Agreement Between Physician Rating and On-Road Decision for Drivers with Multiple Sclerosis

The recommendation of the referring physician is paramount in the decision making process of fitness to drive for individuals with multiple sclerosis (MS). This medical advice is carefully considered by fitness to drive officials when making a final decision. In this study, we sought to determine the reliability between physician recommendation and decision of the on-road assessor in 95 individuals with MS. The percentage agreement (po) and prevalence and bias adjusted kappa (PABAK) were used as measures of reliability. The on-road assessor found no concerns on the road in 87 (92%) of the individuals; 6 (6%) exhibited difficulties on the road that were of concern; and 2 (2%) were advised to discontinue driving based on the findings of the road test. The po between referring physician and on-road assessor was 83%. The PABAK showed a reliability coefficient of 0.76 (p \u3c 0.0001). No differences were found in po between neurologists (83%) and general practitioners (88%, Fisher’s Exact = 0.56). Binocular acuity correlated significantly with the on-road driving decision (Spearman = -0.30; p = 0.004). We conclude that, in this sample of drivers with MS, physicians were most of the time accurate in their appraisal of their patients’ driving capabilities

Comorbidities in Drivers with Parkinson Disease

Previous studies have shown that comorbidities have an impact on driving performance in older adults. No study has established the relationships between comorbidities and driving in persons with Parkinson disease (PD). The aims of this study were (1) to report the types of comorbidity in a group of 111 drivers with PD and (2) to identify whether the comorbidity associated with PD is a predictor of overall fitness-to-drive decisions, crashes, and validity duration of driving license. Results showed that 72 participants (64.9%) had only Parkinson disease, and 39 (35.1%) participants had one or more medical conditions in addition to PD. The most frequent comorbidities were visual disorders (26.4%), heart and blood disorders (16.2%), neurological disorders other than PD (11.8%), and locomotor disorders (11.8%). Contrarily to what we expected, we did not find any significant associations between comorbidities and overall fitness-to-drive decisions, car crashes, or validity duration of driving license. We conclude that in this sample of drivers with PD, comorbidity was not a significant predictor of overall fitness-to-drive decisions

Validation of Driving Simulation to Assess On-Road Performance in Huntington Disease

Driving simulators are increasingly used to assess the driving capabilities of persons with neurodegenerative conditions. However, few driving simulator evaluations have been validated against standardized on-road tests. The aim of this study was to investigate the concurrent validity of a comprehensive driving simulator evaluation in 29 persons with Huntington disease (HD). The Test Ride for Investigating Practical fitness to drive (TRIP) checklist was administered after a 15 km simulator drive and 20 km on-road drive. The total driving simulator TRIP score and each of its item scores were compared with the on-road TRIP scores using Spearman rho correlation statistics. We found significant correlations for 9 of the 12 items. Correlations ranged between 0.12 for the item gap distance at speed below 50 km/h and 0.72 for the total TRIP score, indicating variable strength of the associations. Items assessing operational skills correlated better with on-road driving performance than tactical or higher-order visual items. The results indicate that a fixed-base, single screen driving simulator is a valid tool to assess on-road driving capabilities in persons with HD

Visual performance in homonymous hemianopia : assessment, training and driving

This dissertation concentrates on visual performance in patients with homonymous hemianopia (HH). Homonymous hemianopia indicates blindness for half the field of vision, in both eyes to approximately the same extent and for the same hemifield (either left or right). This visual field defect is caused by post-chiasmal brain damage. We studied visuo-spatial performance in neuropsychological tests and during driving in HH.

A Pilot Evaluation of On-Road Detection Performance by Drivers with Hemianopia Using Oblique Peripheral Prisms

Aims. Homonymous hemianopia (HH), a severe visual consequence of stroke, causes difficulties in detecting obstacles on the nonseeing (blind) side. We conducted a pilot study to evaluate the effects of oblique peripheral prisms, a novel development in optical treatments for HH, on detection of unexpected hazards when driving. Methods. Twelve people with complete HH (median 49 years, range 29–68) completed road tests with sham oblique prism glasses (SP) and real oblique prism glasses (RP). A masked evaluator rated driving performance along the 25 km routes on busy streets in Ghent, Belgium. Results. The proportion of satisfactory responses to unexpected hazards on the blind side was higher in the RP than the SP drive (80% versus 30%; P=0.001), but similar for unexpected hazards on the seeing side. Conclusions. These pilot data suggest that oblique peripheral prisms may improve responses of people with HH to blindside hazards when driving and provide the basis for a future, larger-sample clinical trial. Testing responses to unexpected hazards in areas of heavy vehicle and pedestrian traffic appears promising as a real-world outcome measure for future evaluations of HH rehabilitation interventions aimed at improving detection when driving

Clinical Study A Pilot Evaluation of On-Road Detection Performance by Drivers with Hemianopia Using Oblique Peripheral Prisms

Aims. Homonymous hemianopia (HH), a severe visual consequence of stroke, causes difficulties in detecting obstacles on the nonseeing (blind) side. We conducted a pilot study to evaluate the effects of oblique peripheral prisms, a novel development in optical treatments for HH, on detection of unexpected hazards when driving. Methods. Twelve people with complete HH (median 49 years, range 29-68) completed road tests with sham oblique prism glasses (SP) and real oblique prism glasses (RP). A masked evaluator rated driving performance along the 25 km routes on busy streets in Ghent, Belgium. Results. The proportion of satisfactory responses to unexpected hazards on the blind side was higher in the RP than the SP drive (80% versus 30%; P = 0.001), but similar for unexpected hazards on the seeing side. Conclusions. These pilot data suggest that oblique peripheral prisms may improve responses of people with HH to blindside hazards when driving and provide the basis for a future, larger-sample clinical trial. Testing responses to unexpected hazards in areas of heavy vehicle and pedestrian traffic appears promising as a real-world outcome measure for future evaluations of HH rehabilitation interventions aimed at improving detection when driving

doi:10.1155/2012/176806 Clinical Study A Pilot Evaluation of On-Road Detection Performance by Drivers with Hemianopia Using Oblique Peripheral Prisms

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Aims. Homonymous hemianopia (HH), a severe visual consequence of stroke, causes difficulties in detecting obstacles on the nonseeing (blind) side. We conducted a pilot study to evaluate the effects of oblique peripheral prisms, a novel development in optical treatments for HH, on detection of unexpected hazards when driving. Methods. Twelve people with complete HH (median 49 years, range 29–68) completed road tests with sham oblique prism glasses (SP) and real oblique prism glasses (RP). A masked evaluator rated driving performance along the 25 km routes on busy streets in Ghent, Belgium. Results. The proportion of satisfactory responses to unexpected hazards on the blind side was higher in the RP than the SP drive (80 % versus 30%; P = 0.001), but similar for unexpected hazards on the seeing side. Conclusions. These pilot data suggest that oblique peripheral prisms may improve responses of people with HH to blindside hazards when driving and provide the basis for a future, larger-sample clinical trial. Testing responses to unexpected hazards in areas of heavy vehicle and pedestrian traffic appears promising as a real-world outcome measure for future evaluations of HH rehabilitation interventions aimed at improving detection when driving. 1