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Doing Harm Maya Dusenbery. Positively Parkinson's Ann Andrews. A Practical Guide Helen Aveyard. Second Opinion John Germov. Table of contents Part I: Other Important Considerations show more. Schulthies' clinical and research experience have been focused on the rehabilitation of cognitively impaired populations, including studying the demands of driving.

She has published numerous manuscripts, chapters and other publications and has presented her work at various international and national forums.

Handbook for the Assessment of Driving Capacity : Maria T. Schultheis :

He is currently studying disorders of memory and information processing in a variety of clinical populations including: DeLuca has published over articles, abstracts and chapters in these areas. He served as the editor for the special issue of the Journal of Neurorehabilitation on multiple sclerosis. DeLuca is the recipient of early career awards for his research from both the American Psychological Association and the National Academy of Neuropsychology.

He is the Chairman of the Ph. Book ratings by Goodreads. Handbook for the Assessment of Driving Capacity. Browse book content About the book Search in this book.


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Browse this book By table of contents. Book description This is a resource for professionals involved in determining the driving capacity of individuals with neurological involvement and or trauma. While much work has been completed in However, the authors noted that Trail Making Test Part B approached significance and predicted that this correlation may have been statistically significant with a larger sample size. Dual-task performance during portions of the driving simulation was significantly correlated with crash rate.

The authors concluded that within-task divided attention scores predicted crash rate among drivers with TBI while traditional measures of attention and processing speed were not useful in this sample Cyr et al. More recently, Cuenen and colleagues investigated the potential moderating effects of attention capacity on driving performance during visual and cognitive distraction in a sample of community-dwelling, active drivers aged 70 years and older without history of stroke in the last 6 months and who had a score of 25 or above on the MMSE.

Drivers were presented with a visual distraction task or a cognitive distraction task while driving. Results indicated that when older drivers were cognitively distracted, the number of complete stops at stop signs decreased, initiation of braking at pedestrian crossings was later, and the number of crashes increased. They concluded that attention capacity is negatively related to the number of crashes in this study Cuenen et al. Speed of information processing appears to be an important aspect of safe driving, as it likely plays a role in the ability to react, brake, and efficiently adapt to new situations.

There has been some discussion in the literature about the influence of processing speed on poor performance found on measures of attention. In a retrospective, matched case-controlled study, Cullen and colleagues investigated the ability to predict return to driving following TBI during inpatient rehabilitation.

Performance on measures of processing speed has been shown to determine driving fitness in other groups as well. Findings in the literature are mixed with regard to the importance of language functioning for driving capacity. From a face validity standpoint, drivers benefit from intact language functioning in order to read and understand road signs, potentially communicate with law enforcement, understand oral or visual instructions, read and understand driving laws, and pass written driving examinations.

Some evidence for language dysfunction posing risk to safe driving ability includes work by Hartje and colleagues , who found that driving behavior was impaired in a higher proportion of individuals with aphasia than individuals who suffered damage to the brain but did not have aphasia Hartje et al. Mackenzie and Paton assessed 18 individuals with aphasia following stroke on their ability to recognize road signs. Reger and colleagues performed a meta-analysis on date from studies investigating neuropsychological functioning and driving ability of individuals with dementia.

Although they found medium-to-large effect sizes between language assessments and measures of driving ability e. Findings in the driving literature are somewhat mixed regarding the usefulness of memory assessment for determining driving fitness. For example, results from a meta-analysis suggested that several measures of memory functioning commonly used by neuropsychologists e.

Along those lines, nonverbal memory performance was predictive of some facets of simulated driving in a sample of individuals with HIV Gorman et al. In a more recent study, Aksan and colleagues conducted assessments of on-road driving safety and cognitive functioning on active drivers with valid state licenses aged 70 years and older with and without neurodegenerative diseases i.

Assessments of cognitive functioning included measures of memory, visuospatial construction, processing speed, and executive functioning. The final regression equation for navigation-related secondary task performance indicated that memory performance, as well as visual sensory functioning and set shifting, predicted on-road navigation performance over and above age and disease status.

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In contrast, Vaughan and colleagues investigated the associations between current or former driving status in older women with mild cognitive impairment and all-cause dementia and cognitive performance as well as proxy report of cognitive and functional limitations. They administered a cognitive battery via telephone to assess attention, verbal learning and memory, verbal fluency, executive function, working memory, and global cognitive function.

Results suggested that proxy reports of functional limitations in instrumental activities of daily living were indicative of current driving status of women with mild cognitive impairment, while performance on cognitive testing was not. For women with dementia, both the proxy report and performance on cognitive testing was predictive of current driving status Vaughan et al. Executive functioning has many face valid implications for carrying out complex behaviors associated with safe driving e.

Many clinical groups are vulnerable to executive dysfunction, and are thus at risk for unsafe driving. In the Aksan et al. One measure that has received much attention in the driving literature is the Trail Making Test B. While many neuropsychologists consider the Trail Making Test Part B to be a measure of complex processing speed, many others consider this test to be a measure of executive functioning.

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In an effort to describe changes in health status and driving status over time, Lundqvist and colleagues followed two groups of individuals with TBI or subarachnoid hemorrhage and their controls over a period of 10 years. One aspect of the study was to determine the predictive utility of a short neuropsychological battery consisting of the Trail Making Test Part B, Complex Reaction Time test, Focused Attention test, and Simultaneous Capacity test on driving status 10 years later.

However, Trail Making Part B was the most sensitive test. In fact, when a regression analysis included the other three tests in the battery, no change in overall classification occurred. Results from another study utilizing the Trail Making Test Part B as a measure of executive functioning lends support for its use in driving fitness assessments. Scores on the Trail Making Test Part B were significantly predictive of on-road driving performance, while scores on the Frontal Assessment Battery were not. In a recent study of 68 adults aged 60 years and older, McInerney and Suhr investigated the neuropsychological correlates of hazard perception, which they defined as the ability to identify and react to hazards while driving.

Asimakopulos and colleagues conducted a structured review of executive function measures in the driving literature to describe the specific aspects of executive function they assess as well as the utility of their ability to predict safe driving. They compiled these findings into a Driving Executive Function Tool Guide DEFT Guide , and make helpful practical suggestions for choosing among various measures of executive functioning for determining driving capacity.

As opposed to other batteries that are meant to be used in their entirety to predict fitness to drive, the DEFT is a clinical tool composed of many different measures of executive functioning that can be used to assess the specific facets of executive functioning that are most relevant to a particular individual Asimakopulos et al. Throughout the driving literature, substantial emphasis has been placed on awareness of one's own abilities and deficits in relation to driving fitness.

Awareness, which some researchers consider to be an element of metacognition i. Al Banna and colleagues reviewed the literature to identify the definitions and tools used to assess metacognition. In fact, many clinical groups are vulnerable to the effects of decreased awareness in daily life.


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Thus, the importance of assessing an individual's awareness during a neuropsychological evaluation to determine driving capacity cannot be underestimated. This brief inventory consists of eight questions related to the examinee's perceptions of his or her driving abilities and internal reflections of driving experiences, which are compared to a clinician's ratings on the same questions to calculate a discrepancy score.

It is intended to be used in conjunction with information provided by the referral source and the examinee's performance on clinical tests. Using Rasch modeling, DriveAware demonstrated strong evidence for construct validity, and also appears to measure a unidimensional theoretical construct i. However, the map of items and drivers indicated that the test did not assess the full range of driving ability, and that those with the least awareness of their driving ability were insufficiently assessed.

However, there are several measures that are more likely to be incorporated into a neuropsychological evaluation of driving capacity. Examinees are exposed to a scene from the perspective of a driver, and are subsequently asked to identify everything that is new or absent from a second similar scene.

This is done for a total of six different scenes. In contrast, results from another study investigating the utility of this subtest to predict driving status among participants with PD, Alzheimer's disease, and healthy older adults did not find the Driving Scenes test to be a useful tool Grace et al.

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The Rookwood Driving Battery McKenna, was designed to measure the processing of information in visual, praxic, and executive systems that were deemed essential for safe driving. When the researchers split the sample into two groups based on age, results from the group with individuals under 70 years of age yielded stronger positive 0. However, data from the group of individuals 70 years of age and older indicated a positive predictive value of 0. It was more recently modified for use in the United States, which generally consisted of converting the test stimuli to reflect the laws and standards of driving in the United States Akinwuntan et al.

In a pilot study investigating the potential usefulness of the U. While these findings suggest that this version has the potential to be a good predictor of driving performance, the researchers cautioned that additional research is needed to address the limitations of the current study. Much research has been conducted on factors associated with safe driving and conditions that may impact one's ability to do so.

There are also many studies assessing the predictive ability of neuropsychological measures to determine driving fitness. The present article provides a framework for clinicians to increase their understanding of these areas, but is by no means an exhaustive review of all the literature on driving capacity. In summary, the literature reviewed suggests that thorough assessment of visual perception, visual spatial abilities, attention, processing speed, and executive functioning is imperative for determining an individual's capacity to drive safely.

While impairments in other cognitive domains e. Reviewing the driving capacity literature also provides an appreciation for the utility of more sensitive and specific measures of cognitive functioning when making this important determination, as individuals at risk of unsafe driving may be overlooked if brief mental status examinations are the only source of data providers use. Another important factor to assess in a neuropsychological evaluation of driving capacity is the individual's self-awareness, as this allows an individual to engage in self-monitoring and utilize compensatory strategies while driving.

As described in this article, and as outlined by Yale et al. Knowledge and ability to correlate assessment of the functional level with potential risk for driving accidents. In conclusion, there remains considerable variability in the methods used to determine driving capacity. Future research in this area should continue to focus on replication studies of neuropsychological measures that show the most promising ecological validity along with longitudinal data for confirmatory analysis over time.

Handbook for the Assessment of Driving Capacity

However, in addition to studying aspects of driving capacity, we should also be increasing our efforts in determining alternative means of affordable transportation for the growing number of individuals who are no longer able to drive. Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Close mobile search navigation Article navigation.

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