasing in incidence, with a known impact on fitness to drive. Although great progress has been made on evidence-based guidelines for assessing fitness to drive of persons with PD, a need remains for early identification of at-risk drivers in need of comprehensive assessment. This study investigated whether caregivers of drivers with PD could predict the driver's on-road outcome. We also investigated whether the predictive value of their impressions differed from that of drivers themselves, their neurologist, or from information provided by standardized measures of visual and divided attention. Caregivers' risk impressions (odds ratio [OR] = 13.76, p = .03) and Trail Making Test Part B (Trails B; OR = 0.41, p = .02) emerged as significant predictors of passing an on-road assessment. Our findings suggest that caregiver impressions, with a measure of set shifting, may be used as an efficient screen to identify drivers with PD who are potentially at risk for failing an on-road assessment.
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15
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Greve JMD, Santos L, Alonso AC, Tate DG. Driving evaluation methods for able-bodied persons and individuals with lower extremity disabilities: a review of assessment modalities. Clinics (Sao Paulo) 2015; 70:638-47. [PMID: 26375567 PMCID: PMC4557573 DOI: 10.6061/clinics/2015(09)08] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 04/30/2015] [Accepted: 05/19/2015] [Indexed: 11/29/2022] Open
Abstract
Assessing the driving abilities of individuals with disabilities is often a very challenging task because each medical condition is accompanied by physical impairments and because relative individual functional performance may vary depending on personal characteristics.We identified existing driving evaluation modalities for able-bodied and lower extremity-impaired subjects (spinal cord injury patients and amputees) and evaluated the potential relationships between driving performance and the motor component of driving.An extensive scoping review of the literature was conducted to identify driving assessment tools that are currently used for able-bodied individuals and for those with spinal cord injury or lower extremity amputation. The literature search focused on the assessment of the motor component of driving. References were electronically obtained via Medline from the PubMed, Ovid, Web of Science and Google Scholar databases.This article compares the current assessments of driving performance for those with lower extremity impairments with the assessments used for able-bodied persons. Very few articles were found concerning "Lower Extremity Disabilities," thus confirming the need for further studies that can provide evidence and guidance for such assessments in the future. Little is known about the motor component of driving and its association with the other driving domains, such as vision and cognition. The available research demonstrates the need for a more evidenced-based understanding of how to best evaluate persons with lower extremity impairment.
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Affiliation(s)
- Julia Maria D'Andréa Greve
- Faculdade de Medicina da Universidade de São Paulo, Department of Orthopedics and Traumatology, São Paulo/SP, Brazil
| | - Luciana Santos
- University of Michigan Medical School, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
| | - Angelica Castilho Alonso
- Faculdade de Medicina da Universidade de São Paulo, Department of Orthopedics and Traumatology, São Paulo/SP, Brazil
| | - Denise G Tate
- University of Michigan Medical School, Department of Physical Medicine and Rehabilitation, Ann Arbor, MI, USA
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