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PubMed2003

Preliminary research on the efficacy of virtual reality exposure therapy to treat driving phobia.

This article presents a review of preliminary research of two studies of the efficacy of virtual reality exposure therapy (VRET) to treat driving phobia. Study 1 describes a case study of a patient who completed a 7-day baseline followed by three sessions of VRET. Her peak anxiety decreased within and across sessions. At the post-treatment assessment, her phobic-related symptoms had diminished and she no longer met diagnostic criteria for driving phobia. Clinical improvement was maintained at 1-, 3-, and 7-month follow-up. In study 2, a multiple baseline across-subjects design was used to treat five patients over eight weekly VRET sessions. Visual and statistical analyses showed clear improvement in driving anxiety and avoidance in three patients between pre- and post-treatment assessments, and they no longer met criteria for driving phobia. There was marginal improvement in one patient, and the remaining individual showed no treatment gains. There was negligible change in actual driving frequency for any of the patients. Some gains were lost at the follow-up, particularly for the two individuals with poorer treatment responses. The results from these preliminary studies suggest that VRET may be a promising intervention for treating driving phobia. Avenues for improving treatment outcome are discussed.

Adult↗
PubMed2004

Problems with vision associated with limitations or avoidance of driving in older populations.

OBJECTIVES: This report examines the role of (a) disease processes affecting vision, (b) reported troubles with vision, (c) physical symptoms affecting the eyes, and (d) objective measures in reported driving limitation due to problems with eyesight among older drivers. METHODS: Data for this study (N = 1,840) were obtained from participants in a community-based study of aging and physical performance in people age 55 or older in the city of Sonoma, California. Each of 16 visual conditions was assessed for impact on reported driving limitation due to eyesight by calculating a "risk" ratio. Then, prevalence of the condition was combined with the ratio to generate an attributable risk for that condition for vision-related limitations in driving. RESULTS: Each condition was significantly associated with reported limitations in driving due to eyesight. "Avoiding physical activity due to vision" (ratio = 3.4) and "trouble seeing steps up/down stairs" (ratio = 2.9) had the strongest association. However, "glasses/contacts required for driving" and "trouble with glare from sun/lights" had the highest attributable risks (35.8 and 29.4). DISCUSSION: The risk ratio is relevant for evaluating individuals; the attributable risk is relevant to planning countermeasures in populations. Addressing specific problems related to vision should substantially reduce driving limitations due to eyesight.

Aged↗
PubMed2002

Effects of cognition on driving involvement among the oldest old: variations by gender and alternative transportation opportunities.

PURPOSE: This study explored the impact of cognition and the availability of other drivers on driving restriction and cessation among older adults. DESIGN AND METHODS: Survey data from the first wave of the Asset and Health Dynamics Among the Oldest Old data were analyzed, using multinomial logistic regressions. RESULTS: Cognitive impairment is associated with driving restriction and cessation, although a noteworthy minority of mildly and severely cognitively impaired individuals continue to drive. Partner's driving and involvement and presence of other drivers in the household moderated the effect of cognition on driving restriction and cessation. IMPLICATIONS: The decision processes surrounding an individual's restricting or stopping driving are complex and may include consideration not only of competence, but also of sense of self-worth and relationship with a partner.

Activities of Daily Living↗
PubMed1975

Recovery and simulated driving after intravenous anesthesia with thiopental, methohexital, propanidid, or alphadione.

Recovery from anesthesia was assessed in a double-bind manner in 40 healthy volunteer students after intravenous anesthesia with thiopental (6.0 mg/kg), methohexital (2.0 mg/kg), propanidid (6.6 mg/kg), or alphadione (Althesin), 85 mul/kg using a driving simulator 2,4, 6, and 8 hours after injection of the drugs. Clinical recovery was faster after propanidid and methohexital than after thiopental or alphadione. Driving performances remained significantly (P less than 0.05) worse than in a control group for 6 hours after thiopental and for 8 hours after methohexital, and reaction times 8 hours after thiopental remained worse than in the control subjects. After alphadione driving skills were impaired at 6 hours only. Propanidid produced no impairment in driving skills at any time during the experiment. It is concluded that after the doses used in this study patients should not drive or operate machinery for at least 2 hours after propanidid and for at least 8 hours after alphadione. After methohexital and thiopental patients should probably not drive for 24 hours because of the severity of the disturbances at 8 hours.

Adult↗
PubMed2002

Driving behaviors following brain injury: self-report and motor vehicle records.

BACKGROUND: This study examined both objective and subjective measures of driving behaviors occurring in the past 5 years for 47 individuals with traumatic brain injury (TBI) and 22 healthy controls (HC), matched for age, gender, education, and years of driving experience. RESULTS: Overall, subtle descriptive differences in driving characteristics were observed between the two groups. However, comparison of self-reported and documented reports of aberrant driving behaviors did not reveal a significantly greater number of accidents or violations among TBI participants compared with HC drivers. The results suggest that individuals with TBI, who successfully complete a driving evaluation program, are able to reintegrate into the driving community with minimal difficulty.

Accidents, Traffic↗
PubMedDate not supplied

Visual testing for readiness to drive after stroke: a multicenter study.

OBJECTIVE: The purpose of this study was to determine the ability of a visual-perception assessment tool, the Motor-Free Visual Perception Test, to predict on-road driving outcome in subjects with stroke. DESIGN: This was a retrospective study of 269 individuals with stroke who completed visual-perception testing and an on-road driving evaluation. Driving evaluators from six evaluation sites in Canada and the United States participated. Visual-perception was assessed using the Motor-Free Visual Perception Test. Scores range from 0 to 36, with a higher score indicating better visual perception. A structured on-road driving evaluation was performed to determine fitness to drive. Based on driving behaviors, a pass or fail outcome was determined by the examiner. RESULTS: The results indicated that, using a score on the Motor-Free Visual Perception Test of < or =30 to indicate poor visual-perception and >30 to indicate good visual perception, the positive predictive value of the Motor-Free Visual Perception Test in identifying those who would fail the on-road test was 60.9% (n = 67/110). The corresponding negative predictive value was 64.2% (n = 102/159). Univariate logistic regression analyses revealed that older age, low Motor-Free Visual Perception Test scores and a right hemisphere lesion contributed significantly to identifying those who failed the on-road test. CONCLUSIONS: The predictive validity of the Motor-Free Visual Perception Test is not sufficiently high to warrant its use as the sole screening tool in identifying those who are unfit to undergo an on-road evaluation.

Aged↗
PubMed1994

The effects of Alzheimer disease on driving-related abilities.

Ten Alzheimer disease (AD) patients and 12 healthy elderly controls were evaluated on two tests of driving-related abilities: the Driver Performance Test (DPT) and the Driving Advisement System (DAS). Subjects were administered a battery of neuropsychological tests to determine if severity of dementia in AD correlates with driving performance. On the DPT, the AD patients scored in the average range in two of five skill areas (predicting the effects of a hazard, deciding how to avoid it); below average in two areas (searching for a hazard, executing evasive actions); and poorly in one area (identifying hazards). The elderly controls scored at an average level in all five skill areas. On the DAS, AD patients were significantly slower than the elderly controls on simple, two-choice, and conditional reaction time tests and were much slower than drivers in general. The AD patients' performances on two cognitive tests, the Mini-Mental State Examination (MMSE) and the Category Fluency Test, correlated significantly with aspects of performance on the DPT and the DAS. Although these are preliminary results from a pilot investigation, they suggest that AD patients' driving-related abilities are adversely affected by the disease and that driving-related performance tests and neuropsychological tests may be useful in assessing the impact of AD on driving.

Aged↗
PubMed2002

Residual effects of middle-of-the-night administration of zaleplon and zolpidem on driving ability, memory functions, and psychomotor performance.

Thirty healthy volunteers participated in this two-part study. Part 1 was a single-blind, two-period crossover design to determine the effects of a single dose of ethanol (0.03% < BAC < 0.05%) or ethanol-placebo on driving ability, memory, and psychomotor performance. Part 2 was a double-blind, five-period crossover design to measure the effects of a middle-of-the-night administration of zaleplon 10 or 20 mg, zolpidem 10 or 20 mg, or placebo on driving ability 4 hours after administration and memory and psychomotor performance 6 hours after administration. The on-the-road driving test consisted of operating an instrumented automobile over a 100-km highway circuit at a constant speed (95 km/h) while maintaining a steady lateral position between the right lane boundaries. The standard deviation of lateral position (SDLP) was the primary performance parameter of the driving test. The psychomotor and memory test battery consisted of the Word Learning Test, the Critical Tracking Test, the Divided Attention Test, and the Digit Symbol Substitution Test. Data for each part were analyzed separately using ANOVA for crossover designs. Zaleplon 10 and 20 mg did not significantly impair driving ability 4 hours after middle-of-the-night administration. Relative to placebo, after zolpidem 10 mg, SDLP was significantly elevated, but the magnitude of the difference was small and not likely to be of clinical importance. Memory and psychomotor test performance was unaffected after both doses of zaleplon and zolpidem 10 mg. In contrast, zolpidem 20 mg significantly increased SDLP and speed variability. Further, zolpidem 20 mg significantly impaired performance on all psychomotor and memory tests. Finally, driving performance, Digit Symbol Substitution Test, Divided Attention Test, and immediate and delayed free recall of the Word Learning Test were significantly impaired after ethanol. The results show that zaleplon (10 and 20 mg) is a safe hypnotic devoid of next-morning residual impairment when used in the middle of the night.

Acetamides↗
PubMed2002

Physiological responses to high-speed, open-wheel racecar driving.

UNLABELLED: High-speed auto racing has been demonstrated to produce accelerated heart rate (HR) during competition. However, it has not been determined whether the increase in HR was due to physical work efforts or a result of emotional stress. PURPOSE: The purpose of this investigation was to examine the physiological responses associated with open-wheel automobile driving at competitive speeds. METHODS: Oxygen consumption and HR were assessed in seven professional automobile racing drivers during two incrementally paced driving sessions. A portable metabolic analyzer and EKG were directly attached to the subjects as they participated in driving tests on an oval speedway and a roadway course. Maximal physiological responses of the subjects were also determined during a graded treadmill test. RESULTS: During treadmill testing, maximal oxygen consumption (VO2max) ranged from of 42.0 to 59.7 mL x kg(-1) x min(-1) (mean +/- SD = 47.6+/-8.1). The road course and oval speedway testing at competitive speeds elicited mean VO2 values of 38.5 and 21.9 mL x kg(-1) x min(-1), respectively, which correspond to 79% and 45% of VO2max. Road course driving produced mean HR values of 152 beats x min(-1) with 142 beats x min(-1) recorded when driving at competitive speed on the speedway course. CONCLUSIONS: Professional open-wheel race drivers possess cardiorespiratory capacity similar to athletes participating in sports such as basketball, football, and baseball. The VO2 and HR responses to road course driving were similar to those previously reported in traditional sports settings. The findings of this study suggest that professional open-wheel racing drivers should be regarded as athletes that encounter significant physiological stresses.(2)

Adaptation, Physiological↗
PubMed2003

Improvement in driving reaction time after total hip arthroplasty.

Decisions made regarding resumption of driving after total hip arthroplasty may be determined by a combination of factors including driving reaction time and when postsurgical precautions need no longer be adhered to. Ninety patients, ranging in age from 34 to 85 years old were recruited after total hip arthroplasty to measure driving reaction time preoperatively and from 1 to 52 weeks postoperatively. Driving reaction time worsened 1 week postoperatively for patients who had a right hip arthroplasty. The driving reaction time then improved up to 1 year postoperatively. Patients who had a left arthroplasty improved from 1 week postoperative. In general, patients reach their preoperative driving reaction time 4 to 6 weeks postoperatively and continue to improve.

Adult↗
PubMedDate not supplied

Salivary cortisol response during exposure treatment in driving phobics.

OBJECTIVE: Extensive research on the hypothalamic-pituitary-adrenal (HPA) axis response to stress has not clarified whether that axis is activated by phobic anxiety. We addressed this issue by measuring cortisol in situational phobics during exposure treatment. METHODS: Salivary cortisol was measured in 11 driving phobics before and during three exposure sessions involving driving on crowded limited-access highways and compared with levels measured in 13 healthy controls before and during two sessions of driving on the same highways. For each subject, data collected in the same time period on a comparison nondriving day served as an individual baseline from which cortisol response scores were calculated. RESULTS: Cortisol levels of driving phobics and controls did not differ on the comparison day. Phobics also had normal cortisol response scores on awakening on the mornings of the exposures but these were already increased 1 hour before coming to the treatment sessions. Phobics had significantly greater cortisol response scores during driving exposure and during quiet sitting periods before and afterward. These greater responses generally paralleled increases in self-reported anxiety. At the first exposure session, effect sizes for differences in cortisol response scores between the two groups were large. Initial exposure to driving in the first session evoked the largest responses. CONCLUSION: The data demonstrate that the HPA axis can be strongly activated by exposure to, and anticipation of, a phobic situation.

Adrenal Cortex↗
PubMedDate not supplied

Systematic review of the optimal frequency of follow-up in persons with mild dementia who continue to drive.

Fitness-to-drive guidelines commonly indicate that persons with mild dementia may be safe to drive but that periodic reevaluation is required. This paper presents the findings of a systematic review of primary evidence regarding the optimal timing of follow-up in persons with mild dementia who continue to drive. A search of Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. No published studies focus primarily on the timing of follow-up of drivers with mild dementia. Three studies present longitudinal data that the authors reference when recommending periodicity of follow-up. This study identifies a concerning research gap in the field of dementia and driving. To provide better evidence to guide recommendations for periodicity of follow-up, 3 recommendations are proposed: (1) that prospective cohort driving research be undertaken to follow patients with mild dementia who continue to drive, (2) that data from such longitudinal research be presented as survival analyses, and (3) that existing research on the progression rates of Alzheimer disease be employed as a default until the first 2 recommendations are realized.

Aged↗
PubMed1984

Driving tests with patients.

Mental illness and the use of psychotropic drugs are considered to influence driving skills of patients. However, studies which indicate the relative contributions of these factors are rare. It is emphasized that for measuring the effects of psychotropic drugs on driving performance of patients, real driving tests are needed. Actual driving and psychomotor performance of patients receiving diazepam, and patients and healthy volunteers receiving mebhydrolin were measured to illustrate the use of real driving tests. The results of both studies are discussed in terms of problems associated with the application of these tests. Patient recruitment is considered to be a major problem. To draw conclusions under these circumstances is extremely difficult, but still acceptable in comparison with the limitations and methodological difficulties of the more commonly used laboratory tests. Some guidelines for driving tests with patients are given.

Adult↗
PubMed2004

A dose-ranging study of the effects of mequitazine on actual driving, memory and psychomotor performance as compared to dexchlorpheniramine, cetirizine and placebo.

BACKGROUND: Mequitazine is a so-called 'non-sedative' second-generation antihistamine even though it has never been firmly established that this drug's sedative potential actually differs from that of the 'sedative' first-generation antihistamines. OBJECTIVE: The present study compares the sedative effects of three doses of mequitazine on actual driving, psychomotor performance and memory with those of a first- and a second-generation antihistamine. METHODS: Eighteen healthy volunteers received on separate days a single dose of 5, 10 and 15 mg mequitazine, 10 mg cetirizine, 6 mg dexchlorpheniramine and placebo. Drug effects were assessed using two actual driving tests (highway-driving test and car-following test), cognitive and psychometric tests (tracking, divided attention, memory, reasoning and critical flicker fusion), pupil size and questionnaires. RESULTS: Highway-driving data revealed an overall effect of Treatment on the standard deviation of lateral position (SDLP). Dexchlorpheniramine impaired driving performance as indicated by a significant rise in SDLP. Mequitazine significantly increased SDLP in a dose-related manner, but the separate dose effects failed to reach statistical significance. Divided attention performance was also affected by Treatment. Reaction time (RT) during mequitazine treatments increased in a dose-related manner and significantly differed from placebo at the highest dose. Subjects reported to be less alert after treatment with dexchlorpheniramine. Cetirizine did not affect performance in any of the tasks. CONCLUSION: It was concluded that mequitazine is mildly sedating. The effects of mequitazine are comparable to those of other second-generation antihistamines, in that it causes mild driving impairment, particularly at higher doses.

Adult↗
PubMed1978

Operating room nurses' psychomotor and driving skills after occupational exposure to halothane and nitrous oxide.

Concentrations of halothane and nitrous oxide were assayed by gas chromatography throughout a working day in three operating theatres and in the end-tidal air of 19 nurses 15 and 60 min after leaving the theatres. Perceptual, psychomotor and driving skills were measured in these nurses and in 11 younger nurses working in the wards of the same hospital. A complicated psychomotor test battery and a driving simulator were used. End-tidal air concentrations of halothane and nitrous oxide were positively correlated with the exposure level of these gases in the operating theatres. Some of the operating room nurses had greater amounts of halothane in their end-tidal air (average 15 to 10 ppm) than student volunteers 4.5 h after 3.5 min of general anaesthesia with a combination of halothanenitrous-oxide oxygen (10 ppm halothane). These volunteers had worse psychomotor and driving performances when measured than controls who had not been anaesthetized. No correlations were found between the concentrations of halothane or nitrous oxide in end-tidal air and psychomotor or driving performance. Despite their higher age and exposure to the operating room environment, the driving skills of the operating room nurses were similar to those of the ward nurses. The results suggest that tolerance to anaesthetic gases develops among operating room personnel. No impairment of driving skills can be expected after daily exposure to halothan and nitrous oxide among long-term employees in operating theatres.

Air Pollutants↗
PubMed2002

Aging, driving and vision.

Older people constitute the fastest growing sector of the driving population and are believed to represent a high risk to road safety, given their high crash rate per distance travelled. The crash characteristics of the elderly also differ from those of younger drivers and generally involve multiple vehicles and more complex driving situations. Although the reasons for this deterioration in driving performance are multi-factorial, the age-related changes in vision are likely to be a significant factor, given the important role of vision in driving. This paper provides an overview of some of the complex issues associated with older drivers and considers how the aging changes in visual function might impact on driving performance. Particular emphasis is placed on the literature linking vision to driving, with emphasis on more recent research. The implications of this research for driver licensing and self-regulation of older drivers are also discussed.

Accidents, Traffic↗
PubMed1989

Type 1 diabetes and driving experience: an eight-year cohort study.

The driving habits of 250 drivers with Type 1 diabetes were reviewed 8 years after a previous assessment. At least 45 patients had died and 18 patients could not be traced. A postal questionnaire of the 187 survivors elicited a response from 89%. Fifty-six patients (34%) still held an unrestricted driving licence, demonstrating that a significant proportion of diabetic drivers had not declared diabetes to the licensing authority and/or their motor insurer and continued to ignore the statutory regulations. Fewer patients held Heavy Goods Vehicle licences than 8 years previously. Twenty-four patients had ceased driving as their driving skills had diminished with advancing age and ill health. This was a voluntary decision by all but two patients whose driving licences had been revoked. Thirty-nine patients admitted to a total of 55 road traffic accidents since 1979; 9 accidents (16%) were attributed to hypoglycaemia. Although dependent on patients' honesty and the accuracy of recall, the disclosed accident rates of 4.9 per million miles driven for male drivers and 6.3 per million miles for female drivers are comparable to the accident rate of a non-diabetic driving population of similar age.

Accidents, Traffic↗
PubMed1993

Attitudes of physicians toward elderly drivers and driving policy.

OBJECTIVE: To examine physicians' attitudes toward and knowledge concerning driving in older persons. DESIGN: Questionnaire survey. MEASUREMENTS: A questionnaire was sent to physician members of the American Geriatrics Society (n = 5009). The questionnaire explored physicians' practice characteristics, general approach to record keeping, frequency of behavior toward educating, counseling, and reporting patients to authorities when deemed appropriate, and their personal understanding of driving issues and physician responsibilities within the state in which they practice. RESULTS: A response rate of 48% was obtained. There was a lack of consensus among physicians, with a broad range of attitudes and practices dealing with this growing public health concern. Physicians generally believed that they had a legal responsibility to assess driving ability but were uncertain about how to assess driving competence and their responsibility toward their senior patients who drive. CONCLUSIONS: Physician practices concerning the appropriate management of older drivers vary widely. Physicians should be aware that medical literature is available to aid in the evaluation of the elderly driver with medical impairments. In addition, physicians should consider referring their elderly patients to driver refresher courses to improve or maintain their driving skills. More research is needed to help guide health professionals in assessing the frail elder with multiple medical impairments and decreasing the crash risk for the older driver.

Aged↗