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PubMedDate not supplied

Automobile driving performance of brain-injured patients with visual field defects.

The purpose of this study was to examine whether patients with visual field defects resulting from cerebral injury are handicapped in their driving ability, because visual field loss as assessed in standard perimetry is often the basis for withdrawal of a person's driving license. Driving performance was tested on a driving simulator to obtain standardized results and for safety reasons. The visual field was assessed both with standard automated perimetry and computer-based, high-resolution, qualitative perimetry. We investigated nine patients with purely cerebral field defects (mostly homonymous binocular defects) who had no further neuropsychological or ophthalmological deficits. Their performance (driving speed, reaction time, and driving error rate) was compared with that of a control group of ten subjects. We found no differences in any of the tested parameters between the visually impaired subjects and the normal participants. This suggests that individuals with visual field defects, including those who suffer from homonymous hemianopia, may perform as adequately as normal individuals in realistic driving scenarios. The perimetrically assessed visual field may, thus, be of limited value for the prediction of driving safety, and we conclude that patients who have field defects should not summarily be denied a driving license.

Adult↗
PubMed1999

Role of Na-Ca exchange in the action potential changes caused by drive in cardiac myocytes exposed to different Ca2+ loads.

The role of Na-Ca exchange in the membrane potential changes caused by repetitive activity ("drive") was studied in guinea pig single ventricular myocytes exposed to different [Ca2+]o. The following results were obtained. (i) In 5.4 mM [Ca2+]o, the action potentials (APs) gradually shortened during drive, and the outward current during a train of depolarizing voltage clamp steps gradually increased. (ii) The APs shortened more and were followed by a decaying voltage tail during drive in the presence of 5 mM caffeine; the outward current became larger and there was an inward tail current on repolarization during a train of depolarizing steps. (iii) These effects outlasted drive so that immediately after a train of APs, currents were already bigger and, after a train of steps, APs were already shorter. (iv) In 0.54 mM [Ca2+]o, the above effects were much smaller. (v) In high [Ca2+]o APs were shorter and outward currents larger than in low [Ca2+]o. (vi) In 10.8 mM [Ca2+]o, both outward and inward currents during long steps were exaggerated by prior drive, even with steps (+80 and +120 mV) at which there was no apparent inward current identifiable as I(Ca). (vii) In 0.54 mM [Ca2+]o, the time-dependent outward current was small and prior drive slightly increased it. (viii) During long steps, caffeine markedly increased outward and inward tail currents, and these effects were greatly decreased by low [Ca2+]o. (ix) After drive in the presence of caffeine, Ni2+ decreased the outward and inward tail currents. It is concluded that in the presence of high [Ca2+]o drive activates outward and inward Na-Ca exchange currents. During drive, the outward current participates in the plateau shortening and the inward tail current in the voltage tail after the action potential.

Action Potentials↗
PubMed2001

[Assessment of car driving skills in brain injured individuals].

Independent driving is considered as very important for a full independence and social integration of disabled people. In these patient with disabilities or handicaps, the driving skills must be carefully assessed, especially in presence of a moderate dysexecutive syndrome. A precise neurological and neuropsychological examination is usually necessary to evaluate aptitudes for driving. Standard neuropsychological tests are often limited to value the brain injury patients. At the moment, assessment on driving simulators really improves the opinion of medical experts, as they give qualitative and quantitative data on reproducible conditions. In fact, in more than 80% of cases, the tests on driving simulators allow to determine if the patient is able to drive or no, with or without a specially adapted vehicle. However, in a small percentage of cases, the evaluation of open-road driving by a driving instructor is necessary, proving that driving simulators will never take over from reality.

Automobile Driver Examination↗
PubMed1990

[Absolute driving incapacity at 1.0 promille--an erroneous limit].

Following a well known decision of the Bundesgerichtshof (BGH, German Federal Court) a driver with a blood alcohol concentration (BAC) of more than 0.13% is seen as "absolutely unfit for driving" and will be prosecuted by criminal law. This decision was based on the results of a comprehensive review of the literature about the effects of alcohol done 1966 by the Bundesgesundheitsamt (BGA, National Bureau of Health). There, severe impairments were described at levels above 0.1%, a value which the BGH "rounded up" to 0.11%. The possible errors of measurement were estimated as 0.02%. Adding both values yielded the legal limit of 0.13%. Most recently Salger (vice-president of the BGH) in a decisive manner pleaded for a reduction of this limit to 0.11% both by lowering the assumed measurement error to 0.01% and by taking back the rounding-up operation. Explicitely he based these intended corrections of the former decision on two arguments he derived from the scientific research on alcohol and driving: 1. Significant impairments are linked with BACs higher than 0.1%. 2. This was demonstrated by road-side studies, studies with instrumented cars, and driving simulators which are more valid methods to predict driving behavior than studies conducted in the laboratory. We proved these assumptions by analyzing the literature about driving studies as well as the literature from laboratory studies on alcohol. This article mainly concentrates on the empirical results coming from driving studies. It demonstrates a clear-cut empirical evidence that no single limit can be determined from where alcohol-induced impairment begins. Quality and quantity of this impairment strongly depends on how difficult the driving situation actually is. Therefore, BAC and situational difficulty act together in a synergistic way. A driver only confronted with standard traffic situations which are easy to handle may react correctly despite a BAC of 0.1% and quite more. If difficulty is slightly augmented to situations where a more controlled and/or precision-oriented non-automatic driving is required, significant impairments were seen at levels of 0.07%. In traffic situations with unpredictable events and/or extreme driving conditions severe impairments are found even at levels below 0.05%. These results perfectly match with the results from the laboratory studies. As a consequence, any public policy decision as to the acceptable legal limit of alcohol has to include a decision as to the difficulty of traffic situations which has to be mastered by the driver. Claiming that a normal driver has to deal efficiently with a medium level of difficulty the scientific evidence demands a legal limit of about 0.07%.

Accidents, Traffic↗
PubMed1986

Excitatory synaptic drive for swimming mediated by amino acid receptors in the lamprey.

In order to investigate the properties and pharmacology of the excitatory synaptic drive received by motoneurons during swimming in the lamprey, propriospinal excitatory interneurons were activated as a population by the regional application of N-methyl-D,L-aspartate (NMA) to either the 6-8 rostral-most or the 6-8 caudal-most segments of lengths of isolated spinal cord. This caused a rhythmic motor output to be generated in these regions. Synaptic potentials that were phase-locked to, and dependent on, the rhythmic motor activity of the segments exposed to the agonist could be recorded in motoneurons lying outside the activated regions. The synaptic drive to motoneurons located rostral or caudal to the activated regions was studied. Motoneurons received both descending and ascending synaptic input, which consisted of alternating excitatory and inhibitory phases. The inhibition could be reversed by chloride injection and blocked by strychnine, leaving an oscillating excitatory phase. The descending excitatory drive could extend 1-9 segments from the active region, while the ascending excitatory drive was recorded only in motoneurons that were 1-3 segments rostral to the active region. Both types of drive occurred in phase with the ipsilateral ventral root discharge: The peak depolarization of the descending drive occurred at the same point in the swimming cycle as that of the depolarizing phase seen during fictive swimming, while that of the ascending drive occurred significantly later. Both ascending and descending drives were partially reduced in amplitude by 2-amino-5-phosphonovaleric acid or Mg2+. The blocking action of Mg2+ was, in both cases, voltage dependent. Cis-2,3-piperidine dicarboxylic acid or kynurenic acid caused a much greater reduction in the amplitude of the oscillations. These results suggest that a major part of the excitatory drive for swimming in lamprey motoneurons is generated by populations of propriospinal interneurons with relatively long descending and/or short ascending axons, which fire rhythmically during swimming and release an amino acid transmitter that excites motoneurons through N-methyl-D-aspartate (NMDA) and non-NMDA receptors. This information will allow these important neurons to be identified in future experiments.

Afferent Pathways↗
PubMed1995

A comparison of driving in older subjects with and without age-related macular degeneration.

OBJECTIVE: To determine the effects of age and central vision loss on driving skills. METHODS: Ten subjects with age-related macular degeneration and average binocular visual acuity of 20/70, and 11 age-similar subjects with normal vision, were examined with a battery of cognitive and visual tests, an interactive driving simulator, and an on-road driving test. Data were collected on the frequency of real-world accidents and convictions for traffic violations. RESULTS: There were no significant differences between the two groups on any of the cognitive tests. The age-related macular degeneration group demonstrated poorer performance on the driving simulator, including delayed braking response times to stop signs, slower speeds, and more of both lane boundary crossings and simulator accidents. The age-related macular degeneration group also demonstrated poorer overall on-road test performance, including having significantly more points deducted for driving too slowly and for not maintaining proper lane position. However, these effects on the simulator and the on-road test did not translate into an increased risk of real-world accidents for the age-related macular degeneration group. Significantly more control subjects than patients with age-related macular degeneration were involved in self-reported accidents, and significantly more control subjects had state convictions for traffic violations. There was evidence of compensation in the age-related macular degeneration group in four major areas: (1) not driving in unfamiliar areas; (2) traveling at slow speeds; (3) self-restricting their nighttime driving, and (4) taking fewer risks while driving (eg, not changing lanes). There was also evidence of compensation in the older control group. CONCLUSIONS: Vision, simulator, and on-road test variables combined with subjective risk taking predicted self-reported real-world accidents in a logistic regression analysis. However, risk taking, rather than simulator or road-test performance, was the most significant predictor for both patients with age-related macular degeneration and the control group.

Accidents, Traffic↗
PubMed2005

Early evening low alcohol intake also worsens sleepiness-related driving impairment.

Following night-time sleep restriction, afternoon driving performance during the bi-circadian surge in afternoon sleepiness is markedly worsened by blood alcohol concentrations (BACs) well under most national driving limits. This study assessed how driving with this same sleep restriction and BACs (av 40 mg and 28 mg alcohol/100 ml blood at the beginning and end of drive, respectively) respond during the evening circadian rise in alertness. In a 2 x 2 (alcohol versus control drink [double blind] x normal night sleep versus sleep restricted), repeated-measures design, eight healthy young men drove for 2 h from 18:00 h, in a real-car simulator, on a monotonous, simulated highway. Driving impairment (lane drifting), subjective sleepiness and EEG measures of sleepiness were recorded. While sleep restriction alone produced significant impairments to evening driving and subjective sleepiness, alcohol alone did not. However, alcohol combined with sleep restriction significantly worsened all indices, although, this was less than that found for afternoon driving with identical interventions. Whereas low BACs may not affect driving in normally alert drivers in the early evening, the addition of moderate sleep restriction still produces a dangerous combination. Probably, there is no 'safe' level of alcohol intake for otherwise sleepy drivers, at any time of the day.

Adult↗
PubMed2005

Driving in Parkinson's disease: mobility, accidents, and sudden onset of sleep at the wheel.

Only few studies have addressed driving ability in Parkinson's disease (PD) to date. However, studies investigating accident proneness of PD patients are urgently needed in the light of motor disability in PD and--particularly--the report of "sleep attacks" at the wheel. We sent a questionnaire about sudden onset of sleep (SOS) and driving behavior to 12,000 PD patients. Subsequently, of 6,620 complete data sets, 361 patients were interviewed by phone. A total of 82% of those 6,620 patients held a driving license, and 60% of them still participated in traffic. Of the patients holding a driving license, 15% had been involved in and 11% had caused at least one accident during the past 5 years. The risk of causing accidents was significantly increased for patients who felt moderately impaired by PD, had an increased Epworth Sleepiness Scale (ESS) score, and had experienced SOS while driving. Sleep attacks at the wheel usually occurred in easy driving situations and resulted in typical fatigue-related accidents. Those having retired from driving had a more advanced (subjective) disease severity, higher age, more frequently female gender, an increased ESS score, and a longer disease duration. The study revealed SOS and daytime sleepiness as critical factors for traffic safety in addition to motor disabilities of PD patients. The results suggest that real sleep attacks without any prior sleepiness are rare. However, our data underline the importance of mobility for patients and the need for further studies addressing the ability to drive in PD.

Accidents, Traffic↗
PubMed2006

Effect of a concurrent task on driving performance in people with Parkinson's disease.

Numerous studies previously have reported reduced driving performance in people with Parkinson's disease (PD). Few studies to date, however, have examined how specific cognitive difficulties associated with PD impact on specific aspects of driving performance in this population. In this study, the impact of a concurrent task on driving performance was examined. A simulator was used to measure the driving behavior of 18 current drivers with PD and 18 matched controls. The presence of a concurrent task was manipulated between conditions. Results showed that, although groups were similarly affected by the concurrent task on most driving measures, participants with PD were disproportionately affected on operational level driving behavior. It also appears that participants with PD sacrificed concurrent task performance to maintain driving performance. These results further support the hypothesis that cognitive difficulties associated with PD compromise driving performance in this population, even in the mild to moderate stages of the disease.

Aged↗
PubMed1995

Automobile driving in Huntington's disease.

We assessed the influence of the neurological and cognitive impairments of Huntington's disease (HD) on automobile driving. In a group of 73 HD outpatients, 53 (72%) continued to drive after illness onset. Those no longer driving had more severe symptoms than those still driving. Twenty-nine HD patients who were still driving and 16 healthy control subjects underwent a clinical examination, a cognitive examination, a driving-simulator assessment, and completed questionnaires about driving history and habits. HD patients performed significantly worse than control subjects on the driving-simulator tasks and were more likely to have been involved in a collision in the preceding 2 years (58% of HD vs. 11% of control subjects). Patients with collisions were less functionally impaired but had slower simple reaction time scores than did those without collisions. HD patients are at increased risk for accidents, but patients who have accidents are not easily distinguished from those who do not.

Accidents, Traffic↗
PubMed2004

Effects of MDMA (ecstasy), and multiple drugs use on (simulated) driving performance and traffic safety.

RATIONALE: The effects of MDMA on driving behaviour are not clear, since the direct effects of MDMA on cognitive performance are reported as not generally negative. OBJECTIVES: To assess in an advanced driving simulator acute effects on simulated driving behaviour and heart rate of MDMA, and effects of polydrug use. METHODS: A group of young participants who had indicated that they regularly used MDMA were asked to complete test rides in an advanced driving simulator, shortly after the use of MDMA, just before going to a party. They were tested again after having visited the "rave", while they were under the influence of MDMA and a number of different other active drugs. Participants were also tested sober, at a comparable time at night. Separately, a control group of participants was included in the experiment. RESULTS: Driving performance in the sense of lateral and longitudinal vehicle control was not greatly affected after MDMA, but deteriorated after multiple drug use. The most striking result was the apparent decreased sense for risk taking, both after MDMA and after multiple drug use. This was clear from gap acceptance data, while the ultimate indicator of unsafe driving, accident involvement or even causation, was increased by 100% and 150%, respectively. CONCLUSIONS: Driving under the influence of MDMA alone is certainly not safe; however, driving back (home) after a dance party ("rave") where MDMA users regularly combine MDMA with a host of other drugs can be described as extremely dangerous.

Adult↗
PubMed2004

The effects of dexamphetamine on simulated driving performance.

RATIONALE: The number of road fatalities related to the presence of amphetamines in drivers has been relatively constant over the past 10 years. However, there remains uncertainty as to the extent that these drugs induce driving impairment, and whether any such impairments translate to an increase in road fatalities. OBJECTIVES: To examine the acute effects of 0.42 mg/kg dexamphetamine on simulated driving performance, and to establish which, if any, simulated driving abilities become impaired following dexamphetamine administration. METHODS: A repeated-measures, counter-balanced, double-blind, placebo-controlled design was employed. Twenty healthy volunteers completed two treatment conditions-0.42 mg/kg dexamphetamine and placebo. Performance was assessed using a driving simulator task. Blood and saliva samples were obtained prior to the driving tasks and immediately after task completion (120 min and 170 min post-drug administration, respectively). RESULTS: Mean dexamphetamine blood concentrations were 83 ng/ml and 98 ng/ml at 120 min and 170 min, respectively. Results indicated a decrease in overall simulated driving ability following dexamphetamine administration during the day-time but not the night-time scenario tasks. Contributing to this performance reduction, "incorrect signalling", "failing to stop at a red traffic light" and "slow reaction times" were the behaviours most strongly affected by dexamphetamine. CONCLUSIONS: The decrease in simulated driving ability observed during the day-time driving tasks are consistent with the perceptual narrowing or tunnel vision that is associated with dexamphetamine consumption.

Adult↗
PubMed2005

Next-day residual effects of hypnotics in DSM-IV primary insomnia: a driving simulator study with simultaneous electroencephalogram monitoring.

RATIONALE: Most studies that investigated the next-day residual effects of hypnotic drugs on daytime driving performances were performed on healthy subjects and after a single drug administration. OBJECTIVES: In the present study, we further examine whether the results of these studies could be generalised to insomniac patients and after repeated drug administration. METHOD: Single and repeated (7 day) doses of zolpidem (10 mg), zopiclone (7.5 mg), lormetazepam (1 mg) or placebo were administered at bedtime in a crossover design to 23 patients (9 men and 14 women aged 38.8+/-2.0 years) with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) primary insomnia. Driving tests were performed 9-11 h post-dose. RESULTS: Results showed that treatment effects were evidenced for subjective sleep, for driving abilities, and for electroencephalogram (EEG) recorded before (resting EEG) and during the driving simulation test (driving EEG). Compared to placebo, zopiclone increased the number of collisions and lormetazepam increased deviation from speed limit and deviation from absolute speed, whereas zolpidem did not differentiate from placebo on these analyses. EEG recordings showed that in contrast to zolpidem, lormetazepam and zopiclone induced typical benzodiazepine-like alterations, suggesting that next-day poor driving performance could relate to a prolonged central nervous system effect of these two hypnotics. CONCLUSION: The present results corroborate studies on healthy volunteers showing that residual effects of hypnotics increase with their half-lives. The results further suggest that drugs preserving physiological EEG rhythms before and during the driving simulation test 9-11 h post-dose, such as zolpidem, do not influence next-day driving abilities.

Adult↗
PubMed1999

[Automobile driving capacity after retinal detachment surgery].

BACKGROUND: After vitreoretinal surgery the patient is at least temporarily unable to drive. Buckling procedures may cause refractive changes, reduced motility or impaired binocular vision. We examined the ability of these patients to drive a car according to German law after retinal surgery. PATIENTS AND METHODS: The frequency and extent of changes interfering with driving ability were examined in 112 unselected patients 3.5 years (2-5 years) after successful buckling procedures. We used half-round buckling elements of 3-11 mm diameter or encircling bands (2-3 mm). We examined visual acuity, frequency of permanent diplopia and field of normal binocular vision. Driving ability was considered as impaired, when visual acuity was below 0.4 in the better eye or 0.2 in the worse eye, or when diplopia occurred within a gazing field of 20 degrees of diameter. RESULTS: Eighteen of 112 (16%) patients reported diplopia within the first 3 months, so they were temporarily unable to drive. Two to five years later 14 of 112 patients did not have sufficient visual acuity according to the German requirements. Another 2 patients had an impaired binocular vision, resulting in driving disability. CONCLUSION: Driving ability may be temporarily restricted by double vision in 15% of patients after successful buckling for retinal detachment. Permanent driving ability is mainly impaired by macular involvement in retinal detachment. The type of buckling procedure is of minor importance.

Adult↗
PubMed2006

A hierarchical model of operational anticipation windows in driving an automobile.

Driving an automobile is an example of a goal-directed activity with high complexity in which different behavioral elements have to be integrated and brought into a sequential order. On the basis of the reafference principle and experimental results on temporal perception and cognitive control, we propose a hierarchical model of driving behavior, which can also be adapted to other goal-directed activities. Driving is conceived of as being controlled by anticipatory neuronal programs; if these programs are disrupted by unpredictable stimuli, which require an instantaneous reaction, behavioral control returns after completion of the reactive mode to the anticipatory mode of driving. In the model different levels of anticipation windows are distinguished which, however, are interconnected, in a bi-directional way: (a) Strategic level with a representation of the driving activity from the beginning to reaching the final goal; (b) Segmented tactical level with the sequence of necessary milestones to reach the goal; (c) Maneuver level where actions like passing another car or keeping a lane are controlled; (d) Short-term integration level of a few seconds which allows immediate anticipations; and (e) Synchronization level for sensorimotor control and complexity reduction within neuronal assemblies. A flow diagram schematically describes different driving situations stressing the anticipatory mode of control. In a pilot experiment with 20 subjects using a virtual driving situation in a car simulator predictions of the model could be verified, i.e., subjects showed a significant preference for the anticipatory mode of driving.

Automobile Driving↗
PubMed1996

The scope and nature of the drowsy driving problem in New York State.

A telephone survey was conducted of a random sample of New York State licensed drivers to determine the prevalence and circumstances of drowsy driving. Based on the survey responses, 54.6% of the drivers had driven while drowsy within the past year; 22.6% had ever fallen asleep at the wheel without having a crash, 2.8% had ever crashed when they fell asleep, and 1.9% had crashed when driving while drowsy. Of the reported crashes due to driving while drowsy or falling asleep at the wheel, 82.5% involved the driver alone in the vehicle, 60.0% occurred between 11:00 p.m. and 7:00 a.m. 47.5% were drive-off-road crashes, and 40.0% occurred on a highway or expressway. Multiple regression analysis suggested that the following driver variables are predictive of an increased frequency of driving drowsy: demographic characteristics (younger drivers, more education, and men); sleep patterns (fewer hours of sleep at night and greater frequency of trouble staying awake during the day); work patterns (greater frequency of driving for job and working rotating shifts); and driving patterns (greater number of miles driven annually and fewer number of hours a person can drive before becoming drowsy).

Accidents, Traffic↗
PubMed2004

Wertheim's hypothesis on 'highway hypnosis': empirical evidence from a study on motorway and conventional road driving.

This paper aims to study the phenomenon known as 'highway hypnosis' or 'driving without attention mode', which has been defined as a state showing sleepiness signs and attention slip resulting from driving a motor vehicle for a long period in a highly predictable environment with low event occurrence, this being the case with motorways and very familiar roads [Highway hypnosis: a theoretical analysis. In: Gale, A.G., Brown, I.D., Haslegrave, C.M., Moorhead, I., Taylor, S. (Eds.), Vision in Vehicles-III. Elsevier, North-Holland, pp. 467-472]. According to Wertheim's hypothesis on 'highway hypnosis', long-term driving on motorways and conventional roads, e.g. main roads, secondary roads--implies differences in the predictability of the movement pattern of the visual stimulation, in the eye musculature activity and in the type of feedback used in visual information processing (mostly extra-retinal on motorways and retinal and extra-retinal on conventional roads). All this ultimately leads to alertness differences between both road types. Our research is intended to provide empirical evidence from the hypothesis, based on the data recorded during the actual driving experience of a group of subjects on a motorway and a conventional road. We studied whether or not significant alertness differences were found-measured by EEG data relative to time periods of on-target eye-tracking performance--between motorway and conventional road driving. Our results partially support the hypothesis, as drowsiness proved to be higher on motorways than on conventional roads during the final driving period but not during the starting stage, when the opposite trend was noticed. This result could be explained by the fact that during the first driving periods the effects of the stimulus movement predictability had not yet become apparent, since they tend to show after a long drive.

Adult↗
PubMed2005

Risky driving habits and motor vehicle driver injury.

Risky driving is an important cause of motor vehicle injury, but there is a lack of good epidemiological data in this field, particularly data comparing risky driving in younger drivers to those of other age groups. We examined the relationship between risky driving habits, prior traffic convictions and motor vehicle injury using cross-sectional data amongst 21,893 individuals in New Zealand, including 8029 who were aged 16-24 years. Those who reported frequently racing a motor vehicle for excitement or driving at 20 km/h or more over the speed limit, and those who had received traffic convictions over the past 12 months, were between two and four times more likely to have been injured while driving over the same time period. Driving unlicensed was a risk factor for older but not younger drivers, and driving at 20 km/h or more above the speed limits was a stronger risk factor for younger (<25 years) than older drivers. These results confirm the need for interventions targeting risky driving and suggest that different strategies may be required for different high-risk groups.

Accidents, Traffic↗