Braking Response Research Articles

Good distractions: Testing the effects of listening to an audiobook on driving performance in simple and complex road environments

Distracted driving (driving while performing a secondary task) causes many collisions. Most research on distracted driving has focused on operating a cell-phone, but distracted driving can include eating while driving, conversing with passengers or listening to music or audiobooks. Although the research has focused on the deleterious effects of distraction, there may be situations where distraction improves driving performance. Fatigue and boredom are also associated with collision risk and it is possible that secondary tasks can help alleviate the effects of fatigue and boredom. Furthermore, it has been found that individuals with high levels of executive functioning as measured by the OSPAN (Operation Span) task show better driving while multitasking. In this study, licensed drivers were tested in a driving simulator (a car body surrounded by screens) that simulated simple or complex roads. Road complexity was manipulated by increasing traffic, scenery, and the number of curves in the drive. Participants either drove, or drove while listening to an audiobook. Driving performance was measured in terms of braking response time to hazards (HRT): the time required to brake in response to pedestrians or vehicles that suddenly emerged from the periphery into the path of the vehicle, speed, standard deviation of speed, standard deviation of lateral position (SDLP). Overall, braking times to hazards were higher on the complex drive than the simple one, though the effects of secondary tasks such as audiobooks were especially deleterious on the complex drive. In contrast, on the simple drive, driving while listening to an audiobook lead to faster HRT. We found evidence that individuals with high OSPAN scores had faster HRTs when listening to an audiobook. These results suggest that there are environmental and individual factors behind difference in the allocation of attention while listening to audiobooks while driving.

Executive Attention as a Predictor of Distracted Driving Performance

The present study empirically examines the role of executive attention as a predictor of distracted driving performance. As ADHD is an attention-related disorder, we hypothesized that ADHD individuals would show poorer executive attention compared to individuals from a community sample. Second, we predicted that individuals with poorer executive attention would show riskier driving as measured by a self-report questionnaire and simulated driving trials. One-hundred thirteen individuals with and without ADHD completed an executive attention task, a driving behavior questionnaire, and three (pre-distracted, distracted, and post-distracted) simulated driving routes. Results showed that executive attention is associated with braking response times during distracted driving trials. There was also evidence for carryover effects of distraction, with participants showing slower braking response times even after the distracting task was discontinued. Further research is needed to clarify the relationship between ADHD and executive attention.

Driving simulation test for evaluating hazard perception: Elderly driver response characteristics

We created a driving simulation test for assessing drivers’ hazard-perception skills by measuring their palmar sweating response (PSR), skin potential reflex (SPR), and ability to operate the steering wheel, accelerator, and brake. We recruited 52 elderly people who were aged ≥60years and were active drivers. These participants undertook the driving simulation test, and we measured their PSR, SPR, and device operation responses. PSR tended to be greater in hazard scenes that involved anticipation or complexity processes, suggesting the involvement of factors such as the participants’ readiness to anticipate hazards and their emotional changes. SPR response was faster in hazard scenes that involved a surprise process. SPR response was faster than braking response, except in scenes where the participants had only a fleeting moment to react to the hazard, suggesting that SPR is a suitable evaluation index for hazard perception timing. Two participants were suspected of having decreased cognitive function according to the Mini-Mental State Examination. These individuals exhibited PSR and SPR responses that were not consistent with the hazard scenes, and they made errors in their operation of the driving simulator. These findings highlight the need to examine the impact of decreased cognitive function on hazard perception.

Crash probability estimation via quantifying driver hazard perception

Crash probability estimation is an important method to predict the potential reduction of crash probability contributed by forward collision avoidance technologies (FCATs). In this study, we propose a practical approach to estimate crash probability, which combines a field operational test and numerical simulations of a typical rear-end crash model. To consider driver hazard perception characteristics, we define a novel hazard perception measure, called as driver risk response time, by considering both time-to-collision (TTC) and driver braking response to impending collision risk in a near-crash scenario. Also, we establish a driving database under mixed Chinese traffic conditions based on a CMBS (Collision Mitigation Braking Systems)-equipped vehicle. Applying the crash probability estimation in this database, we estimate the potential decrease in crash probability owing to use of CMBS. A comparison of the results with CMBS on and off shows a 13.7% reduction of crash probability in a typical rear-end near-crash scenario with a one-second delay of driver’s braking response. These results indicate that CMBS is positive in collision prevention, especially in the case of inattentive drivers or ole drivers. The proposed crash probability estimation offers a practical way for evaluating the safety benefits in the design and testing of FCATs.

Diabetic Driving Studies—Part 1: Brake Response Time in Diabetic Drivers With Lower Extremity Neuropathy

Although the effect of lower extremity pathology and surgical intervention on automobile driving function has been a topic of contemporary interest, we are unaware of any analysis of the effect of lower extremity diabetic sensorimotor neuropathy on driving performance. The objective of the present case-control investigation was to assess the mean brake response time in diabetic drivers with lower extremity neuropathy compared with that of a control group and a brake response safety threshold. The driving performances of participants were evaluated using a computerized driving simulator with specific measurement of the mean brake response time and frequency of abnormally delayed brake responses. We analyzed a control group of 25 active drivers with neither diabetes nor lower extremity neuropathy and an experimental group of 25 active drivers with type 2 diabetes and lower extremity neuropathy. The experimental group demonstrated a 37.89% slower mean brake response time (0.757 ± 0.180 versus 0.549 ± 0.076 second; p < .001), with abnormally delayed responses occurring at a greater frequency (57.5% versus 3.5%; p < .001). Independent of a comparative statistical analysis, the observed mean brake response time in the experimental group was slower than the reported safety brake response threshold of 0.70 second. The results of the present investigation provide original data with respect to abnormally delayed brake responses in diabetic patients with lower extremity neuropathy and might raise the potential for impaired driving function in this population.

Diabetic Driving Studies—Part 3: A Comparison of Mean Brake Response Time Between Neuropathic Diabetic Drivers With and Without Foot Pathology

We have previously demonstrated an abnormally delayed mean brake response time and an increased frequency of abnormally delayed brake responses in a group of neuropathic diabetic drivers compared with a control group of drivers with neither diabetes nor lower extremity neuropathy. The objective of the present case-control study was to compare the mean brake response time between neuropathic diabetic drivers with and without specific diabetic foot pathology. The braking performances of the participants were evaluated using a computerized driving simulator with specific measurement of the mean brake response time and the frequency of abnormally delayed brake responses. We analyzed a control group of 20 active drivers with type 2 diabetes, lower extremity neuropathy, and no history of diabetic foot pathology and an experimental group of 20 active drivers with type 2 diabetes, lower extremity neuropathy, and a history of diabetic foot pathology (ulceration, amputation, and/or Charcot neuroarthropathy) from an urban U.S. podiatric medical clinic. Neuropathic diabetic drivers without a history of specific foot pathology demonstrated an 11.11% slower mean brake response time (0.790 ± 0.223 versus 0.711 ± 0.135 second; p < .001), with abnormally delayed reactions occurring at a similar frequency (58.13% versus 48.13%; p = .0927). Both groups demonstrated a mean brake response time slower than a suggested threshold of 0.70 second. The results of the present investigation provide evidence that diabetic patients across a spectrum of lower extremity sensorimotor neuropathy and foot pathology demonstrate abnormal automobile brake responses and might be at risk of impaired driving function.

Diabetic Driving Studies—Part 2: A Comparison of Brake Response Time Between Drivers With Diabetes With and Without Lower Extremity Sensorimotor Neuropathy

We have previously demonstrated an abnormally delayed mean brake response time and an increased frequency of abnormally delayed brake responses in a group of neuropathic drivers with diabetes compared with a control group of drivers with neither diabetes nor lower extremity neuropathy. The objective of the present case-control study was to compare the mean brake response time between 2 groups of drivers with diabetes with and without lower extremity sensorimotor neuropathy. The braking performances of the participants were evaluated using a computerized driving simulator with specific measurement of the mean brake response time and the frequency of the abnormally delayed brake responses. We compared a control group of 25 active drivers with type 2 diabetes without lower extremity neuropathy and an experimental group of 25 active drivers with type 2 diabetes and lower extremity neuropathy from an urban U.S. podiatric medical clinic. The experimental group demonstrated an 11.49% slower mean brake response time (0.757 ± 0.180 versus 0.679 ± 0.120 second; p < .001), with abnormally delayed reactions occurring at a greater frequency (57.5% versus 35.0%; p < .001). Independent of a comparative statistical analysis, diabetic drivers with neuropathy demonstrated a mean brake response time slower than a suggested safety threshold of 0.70 second, and diabetic drivers without neuropathy demonstrated a mean brake response time faster than this threshold. The results of the present investigation provide evidence that the specific onset of lower extremity sensorimotor neuropathy associated with diabetes appears to impart a negative effect on automobile brake responses.

Detection of driver drowsiness using wearable devices: A feasibility study of the proximity sensor

BackgroundDrowsiness is one of the major factors that cause crashes in the transportation industry. Drowsiness detection systems can alert drowsy operators and potentially reduce the risk of crashes. In this study, a Google-Glass-based drowsiness detection system was developed and validated. MethodsThe proximity sensor of Google Glass was used to monitor eye blink frequency. A simulated driving study was carried out to validate the system. Driving performance and eye blinks were compared between the two states of alertness and drowsiness while driving. ResultsDrowsy drivers increased frequency of eye blinks, produced longer braking response time and increased lane deviation, compared to when they were alert. A threshold algorithm for proximity sensor can reliably detect eye blinks and proved the feasibility of using Google Glass to detect operator drowsiness. ApplicationsThis technology provides a new platform to detect operator drowsiness and has the potential to reduce drowsiness-related crashes in driving and aviation.

Emergency braking is affected by the use of cruise control

ABSTRACTObjective: We compared the differences in the braking response to vehicle collision between an active human emergency braking (control condition) and cruise control (CC) or adaptive cruise control (ACC).Methods: In 11 male subjects, age 22 to 67 years, we measured the active emergency braking response during manual driving using the accelerator pedal (control condition) or in condition mimicking CC or ACC. In both conditions, we measured the brake reaction time (BRT), delay to produce the peak braking force (PBD), total emergency braking response (BRT + PBD), and peak braking force (PBF). Electromyograms of leg and thigh muscles were recorded during braking. The tonic vibratory response (TVR), Hoffman reflex (HR), and M-waves were recorded in leg muscles to explore the change in sensorimotor control.Results: No difference in PBF, TVR amplitude, HR latency, and Hmax/Mmax ratio were found between the control and CC/ACC conditions. On the other hand, BRT and PBD were significantly lengthened in the CC/ACC condition (240 ± 13 ms and 704 ± 70 ms, respectively) compared to control (183 ± 7 ms and 568 ± 36 ms, respectively). BRT increased with the age of participants and the driving experience shortened PBD and increased PBF.Conclusions: In male subjects, driving in a CC/ACC condition significantly delays the active emergency braking response to vehicle collision. This could result from higher amplitude of leg motion in the CC/ACC condition and/or by the age-related changes in motor control. Car and truck drivers must take account of the significant increase in the braking distance in a CC/ACC condition.

Brake reactions of distracted drivers to pedestrian Forward Collision Warning systems

Introduction: Forward Collision Warning (FCW) can be effective in directing driver attention towards a conflict and thereby aid in preventing or mitigating collisions. FCW systems aiming at pedestrian protection have been introduced onto the market, yet an assessment of their safety benefits depends on the accurate modeling of driver reactions when the system is activated. This study contributes by quantifying brake reaction time and brake behavior (deceleration levels and jerk) to compare the effectiveness of an audio-visual warning only, an added haptic brake pulse warning, and an added Head-Up Display in reducing the frequency of collisions with pedestrians. Further, this study provides a detailed data set suited for the design of assessment methods for car-to-pedestrian FCW systems. Method: Brake response characteristics were measured for heavily distracted drivers who were subjected to a single FCW event in a high-fidelity driving simulator. The drivers maintained a self-regulated speed of 30km/h in an urban area, with gaze direction diverted from the forward roadway by a secondary task. Results: Collision rates and brake reaction times differed significantly across FCW settings. Brake pulse warnings resulted in the lowest number of collisions and the shortest brake reaction times (mean 0.8s, SD 0.29s). Brake jerk and deceleration were independent of warning type. Ninety percent of drivers exceeded a maximum deceleration of 3.6m/s2 and a jerk of 5.3m/s3. Conclusions: Brake pulse warning was the most effective FCW interface for preventing collisions. In addition, this study presents the data required for driver modeling for car-to-pedestrian FCW similar to Euro NCAP's 2015 car-to-car FCW assessment. Practical applications: Vehicle manufacturers should consider the introduction of brake pulse warnings to their FCW systems. Euro NCAP could introduce an assessment that quantifies the safety benefits of pedestrian FCW systems and thereby aid the proliferation of effective systems.

Evaluation of Brake Response Time Following Primary Achilles Tendon Repair Surgery

Category: Sports. Introduction/Purpose: Although surgical repair of Achilles tendon ruptures are common procedures, there are no studies investigating postoperative driving safety in these patients. Active contracture of the Gastroc-soleus-Achilles mechanism is required during a braking maneuver while driving. There is concern that these patients may be hesitant to rapidly apply braking pressure, putting themselves and others at potential risk. The purpose of this study was to evaluate postoperative brake response time (BRT) in right-sided Achilles rupture repair patients as a means to determine driving preparedness. BRT is defined as the time, in milliseconds, between presentation of a perceived hazardous stimulus and the application of pressure to the brake pedal in a driving simulator model. We hypothesized patients would demonstrate BRTs comparable to control subjects 6-week after repair. Methods: Following IRB approval, 50 right-sided acute primary Achilles rupture repair patients were prospectively identified and enrolled. All patients were managed with a standardized postoperative protocol. Exclusion criteria were age under 18, those not in possession of a valid driver’s license, those undergoing non standard open primary repair, and those declining to participate in the study. All patients were tested for their BRT utilizing a validated driving simulator at their 6-week postoperative follow-up appointment. Those patients that failed to achieve a safe brake response time less than 0.850 seconds were re-tested at weekly intervals until a safe breaking time was achieved. The passing brake response time of 0.850 seconds was determined from the published control data and from testing 20 healthy volunteers in the same simulator. At each testing, patients also filled out an AOFAS Ankle Hindfoot Scale, an Achilles Tendon Total Rupture Scale (ATRS) Questionnaire and a Driving Preparedness survey. Results: Each subject underwent 3 sequential drive-braking simulation tests, with their BRT being calculated as an average of the 3 times. At six weeks post repair the overall average BRT for all 50 patients was 0.658 seconds. 47 of the 50 patients (94%) demonstrated safe average BRT at their 6-week post operative testing of equal to or less than 0.850 seconds, with the remaining 3 patients achieving a safe BRT after 7 weeks. All 47 patients whose test demonstrated a safe BRT at 6 weeks responded in their survey that they “Agreed” or “Strongly Agreed” they were ready to drive at the time of testing. At six weeks post repair, the average AOFAS-AH score was 78.7/100, and the average ATRS score was 54.0. Conclusion: The present study revealed that 94% of primary right-sided acute Achilles tendon rupture repair patients were able to demonstrate a safe BRT comparable to those of healthy control subjects 6 weeks after their surgical procedure, and all by seven weeks following surgery. 100% of these patients also reported that after completing the test, they felt ready to return to driving. Therefore, we believe that it is reasonable to offer primary Achilles tendon repair patients an estimate of 6-weeks recovery time before driving.

Evaluation of Brake Response Time Following Primary Bunionectomy Surgery

Category: Bunion Introduction/Purpose: Although primary bunionectomies are among the most common procedures performed by Foot and Ankle surgeons, there are currently no studies investigating postoperative driving safety in this group of patients. The purpose of this study was to evaluate postoperative brake response time (BRT) in primary right-sided bunionectomy patients as a means to determine driving preparedness. Brake response time is defined as the time, in milliseconds, between presentation of a perceived hazardous stimulus and the application of pressure to the brake pedal. We hypothesized that primary bunionectmomy patients would demonstrate BRTs comparable to control subjects at their 6-week follow-up appointment. Methods: Following IRB approval, 45 primary right-sided bunionectomy patients were prospectively identified and enrolled. All patients were managed with the same postoperative protocols. Patients were excluded if they were under the age of 18, were not in possession of a current driver’s license, had undergone a revision surgery for recurrent hallux valgus, or opted not to partake in the study. All patients were tested for their BRT utilizing a validated driving simulator at their 6-week postoperative follow-up appointment. Those patients that failed to achieve a safe brake response time less than 0.850 seconds were re-tested at weekly intervals until a safe braking time was achieved. The passing brake response time of 0.850 seconds was determined from the published control data and from testing 20 healthy volunteers in the same simulator. At each BRT test, patients were also asked to fill out an AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale and a Driving Preparedness survey. Results: Each subject underwent 3 sequential drive-braking simulation tests, with their BRT being calculated as an average of the 3 times. At six weeks, the overall average BRT for all 45 patients was 0.769 seconds. 40 out of 45 patients (89%) demonstrated safe average BRT at their 6-week appointment of equal to or less than 0.850 seconds. 4 out of 45 patients (9%) were cleared to drive at their 7-week re-test, and 1 out of 45 patients (2%) was cleared to drive at an 8-week re-test. 37 of the 40 patients whose test demonstrated a safe BRT at 6 weeks responded in their survey that they “Agreed” or “Strongly Agreed” they were ready to drive at the time of testing. The average AOFAS-MT-IP score was 65.2/100. Conclusion: The present study revealed that approximately 90% of primary right-sided bunionectomy patients were able to demonstrate a BRT comparable to those of healthy control subjects at their 6-week post-op appointment. 37 of these 40 patients (93%) also reported that after completing the test, they felt ready to return to driving. Therefore, we believe that it is reasonable to offer bunionectomy patients an estimate of 6-weeks recovery time before driving.

A farewell to brake reaction times? Kinematics-dependent brake response in naturalistic rear-end emergencies

Driver braking behavior was analyzed using time-series recordings from naturalistic rear-end conflicts (116 crashes and 241 near-crashes), including events with and without visual distraction among drivers of cars, heavy trucks, and buses. A simple piecewise linear model could be successfully fitted, per event, to the observed driver decelerations, allowing a detailed elucidation of when drivers initiated braking and how they controlled it. Most notably, it was found that, across vehicle types, driver braking behavior was strongly dependent on the urgency of the given rear-end scenario⿿s kinematics, quantified in terms of visual looming of the lead vehicle on the driver⿿s retina. In contrast with previous suggestions of brake reaction times (BRTs) of 1.5s or more after onset of an unexpected hazard (e.g., brake light onset), it was found here that braking could be described as typically starting less than a second after the kinematic urgency reached certain threshold levels, with even faster reactions at higher urgencies. The rate at which drivers then increased their deceleration (towards a maximum) was also highly dependent on urgency. Probability distributions are provided that quantitatively capture these various patterns of kinematics-dependent behavioral response. Possible underlying mechanisms are suggested, including looming response thresholds and neural evidence accumulation. These accounts argue that a naturalistic braking response should not be thought of as a slow reaction to some single, researcher-defined ⿿hazard onset⿿, but instead as a relatively fast response to the visual looming cues that build up later on in the evolving traffic scenario.

Advanced driver assistance systems: Using multimodal redundant warnings to enhance road safety

This study investigated whether multimodal redundant warnings presented by advanced assistance systems reduce brake response times. Warnings presented by assistance systems are designed to assist drivers by informing them that evasive driving maneuvers are needed in order to avoid a potential accident. If these warnings are poorly designed, they may distract drivers, slow their responses, and reduce road safety. In two experiments, participants drove a simulated vehicle equipped with a forward collision avoidance system. Auditory, vibrotactile, and multimodal warnings were presented when the time to collision was shorter than five seconds. The effects of these warnings were investigated with participants performing a concurrent cell phone conversation (Exp. 1) or driving in high-density traffic (Exp. 2). Braking times and subjective workload were measured. Multimodal redundant warnings elicited faster braking reaction times. These warnings were found to be effective even when talking on a cell phone (Exp. 1) or driving in dense traffic (Exp. 2). Multimodal warnings produced higher ratings of urgency, but ratings of frustration did not increase compared to other warnings. Findings obtained in these two experiments are important given that faster braking responses may reduce the potential for a collision.

Consequences of simulated car driving at constant high speed on the sensorimotor control of leg muscles and the braking response.

Due to the increase in time spent seated in cars, there is a risk of fatigue of the leg muscles which adjust the force exerted on the accelerator pedal. Any change in their sensorimotor control could lengthen the response to emergency braking. Fourteen healthy male subjects (mean age: 42±4 years) were explored. Before and after a 1-h driving trial at 120km h-1 , we measured the braking response, the maximal leg extension and foot inversion forces, the tonic vibratory response (TVR) in gastrocnemius medialis (GM) and tibialis anterior (TA) muscles to explore the myotaticreflex, and the Hoffmann reflex (H-reflex). During driving, surface electromyograms (EMGs) of GM and TA were recorded and the ratio between high (H) andlow (L) EMG energies allowed to evaluate the recruitment of high- and low-frequency motor unit discharges. During driving, the H/L ratio decreased in TA, whereas modest and often no significant H/L changes occurred in GM muscle. After driving, the maximal foot inversion force decreased (-19%), while the leg extension force did not vary. Reduced TVR amplitude (-29%) was measured in TA, but no H-reflex changes were noted. The braking reaction time was not modified after the driving trial. Driving at constant elevated speed reduced the myotatic reflex and the recruitment of motor units in TA muscle. The corresponding changes were rarely present in the GM muscle that plays a key role in the braking response, and this could explain the absence of a reduced braking reaction time.

An analysis of collision avoidance manoeuvres in emergency traffic situations

This paper provides an overview of the research into the driver behaviour in simulated near collision situations. The aim of such investigations is to determine various parameters characterising the driver performance, e.g. driver response time. The driver response time is a very important parameter used, for example, to analyse road accidents. The results presented in this paper come from a study performed for two different emergency traffic situations using some predefined procedures (scenarios). The tests included situations in which a person driving a subject vehicle on a test track was to respond to obstacle mock-ups on a conflicting path (intrusion of a pedestrian from the left or from the right and intrusion of a vehicle from the right). The test data was used to determine the parameters describing the driver behaviour, i.e. the braking response time (braking manoeuvre), the steering response time (steering manoeuvre) and the intensity of the two manoeuvres. This paper compares the values of the driver response time for two scenarios, each with two variants. The average values of the braking response time and the steering response time were determined on a closed track in relation to the Time-To-Collision (TTC) in the range 0,6÷3s, characterising a near collision situation. Another parameter describing the driver behaviour discussed in this paper is the intensity of an avoidance manoeuvre. In the case of braking, the relative brake pedal displacement was analysed, while in the steering manoeuvre, the steering angle was taken into account. The average values of the braking displacement and the steering angle were presented in the function of the TTC. This paper looks at the relationship between the intensity of the driver response (braking, steering), the driver response time and the TTC.

Effect of hip braces on brake response time: Repeated measures designed study.

The question whether or not a patient with a hip brace should drive a car is of obvious importance because the advice given to patients to resume driving is often anecdotal as few scientific data are available on this specific subject. To assess driving ability (brake response time) with commonly used hip braces. Repeated measures design. Brake response time was assessed under six conditions: (1) without a brace (control), (2) with a typical postoperative hip brace with adjustable range of motion and the settings: unrestricted, (3) flexion limited to 70°, (4) extension blocked at 20° hip flexion, (5) both flexion and extension limited (20°/70°) and (6) an elastic hip bandage. Brake response time was assessed using a custom-made driving simulator as used in previous studies. The participants were a convenience sample of able-bodied participants. A total of 70 participants (35 women and 35 men) participated in our study. Mean age was 31.1 (standard deviation: 10.6; range: 21.7-66.4) years. A significant within-subject effect for brake response time was found ( p = 0.009), but subsequent post hoc analyses revealed no significant differences between control and the other settings. Based on our findings, it does not seem mandatory to recommend driving abstinence for patients wearing a hip orthosis. We suggest that our results be interpreted with caution, because (1) an underlying pathological hip condition needs to be considered, (2) the ability to drive a car safely is multifactorial and brake response time is only one component thereof and (3) brake response time measurements were performed only with healthy participants. Clinical relevance Hip braces are used in the context of joint-preserving and prosthetic surgery of the hip. Therefore, clinicians are confronted with the question whether to allow driving a car with the respective hip brace or not. Our data suggest that hip braces do not impair brake response time.

On-road Driving Performance of Patients With Bilateral Moderate and Advanced Glaucoma

To compare on-road driving performance of patients with moderate or advanced glaucoma to controls and evaluate factors associated with unsafe driving. Case-control pilot study. A consecutive sample of 21 patients with bilateral moderate or advanced glaucoma from Washington University, St Louis, Missouri and 38 community-dwelling controls were enrolled. Participants, aged 55-90 years, underwent a comprehensive clinical evaluation by a trained occupational therapist and an on-road driving evaluation by a masked driver rehabilitation specialist. Overall driving performance of pass vs marginal/fail and number of wheel and/or brake interventions were recorded. Fifty-two percent of glaucoma participants scored a marginal/fail compared to 21% of controls (odds ratio [OR], 4.1; 95% CI, 1.30-13.14; P= .02). Glaucoma participants had a higher risk of wheel interventions than controls (OR, 4.67; 95% CI, 1.03-21.17; P= .046). There were no differences detected between glaucoma participants who scored a pass vs marginal/fail for visual field mean deviation of the better (P= .62) or worse (P= .88) eye, binocular distance (P= .15) or near (P= .23) visual acuity, contrast sensitivity (P= .28), or glare (P= .88). However, glaucoma participants with a marginal/fail score performed worse on Trail Making Tests A (P= .03) and B (P= .05), right-sided Jamar grip strength (P= .02), Rapid Pace Walk (P= .03), Braking Response Time (P= .03), and identifying traffic signs (P= .05). Patients with bilateral moderate or advanced glaucoma are at risk for unsafe driving-particularly those with impairments on psychometric and mobility tests. A comprehensive clinical assessment and on-road driving evaluation is recommended to effectively evaluate driving safety of these patients.

The Effect of Variable Lower Extremity Immobilization Devices on Emergency Brake Response Driving Outcomes

INTRODUCTION AND OBJECTIVES: Immobilization devices such as surgical shoes and walking boots are commonly prescribed by podiatric physicians in the treatment of a variety of lower extremity pathologies and during the post-operative recovery period, but may have the potential to affect a patient’s ability to maintain a safe level of control over the accelerator and brake pedals while operating an automobile. The objective of this investigation was to assess driving outcomes in a group of healthy participants under variable foot wear conditions. METHODS: Following IRB approval, the braking performances of participants were evaluated with a computerized driving simulator. We assessed three driving outcomes (mean emergency brake response time, frequency of abnormally delayed braking responses, and frequency of inaccurate brake responses) under three variable footwear conditions (regular shoe gear, surgical shoe, and walking boot). RESULTS: We found that mean brake response times were abnormally delayed in the walking boot compared to both the regular shoe (0.736 seconds vs. 0.575 seconds, p &amp;lt; 0.001 seconds) and surgical shoe (0.736 seconds vs. 0.611 seconds, p &amp;lt; 0.001). We found that abnormally delayed brake responses occurred more frequently in the surgical shoe (18.5% vs. 2.5%, p &amp;lt; 0.001) and the walking boot (55.5% vs. 2.5%, p &amp;lt; 0.001) compared to the regular shoe. And we found that inaccurate brake responses occurred more frequently in the walking boot compared to both the surgical shoe (18.0% vs. 4.0%, p &amp;lt; 0.001) and the regular shoe (18.0% vs. 2.0%, p &amp;lt; 0.001). CONCLUSIONS: The results of these investigations provide podiatric physicians with a better understanding of how to assess the risk and how to appropriately advise their patients who have been prescribed lower extremity immobilization devices with respect to the safe operation of an automobile.

Driving ability after right-sided ankle arthroscopy—A prospective Study

IntroductionDue to the current lack of evidence the aim of this study was to investigate the driving ability after right-sided ankle arthroscopy. Materials and MethodsNineteen patients underwent right-sided ankle arthroscopy. Brake response time (BRT) was assessed preoperatively, 2 days, 2 weeks, 6 weeks, and 12 weeks postoperative. We also determined patients’ clinical outcome (AOFAS and AOS questionnaires) and their driving frequency. ResultsBRT was 606ms preoperatively and changed to 821ms 2 days postoperative (p<0.001). The further postoperative BRT course was 606ms (2 weeks), 596ms (6 weeks) and 603ms (12 weeks) (p=n.s.). In addition, a significant influence of the AOS and AOFAS scores on BRT was found, namely poorer clinical outcome also leads to a prolonged BRT (p<0.01 for both). BRT was significantly prolonged in patients with little driving frequency (p=0.001). Furthermore, the ‘time-by-driving interaction’ was significant (p=0.018), which means the BRT-peak on the second day was much lower in low-frequency drivers. ConclusionsFrom the findings made in the current study we conclude that a driving abstinence of two weeks is necessary following right-sided ankle arthroscopy. Greater driving frequency and good clinical outcome seem to be associated with better driving ability. However, for the time being no exceptions should be made from the above-mentioned recommendation on driving abstinence.