Pilot Efficacy of a DriveFocus™ Intervention on the Driving Performance of Young Drivers

Factors Influencing the Use of Mobile Applications for Driving Rehabilitation After Stroke: Exploring the Perspectives of Occupational Therapists

This study describes factors influencing occupational therapists' implementation of mobile applications into driving rehabilitation post-stroke. A qualitative descriptive design was used to analyze interview data from twenty (n = 20) occupational therapists working in stroke rehabilitation. Key factors include awareness of emerging applications, workplace technology policies, patient impairment levels and technological proficiency, and the involvement of caregivers in patient training. The ability to observe cognitive-perceptual abilities when utilizing mobile applications provided key insights into patient progress. Further investigation is necessary to explore methods for remotely monitoring outcomes in driving rehabilitation.

Biofeedback as an intervention for persistent post-concussive symptoms: A randomized feasibility trial

Background

Case reports indicate that low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback may improve physiological functioning in individuals with persistent post-concussive symptoms. However, it is unclear whether larger-scale studies are feasible.

Purpose

To evaluate the feasibility of a combined low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback intervention for individuals with persistent post-concussive symptoms.

Methods

Individuals with persistent post-concussive symptoms were randomized into intervention and control groups, and their baseline and post-test assessments were compared to a healthy control group. Outcomes included self-report questionnaires, resting electroencephalograph and electrocardiograph recordings, and a driving simulation task. Participants in the intervention group completed three 20 min low-resolution electromagnetic tomography neurofeedback sessions per week and at-home heart rate variability biofeedback training every morning and night for 8 weeks. Feasibility was evaluated according to recruitment capability and sample characteristics, data collection procedures, suitability of the intervention and study procedures, management and implementation of the study intervention, and preliminary participant responses to the intervention.

Results

Thirty-three individuals were recruited and 24 completed this study (seven intervention participants, nine persistent post-concussive symptoms control participants, and eight healthy control participants). One-quarter of participants (four intervention participants and three persistent post-concussive symptoms control participants) experienced simulator sickness during the driving simulator task and had to withdraw from the study. Intervention participants had an 88% and 86% compliance rate for the low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback sessions, respectively. Low-resolution electromagnetic tomography neurofeedback sessions took approximately 1 h to complete per participant. Preliminary analysis indicated that the intervention reduced electroencephalograph z-score deviation with a very large effect size ( d = 1.36) compared to the other study groups.

Conclusions

Pilot studies evaluating the efficacy of low-resolution electromagnetic tomography neurofeedback and heart rate variability biofeedback should be performed to confirm these preliminary findings. However, the protocol should be modified to reduce participant fatigue and withdrawal. This trial was registered with Clinicialtrials.gov (NCT03338036; https://clinicaltrials.gov/ct2/show/NCT03338036?term=03338036&draw=2&rank=1 ).

Driving errors that predict simulated rear-end collisions in drivers with multiple sclerosis

OBJECTIVE

Drivers with Multiple Sclerosis (MS) may have an increased crash risk. However, the driving performance deficits that contribute to crashes are not fully understood. Based on the extant literature, adjustment to stimuli errors indicate failing an on-road assessment. This study examines whether adjustment to stimuli errors can detect the occurrence of collisions in a driving simulator in drivers with MS.

METHODS

As part of a quasi-experiment, 38 participants with MS and 21 participants without MS completed visual-cognitive and driving simulator assessments, which also recorded their adjustment to stimuli maneuvers. We quantified participants' adjustment to stimuli maneuvers via initial pedal reaction time (seconds), time to collision (seconds), mean speed (meters per second), and the occurrence of rear-end collisions (collide vs. did not collide) when a simulated vehicle cut across the lane in front of them.

RESULTS

Logistic regression analyses indicated that, compared to drivers without MS, those with MS had a shorter time to collision (OR= .04, p= .001, 95% CI= [.006, .27]) and a faster mean speed (OR= 1.32, p= .04, 95% CI= [1.01, 1.74]) which increased the odds of experiencing a rear-end collision. Receiver operating characteristic curve analyses indicated that, for MS and control groups, time to collision (MS group = AUC= .94, p<.0001, Control group = AUC= .86, p<.0001) and mean speed (MS group = AUC= .76, p=.005, Control group = AUC = .78, p= .005) differentiated between participants who collided vs. did not collide. For drivers with MS, a time to collision of ≤1.81 seconds (85% sensitivity, 100% specificity, 15% error rate), and a mean speed of ≥7.83 meters per second (77% sensitivity, 76% specificity, 47% error rate) predicted the occurrence of collisions with the lowest error rate.

CONCLUSIONS

During a driving simulator assessment, adjustment to stimuli errors predicted the occurrence of rear-end collisions in drivers with MS (vs. without MS). Driving assessors may target scenarios that measure participants' adjustment to stimuli, via time to collision and mean speed, to make decisions about their visual-cognitive deficits and driving performance.

What is the difference between perceived and actual risk of distracted driving? A field study on a real highway

Distracted driving is a leading cause of traffic accidents. It is influenced by driver attitude toward secondary tasks; however, field-based studies on the effects of low-perceived-risk tasks on lateral driving have rarely been reported. A total of 17 experienced non-professional drivers were recruited to participate in two secondary tasks: a cognitive experiment (conversation) and a visual distraction experiment (observation of following vehicles), each representing low-perceived-risk secondary tasks. One-way analysis of variance (ANOVA) was conducted to evaluate the effects of low-perceived-risk tasks on lateral driving performance. ANOVA results indicated that compared with baseline (no task) lateral performance, lane-keeping ability was enhanced during cognitive distractions. In the visual distraction experiment, more than 50% of the distractions required 1–2 s. Lane deviation and its growth rate increased with the duration of distraction. Compared with cognitive distraction, lane deviation increased significantly with visual distraction, and lane-keeping performance was seriously impaired. For low-perceived-risk tasks, visual distractions impaired driving safety more seriously, compared with cognitive distractions, suggesting that drivers misjudge the risks associated with visual tasks. These results can contribute to the design of advanced driving-assistance systems and improve professional driver programs, potentially reducing the frequency of traffic accidents caused by distracted driving.

Clinical Utility of the DriveFocus™ Intervention on Young Drivers With and Without Experience

Introduction: The DriveFocus™ intervention addresses the ability of young drivers to detect and respond to critical roadway information. DriveFocus is an interactive video-based tablet application that teaches users how to detect and prioritize critical roadway items. However, young drivers with and without experience may respond differently to the intervention. Objectives: We compared the simulated driving performance of two 17 year-old licensed drivers with (novice) and without (learner) driving experience, after three (post-test 1) and six (post-test 2) intervention sessions. Methods: We collected clinical, driving performance (number of visual scanning, adjustment to stimuli, and total driving errors) and acceptability data. Results: The learner driver made more visual scanning, adjustment to stimuli and total errors when compared to the novice. Both participants exhibited a decrease in both types and number of driving errors from baseline to post-test 2 and the learner also made less driving errors at post-test 1. Both participants rated the perceived ease of use of the intervention favorably. Conclusions: This study lays the foundation to examine the impact of the DriveFocus™ intervention among novice and more experienced young drivers.

Feasibility of DriveFocus™ and Driving Simulation Interventions in Young Drivers

Motor vehicle collisions are the leading cause of death among North American youth, with a high prevalence of distraction-related fatalities. Youth-focused interventions must address detecting (visual scanning) and responding (adjustment to stimuli) to critical roadway information. In this repeated measures study, we investigated the feasibility (i.e., recruitment and sample characteristics; data collection procedures; acceptability of the intervention; resources; and preliminary effects) of a DriveFocus™ app intervention on youth's driving performance. Thirty-four youth participated in a 9-week protocol (retention rate = 89.7%; adherence rate = 100%). No participants experienced simulator sickness. A preliminary nonparametric evaluation of the results ( n = 34) indicated a statistically significant decrease in the number of visual scanning, F(2, 68) = 3.769, p = .028, and adjustment to stimuli, F(2, 68) = 6.759, p = .002, errors between baseline, midpoint, and posttest. This study lays the foundation to support a targeted intervention trial to improve youth's attention to critical road information, building on their mobile technology preferences.