More young people are involved in distracted driving crashes than any other age group, according to the Virginia DMV, and DRIVE SMART Virginia, a nonprofit that receives funding from the DMV, is charged with raising awareness among youth about the dangers of distracted driving.
Background & aims: Patients with cirrhosis and minimal hepatic encephalopathy (MHE) have driving difficulties but the effects of therapy on driving performance is unclear. We evaluated whether performance on a driving simulator improves in patients with MHE after treatment with rifaximin.
Methods: Patients with MHE who were current drivers were randomly assigned to placebo or rifaximin groups and followed up for 8 weeks (n = 42). Patients underwent driving simulation (driving and navigation tasks) at the start (baseline) and end of the study. We evaluated patients' cognitive abilities, quality of life (using the Sickness Impact Profile), serum levels of ammonia, levels of inflammatory cytokines, and model for end-stage-liver disease scores. The primary outcome was the percentage of patients who improved in driving performance, calculated as follows: total driving errors = speeding + illegal turns + collisions.
Results: Over the 8-week study period, patients given rifaximin made significantly greater improvements than those given placebo in avoiding total driving errors (76% vs 31%; P = .013), speeding (81% vs 33%; P = .005), and illegal turns (62% vs 19%; P = .01). Of patients given rifaximin, 91% improved their cognitive performance, compared with 61% of patients given placebo (P = .01); they also made improvements in the psychosocial dimension of the Sickness Impact Profile compared with the placebo group (P = .04). Adherence to the assigned drug averaged 92%. Neither group had changes in ammonia levels or model for end-stage-liver disease scores, but patients in the rifaximin group had increased levels of the anti-inflammatory cytokine interleukin-10.
Using a single blind design, seventeen AD subjects, eight at a Clinical Dementia Rating (CDR) of 0.5 (possible AD) and nine at a CDR of 1 (probable AD), were compared to 63 cognitively normal, elderly controls. All subjects were trained to drive a computerized interactive driving simulator and then tested on a 19.3 km (12 mile) test course.
To assist clinicians with AD patients in counseling patients and their families, the American Academy of Neurology has developed, and subsequently updated a Practice Parameter for Driving and AD used to assist clinicians in treating patients with dementia. In reviewing the literature related to driving and AD a striking finding was the limited research of AD drivers at a Clinical Dementia Rating (CDR) of 0.5, while there was significant research for drivers with CDR 1 [Dubinsky, Stein, Lyons, 2000; Iverson, Gronseth, Reger et al., 2010].
One method for overcoming the shortfalls of on-the-road examination is testing in a computerized, interactive driving simulator. These simulators have been used extensively to investigate the performance of both normal and impaired drivers. The advantages of driving simulators include standardization of the course, vehicle handling, road conditions, traffic density, and ambient light. Additionally, simulators allow the staging of potential collisions without risk to the subject, the examiner, or the driving public. While simulators do not have the realism of on-the-road testing, they are realistic enough that most subjects report a sensation of movement, and driving performance has been shown to be the same when driving simulator performance is compared with driving performance in an instrumented vehicle on a closed course [Stein, Allen 1987; Allen, et al., 1975].
As part of the overall driving task, vehicles approaching in the opposing lane were included in the driving scenario. If the subject drifted into the opposing lane and struck the approaching vehicle a collision occurred.
The mild, yet significant increase in the standard deviation of lane position and standard deviation of velocity of the control group, when distracted by the divided attention task, is typical driving performance for an unimpaired driver [Allen, Stein, 1987]. The standard deviation of lane position and the standard deviation of velocity did not change for the CDR 0.5 and CDR 1 groups when they were distracted by the divided attention task. This is most likely because both of these groups responded to relatively few of the divided attention tasks. It appears that these drivers were working at capacity during the no divided attention segment to simply maintain their vehicle heading and speed. They appeared to have little cognitive processing reserve to detect and react to the divided attention task. Thus there was no change in their standard deviation of lane position and standard deviation of velocity between the two segments. The poor performance of the drivers with CDR 0.5 and CDR 1 on the divided attention task corresponds to the problems with AD drivers becoming lost reported by other investigators [Friedland, Koss, Kumar, et al, 1988, Gilley, Wilson, Bennett, et al., 1991] and their poor maintenance of lane position is consistent with impaired lane control as reported by Rizzo, Reinach, McGehee, et al. (1997).
This research, as well as the research of others have shown that driving by those with CDR 1 poses a traffic safety problem. The impairments in their driving abilities include an increase in the accident rate, frequently getting lost (even in familiar territory), causing accidents or near accidents, misinterpreting or not responding to traffic signs, and impaired ability to maintain their vehicle at an appropriate speed and position on the roadway.
In this study, by examining drivers at the very earliest stages of AD, we have shown that they make many of the same errors and have the same difficulties with driving performance as drivers with CDR 1. While accident rates of those with CDR 0.5 and CDR 1 are no more than what is tolerated by our society in beginning drivers, driving performance by drivers with early AD is likely to degrade over time. The data presented here suggest that driving performance begins to degrade at the earliest stages of AD.
First, the populations of CDR 0.5 and 1.0 subjects were limited. Thus, any findings in this study may not generalize to the larger population of these drivers. However, it should be noted that this research found results similar in nature to those of others studying driving in these populations. [eg., Duchek, Hunt, Carr, et al., 2003]. It should also be noted that finding drivers in this population is a significant challenge.
Many of these patients have given up driving, and therefore will not qualify for this type of research. The difficulty in recruiting subjects in the CDR population also resulted in an inability to match subjects for driving experience.
The Driving Safety Research Institute (DSRI) at the University of Iowa College of Engineering houses the National Advanced Driving Simulator (NADS-1) and a fleet of instrumented on-road research vehicles. The NADS-1 is one of the largest ground vehicle driving simulators in the world.
NHTSA selects the University of Iowa to house the National Advanced Driving Simulator (NADS-1 simulator), which would become the most sophisticated research driving simulator in the world at the time.
The first automated driving simulations in the world are done at the University of Iowa on the Iowa Driving Simulator, predecessor to the NADS-1. Forward collision warning and adaptive cruise control (ACC) systems are designed, developed, and tested for NHTSA.
NADS-1 is operational. The facility is operated on a self-sustaining basis by the UI. NHTSA owns the simulator while the UI takes responsibility for operation and maintenance. UI owns the building, land, and the software that runs the NADS-1.
The research institute officially changes its name from the University of Iowa National Advanced Driving Simulator (NADS) to the Driving Safety Research Institute (DSRI) to better reflect their expertise in both simulation and in on-road research. The National Advanced Driving Simulator name is retained for the suite of simulators.
Our software is based on the state-of-the-art driving simulation technology at the University of Iowa Driving Safety Research Institute (DSRI), home of the National Advanced Driving Simulator (NADS). DSRI uses its suite of world-class driving simulators and instrumented vehicles to conduct research for the private and public sectors.
DRIVE Sim is open, modular, and extensible letting users customize the simulator to their needs. Extensions are easily built using the included SDK for sensor models, vehicle dynamics, traffic models, or interfaces to custom hardware. DRIVE Sim also has a rich ecosystem of partners who provide compatible extensions.
Recognizing that the ability to drive is an important milestone for people who are recovering from mild neurological conditions, Sacred Heart University Professor Sheelagh Schlegel is leading an occupational therapy (OT) study on the effect of a driving simulator for adults with neurological conditions who want to regain some independence.
Schlegel has determined that eight sessions are insufficient, as participants have continued to make noticeable progress after their study period ended. She also continues to recruit participants for future rounds of the study, and eight more have joined. Referrals come to her from driving rehabilitation specialists at The Next Street driving schools in the state, Easter Seals of Meriden and from occupational therapists at Gaylord Hospital in Wallingford, Norwalk Hospital, Yale New Haven Hospital, Tully Center at Stamford Hospital and the Carolton Chronic Convalescent and Rehabilitation Center in Fairfield.
STISIM Drive provides occupational therapists, physical therapists and speech pathologists with multiple driving scenarios and features to improve patient outcomes. Our simulators support advanced assessments, rehabilitation and community mobility. 041b061a72