Driver Retraining Research Articles

Driving practice effects for older drivers with mild cognitive impairment: A preliminary study

Background Older drivers with mild cognitive impairment (MCI) often show declining driving performance. Evidence is lacking regarding whether their driving skills can be improved after practice. Aims/Objectives To compare the practice effects of older drivers with MCI and drivers with normal cognition in an unfamiliar, standardized driving course with three practices. Materials and Methods Single-blind two-group observational design. Twelve drivers with confirmed MCI as the experimental group and ten with normal cognition (NC) as the control, all ≥ 55 years old. The primary outcome was to assess the practice effects, measured with an in-car global-positioning-system mobile application to compare the speed and directional control of a complex manoeuvre after practices. Secondary outcomes were to assess the pass/fail rate and mistakes observed for the 3rd/final on-road driving practice. No instructions were given during practice. Descriptive statistics and the Mann–Whitney U test were used for data analysis. Results No significant inter-group difference in the pass/fail rate and number of mistakes. Some MCI drivers performed better in the speed and directional control of the S-Bend manoeuvre after practices. Conclusions The driving performance of drivers with MCI may improve with practice. Significance Older drivers with MCI may potentially benefit from driver retraining. Clinical Trial Registration ClinicalTrials.gov (Identifier: NCT04648735).

Identifying current driver rehabilitation practices for clients with physical impairments

Introduction Driving is an important occupation that influences a person’s ability to access community resources and participate in meaningful activities. Occupational therapists and other clinicians who are trained as driver rehabilitation specialists provide interventions to improve function and independence in driving. The objective of this study was to examine consistency of adaptive driving equipment prescription and driver retraining recommendations for clients with physical impairment and identify factors that influence driver rehabilitation recommendations. Methods Clinicians practicing in Canada and the United States were surveyed electronically. Data were analyzed using descriptive statistics and content analysis. Results Out of 36 respondents, the majority (97.2%) were occupational therapists. Completion of in-clinic (97.0%) and on-road (84.4%) evaluations were consistent among the majority of respondents, yet components comprising evaluations varied. Fewer respondents were in agreement in equipment recommendations for secondary controls. Respondents emphasized the importance of clinical reasoning skills when making equipment and intervention recommendations. Conclusion Further development of clinical guidelines and advanced training in driver rehabilitation may be beneficial to facilitate clinical reasoning and improve consistency of practice.

Evaluation of a collision-involved driver improvement scheme

PurposeThe purpose of this study is to compare driver knowledge, attitudes and perceptions (in terms of hazard, risk, accident, offence detection and driving skill perceptions) and self-reported driving style in a sample of 461 drivers before and after attending a UK driver improvement scheme for culpable collision-involved drivers, to inform future directions in the design of driver retraining programmes.Design/methodology/approachParticipants were a sample of 461 drivers attending a UK 1.5 day driver improvement scheme course for culpable collision-involved drivers. The course contained classroom-based training and a practical driving component. Participants completed a driver improvement scheme questionnaire before and immediately after attending the 1.5-day course and again 3 months later.FindingsResults indicated significant pre- and post-course effects in terms of increased driving safety with respect to driving knowledge, perceptions of control, perceived likelihood of accident-involvement, hazard perception and reported risk-taking. Key positive effects of reduced risk-taking and near-misses persisted three months after course completion.Research limitations/implicationsOne limitation of this study is that at the 3-month follow-up there was a reduction in the response rate (44.69%) which included significantly fewer young drivers.Practical implicationsResults indicate positive behavioural, perceptual and behavioural changes, along with specific age, gender and driving experience effects which have implications for the design of future driving courses.Social implicationsThis study has implications for community safety through enhanced road safety training measures.Originality/valueThe analysis of age, gender and driving experience effects of the impact of this driver improvement scheme will allow targeted training methods for specific groups of drivers.

A Study for Elderly Driver Retraining Using Real-time Safety Advice System

A Study for Elderly Driver Retraining Using Real-time Safety Advice System

Addressing the road trauma burden in China: Exploring attitudes, behaviours, risk perceptions and cultural uniqueness

As China continues to motorise rapidly, solutions are needed to reduce the burden of road trauma that is spread inequitably across the community. Little is currently known about how new drivers are trained to deal with on-road challenges, and little is also known about the perceptions, behaviours and attitudes of road users in China. This paper reports on a pilot study conducted in a driver retraining facility in one Chinese city where people who have had their licence suspended for accrual of 12 demerit points in a one year period must attend compulsory retraining in order to regain their licence. A sample of 239 suspended drivers responded to an anonymous questionnaire that sought information about preferred driving speeds and perceptions of safe driving speeds across two speed zones. Responses indicated that speeds higher than the posted limits were commonly reported, and that there was incongruence between preferred and safe speeds, such that a greater proportion of drivers reported preferred speeds that were substantially faster than what were reported as safe speeds. Participants with more driving experience reported significantly fewer crashes than newly licensed drivers (less than 2 years licensed) but no differences were found in offences when compared across groups with different levels of driving experience. Perceptions of risky behaviours were assessed by asking participants to describe what they considered to be the most dangerous on-road behaviours. Speeding and drink driving were the most commonly reported by far, followed by issues such as fatigue, ignoring traffic rules, not obeying traffic rules, phone use while driving, and non-use of seatbelts, which attracted an extremely low response which seems consistent with previously reported low belt wearing rates, unfavourable attitudes towards seatbelt use, and low levels of enforcement. Finally, observations about culturally specific considerations are made from previous research conducted by the authors and others. Specifically, issues of saving face and the importance and pervasiveness of social networks and social influence are discussed with particular regard to how any future countermeasures need to be informed by a thorough understanding of Chinese customs and culture.

Driving after traumatic brain injury: evaluation and rehabilitation interventions.

The ability to return to driving is a common goal for individuals who have sustained a traumatic brain injury. However, specific and empirically validated guidelines for clinicians who make the return-to-drive decision are sparse. In this article, we attempt to integrate previous findings on driving after brain injury and detail the cognitive, motor, and sensory factors necessary for safe driving that may be affected by brain injury. Various forms of evaluation (both in clinic and behind-the-wheel) are discussed, as well as driver retraining and modifications that may be necessary.

Elderly driver retraining using automatic evaluation system of safe driving skill

In Japan, although the rapid aging of the population has caused serious traffic problems, only a few studies have investigated the behaviour of elderly drivers in real traffic conditions. The authors have been developing a system to automatically evaluate safe-driving skill through small wireless wearable sensors that directly measure the driver's behaviour. The authors aim is to promote safe driving by providing a personalised training program according to the individual's own shortcomings in driving behaviour. By employing the sensors together with GPS and driving instructors' knowledge, our system can automatically identify shortcomings in driving skill with an accuracy of over 80%. In February 2010, the Kyoto Prefecture Public Safety Commission, in Japan, certified our system as the first and only support tool for its `mandatory retraining course for elderly drivers' that all elderly drivers, aged over 70 years, are required to take when renewing their driver's license. In this study, the authors discuss the effectiveness of our system and investigate elderly drivers' behaviour through a large-scale demonstration experiment, involving 749 elderly drivers, in the mandatory driver-retraining course on public roads. The authors results reveal that although elderly drivers are able to maintain a safe vehicle speed, their tendency to not scan around their vehicle to ensure safety makes their driving risky.

The Long-Term Effects of Active Training Strategies on Improving Older Drivers’ Scanning in Intersections

To determine the long-term effects of active training on older drivers' scanning in intersections, the present article reports the results of a 2-year followup with drivers who had previously participated the older driver training study reported in Romoser and Fisher. Customized feedback coupled with active learning in a simulator has been shown to be an effective means of significantly improving the intersection scanning behavior of older drivers. However, the long-term effect of such training has not been established. Older drivers from the active learning and control groups from Romoser and Fisher were invited to participate in a 2-year follow-up field drive in their own vehicle starting at their home. Secondary looks, defined as looking away from the path of the vehicle while entering the intersections toward regions to the side from which other vehicles could appear, were recorded. Two years after their training, older drivers in the active learning group still took secondary looks more than one and a half times as often as 2009 pretraining levels. Control group drivers saw no significant change in performance over the 2-year period. Customized feedback and active learning in a simulator is an effective strategy for improving the safe driving habits of older drivers over the long term. It provides drivers a means by which to reincorporate previously extinguished behaviors into their driving habits. These results can guide the development of older driver retraining programs that could have the potential to reduce intersection crashes.

Using virtual reality driving simulators in persons with spinal cord injury: three screen display versus head mounted display

Purpose: Virtual reality (VR) is a relatively new technology that is currently utilized in a wide variety of settings to test and train individuals in specialized skills. This study examines methods for improving driver retraining protocols for persons with spinal cord injury (SCI). Method: We compared a VR driving simulator, under two different display conditions, a head mounted display (HMD) and a three screen display (TSD) to identify the best method for retraining driving skills following SCI. Results: Although there was minimal evidence for driving performance difficulties in the HMD condition relative to the TSD condition (e.g. greater number of times for being off course and longer stopping latencies for the HMD condition), rates of simulator sickness did not differ between display conditions. Conclusions: Taken together, findings suggest that both the HMD and the TSD are reasonable simulator options for driver retraining in SCI.Implications for RehabilitationVirtual reality (VR) may be a useful tool for improving driver retraining for persons with spinal cord injury (SCI).Both head mounted display (HMD) and three screen display (TSD) virtual reality systems are reasonable simulator options for driver retraining in SCI.

Emerging evidence that older driver retraining can improve knowledge and on‐road driving skills

Emerging evidence that older driver retraining can improve knowledge and on‐road driving skills

Access and participation in the community: a prospective qualitative study of driving post-stroke

Purpose: Loss of role as a driver significantly affects community participation; therefore, we aimed to explore the impact of driving issues post-stroke in community-dwelling stroke survivors. Methods: A longitudinal qualitative study of community-dwelling stroke survivors, using semi-structured interviews. Results: Twenty-two participants took part in 84 interviews over a 1-year period post-stroke. The majority of participants was independent and experienced few major depressive symptoms. ages ranged from 50 to 92 years. Emergent key themes included impact on quality of life, personal impacts, change to role performance and knowledge. Participants received inconsistent advice regarding return to driving. Confidence and availability determined public transport use. Conclusions: Driving advice should be standard practice prior to discharge. Allied health professionals can play an essential role in interventions addressing community participation, driver re-training and alternative transport use. Therapists have an important role in assisting stroke survivors to work through feelings of loss and in providing education concerning new skills to support this life transition.Implications for RehabilitationIssues regarding driving are of major importance to stroke survivors.Allied health professionals can play a significant role in providing education and training regarding return to driving and alternate transport options.Allied health professionals have an important role in assisting stroke survivors to transition to a life without driving by working through feelings of loss and by providing education concerning new skills to support this life transition.

Driving Poststroke: Problem Identification, Assessment Use, and Interventions Offered by Canadian Occupational Therapists

Background and Purpose: Driving is a key factor in maintaining autonomy and participation in life. Occupational therapists (OTs) are expected to assess individuals who want to resume driving post stroke and to provide retraining where appropriate. Research from the 1980s and 1990s indicated that patients were, for the most part, not being assessed and retrained. However, little is known about current practice management. Thus, this study examined clinicians’ management of driving-related issues when treating clients with stroke. Methods: We performed a Canadawide telephone survey of 480 OTs providing stroke rehabilitation in both inpatient rehabilitation and community-based settings. Clinicians reported on problems they noted and assessments and interventions they would provide for a “typical patient” described in a vignette that matched their work setting. Results: 20% and 34% of clinicians responding to the inpatient rehabilitation and community-based vignettes, respectively, identified return to driving as a problem. Clinician and work environment variables significantly associated (P < .01) with identifying driving as a potential problem included being male, involvement in university teaching, research conducted in setting, and hosting student placements. The use of driving-specific assessments was under 12%. Less than 6% of clinicians offered driving retraining, and their desired use of retraining was low. Conclusion: Few clinicians identified driving as a problem post stoke, raising concern that patients attempt to drive on their own or never resume driving because of a lack of attention to driving during their rehabilitation. Poststroke driver assessment and retraining is a critical component of poststroke community reintegration that requires greater awareness by clinicians.

The Risk of Motor Vehicle Crashes and Traffic Citations Post Stroke: A Structured Review

Background: Stroke impacts the domains known to be important for driving and is a primary condition for driving evaluation referrals. Given the high prevalence of stroke, the objective was to summarize the evidence regarding risk of crashes and traffic citations post stroke. Methods: A structured review of six databases was conducted to retrieve studies that included stroke as a separate exposure from other disorders and measured crashes or traffic citations as an outcome. Results: Four cohort and three case-control studies met the inclusion criteria. Five of the seven studies found increased odds or risk ratios ranging from 1.9 to 7.7, while two found an association of 0.8. Only one result was statistically significant (RR = 2.7). One study examined the outcome traffic citations and found no significant association. Conclusion: There is cause for concern regarding increased risk of crashes post stroke. Future studies that examine the impact of stroke severity and sequelae will help health professionals, families, and those with stroke make informed decisions regarding driving post stroke. This review indicates that drivers with stroke have an increased risk of crashing compared to their counterparts without stroke, as demonstrated by increased risk estimates in five out of the seven studies that have examined this issue. This review also points to an urgent need for rigorous studies investigating the risk of crashes according to specific stroke sequelae: an understanding of crash risk based on stroke severity, impairments, and function will assist clinicians in making informed decisions regarding the need for comprehensive driving evaluation and the potential for driver retraining for specific subgroups.

Evaluability Assessment of a National Driver Retraining Program: Are We Evaluating in the Right Lane?

Abstract: An evaluability assessment (EA) of the 55 Alive program, a national older driver refresher course aimed at improving driving skills, was conducted. This EA adds to the evaluation literature as previous outcome evaluations neglected to explore whether this program was prepared for such assessments. A mixed-method protocol was executed across three community sites. Based on the results of this EA, several suggestions for future evaluations are discussed: (a) sampling all stakeholder levels for a more holistic snapshot of the program, (b) using EA to facilitate stakeholders’ engagement in the evaluation, and (c) incorporating scientists specializing in the area within the evaluation.

On-road Evaluation: Its Use for the Identification of Impairment and Remediation of Older Drivers

ABSTRACTOn-road assessment is an essential component of a comprehensive older driver evaluation. However, based on a systematic review of the older driver literature, it appears that the importance of specific elements within an on-road assessment differs depending on the following intended purpose of the evaluation: (a) the detection of impaired drivers; or (b) driver retraining. Moreover, driving rehabilitation specialists identify additional components as important. Directions for future research include the design of an on-road evaluation protocol that incorporates retraining as an integral part of the evaluation process. Through this approach, it may become clear which driving behaviors are amenable to retraining.

Older driver retraining: An updated systematic review of evidence of effectiveness

Problem and Objective The number of older drivers who might benefit from driver retraining is growing. A previous review on the effectiveness of older driver retraining included intervention studies up to 2004. The objective was to perform an updated systematic review of the effectiveness of older driver retraining for improving driving-related skills and reducing crash rates. Method Articles published from 2004-2008 were grouped according to the intervention provided and outcome studied. Randomized clinical trials (RCTs) were appraised using the Physiotherapy Evidence Database (PEDro) Scale and scored for quality according to their internal validity. Each intervention's effectiveness was then rated and assigned a level of evidence by combining pre- and post- 2004 findings. Results Three RCTs and one matched-pairs cohort design met the inclusion criteria. There is strong evidence (Level 1a) that education combined with on-road training improves driving performance and moderate evidence (Level 1b) that it improves knowledge. There is moderate evidence (Level 1b) that physical retraining improves driving performance. There is moderate evidence (Level 1b) that an educational intervention curriculum alone is not effective in reducing crashes. Summary The updated evidence on the effectiveness of retraining aimed at older drivers is sufficiently encouraging to merit assertive health promotion actions regarding intervention and program planning. Impact on Industry These positive findings warrant a comprehensive plan that has both behavioral and monetary incentives encouraging older driver participation in programs aimed at driver safety.

Older driver retraining: A systematic review of evidence of effectiveness

Problem The safety of older drivers is of growing concern as fatal crashes in this group increase annually. The objective was to systematically and critically appraise the evidence on effectiveness of older driver retraining. Method Articles were grouped according to the intervention studied: physical retraining, visual perception, or education. Randomized trials were appraised using the Physiotherapy Evidence Database (PEDro) Scale and interpreted following Foley's quality assessment. Each intervention was then rated for effectiveness based on Sackett's levels of evidence. Results Six RCTs, one pre-post-study design, and one descriptive study met the inclusion criteria, one investigating physical retraining, one a visual perception intervention, five using an educational intervention, and one examining a combination of all three, in addition to traffic engineering improvements. There is limited evidence that physical retraining (Level 2a) and visual perception retraining (Level 2a) improve driving related skills in older drivers. There is moderate evidence that educational interventions improve driving awareness and driving behavior (Level 1a), but do not reduce crashes (Level 1b) in older drivers. Summary The current evidence on the effectiveness of retraining aimed at older drivers is limited but sufficiently encouraging to merit further research. Impact on Industry Given the potential cost savings to the insurance and health care industries, as well as the safety impact to the general population, the research agenda in this area requires much greater attention.

Recent Trends in Road Traffic Accident Parameters in Nigeria

This study aims at examining the nature of the rising trends in road traffic accident phenomenon in Nigeria, using data for the period 1990 1995. It examines the spatiotemporal variations of road traffic accident parameters, in addition to studying the fatality (severity) and injury indices as well as the health risk for each state, and the country in general. The paper observes a downward trend in all road traffic accident parameters, with fatal and serious cases declining as much as 33% and 24% respectively, although, the number of person killed during the period experienced an increase. Regionally, the performance varied among the states of the country, with Lagos, Ogun, Niger, Edo, Kano, Kogi, Delta, Jigawa, Sokoto, Cross River States and Abuja (Federal Capital Territory) recording high trends in all cases. These states thus need some more attention from all the agents of road safety in the country. The study concludes that, in addition to the behavioural modification approach which has not been emphasized enough, a lot more still needs to be done in such areas as maintenance of road transport infrastructure, vehicle road worthiness inspection, driver retraining and potential driver training, pedestrian education proper accident data collection, recording, storage and retrieval and finally law enforcement.

Elderly Driver Retraining

This report documents a study of the traffic safety problems associated with drivers. For the purposes of this study, elderly are defined as drivers aged 55 years or older. The study involved five major activities. First, research was reviewed to determine what factors (e.g., deficiencies of performance, health, and knowledge) are most strongly related to the aging process and the accident experience of older drivers. Second, 20 driver education courses made available to older drivers were reviewed to determine what had been and was being done to address these problems. Third, an eight-hour program designed specifically for older drivers by National Retired Teachers Association/American Association of Retired Persons was evaluated. The evaluation design allowed project staff to collect data bearing on subjects personal characteristics, vehicle use patterns, driving problems, and crash and conviction histories. Analysis indicated that the program was effective in increasing subject knowledge. No significant effect on accident rate was found, though the small sample size would allow a modest but significant effect to go undetected. Crash experience did appear to be a function of exposure and medical problems. On the basis of information gained through these three activities, an older driver instructional manual--suitable for distribution by a variety of agencies serving the older community--was developed. Also developed was a set of recommendations to guide the development, content, and instruction approach taken in future programs for older driver retraining.

Current and Future Research Activities in Driver Training

Research programs involving high school driver education, motorcyclist safety education, problem driver retraining, elderly driver retraining, handicapped driver training, commercial vehicle driver training, and an energy efficient driver training program are summarized. Some of the pros and cons of driver education are presented and problems with establishing valid on-the-road driver performance tests are discussed.