Driving-related Skills Research Articles

The Effects of β-myrcene on Simulated Driving and Divided Attention: A Double-Blind, Placebo-Controlled, Crossover Pilot Study.

β-myrcene, one of the most common terpenes found in cannabis, has been associated with sedation. We propose that β-myrcene contributes to driving impairment even in the absence of cannabinoids. To conduct a double-blind, placebo-controlled crossover pilot study of the effect of β- myrcene on performance on a driving simulator. A small sample (n=10) of participants attended two experimental sessions, one in which they were randomized to receive 15 mg of pure β-myrcene in a capsule versus a canola oil control. Each session, participants completed a baseline block and three follow-up blocks on a STISIM driving simulator. β-myrcene was associated with statistically significant reductions in speed control and increased errors on a divided attention task. Other measures did not approach statistical significance but fit the pattern of results consistent with the hypothesis that β-myrcene impairs simulated driving. This pilot study produced proof-of-principle evidence that the terpene β-myrcene, an agent commonly found in cannabis, can contributes to impairment of driving-related skills. Understanding how compounds other than THC affect driving risk will strengthen the field's understanding of drugged driving.

Motor Training After Stroke: A Novel Approach for Driving Rehabilitation.

BackgroundA key component of safe driving is a well-timed braking performance. Stroke-related decline in motor and cognitive processes slows braking response and puts individuals with stroke at a higher risk for car crashes. Although the impact of cognitive training on driving has been extensively investigated, the influence of motor interventions and their effectiveness in enhancing specific driving-related skills after stroke remains less understood. We compare the effectiveness of two motor interventions (force-control vs. strength training) to facilitate braking, an essential skill for safe driving.MethodsTwenty-two stroke survivors were randomized to force-control training or strength training. Before and after training, participants performed a braking task during car-following in a driving simulator. We quantified the cognitive and motor components of the braking task with cognitive processing time and movement execution time.ResultsThe cognitive processing time did not change for either training group. In contrast, the movement execution became significantly faster (14%) following force-control training but not strength training. In addition, task-specific effects of training were found in each group. The force-control group showed improved accuracy and steadiness of ankle movements, whereas the strength training group showed increased dorsiflexion strength following training.ConclusionMotor intervention that trains ankle force control in stroke survivors improves the speed of movement execution during braking. Driving rehabilitation after stroke might benefit from incorporating force-control training to enhance the movement speed for a well-timed braking response.

Utilizing driving simulators for persons with multiple sclerosis: A scoping review

ObjectiveThis scoping review synopsized and mapped the evidence on the utility of driving simulators for drivers with Multiple Sclerosis (MS) including participant characteristics (e.g., demographic, clinical) suited to simulator use; and driving scenario environments, maneuvers, and outcomes reflective of driving performance. Data SourcesThe research team searched six databases for English studies on driving simulator performance in drivers with MS. Study SelectionFour reviewers independently screened 976 unique titles, 148 abstracts, and 18 full-text sources for study inclusion or exclusion. Inclusion criteria ensured that studies utilized measures of driving simulator performance in adults 18 years or older with MS. Data ExtractionReviewers independently charted, verified, and achieved consensus on 100% of the data in the extraction table. Data SynthesisThe scoping review included thirteen studies (twelve assessment, one intervention), published between 2001 and 2021. Studies included small samples (N = 11–50) of adults (M age = 36–50 years; 40–91% female), mostly with a relapsing-remitting (53–100%) diagnosis and low to moderate physical disability (Expanded Disability Status Scale score < 6.0). The assessment studies utilized driving scenarios to assess pre-driving (n = 1) or driving abilities (n = 2), responses to hazardous events in suburban (n = 1) or urban environments (n = 4), or the ability to maintain speed or lateral lane positioning during monotonous highway drives (n = 7), with four scenarios also including responses to secondary divided attention tasks. The intervention study utilized driving simulation as a training program to improve driving-related skills. ConclusionsThe evidence on the utility of driving simulators for adults with MS is limited to assessment of driving performance, mostly during monotonous highway drives. Further research should consider exploring how driving simulators can be utilized to assess driving performance in other environments or for intervention. Gender should be examined to support gender diverse populations.

Effects of Mixing Energy Drinks With Alcohol on Driving-Related Skills.

BackgroundEnergy drinks (EDs) reduce sleepiness and fatigue and improve driving performance whereas alcohol does just the opposite. Although it is a trendy combination among young people, the effects of alcohol mixed with EDs on driving performance have been poorly studied. The aim was to assess if there is an interaction between the effects of both drinks on driving-related skills as well as perceptions about driving ability.MethodsWe conducted a randomized, double-blind, and placebo-controlled 4-way crossover clinical trial. Participants were 16 healthy volunteers. Interventions of 60 g of ethanol and 750 mL of Red Bull (RB) were administered in 2 separated doses. Conditions were alcohol + RB placebo, alcohol + RB, alcohol placebo + RB, and both placebos. Objective performance was assessed using a tracking test and simple reaction time, N-Back, and movement estimation tasks. Additionally, willingness to drive, other subjective effects, and ethanol and caffeine blood concentrations were also measured.ResultsAlcohol increased the time outside the road in the tracking test and increased simple reaction time, but the addition of RB had no main or interaction effects on performance. Nonetheless, driving-related skills after alcohol + RB were better than after alcohol alone. Willingness to drive increased with the combination of drinks. RB also reduced alcohol-induced sedation whereas drunkenness did not change. These effects were seen even though alcohol + RB increased alcohol (14.8%) and caffeine plasma concentrations (17.6%).ConclusionsMixing EDs with alcohol predisposes consumers to drive under alcohol influence, perhaps in part because EDs counteract its detrimental effects on driving-related skills. Clinicaltrials.gov: NCT02771587.

The Combined Effects of Alcohol and Benzodiazepines on Driving-Related Neurocognitive Skills: A Systematic Review

Research concerning the combined effects of alcohol and benzodiazepines on driving-related skills is largely inconsistent. Because as many as 88% of benzodiazepine users report the additional consumption of alcohol, this review aims to provide an updated and concise synthesis of the available high-quality research. We searched EBSCOhost, PubMed, Scopus, and Web of Science until April 1, 2020, for double-blind, placebo-controlled, repeated-measures intervention trials that examined the effects of alcohol (any dose provided as blood alcohol concentration [BAC]) in combination with oral benzodiazepines on neurocognitive tasks related to driving. We identified evidence of a substance and timing-dependent interaction for measures of reaction time, tracking, divided attention, and visual functioning. Administering alcohol in conjunction with or shortly after a benzodiazepine resulted in a stronger interactive effect than when administration occurred further apart. An additive and/or synergistic effect often occurred when a therapeutic dose of benzodiazepine was combined with alcohol at a BAC below .05%. Combined alcohol and benzodiazepine use was associated with significant impairments in driving-related neurocognitive skills. There is a clear need for more high-quality research in this area to better elucidate the mechanisms of alcohol and benzodiazepine interactions. Drivers may be unaware of impairments following the combination of these drugs at legal driving limits. Thus, drivers should be warned to take caution when consuming even small amounts of alcohol while under treatment with benzodiazepines.

The effects of alcohol intoxication on cognitive functions critical for driving: A systematic review

Alcohol is the most frequently detected substance in drivers involved in road traffic collisions. Given that up to 35% of fatal road collisions are alcohol-related, it is important to determine the influence of alcohol intoxication on driving-related skills. This review provides an updated and systematic evaluation of the available research concerning the effect of alcohol intoxication on cognitive functions critical for driving. Databases EBSCOhost, PsycInfo, PubMed, Scopus, Transport Research International Documentation (TRID) and Web of Science were searched for controlled trials examining the effect of alcohol on divided attention, executive functioning, perception, psychomotor skills, reaction time and/or vigilance. Fourteen studies met the inclusion criteria and were included in this review. We found that each of the cognitive domains assessed in this review showed impairment at blood alcohol concentrations equal to or below the legal driving limit in many jurisdictions. Future research could determine the effects of alcohol on cognitive functioning with greater accuracy by employing more consistent, reliable and comparable measures while considering the translation of deficits to real-life driving.

Cognitive and Physical Factors Affecting High-Speed Driving Ability in Older Adults

Background and Purpose: The ability to drive is important for the elderly to maintain their mobility and independence. Therefore, to investigate age-related changes in driving-related functions and their relation to the braking ability of drivers driving at high speeds, subjects were organized by age into study groups (younger, middle-aged, and older). Methods: For a correlational comparative study, 36 male participants were recruited and instructed to complete the Assessment of Driving-Related Skills (ADReS), lower limbs muscle test, and driving tasks on a driving simulator under 3 speed conditions. For the driving tasks, 3 event phases were analyzed: perception-reaction time (PRT), brake-movement time, and fast pressing time. Results: Older drivers demonstrated a significant decline in certain driving-related cognitive and motor abilities, as well as hip flexion and knee extension muscle strength, and exhibited a significantly longer PRT under moderate- and high-speed conditions compared with younger drivers. A longer PRT under moderate- and high-speed conditions was significantly associated with poor driving-related cognitive and motor abilities. Conclusion: The increased PRT for older drivers under moderate- and high-speed conditions might increase their risk of vehicular accidents on highways.

Neuroanatomical variations as a function of experience in a complex daily task: A VBM and DTI study on driving experience

Complex tasks require the learning and integration of multiple cognitive, sensory, and psychomotor skills for correct execution. Driving-related skills are developed step by step through the increase of mileage driven and the accumulation of practice in different traffic situations. The acquisition of these skills should be reflected in the brain structure. However, no previous studies have explored brain structural variations associated with driving experience. The aim of the present study was to investigate whether driving frequency, defined as average annual driving mileage, is related to neuroanatomical variations in gray matter (GM) volume and white matter (WM) integrity using voxel-based morphometry (VBM) and DTI-based fractional anisotropy (FA), respectively. We recruited 83 drivers with variable range of annual driving mileage and controlled for age, sex, handedness, IQ, time since the acquisition of driving license, use of motorcycles/mopeds and bicycles, perceived driving skills, and subjective probability of having an accident. Our results showed variations in white matter FA as a function of mileage driven. Driving experience was related to a significant increase of FA in parts of the right hemisphere superior and inferior longitudinal fasciculus, anterior thalamic radiation, forceps majors, inferior fronto-occipital fasciculus, and corticospinal tract. No significant differences were observed in gray matter volumes. FA variations were found in brain regions that have been associated with cognitive, visual, and motor processes necessary for skilled performance in driving. These results suggest that variations in white matter diffusivity can underlie the development of driving skills and safer driving.

Ethical Challenges in Geriatric Psychiatry.

Ethical Challenges in Geriatric Psychiatry.

What clinical tools can help assess the ability of elderly patients to drive safely?

Evidence-Based Answer Several tools may help a clinician assess the safety of elderly drivers. These include the Assessment of Driving-Related Skills (ADReS), DriveABLE, and the Clinical Dementia Rating (CDR) scale. Unfortunately, all of them have substantial limitations, making them only marginally useful in the clinical setting (SOR: B, cohort studies).

Acute effects of cannabis on young drivers’ performance of driving-related skills

Impaired driving is a major source of preventable death in Canada, especially among young adults. Although the effects of alcohol on driving are well known, the impact of driving under the influence of cannabis has not been studied as thoroughly. This human laboratory study examines the impact of an acute dose of smoked cannabis on driving-related skills among young drivers who use cannabis regularly. Participants were weekly smokers between the ages of 19 and 25 years who have had an Ontario class G or G2 license for at least twelve months. Measures of driving simulator performance, cognition, mood, and motor skills were collected before and after a single dose of smoked cannabis containing 12.5% a 9- tetrahydrocannabinol (a 9-THC). Although the data presented are based on an interim analysis of an ongoing study, some measures of subjective drug effects, objective physical measures, and driving simulator performance were found to be significantly altered after drug administration.%%%%M.Sc.

Preliminary report on the residual effects of cannabis on young drivers’ performance of driving-related skills

Preliminary report on the residual effects of cannabis on young drivers’ performance of driving-related skills

On-the-road driving performance and driving-related skills in older untreated insomnia patients and chronic users of hypnotics

RationaleMany older adults report sleep problems and use of hypnotics. Several studies have shown that hypnotics can have acute adverse effects on driving the next morning. It is unclear however whether driving of chronic hypnotic users is impaired. Therapeutic effects on insomnia and development of tolerance may reduce the residual effects on driving.ObjectivesThe present study aimed to compare actual driving performance and driving-related skills of chronic hypnotic users to good sleepers. To determine whether insomnia itself affects driving performance, driving and driving-related skills were compared between insomnia patients who do not or infrequently use hypnotics and good sleepers.MethodsTwenty-two frequent users of hypnotics (using hypnotics ≥4 nights per week for more than 3 months), 20 infrequent users (using hypnotics ≤3 nights per week), and 21 healthy, age-matched controls participated in this study. On the night before testing, all subjects were hospitalized for an 8-h sleep recorded by polysomnography. Frequent hypnotic users used their regular medication at bedtime (2330 hours), while infrequent users and controls received no medication. Cognitive performance (word learning, digit span, tracking, divided attention, vigilance, and inhibitory control) was assessed 8.5 h and driving performance between 10 and 11 h after bedtime and dosing.ResultsPolysomnographic recordings did not significantly differ between the groups, but the insomnia patients, treated or untreated, still reported subjective sleep complaints. Results show no differences in driving performance and driving-related skills between both groups of insomnia patients and controls.ConclusionsDriving performance in chronic users of hypnotics and untreated insomnia patients is not impaired. For chronic users, this may be due to prescription of relatively safe drugs and low doses. For untreated insomniacs, this corroborates previous findings showing an absence of neuropsychological deficits in this group of patients.

Improvement of Driving Skills in Persons With Relapsing-Remitting Multiple Sclerosis: A Pilot Study

ObjectiveTo determine the potential to improve driving-related skills using a simulator-based program in persons with relapsing-remitting multiple sclerosis (RRMS). DesignPre-post intervention. SettingA university driving simulator laboratory. ParticipantsParticipants (N=50) with RRMS and Expanded Disability Status Scale (EDSS) scores between 1 and 7 were enrolled. Pre- and posttraining data from 36 participants (mean age ± SD, 46±11y; 30 women) who received training and 6 participants (mean age ± SD, 48±13y; 5 women) who did not receive training (control group) were compared. InterventionsFive hours of driving training in a simulator. Main Outcome MeasuresPerformance on a road test at pre- and posttraining. Secondary outcome measures were performance on visual, physical, and cognitive tests. ResultsOverall, no significant differences were observed between the training and control groups before and after training. However, 4 of the 7 participants in the training group who failed the road test at pretraining passed posttraining, while the only participant in the control group who failed at pretraining still failed at posttraining. The training group also improved on perception of red and colored numbers, the Paced Auditory Serial Addition Test, and the dot cancellation test of the Stroke Driver Screening Assessment battery and reported less fatigue. These improvements were most pronounced among those with an EDSS score between 3 and 7. ConclusionsThis pilot study demonstrates the potential of using a simulator to improve driving-related visual, cognitive, and on-road skills in individuals with RRMS, particularly those with an EDSS score >3. Future randomized controlled trials with adequate power are needed to expand this field of study.

Assessment of Driving‐Related Skills Prediction of Unsafe Driving in Older Adults in the Office Setting

To examine the sensitivity and specificity of the Assessment of Driving-Related Skills (ADReS), a clinical tool recommended by the American Medical Association for identifying potentially unsafe older drivers that includes tests of vision, motor function, and cognition. Cross-sectional observation study. Memory assessment outpatient clinic of a university hospital. Drivers with normal cognition (n = 47) and cognitive impairment (n = 75). A neurologist completed the ADReS during an office visit. Additional cognitive tests of executive, visuospatial, and visuomotor function were also performed. On a separate day, participants completed a standardized on-road test, assessed by a professional driving instructor using a global safety rating and a quantitative driving score. In this sample of currently active older drivers with and without cognitive impairment, measures of cognition-particularly the Trail-Making Test Part B-were more highly correlated with driving scores than other measures of function. Using recommended scoring procedures, the ADReS had a sensitivity of 0.81 for detecting impaired driving on the road test, with a specificity of 0.32 and an area under the receiver operating characteristic curve (AUC) of 0.57. A logistic regression model that incorporated computerized maze task and Mini-Mental State Examination scores improved overall classification accuracy, yielding a sensitivity of 0.61, a specificity of 0.84, and an AUC of 0.80. In its present form, the ADReS has limited utility as an office screen for individuals who should undergo formal driving assessment. Improved scoring methods and screening tests with greater diagnostic accuracy than the ADReS are needed for general office practice.

Predicting psychopharmacological drug effects on actual driving performance (SDLP) from psychometric tests measuring driving-related skills

RationaleThere are various methods to examine driving ability. Comparisons between these methods and their relationship with actual on-road driving is often not determined.ObjectiveThe objective of this study was to determine whether laboratory tests measuring driving-related skills could adequately predict on-the-road driving performance during normal traffic.MethodsNinety-six healthy volunteers performed a standardized on-the-road driving test. Subjects were instructed to drive with a constant speed and steady lateral position within the right traffic lane. Standard deviation of lateral position (SDLP), i.e., the weaving of the car, was determined. The subjects also performed a psychometric test battery including the DSST, Sternberg memory scanning test, a tracking test, and a divided attention test. Difference scores from placebo for parameters of the psychometric tests and SDLP were computed and correlated with each other. A stepwise linear regression analysis determined the predictive validity of the laboratory test battery to SDLP.ResultsStepwise regression analyses revealed that the combination of five parameters, hard tracking, tracking and reaction time of the divided attention test, and reaction time and percentage of errors of the Sternberg memory scanning test, together had a predictive validity of 33.4%.ConclusionThe psychometric tests in this test battery showed insufficient predictive validity to replace the on-the-road driving test during normal traffic.

Driving, brain injury and assistive technology

Individuals with brain injury often present with cognitive, physical and emotional impairments which impact their ability to resume independence in activities of daily living. Of those activities, the resumption of driving privileges is cited as one of the greatest concerns by survivors of brain injury. The integration of driving fundamentals within the hierarchical model proposed by Keskinen represents the complexity of skills and behaviors necessary for driving. This paper provides a brief review of specific considerations concerning the driver with TBI and highlights current vehicle technology which has been developed by the automotive industry and by manufacturers of adaptive driving equipment that may facilitate the driving task. Adaptive equipment technology allows for compensation of a variety of operational deficits, whereas technological advances within the automotive industry provide drivers with improved safety and information systems. However, research has not yet supported the use of such intelligent transportation systems or advanced driving systems for drivers with brain injury. Although technologies are intended to improve the safety of drivers within the general population, the potential of negative consequences for drivers with brain injury must be considered. Ultimately, a comprehensive driving evaluation and training by a driving rehabilitation specialist is recommended for individuals with brain injury. An understanding of the potential impact of TBI on driving-related skills and knowledge of current adaptive equipment and technology is imperative to determine whether return-to-driving is a realistic and achievable goal for the individual with TBI.

Effects of time pressure on left-turn decisions of elderly drivers in a fixed-base driving simulator

In countries with right lane traffic left-turn manoeuvres at intersections are known to be particularly critical for elderly drivers. It has been suggested that the implementation and use of Advanced Driver Assistance Systems (ADAS) might offer a solution to compensate for age-related weaknesses in driving-related skills. In the present paper an experiment is reported which explored the effects of time pressure on the performance of left-turn manoeuvres supported by an ADAS function ([`]time gap assistant'). The study was performed in a fixed-base driving simulator with 20 younger (22-37) and 21 elderly drivers (60-84) who were observed when negotiating left-turn manoeuvres on rural roads with and without the assistance function active. Subjects performed the task once under conditions of time pressure once without. Results indicate that both age groups used the assistance function to perform the left-turn manoeuvres with shorter time gaps. Under conditions of time pressure this effect was more pronounced, and the effects of time pressure were stronger for the elderly. However, there were only weak indications for a specific benefit of the assistance function for the elderly.

Retraining Moderately Impaired Stroke Survivors in Driving-Related Visual Attention Skills

Background: Visual inattention is a major cause of road accidents and is a problem commonly experienced after stroke. Purpose: This study investigated the effects of 2 training programs on performance in the Useful Field of View (UFOV), a validated test of driving-related visual attention skills. Method: Data from 69 first-ever, moderately impaired stroke survivors who participated in a randomized controlled trial (RCT) to determine the effects of simulator training on driving after stroke were analyzed. In addition to regular interventions at a rehabilitation center, participants received 15 hours of either simulator-based driving-related training or non–computer-based cognitive training over 5 weeks. Results: Total percentage reduction in UFOV and performance in divided and selective attention and speed of processing subtests were documented at 6 to 9 weeks (pretraining), 11 to 15 weeks (posttraining), and 6 months post stroke (follow-up). Generalized estimating equation (GEE) model revealed neither group effects nor significant interaction effects of group with time in the UFOV total score and the 3 subtests. However, there were significant within-group improvements from pre- through posttraining to follow-up for all the UFOV parameters. Post-hoc GEE analysis revealed that most improvement in both groups occurred from pre- to posttraining. Conclusion: Both training programs significantly improved visual attention skills of moderately impaired stroke survivors after 15 hours of training and retention of benefit lasted up to 6 months after stroke. Neither of the training programs was better than the other.

Drugs of Abuse, Driving and Traffic Safety

Roadside studies indicate that 1-15% of drivers drive under the influence of one or more drugs of abuse. After drug use, drivers are more often culpable for an accident than non-users. Information on drugs and traffic safety comes from roadside studies, epidemiological research, experimental studies on driving-related skills, and on-the-road driving tests. Road-side studies show that drivers most frequently test positive for the use of alcohol and/or cannabis. These two drugs affect driving ability in a dose-dependent matter and result in poor vehicle control, especially when used in combination. Drivers on cocaine, ecstasy and amphetamine show no impairment on basic driving skills, but often overestimate their driving skills. In combination with impaired decision making, this increases risk taking during driving. Only few studies looked at the effects on driving of other drugs of abuse, such as ketamine, inhalants and anabolic steroids, but suggest a negative effect on driving performance. In conclusion, most drugs of abuse negatively affect driving ability, especially when used in combination with alcohol or another drug. It is of concern that a substantial number of drug users are not aware that their driving is impaired.