Driving Characteristics of Teens With Attention Deficit Hyperactivity and Autism Spectrum Disorder

Vehicle crashes are a leading cause of death among teens. Teens with attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), or both (ADHD–ASD) may have a greater crash risk. We examined the between-groups demographic, clinical, and predriving performance differences of 22 teens with ADHD– ASD (mean age 5 15.05, standard deviation [SD] 5 0.95) and 22 healthy control (HC) teens (mean age 5 14.32, SD 5 0.72). Compared with HC teens, the teens with ADHD–ASD performed more poorly on righteye visual acuity, selective attention, visual–motor integration, cognition, and motor performance and made more errors on the driving simulator pertaining to visual scanning, speed regulation, lane maintenance, adjustment to stimuli, and total number of driving errors. Teens with ADHD–ASD, compared with HC teens, may have more predriving deficits and as such require the skills of a certified driving rehabilitation specialist to assess readiness to drive

Indicators of Simulated Driving Skills in Adolescents with Autism Spectrum Disorder

Adolescents are at high risk for motor vehicle crashes (MVCs). Teens with autism spectrum disorder (ASD) may have an even greater risk for MVCs due to impaired visual, cognitive, and motor skills critical for driving. This prospective two group study demonstrated the demographic, clinical, and simulated driving skill differences of seven adolescents with ASD (mean age = 15.14, SD ±1.22) compared to 22 healthy controls (HC) (mean age = 14.32, SD ±.72) through a comprehensive driving evaluation (CDE) conducted by an occupational therapist certified driving rehabilitation specialist (OT-CDRS). Adolescents with ASD performed poorer on right eye acuity (Fischer’s (F) = 13.44, p = .003), cognition (Mann-Whitney Statistic (U) = 29.00, p = .01), visual motor integration (U = 27.50, p = .01), motor coordination (U = 5.00, p = .001), operational skills for managing simulator controls (U = 4.00, pU = 30.50, p = .02), speed regulation (U = 13.50, p = .001), lane maintenance (U = 34.00, p = .03), signaling (U = 38.50, p = .03), and adjustment to stimuli (U = 9.00, pU = 5.00, pConclusion). Compared to the HC, adolescents with ASD performed worse on visual, cognitive, motor, simulator operational, and fitness to drive skills, suggesting that an OT-CDRS may play an important role in assessing teens with ASD before they pursue traditional driver’s education

Indicators of Simulated Driving Skills in Adolescents with Attention Deficit Hyperactivity Disorder

Adolescents with attention deficit hyperactivity disorder (ADHD) have an increased risk for committing traffic violations, and they are four times more likely than neurotypical peers to be crash involved, making them a potentially high risk group for driving. We used a two-group design to measure differences in demographics, clinical off-road tests, and fitness to drive abilities in a driving simulator with nine adolescents with ADHD (mean age = 15.00, SD ± 1.00) compared to 22 healthy controls (HC) (mean age = 14.32, SD ±..716), as evaluated by an Occupational Therapist Certified Driving Rehabilitation Specialist (OT-CDRS). Despite few demographic differences, the adolescents with ADHD performed worse than the HC on tests of right visual acuity (F = 5.92, p = .036), right peripheral field (F = 6.85, p = .019), selective attention (U = 53.00, p = .046), and motor coordination (U = 53.00, p = .046). The ADHD group made more visual scanning (U = 52.50, p = .041), speed regulation (U = 28.00, p = .001), and total driving errors (U = 32.50, p = .003) on the simulator. Adolescents with ADHD performed worse on tests measuring visual, cognitive, motor, and pre-driving skills, and on a driving simulator. They may require the services of an OT-CDRS to determine their fitness to drive abilities prior to referring them for driver’s education

Evidence-Based Review of Interventions for Medically At-Risk Older Drivers

OBJECTIVE. To conduct an evidence-based review of intervention studies of older drivers with medical conditions. METHOD. We used the American Occupational Therapy Association’s classification criteria (Levels I–V, I 5 highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A 5 strongly recommend the intervention; B 5 recommend intervention is provided routinely; C 5 weak evidence that the intervention can improve outcomes; D 5 recommend not to provide the intervention; I 5 insufficient evidence to recommend for or against the intervention. RESULTS. For clients with stroke, we recommend a graded simulator intervention (A) and multimodal training in traffic theory knowledge and on-road interventions (B); we make no recommendation for or against Dynavision, Useful Field of View, or visual–perceptual interventions (I). For clients with visual deficits, we recommend educational intervention (A) and bioptic training (B); we make no recommendation for or against prism lenses (I). For clients with dementia, we recommend driving restriction interventions (C) and make no recommendation for or against use of compensatory driving strategies (I). CONCLUSION. Level I studies are needed to identify effective interventions for medically at-risk older drivers

Utility of an Occupational Therapy Driving Intervention for a Combat Veteran

Many combat veterans are injured in motor vehicle crashes shortly after returning to civilian life, yet little evidence exists on effective driving interventions. In this single-subject design study, we compared clinical test results and driving errors in a returning combat veteran before and after an occupational therapy driving intervention. A certified driving rehabilitation specialist administered baseline clinical and simulated driving assessments; conducted three intervention sessions that discussed driving errors, retrained visual search skills, and invited commentary on driving; and administered a postintervention evaluation in conditions resembling those at baseline. Clinical test results were similar pre- and postintervention. Baseline versus postintervention driving errors were as follows: lane maintenance, 23 versus 7; vehicle positioning, 5 versus 1; signaling, 2 versus 0; speed regulation, 1 versus 1; visual scanning, 1 versus 0; and gap acceptance, 1 versus 0. Although the intervention appeared efficacious for this participant, threats to validity must be recognized and controlled for in a follow-up study

Evaluating Driving as a Valued Instrumental Activity of Daily Living

The purpose of this translational research article is to illustrate how general practice occupational therapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008b). Evidence to support the model is offered by a research study. Participants were compared on their performance of complex instrumental activities of daily living (IADLs) and a behind-thewheel driving assessment. A significant relationship was found between the process skills from the performance assessment and whether the driver passed, failed, or needed restrictions as indicated by the behind-the-wheel assessment. The evidence suggests that occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver. The algorithm addresses how driver rehabilitation specialists can be used most effectively and efficiently with general practice occupational therapy practitioners meeting the needs of senior drivers

Driving Errors in Parkinson’s Disease: Moving Closer to Predicting On-Road Outcomes

Age-related medical conditions such as Parkinson’s disease (PD) compromise driver fitness. Results from studies are unclear on the specific driving errors that underlie passing or failing an on-road assessment. In this study, we determined the between-group differences and quantified the on-road driving errors that predicted pass or fail on-road outcomes in 101 drivers with PD (mean age 5 69.38 ± 7.43) and 138 healthy control (HC) drivers (mean age 5 71.76 ± 5.08). Participants with PD had minor differences in demographics and driving habits and history but made more and different driving errors than HC participants. Drivers with PD failed the on-road test to a greater extent than HC drivers (41% vs. 9%), x2(1) 5 35.54, HC N 5 138, PD N 5 99, p \u3c .001. The driving errors predicting on-road pass or fail outcomes (95% confidence interval, Nagelkerke R2 5.771) were made in visual scanning, signaling, vehicle positioning, speeding (mainly underspeeding, t (61) 5 7.004, p \u3c .001, and total errors. Although it is difficult to predict on-road outcomes, this study provides a foundation for doing so

HBO1 is required for the maintenance of leukaemia stem cells.

Acute myeloid leukaemia (AML) is a heterogeneous disease characterized by transcriptional dysregulation that results in a block in differentiation and increased malignant self-renewal. Various epigenetic therapies aimed at reversing these hallmarks of AML have progressed into clinical trials, but most show only modest efficacy owing to an inability to effectively eradicate leukaemia stem cells (LSCs)1. Here, to specifically identify novel dependencies in LSCs, we screened a bespoke library of small hairpin RNAs that target chromatin regulators in a unique ex vivo mouse model of LSCs. We identify the MYST acetyltransferase HBO1 (also known as KAT7 or MYST2) and several known members of the HBO1 protein complex as critical regulators of LSC maintenance. Using CRISPR domain screening and quantitative mass spectrometry, we identified the histone acetyltransferase domain of HBO1 as being essential in the acetylation of histone H3 at K14. H3 acetylated at K14 (H3K14ac) facilitates the processivity of RNA polymerase II to maintain the high expression of key genes (including Hoxa9 and Hoxa10) that help to sustain the functional properties of LSCs. To leverage this dependency therapeutically, we developed a highly potent small-molecule inhibitor of HBO1 and demonstrate its mode of activity as a competitive analogue of acetyl-CoA. Inhibition of HBO1 phenocopied our genetic data and showed efficacy in a broad range of human cell lines and primary AML cells from patients. These biological, structural and chemical insights into a therapeutic target in AML will enable the clinical translation of these findings

Colorectal cancer incidences in Lynch syndrome: a comparison of results from the prospective lynch syndrome database and the international mismatch repair consortium

Objective To compare colorectal cancer (CRC) incidences in carriers of pathogenic variants of the MMR genes in the PLSD and IMRC cohorts, of which only the former included mandatory colonoscopy surveillance for all participants. Methods CRC incidences were calculated in an intervention group comprising a cohort of confirmed carriers of pathogenic or likely pathogenic variants in mismatch repair genes (path_MMR) followed prospectively by the Prospective Lynch Syndrome Database (PLSD). All had colonoscopy surveillance, with polypectomy when polyps were identified. Comparison was made with a retrospective cohort reported by the International Mismatch Repair Consortium (IMRC). This comprised confirmed and inferred path_MMR carriers who were first- or second-degree relatives of Lynch syndrome probands. Results In the PLSD, 8,153 subjects had follow-up colonoscopy surveillance for a total of 67,604 years and 578 carriers had CRC diagnosed. Average cumulative incidences of CRC in path_MLH1 carriers at 70 years of age were 52% in males and 41% in females; for path_MSH2 50% and 39%; for path_MSH6 13% and 17% and for path_PMS2 11% and 8%. In contrast, in the IMRC cohort, corresponding cumulative incidences were 40% and 27%; 34% and 23%; 16% and 8% and 7% and 6%. Comparing just the European carriers in the two series gave similar findings. Numbers in the PLSD series did not allow comparisons of carriers from other continents separately. Cumulative incidences at 25 years were < 1% in all retrospective groups. Conclusions Prospectively observed CRC incidences (PLSD) in path_MLH1 and path_MSH2 carriers undergoing colonoscopy surveillance and polypectomy were higher than in the retrospective (IMRC) series, and were not reduced in path_MSH6 carriers. These findings were the opposite to those expected. CRC point incidence before 50 years of age was reduced in path_PMS2 carriers subjected to colonoscopy, but not significantly so

Importance of Driving and Community Mobility

Covering the scope, theory, and approaches to the practice of occupational therapy, this title prepares you to care for adults who have physical disabilities. It takes a client-centered approach, following the advanced OT Practice framework as it defines your role as an OTA in physical dysfunction practice. ~publisher\u27s description~https://scholar.dominican.edu/books/1124/thumbnail.jp