[Clinical study on photic driving response in electroencephalography. 1. Photic driving response in patients with thyroid diseases].
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Adult↗
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Construction of forehand drive, backhand drive, and service tennis tests.
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Adult↗
Decreased driving ability in people with Parkinson's disease.
BACKGROUND: Driving is a complex form of activity involving especially cognitive and psychomotor functions. These functions may be impaired by Parkinson's disease. The relation between Parkinson's disease and driving ability is still obscure and clinicians have to make decisions concerning the driving ability of their patients based on insufficient information. Until now no studies have compared different methods for evaluating the driving ability of patients with Parkinson's disease. METHODS: The driving ability of 20 patients with idiopathic Parkinson's disease and 20 age and sex matched healthy control subjects was evaluated by a neurologist, psychologist, vocational rehabilitation counsellor, and driving instructor using a standard 10 point scale. The patients and controls also evaluated their own driving ability. Cognitive and psychomotor laboratory tests and a structured on road driving test were used for evaluating the subjects' driving ability. RESULTS: The patients with Parkinson's disease performed worse than the controls both in the laboratory tests and in the driving test. There was a high correlation between the laboratory tests and driving test both in the patient group and in the control group. Disease indices were not associated with the driving test. The neurologist overestimated the ability of patients with Parkinson's disease to drive compared with the driving ability evaluated by the structured on road driving test and with the driving related laboratory tests. Patients themselves were not capable of evaluating their own ability reliably. CONCLUSION: Driving ability is greatly decreased in patients with even mild to moderate Parkinson's disease. The evaluation of patients' driving ability is very difficult to carry out without psychological and psychomotor tests and/or a driving test.
Adult↗
On-road assessment of driving competence after brain impairment: review of current practice and recommendations for a standardized examination.
OBJECTIVE: To examine the approaches to on-road assessment of driver competence in persons with brain impairment. Items examined were procedures, standardization, scoring methods, equipment requirements, and determination of fitness to drive. DATA SOURCES: All studies identified through citation or Medline search. STUDY SELECTION: The studies reviewed were those published from 1971 to the present that examined driving competence after brain impairment, as measured by a driving test. DATA EXTRACTION: A qualitative review of published studies reporting methodologies and authors' conclusions abstracted from sourced publications. DATA SYNTHESIS: Off-road driving assessments examine proficiency in operating a motor vehicle, but not ability to drive in traffic or accurate prediction of safe driving. On-road driving assessments have been used to examine the predictive validity of other driving assessment methods or the driving performance of subjects with brain impairment. Determining a subject's competence to drive is frequently a subjective evaluation. With a standardized driving test, a significant correlation between the objective driving score and the rater's global evaluation of fitness has been reported. CONCLUSION: Closed-course, off-road driving tests are recommended for examining vehicle operation skills and readiness for in-traffic evaluation only. This allows practice with any vehicle adaptations before on-road evaluation and identification of clients who are unsafe to proceed on-road. A practical driving test in traffic, with standardized route and driving maneuvers, is recommended for determining driver competence. Scoring of driving performance should be standardized, reliable, and specific, to identify deficient driving skills that may be amenable to training. Driving performance should be evaluated according to predefined criteria, and the judgment regarding competence should be closely related to this objective measure.
Automobile Driver Examination↗
[Driving restrictions for arrhythmia patients--with special reference to the implantable cardioverter/defibrillator].
UNLABELLED: The series "Illness and Vehicular Traffic", published by the German Federal Ministry for Transportation, has set forth the following guidelines on the subject of driving for patients with cardiac rhythm disorders: "Anyone suffering from disorders of cardiac rhythm which might, on occasion, lead to the repeated interruption of oxygen supply to the brain and thus cause disturbances in consciousness or even loss of consciousness, must be considered unsuitable for driving a motor vehicle of any class." While these guidelines are essentially indisputable, it remains unclear how they affect patients with an implantable cardioverter/defibrillator (ICD). The issue is further complicated by the fact that these patients, as a rule, suffer from malignant and life-threatening cardiac rhythm disorders, often owing to a severe cardiac disorder (primarily coronary heart disease and cardiomyopathy). It was the purpose of a recent study to investigate how medical permission to drive in ICD patients is handled in various European countries. A specifically designed questionnaire was addressed to 46 European National Delegates of the Working Groups on Cardiac Pacing in order to determine their present practices and criteria utilized when advising driving restrictions to patients (pts) after ICD implantation. RESULTS: Of the 39 (83%) respondents, 22 (56%) cardiologists advised all pts to abstain from driving. Permanent driving abstinence was advised by 13 (33%) of the responding cardiologists, while temporary driving abstinence for periods of 3 to 18 months (mean 9 +/- 4 months) was recommended by 26 (67%) physicians. Criteria for subsequently advising a longer period of driving abstinence were: presyncope by 15 (38%), syncope by 13 (33%) and multiple shocks by 2 (5%) cardiologists. Despite medical advice not to drive, about one-third of pts resume driving. About half of the pts resumed driving after 6 months, with the vast majority driving 12 months after ICD implantation. Two pts experienced ICD discharges while driving, but no motor vehicle accident occurred. One patient had a motor vehicle collision with a fatal outcome which was not caused by loss of consciousness or ICD discharge. CONCLUSIONS: 1) Fatal accidents of ICD discharges while driving are a rare finding in ICD pts. 2) About half of the physicians always advise their pts to cease driving for a period of 9 +/- 4 months. Despite this medical advice pts resume driving 6 months after ICD implantation. 3) Criteria used in advising driving abstinence are not uniform among physicians. In symptomatic bradyarrhythmias the driving privilege may be reinstated after pacemaker implantation provided that symptoms resulting from the interruption of the oxygen supply to the brain have not recurred.
Accidents, Traffic↗
Minimal hepatic encephalopathy impairs fitness to drive.
It has been suggested that the ability to drive a car is impaired in patients with cirrhosis of the liver and minimal hepatic encephalopathy (MHE). However, the only study using an on-road driving test did not reveal such an impairment. In a prospective controlled study, we evaluated patients with cirrhosis of the liver for MHE and the ability to drive a car. MHE was diagnosed using three psychometric tests: Number Connection Test Part A, Digit Symbol Test, and a Complex Choice Reaction Test. In a standardized on-road driving test (22 miles, 90 minutes), designed for patients with brain impairment, a professional driving instructor blind to the subjects' diagnosis and test results assessed the driving performance. Four global driving categories (car handling, adaptation to traffic situation, cautiousness, maneuvering), 17 specific driving actions (e.g., changing lanes, overtaking, etc.), and a total score of driving performance were rated using a 6-point scale. Of 274 consecutive patients with liver cirrhosis, 48 fulfilled the medical and driving inclusion criteria, 14 of them with and 34 without MHE. Forty-nine subjects in a stable phase of chronic gastroenterological diseases and with normal liver findings served as controls. The total driving score of patients with MHE was significantly reduced in comparison to either cirrhotic patients without MHE or to controls (P <.05). Significant differences in ratings were found in the following driving categories: car handling, adaptation, and cautiousness. Significant differences were also found in specific driving actions. The instructor had to intervene in the driving of 5 of the 14 MHE patients to avoid an accident, significantly more than in cirrhotic patients without MHE and in controls. There was no significant difference in any driving category or specific driving action in cirrhotic patients without MHE compared to controls. In conclusion, fitness to drive a car can be impaired in patients with MHE. Therefore, patients with liver cirrhosis should be tested for MHE and informed in the case of abnormal test results. Therapy known to improve psychometric test results should be initiated.
Adult↗
Confidence in, and self-rating of, driving ability among older drivers.
Active drivers (n = 125) in a representative cohort of older individuals age 77 years and older in New Haven, Connecticut were interviewed. Confidence in different driving situations, self-rating of driving ability, and driving patterns were assessed during these in-person interviews. A history of crashes, moving violations and being stopped by police was available for approximately the past 6 years. Concurrent driving performance was assessed in a subsample (n = 35). Analyses focused on determining the relationship of confidence and self-rating of driving ability to: (1) each other; (2) driving patterns; (3) adverse driving events; and (4) driving performance. All participants rated themselves as being average or above average drivers compared to others their age, with the majority rating themselves as above average. Individuals who drove more miles and more frequently were more likely to rate themselves better drivers than same-age peers. Individuals who rated themselves as "much better" drivers than their peers tended to have higher confidence levels than those who rated themselves a "little bit better" or the "same" as other drivers. On-road driving performance and history of adverse events were not associated with self-ratings of driving ability. Confidence was associated with driving frequency and mileage, but not age or education. Although men were more likely to drive under risky conditions, for those conditions in which each drove, men and women were equally confident. No relationship was found between confidence and adverse driving events or driving performance. Understanding the relationship of confidence and self-rating of driving ability to driving patterns, adverse events and driving performance may provide additional insights into identifying older drivers at increased risk for problems and formulating intervention strategies to help lower risk.
Accidents, Traffic↗
Driving impairments in teens and adults with attention-deficit/hyperactivity disorder.
Available research provides compelling evidence that ADHD is associated with significantly increased risks for various adverse outcomes while driving, including increased traffic citations (particularly speeding), motor vehicle crashes for which the driver is at fault, repeated crash occurrences,and more severe crashes as determined from dollar damage and likelihood of bodily injuries from the crash. Not surprisingly, teens and adults with ADHD are more likely to have their licenses suspended and even fully revoked. Research further suggests that these driving risks cannot be accounted for by the comorbid disorders likely to be associated with ADHD, such as ODD, conduct disorder (CD), depression, or anxiety, or by lower than normal levels of intelligence. Recent attempts to study the processes or mechanisms involved in driving in adults with ADHD offer some explanation of how the disorder conveys such increased risks. Driving can be conceptualized usefully as involving at least three or more dimensions or levels, including basic cognitive abilities necessary for driving (operational), actual skills for maneuvering the vehicle in traffic (tactical), and the more executive, goal-directed aspects of driving(strategic). The findings of studies indicate that ADHD interferes with the basic operational components of driving by means of the impairments it produces in attention, resistance to distraction, response inhibition, slower and more variable reaction time, and the capacity to follow rules that may compete with ongoing sensory information. Accumulating evidence also points to a problem in the tactical level of driving, such that those with ADHDrate themselves and are rated by others as employing less safe driving habits during their normal operation of a vehicle than are adults in community control groups. Although this has been more elusive to demonstrate through the use of simple laboratory-based driving simulators. more modern virtual reality driving platforms offer greater promise in providing more realistic appraisals of driving performance and thus more direct evidence of the problems that occur at the tactical level from the disorder. Research has not examined the impact of ADHD at the higher strategic level or goal-directed aspects of driving. But given the mounting evidence that ADHD adversely affects executive functioning in adults, the author and colleagues anticipate that this level also will be found to be impaired in adults with ADHD. Indeed,it recently has been shown that adults with ADHD overestimate their driving abilities relative to normal adults, a problem that likely can be ascribed to more limited self-awareness and related meta-cognitive abilities for self-evaluation arising from the disorder. Although further research on the driving problems posed by ADHD is in order, sufficient evidence exists to warrant focus on possible treatments that may serve to improve these driving problems and reduce the risk for these adverse outcomes. High on the list of such treatments deserving further research and clinical attention is the use of stimulant medication. The more recent noradrenergic reuptake inhibitor. atomoxetine, also may have some promise in this regard. Studies are underway in the author's driving laboratory to see if this is the case. Meanwhile, adults with ADHD and parents of teens with ADHD should be advised about these heightened risks and encouraged to take steps that may reduce them, including the consideration of more graduated licensing for adolescents with ADHD and the possible use of stimulant medication in teens and adults with ADHD while they are operating a motor vehicle.
Adolescent↗
Acceptability of the Checkpoints Parent-Teen Driving Agreement: pilot test.
BACKGROUND: Parent-teen driving agreements are potentially important tools to facilitate parental management of teen driving and reduce adolescent driving risk. The Checkpoints Parent-Teen Driving Agreement (Checkpoints P-TDA) was designed so that parents could initially impose strict limitations on teen driving in high-risk driving conditions (e.g., at night and with teen passengers) and gradually increase driving privileges over time as teens demonstrate responsible driving behavior. METHODS: To assess the acceptability of the format and content of the Checkpoints P-TDA, it was pilot tested with a convenience sample of 47 families recruited as their teens tested for a driver's license at five private driving schools in Connecticut. Family members were interviewed at the driving schools about potential limits on teen driving, asked to use the driving agreement, and re-interviewed within 3 months about acceptability of the driving agreement and initial driving limits placed on teens. RESULTS: Most families (38 of 47) used and liked the agreement. In addition, most parents placed the recommended strict initial limits on teen driving related to driving unsupervised at night, with teen passengers, and on high-speed roads. Moreover, parents reported placing more strict limits on their teens' driving than they originally intended. CONCLUSIONS: The results showed promise for the acceptability of the Checkpoints P-TDA, which will be tested statewide.
Accidents, Traffic↗
Young drivers' health attitudes and intentions to drink and drive.
PURPOSE: To evaluate young drivers' intentions to drink and drive in the context of a health attitude model, the Protection Motivation Theory (PMT). METHODS: Licensed drivers attending college and ranging from 17 to 20 years of age (n = 304) completed questionnaires assessing PMT variables in the context of drinking and driving. More than half the sample consisted of females (62%) and most were white (89%). The drivers rated the extent to which they found drinking and driving to be personally rewarding, their perceived vulnerability to the risks of drinking and driving, the severity of the risks, the response efficacy of alternative adaptive responses to drinking and driving, their self-efficacy for implementing alternative responses, and the response costs associated with the responses. The relationship between PMT variables and drivers' intention to drink and drive was tested using hierarchical multiple regression analyses with attitudes concerning drinking and driving (rewards, vulnerability, and severity) entered in the regression equation first, followed by attitudes concerning alternative adaptive responses (response efficacy, self-efficacy, and response costs). RESULTS: The PMT model was found to predict intentions to drink and drive. Young drivers who perceived rewards for drinking and driving and who felt vulnerable to the risks of drinking and driving were significantly more likely to report intentions to drink and drive. Attitudes about alternative adaptive responses to drinking and driving, including perceiving low self-efficacy for implementing alternative responses and perceiving personal costs for engaging in alternative options, also contributed to drivers' intentions to drink and drive. CONCLUSIONS: Although teenaged drivers are well informed of the dangers of drinking and driving, they still put themselves and others at risk by driving after consuming alcohol. Health professionals promoting safer alternatives might consider how young drivers' attitudes about both drinking and driving and alternative adaptive responses contribute to their intentions to drink and drive.
Adolescent↗
Driving circumstances and accidents among novice drivers.
OBJECTIVE: The study evaluated the accident risk of certain driving circumstances and driving motives among novice drivers. METHODS: Self-reported exposure and accidents according to driving circumstances and driving motives were compared between young (n = 6,847) and middle-aged (n = 942) male and female novice drivers. For young drivers, self-reported accidents were further compared to fatal accidents (n = 645) in terms of the driving conditions in which they occurred. The survey was conducted in 2002 and the questions regarding the quantity and quality of driving exposure and accidents covered the first four years of the novice drivers' driving career after licensing. Data on fatal accidents related to the period of 1990 to 2000. RESULTS: Leisure-time driving, driving just for fun, and driving with passengers and during evenings and at night was more typical for young drivers than for middle-aged drivers. For middle-aged drivers, the most typical driving was driving to or from work. Driving on errands was more typical for females than males. Nighttime driving was overrepresented in young drivers' self-reported and fatal accidents, compared to the share of young drivers' driving at night. Slippery road conditions were over-represented in young male drivers' self-reported accidents, but not in their fatal accidents, whereas for young females slippery road conditions seemed to increase the propensity of fatal accidents. CONCLUSIONS: The study concluded that some driving conditions increase the risk of certain types of accidents among certain driver groups, but not among all drivers. For example, slippery road conditions were overrepresented in young male drivers' minor (self-reported) accidents, but not in their fatal accidents. For young female drivers slippery road conditions seem to increase the propensity of fatal accidents. Driving circumstances are different in minor (self-reported) and fatal accidents. When drawing conclusions regarding accident risk, it is important to determine the seriousness of the accidents which take place.
Accidents, Traffic↗
Driving and Alzheimer's disease.
OBJECTIVE: To examine the driving status of Alzheimer's disease (AD) patients presenting to a geriatric clinic, and to investigate the ability of brief cognitive assessment measures to identify those who are no longer able to continue driving safely. DESIGN: Based on caregivers' reports of driving status, AD patients were divided into three groups: those who were still driving with no difficulty, those still driving but having difficulty, and those who had stopped driving due to their cognitive problems. Scores on commonly used cognitive tests were compared across groups. Age, gender, and duration of dementia were also investigated. SETTING: The University of Washington Medical Center (UWMC) outpatient Geriatric and Family Services Clinic. PARTICIPANTS: One hundred consecutive patients who met DSM-III-R criteria for primary degenerative dementia and were either currently driving or had stopped driving due to cognitive deficits. MEASUREMENT AND MAIN RESULTS: Twenty-two subjects were reportedly still driving with no difficulty, 23 were still driving with difficulty, and 55 were no longer driving. Both mental status screening and functional assessments were significantly different between drivers and nondrivers, as were scores on a visual-spatial task. In addition, gender and age distinguished the groups: younger drivers and men drivers were less likely to stop driving despite significant cognitive impairment. CONCLUSIONS: Given the large number of AD patients who continue to drive and who experience problems with driving, this investigation highlights the need for assessment of driving safety as part of a clinical dementia evaluation. In addition, the results suggest a combination of cognitive and functional measures that may be helpful in identifying patients who are at greatest risk for unsafe driving.
Aged↗
Fatigue, sleepiness, and performance in simulated versus real driving conditions.
STUDY OBJECTIVES: To determine whether real-life driving would produce different effects from those obtained in a driving simulator on fatigue, performances and sleepiness. DESIGN: Cross-over study involving real driving (1200 km) or simulated driving after controlled habitual sleep (8 hours) or restricted sleep (2 hours). SETTING: Sleep laboratory and open French Highway. PARTICIPANTS: Twelve healthy men (mean age +/- SD = 21.1 +/- 1.6 years, range 19-24 years, mean yearly driving distance +/- SD = 6563 +/- 1950 miles) free of sleep disorders. MEASUREMENTS: Self-rated fatigue and sleepiness, simple reaction time before and after each session, number of inappropriate line crossings from the driving simulator and from video-recordings of real driving. RESULTS: Line crossings were more frequent in the driving simulator than in real driving (P < .001) and were increased by sleep deprivation in both conditions. Reaction times (10% slowest) were slower during simulated driving (P = .004) and sleep deprivation (P = .004). Subjects had higher sleepiness scores in the driving simulator (P = .016) and in the sleep restricted condition (P = .001). Fatigue increased over time (P = .011) and with sleep deprivation (P = .000) but was similar in both driving conditions. CONCLUSIONS: Fatigue can be equally studied in real and simulated environments but reaction time and self-evaluation of sleepiness are more affected in a simulated environment. Real driving and driving simulators are comparable for measuring line crossings but the effects are of higher amplitude in the simulated condition. Driving simulator may need to be calibrated against real driving in various condition.
Adult↗
Hypoglycaemia and driving in people with insulin-treated diabetes: adherence to recommendations for avoidance.
BACKGROUND: Hypoglycaemia impairs driving performance, so drivers with insulin-treated diabetes should try to avoid hypoglycaemia when driving, and treat it effectively if it occurs. It is not known how many insulin-treated drivers are familiar with, or adhere to, recommended safe practice. METHODS: We surveyed a representative sample of 202 current drivers with insulin-treated diabetes (115 with Type 1 diabetes), using a structured questionnaire. Data were obtained on driving history, estimated frequency of hypoglycaemia, and measures taken to avoid and treat hypoglycaemia when driving. RESULTS: The licensing authority (DVLA) and motor insurance company had been informed by almost all participants. Sixty-four participants (31.7%) had experienced hypoglycaemia while driving, and 27 (13.4%) reported that this had occurred within the preceding year. A minimum blood glucose level of 4.0 mmol/l or higher was considered necessary for driving by 151 drivers (74.8%), and 176 (87.1%) reported always keeping carbohydrate in their vehicle. However, 77 (38.1%) reported never carrying a glucose meter when driving, and 121 (59.9%) that they never test blood glucose before driving, or test only if symptomatic of hypoglycaemia. Most participants (89%) would stop driving to treat hypoglycaemia and would not resume driving immediately, although only 28 (13.9%) would wait longer than 30 min. Almost half of participants were failing to observe at least one essential aspect of safe driving. CONCLUSIONS: Compliance with statutory requirements to inform the licensing authority and motor insurer is good, and drivers' perceptions of the minimum safe blood glucose level for driving are encouraging. However, most drivers rely on symptoms to detect hypoglycaemia while driving, and seldom test blood glucose before driving. Patient education should emphasize the role of blood glucose monitoring in relation to driving, and highlight the potential deterioration in driving performance when blood glucose falls below 4.0 mmol/l.
Accidents, Traffic↗
Clinical evaluation of the driving ability in stroke patients.
OBJECTIVES: Stroke often causes physical, cognitive and psychomotor dysfunction, which markedly decreases the driving ability of stroke patients. The aim of this study was to evaluate the driving ability of stroke patients using multidisciplinary clinical evaluation and driving-related laboratory tests. MATERIALS AND METHODS: A neurologist evaluated the driving ability of 20 male stroke patients on the basis of his own clinical examination and the observations and measurements of a neurological multidisciplinary rehabilitation team. After that a traffic psychologist evaluated the patients' driving ability on the basis of the driving-related cognitive and psychomotor laboratory tests. The patients themselves also evaluated their driving ability, as did their spouses. All the evaluations were carried out independently using the same 10-point scale. The control group consisted of 20 healthy males, matched by age and driving experience, who went through the same laboratory test package as the patients did. RESULTS: The stroke patients had more deficiencies in all tested driving related cognitive and psychomotor functions than the controls. The neurologist and the psychologist together evaluated 12 (60%) of the 20 stroke patients being unable to drive; 8 patients out of 11 with non-dominant hemisphere lesion and 4 in the dominant group. The patients themselves and their spouses had a clear tendency to overestimate driving ability compared to the estimates of the neurologist and the psychologist. The hit-rate of the evaluations of the neurologist and traffic psychologist (75%) was high. CONCLUSION: Stroke patients form a risk group as drivers due to their decreased cognitive and psychomotor abilities, and driving ability should always be evaluated after stroke. The results suggest that multidisciplinary neurological teams are able to evaluate the driving ability of stroke patients reliably. A careful evaluation of driving ability without a driving test requires assessment of cognitive and psychomotor functions critical in driving, which is not feasible for physicians without the support of a multidisciplinary team and/or traffic-related laboratory tests.
Attention↗
Intra-abdominal pressure and rowing: the effects of inspiring versus expiring during the drive.
BACKGROUND: The lumbar vertebrae of rowers are subjected to high levels of shear and compression at mid-drive, but intra-abdominal pressure (IAP) may partially neutralize these forces. IAP fluctuates with breathing. This study compared the IAP between inspiring during the drive and expiring during the drive. METHODS EXPERIMENTAL DESIGN: ten volunteers performed one 5x2-minute repetition test while inspiring during the drive and one 5x2-minute repetition test while expiring during the drive on a rowing ergometer. The five work rates were: 100, 125, 150, 175 and 200 watts at 22, 24, 26, 28 and 30 strokes per minute, respectively. MEASURES: the movement of the body while rowing was analyzed using a position sensor, and IAP was measured using a pressure transducer catheter. RESULTS: A 2x5 repeated measures analysis of variance showed that there was a significant interaction for the dependent variable mid-drive IAP (p<0.05), with the mid-drive IAP increasing at a greater rate while expiring during the drive relative to inspiring during the drive. Across work rate, the mid-drive IAP and minimal IAP were significantly higher while expiring during the drive than inspiring during the drive (p<0.05). Across breathing pattern, the minimal IAP, maximal IAP, average change in IAP and mid-drive IAP increased significantly with work rate (p<0.05). CONCLUSIONS: The data show that expiring during the drive leads to a greater mid-drive IAP than inspiring during the drive.
Abdomen↗
Return to driving after lower-extremity amputation.
OBJECTIVES: To study driving behaviors after major lower-extremity amputations and to determine which factors influence return to driving after amputation. DESIGN: A cross-sectional study. SETTING: Data were collected from patients attending an outpatient amputee and prosthetics clinic between February 2001 and September 2001. PARTICIPANTS: A convenience sample (N=123). Inclusion criteria were: age greater than 18 years, unilateral or bilateral major lower-extremity amputation, minimum 1 year since prosthetic fitting, and active automobile driver within 6 months prior to amputation. Subjects had an average age of 63.4+/-12.1 years and were on average 6.8+/-8.3 years since amputation. Common causes for amputation were peripheral vascular disease (73.2%), trauma (13.8%), and tumor (12.2%). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Driving habits after lower-extremity amputation. RESULTS: Overall, 80.5% of participants were able to return to driving an average of 3.8 months after amputation, although the majority reported a decreased driving frequency. Female sex (odds ratio [OR]=.08; 95% confidence interval [CI], .02-.34), age of 60 years or greater (OR=.16; 95% CI, .03-.74), right-sided amputation (OR=.13; 95% CI, .03-.52), and preamputation driving frequency of less than every day (OR=.18; 95% CI, .05-.69) were all significantly related to a reduced likelihood of return to driving postamputation. Items that did not have a statistically significant association with return to driving included level of amputation, reason for amputation, preamputation automobile transmission, and accessibility to public transit. Subjects with left-sided amputation had significantly fewer concerns about driving, while those with a right amputation frequently required vehicle modifications (40.6%) or switch to a left-foot driving style for braking (81.3%) and accelerating (65.6%). Common barriers to return to driving included preference not to drive, fear and/or lack of confidence, and related medical conditions. CONCLUSIONS: The majority of subjects with major lower-extremity amputation were able to return to driving after major lower-extremity amputation. Major automobile modifications are commonly performed by right-sided amputees. Several predictors of return to driving and barriers preventing return to driving were identified.
Aged↗
Cognitive abilities in driving: differences between normal and hazardous situations.
This study investigated the relationship between cognitive abilities and driving behaviour in situations of normal driving and hazardous driving. For driving behaviour, driving component skills were measured from two different types of driving situations such as normal driving situations and hazardous driving situations. Normal driving skills were evaluated through an on-street driving test, where search, speed control, and direction control were considered as driving component skills. Hazardous driving component skills were evaluated using a standardized video driving paradigm. Component skills that were evaluated in this paradigm were search, identify, predict, decide, and execute. A battery of predictive tests was administered to the participants. Forty-two students from high schools participated in this study. Analysis of multiple regression implied that the measure of dynamic visual signal perception introduced to this study could be used as a predictor of driving performance for both situations. Driving component skills showed different effects between normal situations and hazardous situations.
Accidents, Traffic↗