Automated vehicles for older adults with cognitive impairment: a survey study

As the population is ageing, the number of older adults with cognitive impairment (CI) is increasing. Automated vehicles (AVs) can improve independence and enhance the mobility of these individuals. This study aimed to: (1) understand the perception of older adults (with and without CI) and stakeholders providing services and supports regarding care and transportation about AVs, and (2) suggest potential solutions to improve the perception of AVs for older adults with mild or moderate CI. A survey was conducted with 435 older adults with and without CI and 188 stakeholders (e.g. caregivers). The results were analysed using partial least square - structural equation modelling and multiple correspondence analysis. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided recommendations to improve older adults' perception of AVs including education and adaptive driving simulation-based training.Practitioner summary: This study investigated the perception of older adults and other stakeholders regarding AVs. The findings suggested relationships between older adults' level of cognitive impairment, mobility, knowledge of AVs, and perception of AVs. The results provided guidelines to improve older adults' perception of AVs.

Drink…then drive away: The effects of lowering the blood alcohol concentration in Utah

In March of 2017 Utah announced its intent to lower the legal blood alcohol content (BAC) for driving from 0.08 to 0.05 g/dL. However, this change did not take effect until 2019. We employ a difference-in- differences strategy on Utah counties using neighboring states as controls to test whether this policy change significantly affected the number of traffic accidents or the severity of those accidents. Results show the policy appears to temporarily decrease the total number of accidents, limited primarily to property damage- only accidents. We believe these results may be partially explained by drivers who, after the policy is enacted, avoid reporting property damage-only accidents if possible. Using insurance claims data, we show there is no corresponding fall in insurance claims or payouts suggesting that the fall in total accidents likely comes from under-reporting.

Revisiting the maintenance of wakefulness test: from intra-/inter-scorer agreement to normative values in patients treated for obstructive sleep apnea

The Maintenance of Wakefulness Test is widely used to objectively assess sleepiness and make safety-related decisions, but its interpretation is subjective and normative values remain debated. Our work aimed to determine normative thresholds in non-subjectively sleepy patients with well-treated obstructive sleep apnea, and to assess intra- and inter-scorer variability. We included maintenance of wakefulness tests of 141 consecutive patients with treated obstructive sleep apnea (90% men, mean (SD) age 47.5 (9.2) years, mean (SD) pre-treatment apnea-hypopnea index of 43.8 (20.3) events/h). Sleep onset latencies were independently scored by two experts. Discordant scorings were reviewed to reach a consensus and half of the cohort was double-scored by each scorer. Intra- and inter-scorer variability was assessed using Cohen's kappa for 40, 33, and 19 min mean sleep latency thresholds. Consensual mean sleep latencies were compared between four groups according to subjective sleepiness (Epworth Sleepiness Scale score < versus ≥11) and residual apnea-hypopnea index (< versus ≥15 events/h). In well-treated non-sleepy patients (n = 76), the consensual mean (SD) sleep latency was 38.4 (4.2) min (lower normal limit [mean - 2SD] = 30 min), and 80% of them did not fall asleep. Intra-scorer agreement on mean sleep latency was high but inter-scorer was only fair (Cohen's kappa 0.54 for 33-min threshold, 0.27 for 19-min threshold), resulting in changes in latency category in 4%-12% of patients. A higher sleepiness score but not the residual apnea-hypopnea index was significantly associated with a lower mean sleep latency. Our findings suggest a higher than usually accepted normative threshold (30 min) in this context and emphasise the need for more reproducible scoring approaches.

Cervical spondylotic myelopathy and driving abilities: defining the prevalence and long-term postoperative outcomes using the Quality Outcomes Database

OBJECTIVE

Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual's quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored.

METHODS

The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to evaluate mediators of baseline impairment and improvement at 24 months after surgery, which was defined as an NDI driving score < 3.

RESULTS

A total of 1128 patients who underwent surgical intervention for CSM were included, of whom 354 (31.4%) had baseline driving impairment due to CSM. Moderate (OR 2.3) and severe (OR 6.3) neck pain, severe arm pain (OR 1.6), mild-moderate (OR 2.1) and severe (OR 2.5) impairment in hand/arm dexterity, severe impairment in leg use/walking (OR 1.9), and severe impairment of urinary function (OR 1.8) were associated with impaired driving ability at baseline. Of the 291 patients with baseline impairment and available 24-month follow-up data, 209 (71.8%) reported postoperative improvement in their driving ability. This improvement seemed to be mediated particularly through the achievement of the minimal clinically important difference (MCID) in neck pain and improvement in leg function/walking. Patients with improved driving at 24 months noted higher postoperative satisfaction (88.5% vs 62.2%, p < 0.01) and were more likely to achieve a clinically significant improvement in their quality of life (50.7% vs 37.8%, p < 0.01).

CONCLUSIONS

Nearly one-third of patients with CSM report impaired driving ability at presentation. Seventy-two percent of these patients reported improvements in their driving ability within 24 months of surgery. Surgical management of CSM can significantly improve patients' driving abilities at 24 months and hence patients' quality of life.

Use of mindfulness training to improve BAC self-estimation during a drinking episode

OBJECTIVE

Individuals are often inaccurate at estimating levels of intoxication following doses of alcohol. Previous research has shown that when required to estimate (BAC) at different time points, participants often underestimate their BACs and amounts of alcohol consumed. The present study aimed to increase drinkers' BAC estimation accuracy after drinking alcohol using mindfulness-based feedback to increase their awareness of the interoceptive cues associated with alcohol intoxication.

METHOD

Thirty-three adults were given 0.65 g/kg of alcohol and received one of three training conditions: BAC feedback only, body scan exercise + BAC feedback and no treatment control. Those in the BAC feedback group received feedback concerning their observed BAC during dose exposure. Participants in the body scan group received BAC feedback and underwent a mindfulness exercise to enhance their perception of the acute subjective effects of alcohol. The control group received no BAC estimation training. Participants attended four study sessions: Two training sessions where participants underwent structured training based on their condition and two retention sessions to test for the lasting effects of the training exercises.

RESULTS

Retention tests showed that participants in both treatment groups were most accurate in estimating their BACs. There were no differences among the groups in their perceived levels of intoxication at posttraining. The findings suggest that BAC feedback, alone and in combination with, mindfulness training can improve accuracy in estimating BACs.

CONCLUSIONS

The findings provide preliminary support for the efficacy of mindfulness training in combination with BAC feedback to improve BAC estimation accuracy. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A Two-Year Review of Cocaine Findings in Impaired Driving Investigations in Ontario, Canada

Drug impaired driving is an increasing public safety concern across Canada, particularly due to the demonstrated increase in use of recreational drugs such as cocaine. Cocaine is a central nervous system stimulant drug; however, it can impair an individual's driving ability in both the stimulant and crash phases. Despite the scientific consensus regarding cocaine's potential for driving impairment, there is relatively little information available regarding blood concentrations and associated observations of impairment in suspected impaired drivers. Retrospective data analysis was performed to evaluate suspected impaired driving cases in which cocaine and/or benzoylecgonine were detected alone, or in combination with other drugs, in blood and urine samples submitted to the Toxicology Section of the Centre of Forensic Sciences with incident dates between 2021 and 2022. Cocaine and/or benzoylecgonine were detected in 46% (blood) and 66% (urine) of the total impaired driving samples submitted. In 41 cases where cocaine and/or benzoylecgonine were the only drug finding in blood, concentrations of cocaine and benzoylecgonine ranged from 0.0073 to 0.26 mg/L (mean 0.096 mg/L) and 0.13 to 5.3 mg/L (mean 2.1 mg/L) respectively. Driving observations reported by the arresting officer in cases where cocaine and/or benzoylecgonine were the only drug finding in blood and urine included the driver being involved in a collision, the vehicle leaving the roadway, erratic driving and the driver being asleep at the wheel; observations of drug impairment reported by the drug recognition expert (DRE) at the time of driver evaluation included abnormal speech patterns, poor balance/incoordination, abnormal body movements and the individual falling asleep. The results provide concentrations of cocaine and benzoylecgonine observed in suspected impaired drivers, insight into observations that may be associated with prior cocaine use and additional information to inform on the effects of cocaine on driving.

Neuroanatomical correlates of distracted straight driving performance: a driving simulator MRI study across the lifespan

Background

Driving is the preferred mode of transportation for adults across the healthy age span. However, motor vehicle crashes are among the leading causes of injury and death, especially for older adults, and under distracted driving conditions. Understanding the neuroanatomical basis of driving may inform interventions that minimize crashes. This exploratory study examined the neuroanatomical correlates of undistracted and distracted simulated straight driving.

Methods

One-hundred-and-thirty-eight participants (40.6% female) aged 17-85 years old (mean and SD = 58.1 ± 19.9 years) performed a simulated driving task involving straight driving and turns at intersections in a city environment using a steering wheel and foot pedals. During some straight driving segments, participants responded to auditory questions to simulate distracted driving. Anatomical T1-weighted MRI was used to quantify grey matter volume and cortical thickness for five brain regions: the middle frontal gyrus (MFG), precentral gyrus (PG), superior temporal cortex (STC), posterior parietal cortex (PPC), and cerebellum. Partial correlations controlling for age and sex were used to explore relationships between neuroanatomical measures and straight driving behavior, including speed, acceleration, lane position, heading angle, and time speeding or off-center. Effects of interest were noted at an unadjusted p-value threshold of 0.05.

Results

Distracted driving was associated with changes in most measures of straight driving performance. Greater volume and cortical thickness in the PPC and cerebellum were associated with reduced variability in lane position and heading angle during distracted straight driving. Cortical thickness of the MFG, PG, PPC, and STC were associated with speed and acceleration, often in an age-dependent manner.

Conclusion

Posterior regions were correlated with lane maintenance whereas anterior and posterior regions were correlated with speed and acceleration, especially during distracted driving. The regions involved and their role in straight driving may change with age, particularly during distracted driving as observed in older adults. Further studies should investigate the relationship between distracted driving and the aging brain to inform driving interventions.

'It is empowering and gives people dignity in a very difficult process': A multistage, multimethod qualitative study to understand the views of end users in the cultural adaptation of a dementia and driving decision aid

BACKGROUND

Decisions about driving for individuals living with dementia (ILWD) can be challenging. There are limited evidence-based person-centred interventions in the United Kingdom that support decisions about transitioning to not driving or guidelines for developing decision aids for ILWD. This study aimed to understand the important features of a decision aid through the cultural adaptation of Australian dementia and driving decision aid (DDDA) for ILWD residing in the United Kingdom.

METHODS

This qualitative study was theoretically underpinned by a person-centred framework and conducted over three stages: (1) Development of a draft UK-specific DDDA; (2) semistructured interviews with ILWD and an online survey with stakeholders to obtain their views on a draft UK DDDA and (3) content analysis and synthesis of qualitative data to inform the final version of the decision aid.

RESULTS

Eleven ILWD and six of their spouses participated in interviews, and 102 stakeholders responded to an online survey. The four broad features identified as important to include in a decision aid for drivers living with dementia were: a structured and interactive format; positive and supportive messaging and presentation; relevant and concise content and choice-centred. The perceived benefits of the decision aid were identified as supporting conversations, enhancing collaborative decision making and enabling agency with decisions about driving and future mobility options.

CONCLUSIONS

Decision aids that are underpinned by interactive choice-driven questions enhance a person-centred approach to decisions about driving. Positively framing decision aids through the presentation and content can facilitate engagement with the decision-making process about driving. The findings have implications for the development of decision aids designed for ILWD on other important health and social topics.

PATIENT AND PUBLIC INVOLVEMENT

Advocating for the development of a UK DDDA were ILWD. Healthcare professionals contributed to the development of a draft UK DDDA. Former and current drivers living with dementia, family members, healthcare professionals and other support networks of ILWD participated in interviews or an online survey which informed the final version of the UK DDDA.

Relationship of Decisional Conflict About Driving Habits Between Older Adult Drivers and Their Family Members and Close Friends

This study examines the relationship of decisional conflict about driving habits between older adult drivers (≥70 years old) and their family members and close friends. This secondary analysis utilizes data originating from a multi-site randomized controlled trial assessing the effect of a driving decision aid (DDA) intervention. Decisional conflict about stopping or changing driving habits for drivers was measured with the Decisional Conflict Scale (DCS). Dyadic associations between drivers' and study partners' (SPs') DCS scores were analyzed using an actor-partner interdependence model. Among 228 driver-SP dyads, Dyadic DCS was correlated at baseline (r = .18, p < .01), and pre-intervention DCS was associated with post-intervention DCS (p < .001 for SPs [β = .73] and drivers [β = .73]). Drivers' baseline DCS and SPs' post-intervention DCS were slighly correlated (β = .10; p = .036). Higher decisional conflict about driving among older drivers is frequently shared by their SPs. Shared decisional conflict may persist beyond intervening to support decision-making about driving cessation.

Bridging the Gap Between Self-Report and Behavioral Laboratory Measures: A Real-Time Driving Task With Inverse Reinforcement Learning

A major challenge in assessing psychological constructs such as impulsivity is the weak correlation between self-report and behavioral task measures that are supposed to assess the same construct. To address this issue, we developed a real-time driving task called the "highway task," in which participants often exhibit impulsive behaviors mirroring real-life impulsive traits captured by self-report questionnaires. Here, we show that a self-report measure of impulsivity is highly correlated with performance in the highway task but not with traditional behavioral task measures of impulsivity (47 adults aged 18-33 years). By integrating deep neural networks with an inverse reinforcement learning (IRL) algorithm, we inferred dynamic changes of subjective rewards during the highway task. The results indicated that impulsive participants attribute high subjective rewards to irrational or risky situations. Overall, our results suggest that using real-time tasks combined with IRL can help reconcile the discrepancy between self-report and behavioral task measures of psychological constructs.

Comparative analysis of mental workload and performance between young and elderly drivers: Implications for road safety and age-related driving challenges

BACKGROUND

Driving represents a multifaceted cognitive endeavor, demanding heightened vigilance and swift responses. Considering the high statistics of driving accidents and heavy loads, as well as the effect of the driver's age on the occurrence of accidents, it is important to investigate these factors to reduce accidents.

OBJECTIVE

This study investigates the impact of mental workload on the performance of young and older drivers in a dynamic driving scenario to compare cognitive performance, workload perception, and driving outcomes between the two age groups.

METHODS

Cognitive tests including the Stroop test, Continuous Performance test, and Focused Attention test were conducted, alongside the use of the DALI questionnaire to measure workload levels. Participants encompassed twenty male drivers, divided into two age groups: 20 to 35 years and 55 to 70 years, with varying years of driving experience. The study entailed a dynamic driving scenario involving a designated route in Tehran, Iran.

RESULTS

Results exhibited differences in workload scores between the age groups, particularly in dimensions such as visual demand, auditory demand, attention, and interference. Older drivers demonstrated heightened cognitive and physical demands during driving, implying a greater need for attention and cognitive effort.

CONCLUSION

The findings of this study indicated that navigating through congested roads and dense urban traffic significantly elevates the mental workload for drivers, consequently impacting their cognitive functioning. Given the critical need for attention in driving, this heightened workload can manifest as increased fatigue, increasing stress levels, and diminished concentration, all of which substantially raise the risk of vehicular accidents. Furthermore, the study highlighted a particular concern for older drivers, whose diminished cognitive capacities further raise their vulnerability to accidents under such demanding driving conditions.

Are brake response times altered post CT-guided cervical spine nerve root injections?

OBJECTIVES

To assess if brake response times are altered pre and post CT-guided cervical spine nerve root injections.

METHODS

Brake response times were assessed before and after CT-guided cervical spine nerve root injections in a cohort of patients. The average of 3 brake response times was recorded before and 30 min after injection. Statistical analysis was performed using GraphPad. A paired Student t-test was used to compare the times before and after the injections.

RESULTS

Forty patients were included in this study. The mean age was 55 years. There were 17 male and 23 female patients. There was no significant difference in the mean pre and post CT-guided cervical spine nerve root injection brake response times; 0.94 s (range 0.4-1.2 s) and 0.93 s (range 0.5-1.25 s), respectively (P = .77).

CONCLUSIONS

Brake response time did not significantly differ pre and 30 min post CT-guided cervical spine nerve root injections.

ADVANCES IN KNOWLEDGE

To the authors' best knowledge, there are no current studies assessing brake response times post CT-guided cervical spine nerve root injections. While driving safety cannot be proven by a single metric, it is a useful study in demonstrating that this is not inhibited in a cohort of patients.

Driving and mobile phone use: Work addiction predicts hazardous but not excessive mobile phone use in a longitudinal study of young adults

Background and objectives

Work addiction (WA), characterized by dimensions such as overcommitment, difficulties in detachment from work, and work-life imbalance, is presumed to be associated with increased smartphone usage, even during risky activities like driving. The study investigated the connection between WA and future problematic and hazardous smartphone use, considering personality factors: anxiety, rumination, and worry.

Methods

A three-wave longitudinal study (N = 1,866) was conducted from March to July 2019, June to September 2020, and June to November 2021, involving a representative sample of 18-34-year-old residents in Hungary's capital. The study employed Hungarian versions of the Bergen Work Addiction Scale, Problematic Mobile Phone Use Questionnaire, Ruminative Response Scale, Anxiety subscale of the Brief Symptom Inventory 18, and Penn-State Worry Questionnaire. Additionally, author-developed questions on mobile phone use while driving were included.

Results

At baseline, those at risk for WA showed more frequent mobile phone use while driving at both time points 2 and 3 compared to the non-risk group. Path analyses revealed rumination, anxiety at time 1, and worry at time 2 as significant mediators between baseline WA and mobile phone use while driving at time 3. However, when analyzing all three mediators together, only anxiety at time 1 and worry at time 2 remained significant.

Discussion and conclusion

This study demonstrates that WA predicts future mobile phone use while driving through mediation by anxiety and worry. Our findings add to the growing evidence highlighting the detrimental aspects of WA, emphasizing the need for improved prevention and treatment strategies.

Association of Depression and Antidepressant Use With Driving Behaviors in Older Adults: A LongROAD Study

Older adults aged 70 and older who drive have higher crash death rates per mile driven compared to middle aged (35-54 years) adults who drive in the US. Prior studies have found that depression and or antidepressant medication use in older adults are associated with an increase in the vehicular crash rate. Using data from the prospective multi-site AAA Longitudinal Research on Aging Drivers Study, this analysis examined the independent and interdependent associations of self-reported depression and antidepressant use with driving behaviors that can increase motor vehicle crash risk such as hard braking, speeding, and night-time driving in adults over age 65. Of the 2951 participants, 6.4% reported having depression and 21.9% were on an antidepressant medication. Correcting for age, race, gender, and education level, participants on an antidepressant had increased hard braking events (1.22 [1.10-1.34]) but self-reported depression alone was not associated with changes in driving behaviors.

Alcohol-related non-fatal motor vehicle crash injury in the US from 2019 to 2022

Background: Information on recent alcohol-related non-fatal motor vehicle crash (MVC) injuries is limited.Objectives: To analyze alcohol-related non-fatal MVC injuries, 2019-2022, considering COVID-19 and Stay-at-Home policies.Methods: State-level counts of alcohol-related non-fatal MVC injuries (involving individuals age 15+) from Emergency Medical Services data in 18 US states, chosen for comprehensive coverage, were analyzed for the annual rate. The total non-fatal MVC injury count in each state served as the denominator. We used analysis of variance to evaluate annual rate changes from 2019 to 2022 and used robust Poisson regression to compare annual mean rates to the 2019 baseline, pre-pandemic, excluding Quarter 1 due to COVID-19's onset in Quarter 2. Additional Poisson models compared rate changes by 2020 Stay-at-Home policies.Results: Data from 18 states were utilized (N = 1,487,626, 49.5% male). When evaluating rate changes of alcohol-related non-fatal MVC injuries from period 1 (Q2-4 2019) through period 4 (Q2-4 2022), the rate significantly increased from period 1 (2019) to period 2 (2020) by 0.024 (p = .003), then decreased from period 2 to period 4 (2022) by 0.016 (p = .04). Compared to the baseline (period 1), the rate in period 2 was 1.27 times higher. States with a 2020 Stay-at-Home policy, compared to those without, had a 30% lower rate (p = .05) of alcohol-related non-fatal MVC injuries. States with partial and mandatory Stay-at-Home policies had a 5.2% (p = .01) and 10.5% (p < .001) annual rate decrease, respectively.Conclusion: Alcohol-related non-fatal MVC injury rates increased initially (2019-2020) but decreased thereafter (2020-2022). Stay-at-home policies effectively reduced these rates.

[Practical review of driving in older patient: from theory to practice]

As the French population is ageing, the number of older people on the road is increasing all the time. For many older adults, this everyday activity remains an important way of maintaining their independence. Putting this right into question on the sole basis of age can be seen as a particularly stigmatising measure. However, this population is particularly vulnerable on the road. While behavioural factors are frequently involved in young adults, driving errors seem to be more frequently the main mechanism in older people. Driving is a succession of complex tasks that can be affected by ageing and the presence of pathologies (cognitive decline, sensory deficiencies or cardiovascular conditions that have not stabilised, etc.). As these medical conditions increase with age, it is important that healthcare professionals identify high-risk situations. When it is required, the professionals should assist patients to stop driving and find alternatives. Maintaining the mobility and ensure safety for older adults on the road remain challenging for the community. In this article, we discuss the issues surrounding the maintenance of driving in older adults. We also discuss the appropriate way to help patients stop driving when necessary.

Parkinson's Disease and Driving Fitness: A Systematic Review of the Existing Guidelines

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.

Stress influence on real-world driving identified by monitoring heart rate variability and morphologic variability of electrocardiogram signals: the case of intercity roads

Objectives. This study examines which of the heart rate variability (HRV) and morphologic variability (MV) metrics may have the highest accuracy in different stress detection during real-world driving. Methods. The cross-sectional study was carried out among 93 intercity mini-bus male drivers aged 22-67 years. The Trillium 5000 Holter Recorder and GARMIN Virb Elite camera were used to determine heart rate and vehicle speed measurements along the path, respectively. We considered the HRV and MV metrics of electrocardiogram (ECG) signals including the mean RR interval (mRR), mean heart rate (mHR), normalized low-frequency spectrum (nLF), normalized high-frequency spectrum (nHF), normalized very low-frequency spectrum (nVLF), difference of normalized low-frequency spectrum and normalized high-frequency spectrum (dLFHF), and sympathovagal balance index (SVI). Results. The analysis showed that the HRV metrics mHR, mRR, nVLF, nLF, nHF, dLFHF and SVI are effective in mental stress detection while driving as compared to rest time. We obtained a high accuracy of stress detection for MV metrics as compared to the traditional HRV analysis, of approximately 92%. Conclusions. Our findings indicate that driver stress could be detected with an accuracy of 92% using MV metrics as an accurate physiological index of the driver's state.

Clearance for Driving in Genetic Generalized Epilepsy

A key aspect of management of genetic generalized epilepsy involves assessing seizure control and deciding suitability for driving motor vehicles. We surveyed child neurologists and pediatric epileptologists on key questions that practitioners should ask prior to providing clearance for driving. The results showed a wide variability of practice among responders. We propose a likely appropriate process necessary to determine seizure control.

Caregivers' Perspectives on Use of and Need for Driving Resources for Their Autistic Adolescent

Introduction

Autistic individuals who independently travel-or commute without companionship or supervision-report feeling more connected to social, education, and employment opportunities. Despite the potential for independent transportation to improve quality of life, little is known about what transportation-related resources, specifically driving focused ones, exist for autistic individuals or how they and their families find and use them. The objectives of this study were to characterize: (1) where and how families in the United States find driving-related resources for their autistic adolescents; (2) families' perceived availability and utility of identified resources; and (3) resources families believe should be developed.

Methods

We conducted semi-structured interviews with 33 caregivers of autistic adolescents aged 16-24 years without an intellectual disability. We used a directed-content approach to develop and implement codes; three trained coders analyzed all transcripts (inter-rater reliability ≥0.8 for all codes). Members of the research team reviewed coded data and created code summaries, which were then developed and discussed by the larger research team to determine final consensus.

Results

Caregivers described a few existing resources that were helpful in guiding driving-related decisions. In addition, caregivers voiced that there were limited resources tailored to the unique needs that arise while teaching or learning how to drive, particularly ones that support their own and their adolescent's mental health. The limited resources and services identified as helpful-specifically support groups/perspectives of other families and specialized driving instructors-are seemingly difficult to find, costly, and/or perceived as having geographic- and time-related barriers.

Conclusion

There is a critical need and opportunity for stakeholders of the autism community to both expand access to existing and develop novel driving-related resources for families with autistic adolescents, with a particular focus of supporting caregiver and adolescent mental health.

Does aphasia impact on return to driving after stroke? A scoping review

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.

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.

Gender Differences in Prevalence of Sleepy Driving Among Young Drivers in Saudi Arabia

Introduction

Sleepy driving is associated with Motor Vehicles Accidents (MVAs). In Saudi Arabia, previous studies have addressed this association among men only. Therefore, the aim of this study was to compare the prevalence of sleepy driving and associated factors between genders.

Methods

In a cross-sectional study design, we offered a self-administered online questionnaire to 3272 participants from different regions of Saudi Arabia. The questionnaire included 46 questions covering sociodemographics, driving habits, sleeping habits, Epworth Sleepiness Scale, and Berlin questionnaire to assess the risk of sleep apnea. Univariable and multivariable logistic regression analyses were used to determine the significant factors associated with self-reported sleepy driving, defined as operating a motor vehicle while feeling sleepy in the preceding six months.

Results

Of the 3272 invitees, 2958 (90%) completed the questionnaire, of which 1414 (48%) were women. The prevalence of sleepy driving in the preceding six months was 42% (men: 50% and women 32%, p<0.001). Specifically, participants reported the following: 12% had had to stop their vehicle due to sleepiness (men: 16.2% and women 7%, p<0.001), 12.4% reported near-miss accidents (men: 16.2% and women: 8.2%, p<0.001) and 4.2% reported an accident due to sleepiness (men: 4.3% and women: 4%, p=0.645). In multivariable analysis, being male, younger age, use of any type of medications, shift working, working more than 12 hours per day, driving duration of 3-5 hours per day, driving experience of more than 2 years, excessive daytime sleepiness and risk of having obstructive sleep apnea were all associated with increased likelihood of falling asleep while driving in the preceding 6 months.

Conclusion

Sleepy driving and MVA are prevalent in both gender but was higher in men. Future public health initiatives should particularly focus on men, since men reported a greater likelihood of both sleep-related MVA and "near miss" events.

Simulator Driving Abilities, Executive Functions, and Adaptive Behavior Among Adolescents With Complex Attention Deficit Hyperactivity Disorder

OBJECTIVE

To examines the driving skills, executive functions, and adaptive behavior of adolescents diagnosed with Attention-deficit/hyperactivity disorder (ADHD) combined with emotional difficulties and/or learning disabilities (complex ADHD), compared to adolescents without ADHD.

METHOD

A cross-sectional study including 30 adolescents with complex ADHD and 33 adolescents without ADHD aged 15 to 18 years. Driving skills on a simulator, executive functions, and adaptive behavior were evaluated.

RESULTS

Adolescents without ADHD demonstrated significantly higher total scores on the driving simulator, indicating better driving performance compared to adolescents with complex ADHD. In the complex ADHD group, after controlling for different Conners Comprehensive Behavior Rating Scale-Self Report scales, driving simulator scores were partially correlated with executive functions.

CONCLUSION

These findings emphasize the unique needs of adolescents with complex ADHD. Given the significance of driving in today's society, it is crucial to consider the development of intervention programs to support this population's driving skills.

Performance Analysis of Driving Ability (P-Drive): Investigating Construct Validity and Concordance of Australasian Data

On-road assessment is optimal for determining medical fitness-to-drive but unreliable if determined by global pass/fail decisions alone. Occupational therapists need standardized, psychometrically sound on-road scoring procedures. Performance Analysis of Driving Ability (P-Drive) is a promising on-road test developed in Sweden, but it has not been standardized for Australasia. We investigated the psychometric properties and concordance with an on-road decision of data gathered with the Australasian version of P-Drive. P-Drive was administered to older and cognitively impaired drivers (N = 134) aged 18 to 91 years (mean age 68) who were referred to 10 driving clinics in Australia and New Zealand to determine driving performance. Rasch analysis provided evidence for construct validity and concordance of the data gathered. An optimal cut-off score of 85 was set, yielding evidence of good sensitivity at 88% and specificity at 88%. The Australasian version of P-Drive produces valid and reliable data regarding on-road driving performance.

The frequency and cueing mechanisms of involuntary autobiographical memories while driving

Involuntary autobiographical memories (IAMs) have been typically studied with paper diaries, kept for a week or longer. However, such studies are unable to capture the true frequency of IAMs, nor the level of detail that would give new insights into the mechanisms of IAMs. To address this gap, a new audio-recording method was developed and tested on the first author who recorded 674 IAMs while driving a car on a 30-40-minute-long habitual route on 20 occasions. Results revealed very high frequency of IAMs (almost 34 per journey) that were reported more often in response to dynamic (one-off) than static cues. Moreover, a substantial number of memory chains and long-term priming of IAMs by previously encountered incidental stimuli were also recorded. Based on these results, a new theoretical model is proposed in which the occurrence of IAMs is determined by an interplay of factors at the time of the IAM, such as the type of ongoing activity and internal or external triggers, as well as different types of long-term priming. The results also have practical implications for studying mind-wandering and safety issues in driving and aircraft-flying, where periods of concentration are followed by monotony and less demanding tasks.

Lateral spatial biases in naturalistic and simulated driving: Does pseudoneglect influence performance?

Whereas a rightward bump is more likely than a leftward bump when walking through a doorway, investigations into potential similar asymmetries for drivers are limited. The research presented here aims to determine the influence of innate lateral spatial biases when driving. Data from the Strategic Highway Research Program Naturalistic Driving Study (SHRP 2 NDS) and a driving simulation were used to address our research questions. Data points from SHRP 2 were aggregated within relevant variables (e.g., left/right obstacles). In the simulation, participants drove in ways that were consistent with their everyday driving in urban and rural environments. Collision frequency, collision severity and average lateral lane position were analyzed with rightward biases throughout both analyzes. SHRP 2 data indicated greater likelihoods of collisions when vehicles crossed the right line/edge of the road and when making a right turn. There were more collisions with obstacles on the right side, which were also more severe, and greater rightward lane deviations in the driving simulation, contrasted with more severe collisions on the left side in SHRP 2 data, possibly because of the presence of traffic. These findings suggest that previously observed rightward biases in distant space when walking are also present when driving.

A systematic review of oculomotor deficits associated with acute and chronic cannabis use

Driving is a critical everyday task necessitating the rapid and seamless integration of dynamic visually derived information to guide neurobehaviour. Biological markers are frequently employed to detect Δ9-tetrahydrocannabinol (THC) consumption among drivers during roadside tests, despite not necessarily indicating impairment. Characterising THC-specific alterations to oculomotor behaviour may offer a more sensitive measure for indexing drug-related impairment, necessitating discrimination between acute THC effects, chronic use and potential tolerance effects. The present review aims to synthesise current evidence on the acute and chronic effects of THC on driving-relevant oculomotor behaviour. The review was prospectively registered (10.17605/OSF.IO/A4H9W), and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines informed reporting standards. Overall, 20 included articles comprising 12 experimental acute dosing trials, 5 cross-sectional chronic use studies and 3 roadside epidemiological studies examined the effects of cannabis/THC on oculomotor parameters including saccadic activity gaze behaviour, nystagmus, smooth pursuit and eyelid/blink characteristics. Acute THC consumption selectively impacts oculomotor control, notably increasing saccadic latency and inaccuracy and impairing inhibitory control. Chronic cannabis users, especially those with early age of use onset, display enduring oculomotor deficits that affect visual scanning efficiency. The presence of eyelid tremors appears to be a reliable indicator of cannabis consumption while remaining distinct from direct impairment associated with visual attention and motor control. Cannabis selectively influences oculomotor activity relevant to driving, highlighting the role of cannabinoid systems in these processes. Defining cannabis/THC-specific changes in oculomotor control may enhance the precision of roadside impairment assessments and vehicle safety systems to detect drug-related impairment and assess driving fitness.

An Examination of Two Diverse Communities: Residents' Transportation Behaviors, Challenges, and Opportunities

The Smart Cities Collaborative aims to mitigate transportation challenges and inequities with new approaches and technologies (e.g., ridesharing). Therefore, assessing community transportation needs is essential. The team explored the travel behaviors, challenges, and/or opportunities among low- and high-socioeconomic status (SES) communities. Using Community-Based Participatory Research principles, four focus groups were conducted to investigate residents' behaviors and experiences with transportation availability, accessibility, affordability, acceptability, and adaptability. Focus groups were recorded, transcribed, and verified before thematic and content data analysis. Participants with low SES (n = 11) discussed user-friendliness, uncleanliness, and bus accessibility challenges. Comparatively, the participants with high SES (n = 12) discussed traffic congestion and parking. Both communities had concerns about safety and limited bus services and routes. Alternatively, opportunities included a convenient fixed-route shuttle. All groups stated the bus fare was affordable unless multiple fares or rideshare were needed. Findings provide valuable insight when developing equitable transportation recommendations.

Perceptions and Attitudes Related to Driving after Cannabis Use in Canadian and US Adults

BACKGROUND

This study examined the risk perceptions related to driving after cannabis use (DACU) among Canadian and US adults who used cannabis in the past six months.

METHODS

Perceptions of danger, normative beliefs, perceived likelihood of negative consequences, and other driving-related variables were collected via online surveys in Canadian (n = 158; 50.0% female, 84.8% White, mean age = 32.73 years [SD = 10.61]) and US participants (n = 678; 50.9% female, 73.6% White, mean age = 33.85 years [SD = 10.12]). Driving cognitions and DACU quantity/frequency were compared between samples using univariate analyses of variance, and Spearman's (ρ) correlations were performed to examine associations between driving cognitions and DACU quantity/frequency.

RESULTS

The two samples did not significantly differ in self-reported level of cannabis use, lifetime quantity of DACU, or the number of times they drove within two hours of cannabis use in the past three months (Ps > .12). Compared to US participants, Canadians perceived driving within two hours of cannabis use as more dangerous (P < 0.001, ηp2 = 0.013) and reported more of their friends would disapprove of DACU (P = 0.03, ηp2 = 0.006). There were no differences in the number of friends who would refuse to ride with a driver who had used cannabis (P = 0.15) or the perceived likelihood of negative consequences (Ps > 0.07). More favorable perceptions were significantly correlated with greater lifetime DACU and driving within two hours of use (ρ = 0.25-0.53, Ps < 0.01).

CONCLUSIONS

These findings reveal differences in distal risk factors for DACU between Canada and the US and may inform prevention efforts focusing on perceptions of risk and social acceptance of DACU.

Adolescents, 2019, USA

Distracted driving, the act of focusing on something else while operating a vehicle, is a significant health problem among adolescents. Although some studies have reported on prevalence among adolescents in the United States, limited studies have examined differences by sexual identity status. The purpose of the present study was to examine past 30-day distracted driving by sexual identity status among a large, national sample of adolescents ages 14 to 18 years. A secondary analysis was conducted on the 2019 Youth Risk Behavioral Surveillance System (YRBSS) data, and associations between distracted driving and demographics (e.g., biological sex, age, race/ethnicity) were assessed with weighted logistic regression analyses. A total of 13,590 adolescents ages 14 to 18 years were part of the final analytic sample. Twenty-three percent of adolescents reported distracted driving in the past 30 days. Compared with heterosexual adolescents, gay/lesbian (14.3%), bisexual (18.1%), and questioning (12.9%) adolescents reported lower distracted driving in the past 30 days. Findings through a health equity approach may inform harm reduction efforts and behavioral interventions.

Executive Functioning as a Predictor of Adverse Driving Outcomes in Teen Drivers With ADHD

OBJECTIVE

The present study examined the association between executive functioning (EF) and risky driving behaviors in teens with ADHD.

METHOD

Teens diagnosed with ADHD (n = 179; Mage = 17.4 years) completed two 15-min drives in a fixed-base driving simulator. EF was assessed using parent- and self-report Behavior Rating Inventory of Executive Functioning (BRIEF-2), a temporal reproduction task, and a Go/No-Go task (GNG). Driving outcomes included known predictors of crashes: count of long (>2 s) off-road glances, standard deviation (SD) of lane position (SDLP), mean speed, and SD speed. Generalized linear mixed models, controlling for intelligence and driving experience, were conducted.

RESULTS

Higher rates of GNG commission errors predicted higher rates of long off-road glances. Lower parent-rated EF and increased rates of GNG omission errors predicted SDLP. Higher rates of GNG commission errors also predicted faster average driving speed.

CONCLUSION

Heterogeneity in EF is associated with differences in teen ADHD risky driving behaviors.

UK exceptional case driving application outcomes in post-stroke homonymous hemianopia: results from a clinical study

PURPOSE

We report results in relation to returning to driving in the UK under the exceptional cases rule for visual field loss.

METHODS

The Hemianopia Adaptation Study is a prospective clinical study recruiting adult stroke survivors with new onset homonymous hemianopia. The mobility assessment course (MAC) was used to measure navigational scanning. Car drivers were offered a 1-year post-stroke assessment to consider referral for driving assessment.

RESULTS

Of 144 participants, 51 were eligible for driving assessment, with 13 (25.4%) accepting appointment for UK Driving and Vehicle Licensing Agency (DVLA) referral. A statistically significant difference in gender and baseline Barthel (stroke severity) scores was found between those requesting referral and those declining (p = 0.046; p < 0.001). MAC outcomes were significantly different, with those referred having a lower percentage of target omissions (9.0%) and faster mean course completion time (46.0 s), than those not referred (28.3%/72.5 s) (p = 0.006/p < 0.001). Twelve of the 13 referred were offered a driving assessment by the DVLA. All 12 passed and returned to driving.

CONCLUSIONS

It is possible for individuals with post-stroke homonymous hemianopia to return to driving, where exceptional cases criteria are met. There is evidence to support use of the MAC as a clinical measurement of adaptation.IMPLICATIONS FOR REHABILITATIONIndividuals with post-stroke homonymous hemianopia should be fully informed regarding driving regulations that can differ between countries and sometimes different states within a country, as well as provided with the support and opportunity to consider a return to driving if appropriate.Professionals providing care within the stroke multi-disciplinary team should be aware that it is possible for patients with homonymous hemianopia to return to driving, when exceptional cases criteria are met.The mobility assessment course (MAC) should be considered as a clinical measurement of adaptation in homonymous hemianopia.A cut-off score of ≤25% omissions on MAC could be employed to determine those likely to adapt to hemianopia long-term and potentially return to driving.

Can inhaled cannabis users accurately evaluate impaired driving ability? A randomized controlled trial

Aims

To study the effect of inhaled cannabis on self-assessed predicted driving ability and its relation to reaction times and driving ability on a driving simulator.

Participants and methods

30 healthy male volunteers aged 18-34: 15 chronic (1-2 joints /day) and 15 occasional (1-2 joints/week) consumers. Self-assessed driving confidence (visual analog scale), vigilance (Karolinska), reaction time (mean reciprocal reaction time mRRT, psychomotor vigilance test), driving ability (standard deviation of lane position SDLP on a York driving simulator) and blood concentrations of delta-9-tétrahydrocannabinol (THC) were measured before and repeatedly after controlled inhalation of placebo, 10 mg or 30 mg of THC mixed with tobacco in a cigarette.

Results

Cannabis consumption (at 10 and 30 mg) led to a marked decrease in driving confidence over the first 2 h which remained below baseline at 8 h. Driving confidence was related to THC dose and to THC concentrations in the effective compartment with a low concentration of 0.11 ng/ml for the EC50 and a rapid onset of action (T1/2 37 min). Driving ability and reaction times were reduced by cannabis consumption. Driving confidence was shown to be related to driving ability and reaction times in both chronic and occasional consumers.

Conclusions

Cannabis consumption leads to a rapid reduction in driving confidence which is related to reduced ability on a driving simulator.

Clinical trial registration

ClinicalTrials.gov, identifier: NCT02061020.

Feeling sleepy? stop driving-awareness of fall asleep crashes

STUDY OBJECTIVES

To examine whether drivers are aware of sleepiness and associated symptoms, and how subjective reports predict driving impairment and physiological drowsiness.

METHODS

Sixteen shift workers (19-65 years; 9 women) drove an instrumented vehicle for 2 hours on a closed-loop track after a night of sleep and a night of work. Subjective sleepiness/symptoms were rated every 15 minutes. Severe and moderate driving impairment was defined by emergency brake maneuvers and lane deviations, respectively. Physiological drowsiness was defined by eye closures (Johns drowsiness scores) and EEG-based microsleep events.

RESULTS

All subjective ratings increased post night-shift (p < 0.001). No severe drive events occurred without noticeable symptoms beforehand. All subjective sleepiness ratings, and specific symptoms, predicted a severe (emergency brake) driving event occurring in the next 15 minutes (OR: 1.76-2.4, AUC > 0.81, p < 0.009), except "head dropping down". Karolinska Sleepiness Scale (KSS), ocular symptoms, difficulty keeping to center of the road, and nodding off to sleep, were associated with a lane deviation in the next 15 minutes (OR: 1.17-1.24, p<0.029), although accuracy was only "fair" (AUC 0.59-0.65). All sleepiness ratings predicted severe ocular-based drowsiness (OR: 1.30-2.81, p < 0.001), with very good-to-excellent accuracy (AUC > 0.8), while moderate ocular-based drowsiness was predicted with fair-to-good accuracy (AUC > 0.62). KSS, likelihood of falling asleep, ocular symptoms, and "nodding off" predicted microsleep events, with fair-to-good accuracy (AUC 0.65-0.73).

CONCLUSIONS

Drivers are aware of sleepiness, and many self-reported sleepiness symptoms predicted subsequent driving impairment/physiological drowsiness. Drivers should self-assess a wide range of sleepiness symptoms and stop driving when these occur to reduce the escalating risk of road crashes due to drowsiness.

Real Life Impact of Dry Eye Disease

Dry Eye Disease (DED) is an increasingly common condition that affects between 5% and 50% of the global population. Even though DED is most frequently diagnosed in older people, it has also been diagnosed in young adults and adolescents more frequently in recent years (employees, gamers). People can experience different types of symptoms and find it challenging to read, watch TV, cook, climb stairs, and meet friends. Mild and severe dry eye can reduce quality of life similarly to mild psoriasis and moderate-to-severe angina. Furthermore, DED patients experience serious difficulties driving vehicles, especially at night, and show a decrease in work productivity, which, when combined with the relevant indirect cost that this condition produces, poses a serious challenge in our days. In addition, DED patients are more likely to develop depression and suicidal ideations and experience frequent sleep disorders. Finally, it is discussed how lifestyle changes, such as increased physical activity, blinking exercises, and a proper diet, have positive implications for the management of this condition. Our aim is to draw attention to the negative effects of dry eye in real life, which are unique to each patient, especially as they relate to the non-visual symptoms experienced by DED patients.

Social Cognitive Theory, Driving Cessation, and Alternative Transportation in Later Life

Having viable alternative transportation options could help individuals stop driving when appropriate. This study employs the Social Cognitive Theory (SCT) to understand the barriers and facilitators of alternative transportation among a sample of adults aged 55 and older (N = 32). Using a daily transportation data collection app, MyAmble, the research team asked participants questions structured around environmental, individual, and behavioral factors as outlined in the SCT framework. Responses were analyzed using directed content analysis. Findings suggest a substantial reliance on motor vehicles and it was evident that many participants had never seriously considered what they would do if they could no longer drive. We posit that SCT principles may be applied to help older adults build self-efficacy to transition to driving cessation when needed.

Driving predictors in a cohort of cognitively impaired Mexican American and non-Hispanic White individuals

BACKGROUND

Individuals with Alzheimer's disease and Alzheimer's disease-related dementias may lose the ability to drive safely as their disease progresses. Little is known about driving prevalence in older Latinx and non-Hispanic White (NHW) individuals. We investigated the prevalence of driving status among individuals with cognitive impairment in a population-based cohort.

METHODS

This was a cross-sectional analysis of the cohort BASIC-Cognitive study in a community of Mexican American (MA) and NHW individuals in South Texas. Participants scored ≤25 on the Montreal Cognitive Assessment (MoCA), indicating a likelihood of cognitive impairment. Current driving status was assessed by the Harmonized Cognitive Assessment Protocol informant interview. Logistic regression was used to assess driving versus non-driving adjusted for pre-specified covariates. Chi-square and Mann-Whitney U tests were used to compare NHW and MA differences in driving outcomes from the American Academy of Neurology (AAN) questions for evaluating driving risk in dementia.

RESULTS

There were 635 participants, 77.0 mean age, 62.4% women, and 17.3 mean MoCA. Of these, 360 (61.4%) were current drivers with 250 of 411 (60.8%) MA participants driving, and 121 of 190 (63.70%) NHW participants driving (p = 0.50). In fully adjusted models age, sex, cognitive impairment, language preference, and Activities of Daily Living scores were significant predictors for the likelihood of driving (p < 0.0001). Severity of cognitive impairment was inversely associated with odds of driving, but this relationship was not found in those preferring Spanish language for interviews. Around one-third of all caregivers had concerns about their care-recipient driving. There were no significant differences in MA and NHW driving habits and outcomes from the AAN questionnaire.

CONCLUSIONS

The majority of participants with cognitive impairment were currently driving. This is a cause for concern for many caregivers. There were no significant ethnic driving differences. Associations with current driving in cognitively impaired persons require further research.

Sleepless on the road: Are mothers of infants with insomnia at risk for impaired driving?

Infant sleep problems have been associated with a myriad of adverse child and parent outcomes, yet whether these problems may pose a risk for parents on the road has received little research attention. This study sought to test whether mothers of infants with insomnia are at an elevated risk for vehicular crashes, by comparing their objectively measured driving performance with that of mothers of well-sleeping infants and with that of women without children. Fifty-four women from these three groups completed a simulated driving task. Outcome measures included standard deviation of lateral position, number of lane crossings, standard deviation of speed, average speed and maximum speed. Women additionally reported on their driving behaviour using the Driving Behaviour Questionnaire, and on sleep, sleepiness and insomnia symptoms using 7-day sleep diaries and questionnaires. Mothers of infants with insomnia demonstrated greater lane deviation (Wald = 9.53, p = 0.009), higher maximum speed (Wald = 6.10, p = 0.04) and poorer self-rated driving behaviour (Wald = 7.44, p = 0.02) compared with control groups. Analyses also indicated that driving performance in mothers of infants with insomnia tended to be poorer relative to control groups with the progression of time on task. While further research is needed to assess the scope of these effects, our findings suggest that parents, healthcare providers and policymakers should be aware of the potential consequences of infant sleep problems on road safety, and collaborate to establish strategies to mitigate these risks.

Wrist-Worn Sensor Validation for Heart Rate Variability and Electrodermal Activity Detection in a Stressful Driving Environment

Wearable sensors are widely used to gather psychophysiological data in the laboratory and real-world applications. However, the accuracy of these devices should be carefully assessed. The study focused on testing the accuracy of the Empatica 4 (E4) wristband for the detection of heart rate variability (HRV) and electrodermal activity (EDA) metrics in stress-inducing conditions and growing-risk driving scenarios. Fourteen healthy subjects were recruited for the experimental campaign, where HRV and EDA were recorded over six experimental conditions (Baseline, Video Clip, Scream, No-Risk Driving, Low-Risk Driving, and High-Risk Driving) and by means of two measurement systems: the E4 device and a gold standard system. The overall quality of the E4 data was investigated; agreement and reliability were assessed by performing a Bland-Altman analysis and by computing the Spearman's correlation coefficient. HRV time-domain parameters reported high reliability levels in Baseline (r > 0.72), Video Clip (r > 0.71), and No-Risk Driving (r > 0.67), while HRV frequency domain parameters were sufficient in Baseline (r > 0.58), Video Clip (r > 0.59), No-Risk (r > 0.51), and Low-Risk Driving (r > 0.52). As for the EDA parameters, no correlation was found. Further studies could enhance the HRV and EDA quality through further optimizations of the acquisition protocol and improvement of the processing algorithms.

The association between diabetes and safe driving: A systematic search and review of the literature and cross-reference with the current guidelines

AIMS

We conducted this review to characterize the quality of evidence about associations between diabetes and safe driving and to evaluate how these findings are reflected within current guidelines available to support clinicians and their patients with diabetes.

METHODS

The first stage entailed a systematic search and review of the literature. Evidence surrounding harms associated with diabetes and driving was identified, screened, extracted and appraised for quality utilizing the Newcastle Ottawa Scales (NOS). Next, relevant guidelines regarding driving and diabetes were sourced and summarized. Finally, the identified guidelines were cross-referenced with the results of the systematic search and review.

RESULTS

The systematic search yielded 12,461 unique citations; 52 met the criteria for appraisal. Fourteen studies were rated as 'high', two as 'medium' and 36 as 'low'. Studies with ratings of 'high' or 'medium' were extracted, revealing a body of inconsistent methods and findings. These results, cross-referenced with the guidelines, suggest a lack of agreement and a limited evidence base to justify recommendations.

CONCLUSIONS

The results presented emphasize the need for a better understanding of the impacts of diabetes on safe driving to inform evidence-based guidelines.

The relationship between Rating of Everyday Arm-use in the Community and Home (REACH) scale affected arm-use assessment, activity and participation after stroke

BACKGROUND AND OBJECTIVES

While arm function has been traditionally used as a primary goal for upper extremity rehabilitation post-stroke, we propose a simple measure of arm use, which may translate into better activities and participation. The aim was to determine the relationship between arm use and measures of activity and participation.

METHODS

This was a cross-sectional study with evaluative components involving community-dwelling individuals with chronic stroke. The Rating of Everyday Arm-Use in the Community and Home (REACH) Scale was used to assess affected arm use, Barthel Index and activity domain of the Stroke Impact Scale (SIS) for activities, and participation domain of the SIS for participation. The participants were also asked if they resumed driving after the stroke.

RESULTS

Forty-nine individuals (mean age = 70.3 ± 11.5 years, male sex = 51%) living with the effects of a stroke for at least 3 months participated in this study. There was a positive relationship between affected arm use and activities (Barthel Index score - rs  = 0.464; SIS activities - rs  = 0.686), participation (rs  = 0.479), and driving (rs  = 0.581). The Barthel Index scores were higher for individuals with dominant arm hemiparesis (p = 0.003) or left hemisphere lesions (p = 0.005). There was also greater arm use in left hemisphere lesions (p = 0.018).

CONCLUSIONS

Affected arm use in individuals with chronic stroke is related to activities and participation. Given the importance of arm use in activities and participation after stroke, rehabilitation therapists may consider utilizing the REACH Scale, a simple and quick outcome measure, as a means to assess arm use and implement effective interventions for improving arm use.

Real-World Driving Data Indexes Dopaminergic Treatment Effects in Parkinson's Disease

Background

Driving is a complex, everyday task that impacts patient agency, safety, mobility, social connections, and quality of life. Digital tools can provide comprehensive real-world (RW) data on driver behavior in patients with Parkinson's disease (PD), providing critical data on disease status and treatment efficacy in the patient's own environment.

Objective

This pilot study examined the use of driving data as a RW digital biomarker of PD symptom severity and dopaminergic therapy effectiveness.

Methods

Naturalistic driving data (3974 drives) were collected for 1 month from 30 idiopathic PD drivers treated with dopaminergic medications. Prescriptions data were used to calculate levodopa equivalent daily dose (LEDD). The association between LEDD and driver mobility (number of drives) was assessed across PD severity, measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS).

Results

PD drivers with worse motor symptoms based on self-report (Part II: P = 0.02) and clinical examination (Part III: P < 0.001) showed greater decrements in driver mobility. LEDD levels >400 mg/day were associated with higher driver mobility than those with worse PD symptoms (Part I: P = 0.02, Part II: P < 0.001, Part III: P < 0.001).

Conclusions

Results suggest that comprehensive RW driving data on PD patients may index disease status and treatment effectiveness to improve patient symptoms, safety, mobility, and independence. Higher dopaminergic treatment may enhance safe driver mobility in PD patients with worse symptom severity.

[Driving: What is the relevance and usability of the Reisberg scale in 2023?]

The publication of the decree on the care of people with neurocognitive disorders brought to the fore the Reisberg's Global Deterioration Scale, a scale that only few clinicians use in memory centers or in geriatric. This scale has a number of limitations, not least of which is that it is obsolete, since it does not take into account disease advances in scientific knowledge with biomarkers. Consequently, the stages evoked no longer correspond to current descriptions. Moreover, it only concerns Alzheimer's disease, whereas in our practice we encounter other neurodegenerative pathologies. Even if we decide to use another global assessment scale, such as the Clinical Dementia Rating or the Functional Assessment Staging, they cannot replace a personalized assessment. Indeed, it is important to stress that this decree does not take into account the relevance of personalized assessments using, for example, neuropsychological tests to estimate driving ability. A personalized assessment accompanied by a real-life driving test would be preferable than a score on a global scale. This article therefore presents the Global Deterioration Scale, highlighting its unsuitability for assessing whether or not to continue driving.

The Association between Psychological Resilience and Driving Behavior among Older Drivers in Australia

This study compared a sample of Australian drivers aged 77 years and older to participants from an older driver longitudinal cohort study (Ozcandrive) and examined the relationship between resilience and self-reported driving measures within these samples. Using a survey with a subset of questions from Ozcandrive, data were collected from 237 older drivers throughout Australia. The two samples were analyzed for differences in demographics, health, resilience, and self-reported driving behavior. A series of multiple regression models were fit for each driving outcome measure for both samples. The two samples had both similarities and differences, with the largest difference observed for resilience. Strong and consistent associations were found between resilience and driving comfort, abilities, and frequency for the Australian sample. Across samples, resilience remained a significant variable in seven of 10 regression models, more than any other independent variable.

Measuring vibration and shock in power wheelchairs for clinical application

Research evidence demonstrates the negative effects of Whole-Body Vibration (WBV) and correlation between exposure to WBV and detriment to health. ISO Standard 2631-1 (1997) is the accepted standard for human exposure to WBV in vehicle vibration, and provides vibration guidelines for health and comfort. These standards have not been applied to power wheelchairs (PWC), and no clinical tool exists that measures vibration levels during live power wheelchair driving. This study measures WBV and shock levels during PWC driving, considering the impact of terrains, base configurations, and seat cushions. A sensor tag accelerometer was used to measure vibration and shock in three different PWC configurations driven over seven different terrains. Data was collected for two runs per wheelchair, per terrain type, per cushion type. Differences were significant (p < .001) for overall mean and median peak vibration compared across the seven terrains, and for overall mean vibration for basic and enhanced cushions. Differences were also noted in mean and peak vibration in the three different base configurations (p = .0052). Results were compared with ISO 2631-1 guidelines. Mechanical shock on certain terrains created peak vibration levels with likely health risk. Results from this study can inform PWC prescription process.

Experience of helmet usage among hearing aid users: a cross sectional study

Background

In India, persons with hearing impairment who benefit from hearing aids can acquire a driving license. The law mandates helmet use while driving two-wheelers. Using a hearing aid with a helmet on may be a challenge, but it is paramount to understand the difficulties the hearing aid users face.

Methods

A cross-sectional research design was used to study the experience of hearing aid users who ride two-wheelers. A checklist was developed and administered to 15 individuals with hearing impairment who ride two-wheelers. The checklist had 11 questions under three domains; 'Helmet related,' 'Comfort related', and 'Driving/Listening related. The study was carried out in and around Bangalore. The data was collected through the interview method.

Results

The subjects reported difficulties in the comfort-related and driving/listening-related domains. Many participants felt the need to modify the helmet design to suit hearing aid users. They also felt a need for a special program for driving mode in the hearing aids.

Conclusions

Hearing-impaired two-wheeler riders face problems in localization, fear of hearing aid falling, and sweating using hearing aids while driving. It affects them on two fronts. One, it may pose a risk to others or the hearing impaired themselves on the road. Second, avoiding riding two-wheelers may limit their rights and mobility.

The impact of alcohol consumption on commercial eye blink drowsiness detection technology

INTRODUCTION

Driver drowsiness detection technology that assesses eye blinks is increasingly being used as a safety intervention in the transport industry. It is unclear how alcohol consumption to common legal driving limits impacts upon this technology. The aim of the study was to assess the impact of a blood alcohol content (BAC) of 0.05% and of 0.08% on drowsiness detection technology during simulated driving.

METHODS

Participants completed a 60-min driving simulation and sleepiness questionnaire under three conditions: 1-0.00% BAC, 2-0.05% BAC and 3-0.08% BAC. During the driving simulation task participants wore a commercial eye blink drowsiness detection technology (Optalert) with the drowsiness alarms silenced.

RESULTS

Twelve participants (3 female) completed all alcohol conditions. Relative to baseline, all eye blink parameters were affected at 0.08% BAC (all p < 0.05), whereas 0.05% BAC only affected the composite eye blink drowsiness measure (the Johns Drowsiness Scale).

CONCLUSIONS

Alcohol consumption to 0.08% BAC impaired eye blink measures to a level that would be considered a moderate drowsiness risk. Therefore, employers should be aware that drowsiness alerts from these technologies may increase after alcohol consumption.