On the psychoanalytic theory of instinctual drives. II: The sexual drives and the ego drives.
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"Doctor, when can I drive?': a medical and legal view of the implications of advice on driving after injury or operation.
In view of the increasing medicolegal implications of advice given to patients, in particular the apparent increasing frequency of requests for advice about whether patients are fit to drive, a review was made of the literature, the law and the views of the major motor insurers. A patient should be advised when it is not safe to drive. If he disregards this advice and drives, he would be breaking the law and would not be covered by his insurance. Whilst recovering from an injury or an operation, a patient may not be as physically able as before but he may still be fit enough to drive. When it is considered that the patient's disability is more than about 3 months he should be advised to inform his insurers and to act in accordance with their response. On the other hand, when it is felt that the patient's disability is short-term, he should be advised that he is fit to drive but that he should be careful during the early stages. Provided that the patient feels safe to drive and drives carefully, he should be acting within the law, and should be covered by his existing insurance. In doubt, the patient should contact the Driver, Vehicle and Licensing Centre and his insurers and act accordingly. Doctors should record their advice in the patient's notes and should remember that the patient may be driving vehicles other than a car.
Automobile Driving↗
On-road driving evaluations: a potential tool for helping older adults drive safely longer.
PROBLEM: This paper explores the potential use of on-road driving evaluations as a tool for helping older adults extend their safe driving years. METHOD: Three separate research activities were carried out. The first was a national telephone survey of current and former older drivers. The results of this survey provide information relevant to the potential market for on-road driving evaluations. The second was a series of focus groups with potential stakeholders in the process: driver educators, occupational therapists, and physicians. These groups explored the feasibility and requirements of offering on-road driving evaluations to the wider public. Supplemental data were also collected from a mail survey of driving schools nationwide. RESULTS: Based on the results of these efforts, a number of recommendations are presented for expanding the availability of on-road driving evaluations, specifically to help older adults make more responsible decisions about continuing or stopping driving, and more generally to help them drive safely longer.
Accidents, Traffic↗
Assessing the driving performance of older adult drivers: on-road versus simulated driving.
To validate a laboratory-based driving simulator in measuring on-road driving performance, 129 older adult drivers were assessed with both the simulator and an on-road test. The driving performance of the participants was gauged by appropriate and reliable age-specific assessment criteria, which were found to be negatively correlated with age. Using principal component analysis, two performance indices were developed from the criteria to represent the overall performance in simulated driving and the on-road assessment. There was significant positive association between the two indices, with the simulated driving performance index explaining over two-thirds of the variability of the on-road driving performance index, after adjustment for age and gender of the drivers. The results supported the validity of the driving simulator and it is a safer and more economical method than the on-road testing to assess the driving performance of older adult drivers.
Accidents, Traffic↗
[Driving simulator performance in patients with obstructive sleep apnea syndrome: what consequences for driving capability?].
BACKGROUND AND OBJECTIVE: Patients with obstructive sleep apnea (OSA) have an increased accident risk. The German Society of Sleep Research and Sleep Medicine (DGSM) recommends for patients with OSA and daytime sleepiness that their driving ability should be re-established 6 weeks after the initiation of CPAP (continuous positive airway pressure), with documentation of therapeutic effects on daytime symptoms and performance. The present study was conducted to investigate whether an improvement of driving ability can be documented in neuropsychological tests and a simulated driving situation 14 days after the initiation of CPAP. PATIENTS AND METHODS: Driving simulation and neuropsychological tests of vigilance were conducted in 36 patients (36 males, aged 54 9 years) with OSAS before and 2 (n=23), 14 (n=18) and 42 days (n=17) after initiation of CPAP. RESULTS: Vigilance tests showed only slight changes under CPAP. Frequency of accidents during driving simulation was reduced after 14 days of CPAP, but a statistically remarkable decrease was achieved only on day 42. In contrast, concentration faults were reduced after 2 and 14 days of CPAP. CONCLUSIONS: In OSA-patients improvement of daytime performance in a simulated driving situation can be documented 14 days after initiation of CPAP. There is need for investigating larger cohorts of patients so that current recommendations for driving licensing can be modified and permission to drive can be given earlier.
Automobile Driving↗
Driving with cognitive deficits: neurorehabilitation and legal measures are needed for driving again after severe traumatic brain injury.
PRIMARY OBJECTIVE: This article presents a retrospective study on a group of survivors of severe traumatic brain injury with the purpose of discerning whether post-traumatic cognitive deficits prevent them from safely resuming driving and to see if holistic neurorehabilitation improves the rate of patients fit for returning to driving. METHODS AND PROCEDURES: We studied 17 patients who had suffered severe traumatic brain injury (TBI) as measured by Glasgow Coma Scale scores. All subjects underwent a holistic, intensive and multidisciplinary neurorehabilitation program during a mean period of 10.53 months in the Centro de Rehabilitación de Daño Cerebral (CRECER)--Center for Brain Injury Rehabilitation--in Seville, Spain. Patients were divided into two different groups: drivers (patients who drove despite strong and repeated recommendations from the Center to desist from doing so when they began the rehabilitation program) and non-drivers (patients not driving at the time they began the rehabilitation program although they had a pre-injury driver's license). The FIM+FAM-Revised Scale [1] was administered both before commencing treatment and upon termination. RESULTS AND CONCLUSION: (1) Patients showing physical functionality above 80% returned to driving, regardless of their cognitive and/or emotional deficits, and against doctor recommendations. (2) Severe TBI survivors that have not been certified as fit to drive are at increased risk for driving incidents other than collisions and traffic accidents. This is illustrated by significant incidents involving some of the subjects in our study that were due to disorientation, confusion and confrontations with people or situations. (3) We found that neurorehabilitation is worthwhile; after integral and multidisciplinary neurorehabilitation more than 70% of survivors of severe TBI can return to driving with regular safety. (4) We also suggest that laws be introduced to keep not-clinically-apt patients from driving.
Adolescent↗
Identifying driving impairment in Alzheimer disease: a comparison of self and observer reports versus driving evaluation.
This study examined the relationship between driving behaviors and awareness of deficit in patients with Alzheimer's disease (AD). Fifteen mildly impaired AD patients and 15 healthy elderly controls with valid drivers' licenses were administered a series of questionnaires concerning daily functioning and driving performance, and all 30 subjects were evaluated on a standardized road test. Self-report and caregiver/informant responses were compared with determine levels of discrepancy in ratings, while comparisons of AD and healthy elderly controls revealed group differences. Actual driving performance was considered the standard by which to determine accuracy of perceptions. Drivers with AD were rated as significantly worse than healthy elderly drivers on nine of 10 driving behaviors by an independent evaluator. AD patients' self-reports of driving ability were significantly better than the evaluator's ratings on seven of the 10 items, whereas the healthy elderly drivers rated themselves better than did the evaluator on one item. Although caregivers were likely to acknowledge a general concern with their AD patients' driving, they underreported specific driving problems when their ratings were compared with those of an independent evaluator. These findings have implications for the development of caregiver-based modifications of driving behavior.
Aged↗
Observational study of the extent of driving while suspended for alcohol impaired driving.
OBJECTIVE: To determine the proportion of first time driving while alcohol impaired (DWI) offenders who drive while their driver's license is suspended. DESIGN: Systematic, unobtrusive observations were conducted by surveillance professionals from Pinkerton Investigative Services, Inc, of first time offenders in the City of Milwaukee, Wisconsin, and Bergen County, New Jersey. Observations included two four hour periods during suspension (one weekday morning, one Friday/Saturday evening) and two four hour periods after license reinstatement (matched by day of week and time of day). Focus groups of first time offenders were conducted in each site. SETTING: New Jersey laws pertaining to license suspension for DWI and driving while suspended are stronger than Wisconsin laws. SUBJECTS: 93 recently convicted first time DWI offenders (57 in Milwaukee and 36 in Bergen County). MAIN OUTCOME MEASURES: Proportion of subjects observed driving during suspension and after license reinstatement, with reference to all subjects and subjects observed traveling by any means. RESULTS: Of subjects observed traveling while suspended, 88% of Milwaukee subjects compared with 36% of Bergen County subjects drove. Five percent of Milwaukee subjects and 78% of Bergen County subjects reinstated their driver's license. Bergen County subjects were significantly more likely to drive after reinstatement (54%) than during suspension (25%). CONCLUSION: Prevalence of driving while suspended among first time offenders is high and can vary substantially between jurisdictions. However, the license suspension can have a positive impact on the driving patterns of offenders during suspension, relative to after license reinstatement. Lower prevalence of driving while suspended in New Jersey may partly be attributable to that state's tougher laws.
Adult↗
Assessment of driving performance in patients with relapsing-remitting multiple sclerosis by a driving simulator.
OBJECTIVE: To compare the driving performance using a driving simulator with physical and cognitive functions as measured by the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients suffering from the relapsing-remitting form of multiple sclerosis (RRMS). METHODS: 31 RRMS patients (18 women, 13 men, mean age 35.6 +/- 8.3 years, EDSS 2.8 +/- 1.4) were compared with 10 healthy controls (8 men, 2 woman, age 45.1 +/- 7.8 years). RESULTS: Compared with controls, the accident rate (5.3 +/- 3.8 vs. 1.3 +/- 1.5, p < 0.001) and concentration faults (21.1 +/- 15.5 vs. 7.1 +/- 2.6, p < 0.01) of RRMS patients using the driving simulator were increased. While there was no correlation with the EDSS score, the accident rate was correlated with the MSFC (r = -0.5, p < 0.05). Regarding the three dimensions of the MSFC, accidents were related to the number of correct answers and Z-score in the paced auditory serial addition test (PASAT) as a measure for cognitive function (r = -0.33, p < 0.05). CONCLUSION: The current study demonstrates the need to focus also on driving skills in MS patients. The risk of accidents should be evaluated after relapses in particular. However, there are great interindividual differences. In the MSFC, most deficits could be evaluated in the PASAT. As there was a significant correlation between the accident rate in the driving simulator and the PASAT results, accidents seem to be more influenced by cognitive decline than by physical impairment. This indicates that the MSFC is a broader, more dimensional scale than the EDSS and should be preferred in the case of driving assessment. At the present time, the driving simulator seems to be a useful instrument judging driving ability, especially in cases with ambiguous neuropsychological results.
Adult↗
To drive or not to drive (after TBI)? A review of the literature and its implications for rehabilitation and future research.
Development of reliable procedures to assess fitness to safe driving after traumatic brain injury (TBI) is a crucial step in rehabilitation. However, prior studies are highly inconsistent in the choice of measures recommended for predicting driving fitness from different pre-driving measures. In the present paper the relevant literature is reviewed with the aim of shedding light on the reasons for these inconsistencies. The discrepant results reflect investigative choices which differ in five aspects: (1) the type of predictors used as pre-driving screening; (2) the type of measures considered as the criterion for the determination of fitness to drive after TBI; (3) the severity of the TBI in the sample of patients studied; (4) the extent of the neural structures damaged by TBI and the overlap of these areas with those involved in driving tasks; (5) the length of the follow-up considered. The strengths and weaknesses of the different methods and measures are discussed with their implications for future research and clinical rehabilitation. Encouraging findings come from recent studies that combined together medical, psychosocial, and personality measures, thereby improving the explanatory power of the predictors used. The use of post-injury driving fitness measures with great ecological and external validity seems equally promising in assessing actual driving in the real world.
Automobile Driving↗
The current status of the psychoanalytic theory of instinctual drives. II: The relation of the drive concept to structures, regulatory principles, and objects.
There has been and continues to be some degree of failure to recognize the effects of the introduction of the ego-id-superego model on the drive construct. In particular, some of the criticisms of drive theory fail to take cognizance of the structural position of drives. Drives, as an aspect of id, are more clearly separated from behavior conceptually than many discussions imply. Drive energy is a different concept from drive. Especially in the area of the governance of drives by the regulatory principles of mental functioning some improvement in clarity and utility seems possible through the use of different, more sophisticated models. Difficulties in the concept of objects appear to underlie considerable controversy in psychoanalysis today. I have here attempted to clarify the concept of drive objects, as a step in resolving the broader issues.
Cathexis↗
Sleepiness as a state-trait phenomenon, comprising both a sleep drive and a wake drive.
In this paper it is proposed to extend the classical models of sleepiness in two ways. Firstly, the role of a wake drive, besides a sleep drive, in determining sleepiness is emphasised. Although this has already been suggested in literature and convincing arguments can be found, it is not generally accepted. Secondly, we argue to incorporate trait aspects of sleepiness or a long-term person-specific level of sleepiness, besides short-term changes of sleepiness or 'state-sleepiness'. Shortly, a conceptualisation of sleepiness in which situational wake drive and sleep drive modify a basal level of both wake drive and sleep drive, is proposed. It implies that sleepiness can result from essentially different factors involved: a chronic condition or an acute state of either a high level of sleep drive, a low level of arousal or a combination of both. This is illustrated in a working model and potential assessment tools for the wake drive and state versus trait sleepiness are discussed.
Humans↗
Driving prevalence and factors associated with driving among patients with epilepsy.
PURPOSE: The goal of the work described here was to determine the prevalence of driving and associated variables among patients followed at a level 4 epilepsy center. METHOD: A survey was mailed out to patients seen at the University of Florida/Jacksonville Comprehensive Epilepsy Program. RESULTS: The study population comprised 308 respondents. Nearly 20% of patients with poorly controlled seizures continued to drive. Although several demographic and clinical variables were associated with driving, on univariate analysis, using multiple logistic regression, being employed, not receiving disability benefits, having less frequent seizures, and taking fewer antiepileptic drugs were the variables independently associated with driving. A subset analysis of patients with poorly controlled seizures indicated that being employed was still an independent factor associated with driving, along with higher annual household income and absence of convulsions and waking seizures. CONCLUSION: A significant number of patients with poorly controlled seizures drive. Being employed is a major reason these patients continue to drive.
Adult↗
How do visual status and age impact on driving performance as measured on a closed circuit driving track?
The aim of this study was to determine the effects of age and visual impairment on driving performance as measured on a closed circuit course. Sixty two subjects were tested, including young (< 30 years) visual normals, old (> 60 years) visual normals and old (> 60 years) subjects with early visual impairment. All subjects had a binocular visual acuity of 6/12 or better and were legally eligible to drive in Australia. Driving performance was assessed for sign detection and recognition, driving reaction times, speed estimation, and driving time. Age and early visual impairment had significant (P < 0.05) effects on sign detection and recognition, peripheral reaction times and driving time. This is of significance because all of the drivers drove regularly and were legally eligible to do so. The results also demonstrate that high contrast visual acuity is a poor predictor of the driving performance skills measured for this range of licensed drivers.
Adult↗
Learning from errors in a driving simulation: effects on driving skill and self-confidence.
Two experiments investigated the effect of making errors during training (error training) on a driving simulator versus learning from examples of errors (guided error training) on driving skill and confidence. Experiment 1 indicated that compared with errorless learning (where participants drove through a training run not designed to elicit errors), error training led to significantly better transfer to driving tests that were analogous to those situations encountered in training and more effective use of strategies for coping with a novel driving situation. Error training also reduced self-confidence in driving skill at the end of training relative to errorless learning. Experiment 2 provided weak evidence of the superiority of guided error training over errorless learning (where the driver in the video did not make any errors) on analogous tests, and no evidence of transfer to a novel test. Furthermore, guided error training did not influence self-confidence in driving skill. The potential value of driving simulators in providing active processing during driver training is discussed, along with the effects of passive and active exposure to errors on driver confidence.
Adult↗
Prevention of traffic accidents: the assessment of perceptual-motor alterations before obtaining a driving license. A longitudinal study of the first years of driving.
UNLABELLED: A longitudinal study was designed with two objectives: first, to provide a wide cognitive, personality and social description of new drivers before they started to drive cars. Second, to examine the relationship between cognitive and other characteristics drivers had before obtaining their driving license and the number and type of accidents they were involved in during the first years as drivers. RESEARCH DESIGN: The longitudinal study started in 1997 and ended in 2002. The first assessment was made up of 241 individuals at the time they enrolled on the driving course. The follow-up evaluation in the year 2002 was carried out on 144 components of the initial sample after five years driving. Age, gender and education level were matched to represent the population of Spain. METHOD AND PROCEDURES: Participants were assessed with the Bender Test for visual-motor ability, the B101 Test for practical intelligence, the B19 Test for visual-motor bi-manual coordination, and the TKK-1108 for speed anticipation. Personality was also evaluated with the Rorschach test and the PSY (Psychological Assessment Questionnaire). Five years later, a new examination of all those variables was made as well as a structured interview with each participant in order to collect data relating to significant life events during that time, driving habits, opinions in relation to certain traffic rules and information on accidents, incidents and/or sanctions. MAIN OUTCOMES AND RESULTS: Serious and/or minor accidents are concentrated on a few drivers. Accidentality is not related to gender or age, but educational level is related to serious accidents. The number of accidents (severe or minor ones) cannot be predicted if considered as a continuous variable, but it is possible if considered as a discrete variable. In this case two different cognitive profiles account for the number and type of accidents. CONCLUSION: The number and type of accidents during their first years of driving are related to the cognitive profiles of drivers assessed before they obtained their driving license.
Accidents, Traffic↗
Do recommended driving limits affect teen-reported traffic violations and crashes during the first 12 months of independent driving?
OBJECTIVES: Motor vehicle crashes are highly elevated among newly licensed teenage drivers. Limits on high-risk driving conditions by driver licensing policies and parents can protect novice teens from negative driving outcomes, while they experience and driving proficiency. The purpose of this research was to evaluate the effects of strict parent-imposed driving limits on driving outcomes during the first year of licensure. METHODS: A sample of 3,743 Connecticut teens was recruited and randomized to the Checkpoints Program or comparison condition. Assessments conducted at baseline, licensure, 3-, 6-, and 12-months postlicensure included parent-imposed driving limits, traffic violations, and crashes. Bivariate and multivariate analyses were conducted to assess the effects of strict parent limits on traffic violations and crashes during the first year of licensure. RESULTS: Thirty percent of teens reported at least one traffic violation and 40% reported at least one crash. More strict parent-imposed limits at licensure, 3-, 6-, and 12-months postlicensure, were associated with fewer violations and crashes in multivariate analyses. Notably, adherence to recommended night curfew was consistently associated with fewer violations and crashes. CONCLUSIONS: The findings indicate that strict parent-imposed limits may protect novice teen drivers from negative driving outcomes.
Accidents, Traffic↗
[Evaluating driving ability after brain damage. Neuropsychological diagnosis and driving test].
The study examined the validity of psychometric measures for the assessment of driving ability in brain-damaged subjects. 116 patients with brain damage mainly of vascular and traumatic origin underwent extensive neuropsychological examinations emphasizing attentional performance and visual perceptual speed and participated in a comprehensive on-road driving test. Only 58% of the patients passed the driving test. Attempts to predict the outcome of the driving test by discriminant analysis or cut-off procedures based on neuropsychological and/or other subject-related data yielded a maximum of 73% correct predictions. In view of the frequent impairment in driving ability after brain damage and in view of the failure to reliably predict driving ability from psychometric test results, it is recommended that in each case an on-road driving test is given.
Adult↗