Driving Simulator Assessment Research Articles

Feasibility of utilizing clinical and driving simulator assessments to indicate driving performance deficits in adults with multiple sclerosis

BACKGROUND: Drivers with Multiple Sclerosis (MS) experience visual-cognitive impairment that impact on-road driving performance. OBJECTIVE: This study examines the feasibility of utilizing visual-cognitive and driving simulator assessments to indicate driving performance deficits (operational, tactical, and strategic maneuvers) in drivers with MS. METHODS: Through an evidence-informed feasibility framework, we evaluated recruitment capability and resulting sample characteristics, data collection procedures and outcome measures, participants’ acceptability and suitability of the driving simulator, the resources and ability to implement the study, and clinical and driving simulator assessment results. RESULTS: Thirty-eight persons with MS (median age = 43 years, IQR = 19) and 21 persons without MS (median age = 41 years, IQR = 14) participated. Missing data on the driving simulator resulted from scenario complexity (13 with MS, 4 without MS) or the onset of simulator sickness (1 with MS, 1 without MS). Seven participants with MS and two participants without MS reported symptoms of simulator sickness. Participants with MS (vs without MS) made more adjustment to stimuli errors (tactical maneuvers). For participants with MS, immediate verbal/auditory recall or divided/selective attention correlated with simulated driving maneuvers. CONCLUSIONS: Study findings identified challenges (missing data, simulator sickness), but established feasibility for executing a full-scale study to predict driving simulator performance in drivers with MS.

Changes in driving performance after first and second eye cataract surgery: A driving simulator study

Introduction: This study investigated the separate impact of first eye and second eye cataract surgery on driving performance, as measured on a driving simulator. Method: Forty-four older drivers with bilateral cataract aged 55+ years, awaiting first eye cataract surgery participated in a prospective cohort study. They completed a questionnaire, visual tests and a driving simulator assessment at three time points: before first eye, after first eye, and after second eye cataract surgery. Generalized Estimating Equation Poisson or linear regression models were undertaken to examine the change in four driving outcomes of interest after adjusting for cataract surgery and other potential confounders. Results: The rate of crashes/near crashes decreased significantly by 36% (incidence rate ratio (IRR) 0.64, 95% CI 0.47–0.88, p = 0.01) after first eye surgery and 47% (IRR 0.53, 95% CI 0.35–0.78, p < 0.001) after second eye surgery, compared to before first eye cataract surgery, after accounting for confounders. The rate of crashes/near crashes also decreased with better contrast sensitivity (IRR 0.69, 95% CI 0.48–0.90, p = 0.041). A separate model found that time spent speeding 10 kilometers per hour or more over the limit after second eye surgery was significantly less (0.14 min, p = 0.002), compared to before first eye surgery, after accounting for confounders. As contrast sensitivity improved, the duration of speeding also decreased significantly by 0.46 min (p = 0.038). There were no statistically significant changes in lane excursions or speed variation. Practical applications: The findings highlight the importance of timely first and second eye cataract surgery to ensure driver safety, especially as older drivers wait for second eye cataract surgery. It also provides further evidence that contrast sensitivity is probably a better predictor of driving ability in older drivers with cataract than visual acuity, the measure on which driver licensing requirements are currently based, and should also be used when assessing fitness to drive.

Driving errors that predict simulated rear-end collisions in drivers with multiple sclerosis

Objective Drivers with Multiple Sclerosis (MS) may have an increased crash risk. However, the driving performance deficits that contribute to crashes are not fully understood. Based on the extant literature, adjustment to stimuli errors indicate failing an on-road assessment. This study examines whether adjustment to stimuli errors can detect the occurrence of collisions in a driving simulator in drivers with MS. Methods As part of a quasi-experiment, 38 participants with MS and 21 participants without MS completed visual-cognitive and driving simulator assessments, which also recorded their adjustment to stimuli maneuvers. We quantified participants’ adjustment to stimuli maneuvers via initial pedal reaction time (seconds), time to collision (seconds), mean speed (meters per second), and the occurrence of rear-end collisions (collide vs. did not collide) when a simulated vehicle cut across the lane in front of them. Results Logistic regression analyses indicated that, compared to drivers without MS, those with MS had a shorter time to collision (OR= .04, p= .001, 95% CI= [.006, .27]) and a faster mean speed (OR= 1.32, p= .04, 95% CI= [1.01, 1.74]) which increased the odds of experiencing a rear-end collision. Receiver operating characteristic curve analyses indicated that, for MS and control groups, time to collision (MS group = AUC= .94, p<.0001, Control group = AUC= .86, p<.0001) and mean speed (MS group = AUC= .76, p=.005, Control group = AUC = .78, p= .005) differentiated between participants who collided vs. did not collide. For drivers with MS, a time to collision of 1.81 seconds (85% sensitivity, 100% specificity, 15% error rate), and a mean speed of 7.83 meters per second (77% sensitivity, 76% specificity, 47% error rate) predicted the occurrence of collisions with the lowest error rate. Conclusions During a driving simulator assessment, adjustment to stimuli errors predicted the occurrence of rear-end collisions in drivers with MS (vs. without MS). Driving assessors may target scenarios that measure participants’ adjustment to stimuli, via time to collision and mean speed, to make decisions about their visual–cognitive deficits and driving performance.

Clinical predictors of driving simulator performance in drivers with multiple sclerosis

Background: Drivers with multiple sclerosis (MS) may experience visual–cognitive impairment that affects their fitness to drive. Due to limitations associated with the on-road assessment, an alternative assessment that measures driving performance is warranted. Whether clinical indicators of on-road outcomes can also predict driving performance outcomes on a driving simulator are not fully understood. Objective: This study examined if deficits in immediate verbal/auditory recall (California Verbal Learning Test–Second Edition; CVLT2-IR) and/or slower divided attention (Useful Field of View™; UFOV2) predicted deficits in operational, tactical, or strategic maneuvers assessed on a driving simulator, in drivers with and without MS. Methods: Participants completed the CVLT2-IR, UFOV2, and a driving simulator assessment of operational, tactical, and strategic maneuvers. Results: Deficits in immediate verbal/auditory recall and slower divided attention predicted adjustment to stimuli errors, pertaining to tactical maneuvers only, in 36 drivers with MS (vs 20 drivers without MS; F(3, 51) = 6.1, p = 0.001, R2 = 0.3, ). Conclusion: The CVLT2-IR and UFOV2 capture the visual and verbal/auditory recall, processing speed, and divided attention required to appropriately adjust to stimuli in a simulated driving environment. Clinicians may use the CVLT2-IR and UFOV2 as precursors to driving performance deficits in drivers with MS.

Consistency of neuropsychological and driving simulator assessment after neurological impairment

Deficits in attentional and executive functioning may interfere with driving ability and result in a lower level of fitness to drive. Studies show mixed results in relation to the consistency of neuropsychological and driving simulator assessment. The objective of this study was to investigate the consistency of both types of assessment. Ninety-nine patients with various neurological impairments (72 males; M = 48.98 years; SD = 17.27) performed a 30-minute drive in a driving simulation in three different road settings; a (non-)residential rural area, a highway and an urban area. They also underwent neuropsychological assessment of attention and executive function. An exploratory correlational analysis was conducted. We found weak, but significant correlations between attention and executive function measures and more efficient driving in the driving simulator. Distractibility was associated with the most simulator variables in all three simulated road settings. Participants who were better at maintaining attention, eliminating irrelevant information and suppressing inappropriate responses, were less likely to drive above the speed limit, produced a less jerky ride, and used the rearview mirror more regularly. A lack of moderate or strong significant correlations (inconsistency) between traditional neuropsychological and simulator assessment variables may indicate that they don’t evaluate the same cognitive processes.

Impact of the Rural Intersection Active Warning System (RIAWS) on driver speed: A driving simulator study

The Rural Intersection Active Warning System (RIAWS) is an innovative road safety treatment designed to slow traffic on major approaches to a high-risk rural intersection when vehicles are turning or crossing into or out of the side roads, thus reducing fatal and serious casualties. A 2 × 2 experimental driving simulation study was undertaken which aimed to determine the impact of signage (RIAWS versus traditional painted) and sign content (80 km/h versus slow down) on drivers’ instantaneous speed at rural intersections.The driving simulator assessment was completed by 96 drivers aged between 18 and 80 years with a current WA C class licence (passenger vehicle). This provided a total of 384 observations. The results of a two-way ANOVA found a significant interaction effect between speed signage and sign content (F(1,3) = 11.78, p < 0.001). The RIAWS “80 km/h” sign resulted in significantly lower instantaneous speeds than all other types of signs including RIAWS “slow down signs (p < 0.001), traditional painted “80 km/h” signs (p = 0.023) and traditional painted “slow down” signs (p = 0.001). Overall, the study found that RIAWS “80 km/h” sign and not the RIAWS “slow down” sign provided the most effective option for reducing driver speeds on approach to rural intersections. Further research is needed to determine the most effective placement of the RIAWS “80 km/h” signs and how they perform on curved roads.

Development of single-session driving simulator-based and computer-based training for at-risk older drivers

ABSTRACTA possible path towards preserving and remediating driving skills while aging is driver training. Previous studies have yielded mixed results with respect to various types of interventions, such as classroom-based training, on-road driving classes and functional abilities training. The present study-incorporated training features found to be effective in previous older driver training studies, into both a computer-based and driving simulator-based intervention. The purpose of the present study was to investigate the effect of both training formats on general driving ability and specific aspects of driving in older drivers at risk of reduced driving abilities. Additionally, the effect of training on perceived task demand was studied, and learning capacity was considered as an influencing factor on training effectiveness. A total of 31 older drivers were randomly assigned to three groups: driving simulator-based training, computer-based training, and an active control group. The participants completed a cognitive assessment including evaluation of learning capacity and a self-assessment of task demand in various traffic situations. Additionally, participants took a driving simulator assessment. Knowledge of road signs, general driving and specific aspects of driving (i.e., average speed, response time to hazards) improved with training, although improvement was found to be evenly strong in all groups. Learning capacity did not influence training effectiveness, and no difference was found in perceived task demand before and after training. The proposed methodology to evaluate training effectiveness, focusing both on clinically relevant and detailed transfer effects can serve as an example for further studies in the field of driver training.

Driving and Alzheimer's disease: A neuropsychological screening battery for the elderly.

ABSTRACTAs life expectancy increases, there is a marked increase in the elderly population eager to continue driving. A large proportion of these elderly drive safely, however, patients with mild dementia are high-risk drivers.Objective:to identify the cognitive tests that best predict driving ability in subjects with mild dementia.Methods:28 drivers with mild dementia and 28 healthy elderly subjects underwent an extensive cognitive assessment (NACC Uniform Data Set Neuropsychological Battery), completed an adapted On Road Driving Test (ORDT) and a Driving Simulator assessment.Results:drivers with mild dementia made more mistakes on the ORDT and had slower responses in the simulator tasks. Cognitive tests correlated strongly with on road and simulator driving performance. Age, the Digit Symbol Modalities Test and Boston Naming Test scores were the variables that best predicted performance on the ORDT and were included in a logistic regression model.Conclusion:the strong correlation between driving performance and performance on specific cognitive tests supports the importance of cognitive assessment as a useful tool for deciding whether patients with mild dementia can drive safely. The algorithm including these three variables could be used as a screening tool for the detection of unsafe driving in elderly subjects with cognitive decline.

Aiding medical professionals in fitness-to-drive screenings for elderly drivers: development of an office-based screening tool.

The main objective of this study was to develop a fitness to drive screening tool for elderly drivers to be used in a doctor's office. Furthermore, this study investigated the additional value of driving simulator tests in the assessment of fitness to drive. Both screenings (functional abilities and driving simulator test) were benchmarked against the official Belgian fitness to drive licensing procedure. One-hundred thirty-six elderly drivers participated in a functional abilities screening, a driving simulator assessment and an on-road driving test. Sixty-five percent of the sample was considered fit to drive. Visual acuity, physical flexibility, and knowledge of road signs were found to be the best predictive set of tests for the on-road fitness to drive outcome. A performance based driving simulator assessment increased predictive accuracy significantly. The proposed screening procedure saves part of the at-risk elderly driver population from stressful and costly on-road driving evaluations. This procedure provides more information of an individual driver's specific driving parameters. This opens doors for personalized older driver training to maintain independent mobility in later life.

Simulator-based driving assessment of brain-injured patients in real life practice

To describe the characteristics of brain-injured patients who were referred to a simulator-based driving evaluation, evaluate the different components of driving assessment and to search for factor of success on the driving simulator assessment. We retrospectively analyzed data of brain-injured patients (205 after stroke and 66 after traumatic brain injury (TBI)) who performed a driving simulator assessment of fitness to drive in the neurorehabilitation unit of the Lille University Hospital. Data from disease characteristics, physical, visual and cognitive deficiencies and evaluation of the patient's behavior during the driving evaluation were collected. Before the driving assessment, about 30% of either stroke or TBI patients resumed driving without any legal agreement and 20% declared they could present driving difficulties. Half of the stroke patients and 38% of TBI ones showed a motor deficit (most of the time a hemiparesia) and 19% a visual field defect. In the driving assessment, hand-foot coordination, visual exploration, divided attention, speed of the decision process and adaptability to unexpected events were more frequently impaired. In both groups, half of the patients were considered as able to drive on the basis of the synthesis of clinical and simulator data, whereas about 15% were not; a conclusion was not possible for the rest of the population who performed an on-road evaluation, a second simulator-based assessment or training driving sessions. Ability to drive was significantly associated with the patient's self-assessment ( P = 0.026) and the proxy's assessment ( P = 0.001), the presence of a visual field defect ( P = 0.001) and most of qualitative physical and cognitive evaluations during simulator driving assessment ( P < 0.01). Correlations between neuropsychological assessment and visual field hand and attention in one and behavioral evaluation in driving assessment are being processed. About 2/3 of patients have effectively resume driving (max 5 years follow-up). A significant proportion of those who showed objective limitations in the simulator-based assessment were subsequently allowed to drive by authorities, which raises the problem of the separation between assessment and decision processes. Simulator-based driving assessment is of interest to assess fitness to drive in brain-injured patients.

Incidental and intentional memory performance in depression and amnestic mild cognitive impairment

Incidental and intentional memory performance in depression and amnestic mild cognitive impairment

Relationship Between Motor Vehicle Collisions and Results of Perimetry, Useful Field of View, and Driving Simulation in Drivers With Glaucoma.

To examine the relationship between Motor Vehicle Collisions (MVCs) in drivers with glaucoma and standard automated perimetry (SAP), Useful Field of View (UFOV), and driving simulator assessment of divided attention. A cross-sectional study of 153 drivers from the Diagnostic Innovations in Glaucoma Study. All subjects had SAP and divided attention was assessed using UFOV and driving simulation using low-, medium-, and high-contrast peripheral stimuli presented during curve negotiation and car following tasks. Self-reported history of MVCs and average mileage driven were recorded. Eighteen of 153 subjects (11.8%) reported a MVC. There was no difference in visual acuity but the MVC group was older, drove fewer miles, and had worse binocular SAP sensitivity, contrast sensitivity, and ability to divide attention (UFOV and driving simulation). Low contrast driving simulator tasks were the best discriminators of MVC (AUC 0.80 for curve negotiation versus 0.69 for binocular SAP and 0.59 for UFOV). Adjusting for confounding factors, longer reaction times to driving simulator divided attention tasks provided additional value compared with SAP and UFOV, with a 1 standard deviation (SD) increase in reaction time (approximately 0.75 s) associated with almost two-fold increased odds of MVC. Reaction times to low contrast divided attention tasks during driving simulation were significantly associated with history of MVC, performing better than conventional perimetric tests and UFOV. The association between conventional tests of visual function and MVCs in drivers with glaucoma is weak, however, tests of divided attention, particularly using driving simulation, may improve risk assessment.

Driving simulator performance of Veterans from the Iraq and Afghanistan wars

Driving simulator performance was examined in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans to objectively evaluate driving abilities among this cohort who self-report poorer driving safety postdeployment. OIF/OEF Veterans (n = 25) and age- and education-matched civilian controls (n = 25) participated in a 30 min driving simulator assessment that measured the frequency of minor, moderate, and severe driving errors. Frequency of errors in specific content domains (speed regulation, positioning, and signaling) was also calculated. All participants answered questions about number of lifetime traffic "warnings," moving violation tickets, and accidents. Veterans completed the Posttraumatic Stress Disorder (PTSD) Checklist-Military Version. On the driving simulator assessment, Veterans committed more minor, moderate, severe, and speeding errors and reported poorer lifetime driving records than the civilian control group. Exploratory analyses revealed an association between increasing errors on the driving simulator with increasing symptoms of PTSD, although statistically this correlation did not reach significance. These findings suggest that Veterans perform more poorly on an objective evaluation of driving safety and that the presence of PTSD could be associated with worse performance on this standardized driving simulator assessment.

Multiple Chronic Medical Conditions and Associated Driving Risk: A Systematic Review

Background: Numerous medical conditions can affect one's ability to operate a motor vehicle. The likelihood of having multiple medical conditions increases with advancing age; however, the interplay of the associated impairments has not been previously addressed in the literature. Objective: To identify the incremental risks for the effects of multiple chronic medical conditions on driving ability and crash risk. Methods: A comprehensive English-language literature search using the keywords driving, motor vehicle crashes, accidents, multiple medical conditions, and chronic medical conditions was completed. To be included, the article had to address the effects of the combination of multiple chronic medical conditions on driving and include a relevant outcome, such as crashes, driving violations, on-road driving assessment, driving simulator assessment, or driving cessation/avoidance patterns. Results: The overall trend was for increasing number of chronic medical conditions to be associated with higher crash risk and higher likelihood of driving cessation. Although there is some evidence that impaired functional abilities are associated with poorer driving outcome, most of the studies do not support this. No studies were identified that evaluated compensation techniques for drivers with multiple chronic medical conditions with the exception of driving avoidance or self-restriction. Conclusions: The evidence supports the view that drivers with more chronic medical conditions tend to cease driving or engage in driving avoidance. The myriad combinations of diseases and disease severity present a level of complexity that complicates making informed decisions about driving with multiple chronic medical conditions.

Automobile driving in Huntington's disease

We assessed the influence of the neurological and cognitive impairments of Huntington's disease (HD) on automobile driving. In a group of 73 HD outpatients, 53 (72%) continued to drive after illness onset. Those no longer driving had more severe symptoms than those still driving. Twenty-nine HD patients who were still driving and 16 healthy control subjects underwent a clinical examination, a cognitive examination, a driving-simulator assessment, and completed questionnaires about driving history and habits. HD patients performed significantly worse than control subjects on the driving-simulator tasks and were more likely to have been involved in a collision in the preceding 2 years (58% of HD vs. 11% of control subjects). Patients with collisions were less functionally impaired but had slower simple reaction time scores than did those without collisions. HD patients are at increased risk for accidents, but patients who have accidents are not easily distinguished from those who do not.