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Driving a motor vehicle is a common rehabilitation goal following acquired brain injury (ABI). There is increasing interest in the use of driving simulators for driver rehabilitation post-ABI; however, there is still limited research demonstrating efficacy and acceptability. This study sought to examine the user experience of a driving simulator intervention for ABI survivors. Semi-structured interviews were conducted with 14 individuals, including 12 ABI survivors (42% male; Mean age = 53.92 years, SD age = 17.63) who completed the intervention, and 2 occupational therapist driver assessors who facilitated the intervention. Thematic analysis was adopted to analyse interview data. Findings suggest that individual differences (e.g., anxiety, previous experience) influenced participant response to training. The intervention allowed participants to practise various driving skills, re-familiarize themselves with the task of driving, and prepare for return to on-road driving within a safe environment. The intervention was perceived to be useful for enhancing driver self-awareness, autonomy, confidence and patience. Fidelity and simulator sickness were considered limitations of the simulator technology. Subjective accounts of the appropriateness of intervention components are also documented. Overall, the simulator intervention was reported to be a positive experience for participants. Themes emerging from this study can inform future driving simulator interventions for ABI survivors.

Objective: The objective of this study was to address the uptake of safer vehicles and in-vehicle technologies among older adults through a better understanding of extent and use of safer vehicles ...

BackgroundIncorrect use of child restraints is a long-standing problem that increases the risk of injury in crashes. We used user-centred design to develop prototype child restraint instructional materials. The objective of this study was to evaluate these materials in terms of comprehension and errors in the use of child restraints. The relationship between comprehension and errors in use was also explored.MethodsWe used a parallel-group randomised controlled trial in a laboratory setting. The intervention group (n=22) were provided with prototype materials and the control group (n=22) with existing instructional materials for the same restraint. Participants installed the restraint in a vehicle buck, secured an appropriately sized mannequin in the restraint and underwent a comprehension test. Our primary outcome was overall correct use, and our secondary outcomes were (1) comprehension score and (2) percent errors in the installation trial.ResultsThere was 27% more overall correct use (p=0.042) and a higher mean comprehension score in the intervention group (mean 17, 95% CI 16 to 18) compared with the control group (mean 12, 95% CI 10 to 14, pConclusionsConsumer-driven design of informational materials can increase the correct use of child restraints. Targeting improved comprehension of informational materials may be an effective mechanism for reducing child restraint misuse.

Vision is important for safe driving, but there is limited understanding regarding the impact of vision disorders on driving ability and safety. This systematic review evaluated and summarized evidence on the impact of vision disorders and impairment on motor vehicle crash (MVC) risk and on-road driving performance across seven databases, was prospectively registered with PROSPERO (CRD42020180135), and study quality rated using a standard tool. Forty-eight studies met the inclusion criteria for MVC risk (N = 36), on-road performance (N = 9), and both MVC risk and on-road performance (N = 3). Of these studies, less than half were rated as 'good' quality. Due to the small number of studies and often conflicting findings, it was not possible to draw firm conclusions for most vision disorders. However, evidence from several 'good' and 'fair' quality studies suggested increased MVC risk with binocular visual field impairment. There was mixed evidence regarding the impact of cataract, glaucoma, age-related macular degeneration and homonymous field loss on MVC risk and no evidence of increased MVC risk with mild VA impairment. This review highlights the need for well-designed future studies to further explore the impact of vision disorders and impairment on driving outcomes to inform evidence-based policy and fitness to drive guidelines.

Objective: To investigate the feasibility and preliminary efficacy of a driving simulator intervention on driving outcomes following acquired brain injury. Design: Pilot randomised controlled trial. Setting: Occupational therapy driver assessment and rehabilitation service. Subjects: Individuals post-acquired brain injury aiming to return to driving. Intervention: Eight sessions of simulated driver training over four weeks, in addition to usual care. Control: Usual care only. Main measures: Feasibility outcomes: Participant recruitment and retention; data completeness; therapy attendance and fidelity; adverse events. Performance outcomes: on-road driving performance; Simulator Sickness Questionnaire; Brain Injury Driving Self-Awareness Measure and Driving Comfort Scale – Daytime, assessed at baseline and five weeks post-randomisation. Results: Out of 523 individuals screened, 22 (4%) were recruited and randomised, with 20 completing their allocated group ( n = 12 Simulator, n = 8 Usual Care). For those who completed training, session attendance was 100% with simulator sickness rated, on average, as mild. Six individuals (50%) in the Simulator group failed the on-road assessment, versus two (25%) in the Usual Care group ( P = 0.373). On average, the Simulator group reported a positive change in confidence ratings ( M = 5.77, SD = 13.96) compared to the Usual Care group, who reported a negative change ( M = −6.97, SD = 8.47), P = 0.034. The Simulator group ( M = 0.67, SD = 3.34) demonstrated no significant change in self-awareness relative to the Usual Care group ( M = −0.83, SD = 1.83, P = 0.325). Conclusions: With adjustments to inclusion criteria and recruitment strategies, it may be feasible to deliver the intervention and conduct a larger trial. There is potential benefit of simulator training for improving driver confidence after acquired brain injury.

Objective To synthesize knowledge of the risk of motor vehicle collision (MVC) following a traumatic brain injury (TBI) and the associated risk of driving impairment, as measured by on-road tests, computerized simulators, and self-reported or state-recorded driving records. Methods Our international team searched 7 databases for studies published between 1990 and 2015 of people with TBI, controls, and data concerning either MVC or driving impairment. The included articles examined the risk of MVC among people with TBI; we excluded studies that examined the risk of having a TBI associated with being involved in an MVC. Results From 13 578 search results, we included 8 studies involving 1663 participants with TBI and 4796 controls. We found no significant difference in the risk of MVC (odds ratio = 1.24, 95% confidence interval = 0.80-1.91, P = .34). When we restricted the analysis to self-report, the risk of MVC was higher for those without a TBI (odds ratio = 1.63, 95% confidence interval = 1.21-2.22, P = .002). In contrast, participants with TBI consistently performed worse during on-road assessments and had more problems with vehicular control. Conclusion Limitations of reviewed studies included small sample sizes, failure to specify TBI severity or time postinjury, and absence of objective measures of risk. Findings concerning the relationship between TBIs from non-MVC causes and crash risk are, therefore, inconclusive and do not provide evidence for major changes to existing clinical guidelines for driving with TBI.

Objective: The aim of this study was to evaluate the consequences of frontal and oblique crashes when positioning a Hybrid III (HIII) 6-year-old child anthropometric test device (ATD) using observed child passenger postures from a naturalistic driving study (NDS). Methods: Five positions for booster-seated children aged 4–7 years were selected, including one reference position according to the FMVSS 213 ATD seating protocol and 4 based on real-world observed child passenger postures from an NDS including 2 user positions with forward tilting torso and 2 that combined both forward and lateral inboard tilting of the torso. Seventeen sled tests were conducted in a mid-sized vehicle body at 64 km/h (European New Car Assessment Programme [Euro NCAP] Offset Deformable Barrier [ODB] pulse), in full frontal and oblique (15°) crash directions. The rear-seated HIII 6-year-old child ATD was restrained on a high-back booster seat. In 10 tests, the booster seat was also attached with a top tether. In the oblique tests, the ATD was positioned on the far side. Three camera views and ATD responses (head, neck, and chest) were analyzed. Results: The shoulder belt slipped off the shoulder in all ATD positions in the oblique test configuration. In full frontal tests, the shoulder belt stayed on the shoulder in 3 out of 9 tests. Head acceleration and neck tension were decreased in the forward leaning positions; however, the total head excursion increased up to 210 mm compared to te reference position, due to belt slip-off and initial forward leaning position. Conclusions: These results suggest that real-world child passenger postures may contribute to shoulder belt slip-off and increased head excursion, thus increasing the risk of head injury. Restraint system development needs to include a wider range of sitting postures that children may choose, in addition to the specified postures of ATDs in seating test protocols, to ensure robust performance across diverse use cases. In addition, these tests revealed that the child ATD is limited in its ability to mimic real-world child passenger postures. There is a need to develop child human body models that may offer greater flexibility for these types of crash evaluations.

Objectives To establish the crash risk for drivers with epilepsy and quantify any impacts on on-road driving performance. Methods A systematic search of public health-, psychology-, and transport-databases was conducted. This systematic review was registered with PROSPERO (see CRD42019129664). The quality of evidence for each study was rated using the National Heart, Lung and Blood Institute Quality Assessment tools. Results Twenty-three studies using various designs published between 1961 and 2017 met the inclusion criteria (n = 18 rated ‘good’ or ‘fair’). Of these 18 studies, only 11 (case-control: n = 2; cohort: n = 8; cross-sectional: n = 1) specifically addressed crash risk for drivers with epilepsy, with five reporting evidence for increased crash risk, (n = 3 rated ‘good), three reporting evidence no difference in crash risk relative to controls (n = 2 rated ‘good’), and three reporting inconclusive evidence (n = 1 rated ‘good’. The remaining seven studies examined crash responsibility, injury severity, anti epileptic medicine, seizure-free intervals, and the influence of auras for drivers with epilepsy. No studies investigated the impacts of epilepsy on on-road driving performance. Significance There is evidence for a slight elevation of risk for drivers with epilepsy. Generalisability is limited by lack of controlling for confounds and wide time period over which medical treatment and licensing authority requirements applied. Development of consensus based medical and licensing standards taking these findings into account.

This study investigated parents’ attitudes, knowledge and behaviours relating to their role in protecting and teaching their young children road safety skills; and in particular parents’ perceptions regarding where they thought their child learnt the most about road safety. A questionnaire exploring attitudes, knowledge and behaviours on general road safety was completed by 272 participants with at least one child aged between 3 and 10 years residing in the Australian state of Victoria. Participants were predominantly female (74%); were either married or in a de facto relationship (92%); and had completed secondary school education (73%). General road safety behaviours and attitudes were fairly positive, with most participants reporting that they restrict their alcohol consumption or do not drink at all while driving (98%), they drive at or below the speed limit (85%) and ‘always’ wear their seatbelts (98%). However, more than half of the participants reported engaging in distracting behaviours ‘sometimes’ or ‘often’ (54%) and only half reported never engaging in aggressive driving (49%). Only 77% believed they were their child’s primary learning source for road safety skills (internal locus of control). The remaining 23% believed school, friends or television were the primary source (external locus of control). Parents with an internal locus of control in educating their children about road safety skills were significantly more likely to be educated at a University level or higher and were more likely to reside in metropolitan versus rural/regional areas, compared with parents with an external locus of control. Parents with an internal locus of control typically had greater knowledge about: whether it is legal in Victoria to drive with unrestrained passengers; whether fines were intended for revenue raising; and whether it is OK to drive 10 km/h above the speed limit in some circumstances. This research provides evidence for road safety intervention development, particularly the potential for parents to be the primary trainers in road safety skills.

With little to guide researchers and clinicians on how best to develop driving simulator interventions for ABI survivors, we aimed to describe the development process of a driving simulator intervention for ABI survivors in a rehabilitation setting.Intervention mapping methodology was used as a framework for the development of our driving simulator intervention. A qualitative synthesis of theoretical and empirical literature and stakeholder meetings enabled identification of factors affecting return to driving, selection of justifiable intervention goals, and identification of appropriate theoretically-informed techniques to facilitate change. These were used as a basis for design of intervention components and materials. A plan for delivery, implementation and evaluation was then developed.Determinants of driving ability, including knowledge and skills, self-efficacy, self-awareness of driving skills, awareness of risk and compensatory strategies were identified. These were applied to a range of tactical and operational driving behaviours to identify targets for change. Theoretically-informed strategies included direct instruction, repetition, graded difficulty, feedback and tailoring. An eight-session protocol, with a corresponding clinical manual, was developed for brain-injured patients who were referred for occupational therapy driving assessment. Protocols for recruitment, inclusion/exclusion criteria and facilitator training were developed, as well as a plan for evaluating feasibility, acceptability and effectiveness.Intervention mapping was a useful approach to systematically develop an intervention tailored to the rehabilitation hospital context to complement existing driver rehabilitation. The feasibility and effectiveness of the simulator programme developed in this study will be evaluated in future studies.IMPLICATIONS FOR REHABILITATIONWe were able to gather important information and provide recommendations to tailor a new driving simulator intervention for individuals with acquired brain injury within a rehabilitation service.The processes and methods described provide researchers and clinicians with a systematic process for the selection of driving simulator intervention components and delivery.This investigation can be used to educate rehabilitation clinicians and technicians to improve driver training and delivery to acquired brain injury survivors.

Objective: Child occupant behavior and head position when travelling in child restraint systems (CRS) may have an effect on injury risk in the event of a motor vehicle crash. The current study aimed to describe the common characteristics and behaviors of child occupants during everyday, real-world motor vehicle travel in a sample of Australian families to identify potential safety implications of observed behaviors and head position within the CRS. Methods: Two instrumented study vehicles were used by 42 families for approximately two weeks. Continuous video and audio data were collected across 1,651 trips (over 600 hours). An online survey provided additional parent, familial and child occupant data. The characteristics and behaviors of 72 child occupants (aged 14 months to 9 years) who travelled in a forward-facing CRS (FFCRS) or a belt-positioning booster seat (BS) were observed and recorded by manual review of a sample of the video/audio recordings. One quarter of all trips (n = 414) was randomly selected for coding/analysis and, within each trip, one child occupant was selected who was travelling in a FFCRS or BS. Child occupant behaviors, head position within the FFCRS or BS, and other relevant information was coded for each trip during nine discrete five second intervals or ‘epochs’ (5%, 17%, 25%, 30%, 50%, 53%, 75%, 89% and 95% of trip duration). Results: In the majority of epochs (74%), child occupants’ heads were observed to be ‘optimally’ positioned within the FFCRS or BS. For more than half of the epochs, child occupants were observed to be: correctly restrained (58%) and involved in an interaction with another vehicle occupant (59%). Bivariate analyses revealed that children travelling in a FFCRS were significantly more likely to be observed to have optimal head positions than those travelling in a BS (78% vs. 62%), χ2 (1) = 86.00, p < 0.001. Child occupants who were observed to be ‘correctly’ restrained were significantly more likely to be observed to have optimal head positions than those who were observed to be ‘incorrectly’ restrained (80% vs. 20%), χ2 (1) = 10.33, p < 0.01. Conclusions: This is the first naturalistic driving study (NDS) to specifically explore the factors associated with child occupants’ head position when travelling in a CRS. Findings from the current study can be used to inform the positioning of anthropometric test dummies (ATD) in CRS testing, guide improvements to CRS/vehicle design, and develop targeted educational strategies to improve child occupant safety.

To examine self-rated, clinician-rated, and self-awareness of on-road driving performance in individuals with traumatic brain injury (TBI) deemed fit and unfit to resume driving and healthy controls, and to explore their associations with demographic, injury, cognitive, and mood variables.Participants included 37 individuals with moderate to severe TBI, and 49 healthy age, sex, and education-matched controls from Australia and Canada. Participants completed an on-road assessment, the Brain Injury Driving Self-Awareness Measure (BIDSAM), and a comprehensive neuropsychological assessment.Awareness scores on the BIDSAM were significantly different between groups, F(2, 83) = 28.44 (P.001; η = 0.41), with post hoc tests indicating TBI participants who failed the on-road assessment had worse scores compared with those who passed and controls. Poor self-awareness was significantly correlated with reduced psychomotor speed (rs = -0.37; P.01) and attentional switching (rs = 0.28; P.01). Worse self-ratings of driving were associated with depression (rs = 0.42; P.01) and anxiety (rs = 0.38; P.01).Individuals with TBI who failed an on-road assessment significantly overestimated their driving ability. Impaired cognitive function was associated with reduced self-awareness of driving. These findings suggest impaired awareness of driving may need to be addressed as part of driver rehabilitation programs.

The aim of this study was to explore self-reported driving habits and the factors associated with these within the first three months of return to driving following traumatic brain injury (TBI). Participants included 24 individuals with moderate to severe TBI (post-traumatic amnesia duration M = 33.26, SD = 29.69 days) and 28 healthy age, education, and gender-matched controls who completed an on-road assessment. Driving frequency and avoidance questionnaires were administered to assess premorbid driving, anticipated driving upon resuming, and driving at three months post-assessment. There were no differences between groups for premorbid driving frequency or avoidance. Individuals with TBI anticipated greater reductions in driving frequency, t(29.57) = -3.95, p

Background Good vision is essential for safe driving and studies have associated visual impairment with an increased crash risk. Currently, there is little information about the medical review of drivers with visual field loss. This study examines the prevalence of visual field loss among drivers referred for medical review in one Australian jurisdiction and investigates factors associated with licence outcome in this group. Methods A random sample of 10,000 (31.25 per cent) medical review cases was extracted for analysis from the Victorian licensing authority. Files were screened for the presence of six visual field‐related medical conditions. Data were captured on a range of variables, including referral source, age, gender, health status, crash history and licence outcome. Prevalence analyses were univariate and descriptive. Logistic regression was used to assess factors associated with licence outcomes in the visual field loss group. Results Approximately 1.9 per cent of the 10,000 medical review cases screened had a visual field loss condition identified (n = 194). Among the visual field loss group, 57.2 per cent were permitted to continue driving (conditional/unconditional licence). Primary referral sources were the police, self‐referrals and general medical practitioners. Key factors associated with licence test outcomes were visual field condition, age group, crash involvement and referral to the Driver Licensing Authority's Medical Advisors. Those who were younger had a crash involvement triggering referral and those who were referred to the Medical Advisors were more likely to have a positive licensing outcome. Conclusion The evidence base for making licensing decisions is complicated by the variable causes, patterns, progressions and measuring technologies for visual field loss. This study highlighted that the involvement of an expert medical advisory service in Victoria resulted in an increased likelihood that drivers with visual field loss will be allowed to continue driving. Further research is warranted to explore issues relating to severity of field loss and the capacity for compensation.

AIM: The aim of this study was to develop and provide initial validation data for a self-awareness of on-road driving ability measure for individuals with brain injury. METHOD: Thirty-nine individuals with Traumatic Brain Injury completed an on-road driving assessment, the Self-Regulation Skills Interview (SRSI) and the newly developed Brain Injury Driving Self-Awareness Measure (BIDSAM). RESULTS: BIDSAM self, clinician and discrepancy scales demonstrated high levels of internal consistency (α = 0.83-0.92). Criterion-related validity was established by demonstrating significantly higher correlations between clinician ratings and on-road performances, rs = 0.82, P CONCLUSIONS: These results provide initial support for the BIDSAM as a reliable and valid measure of self-awareness of on-road driving ability following TBI.© 2016 Occupational Therapy Australia. Language: en

Objective This study examined the relationship between restraint design features and comfort, posture and seat belt position of children in booster seats during a driving trial. The relationship between comfort and errors introduced by a child throughout a trip were also explored. Method Fifteen children were recruited in this study. Due to technical issues affecting video capture of three participants, the comfort, belt fit, errors and posture of twelve Australian children aged 4–8 years were analysed during two, one hour on-road drives in an instrumented study vehicle fitted with in-vehicle video monitoring equipment. Each child sat in two different types of booster seats, which varied markedly in design. Restraint 1 featured an adjustable headrest, sash belt guide and side wings, whilst Restraint 2 had a longer cushion length (R1: 29 cm, R2: 34 cm), no sash belt guide or side wings. Three five-minute video segments were analysed per seating condition; at the beginning, middle and end of the trip. The Discomfort Avoidance Behaviour (DAB) rate, DAB time, errors and average participant trip time observed in shoulder belt, sagittal torso and head positions were quantified. Results The average DAB rate was higher in R2 than R1 (R2 = 2.79 vs. R1 = 1.85, p = 0.009) and the average number of errors across time points was greater in R2 than R1 (R2 = 0.81 vs. R1 = 0.38, p = 0.01). The DAB rate was associated with increases in the number of child induced errors (log (errors in use) = −2.07 + 0.57 × DAB, p Conclusions The design of a restraint and its influence on comfort, errors, shoulder belt fit and posture may provide an effective avenue to enhance the correct use of child restraints throughout a trip.

Introduction This study systematically reviewed the literature on key issues relating to the safety benefits of older drivers attending an in-person licence renewal. This included identifying: 1) screening tools that are suitable for inclusion in a populationbased in-person licence renewal process for drivers aged 75 years and older which: a) can be administered by non-health professionals (or via a computer terminal/smart device), and b) are compatible with Australian fitness to drive requirements; 2) the evidence that in-person licence renewal policies are associated with safety benefits, as defined by: a) a reduction in motor vehicle crash risk, or b) on-road driving test outcomes. Methods This review was registered with PROSPERO 2019: CRD42019120809. A systematic search of public health, psychology and transport databases was conducted on March 20th 2019. Results Five studies published between 1986 and 2011 met the inclusion criteria. The review did not identify any suitable screening tools for inclusion in a population-based in-person licence renewal process for older drivers. There was inconclusive evidence regarding the safety benefits associated with in-person licence renewal policies for older drivers. Two studies reported that these policies were associated with a reduced crash risk. However, two studies reported that these policies were not associated with a reduced crash risk, and a third study provided inconclusive evidence. It is important to note that the included studies were conducted across different licensing jurisdictions, with different in-person licence renewal policies – both with and without vision and cognitive testing, which limit the generalisability of the findings. Conclusions It is recommended that a population-based controlled research study in multiple licensing jurisdictions is conducted to specifically investigate the safety benefits of in-person licence renewal policies, as well as the efficacy of different components (including screening by health professionals prior to renewal), as a means to reduce road trauma.

Returning to driving after stroke is one of the key goals in stroke rehabilitation, and fitness to drive guidelines must be informed by evidence pertaining to risk of motor vehicle collision (MVC) in this population.The purpose of the present study was to determine whether stroke and/or transient ischemic attack (TIA) are associated with an increased MVC risk.We searched MEDLINE, CINAHL, EMBASE, PsycINFO, and TRID through December 2016. Pairs of reviewers came to consensus on inclusion, based on an iterative review of abstracts and full-text manuscripts, on data extraction, and on the quality of evidence.Reviewers identified 5,605 citations, and 12 articles met inclusion criteria. Only one of three case-control studies showed an association between stroke and MVC (OR 1.9, 95% CI 1.0-3.9). Of five cohort reports, only one study, limited to self-report, found an increased risk of MVC associated with stroke or TIA (RR 2.71, 95% CI 1.11-6.61). Two of four cross-sectional studies using computerized driving simulators identified a more than two-fold risk of MVCs among participants with stroke compared with controls. The difference in one of the studies was restricted to those with middle cerebral artery stroke.The evidence does not support a robust increase in risk of MVCs. While stroke clearly prevents some patients from driving at all and impairs driving performance in others, individualized assessment and clinical judgment must continue to be used in assessing and advising those stroke patients who return to driving about their MVC risk.

Objective: To characterise on-road driving performance in individuals with traumatic brain injury who fail on-road driving assessment, compared with both those who pass assessment and healthy controls, and the injury and cognitive factors associated with driving performance. Study design: Cross-sectional. Methods: Forty eight participants with traumatic brain injury (Age M = 40.50 SD = 14.62, 77% male, post-traumatic amnesia days M = 28.74 SD =27.68) and 48 healthy matched controls completed a standardised on-road driving assessment in addition to cognitive measures. Results: Individuals with traumatic brain injury who passed on-road driving assessment performed no differently from controls while individuals with traumatic brain injury who failed the assessment demonstrated significantly worse driving performance relative to controls across a range of driving manoeuvres and error types including observation of on-road environment, speed control, gap selection, lane position, following distance and basic car control. Longer time post-injury and reduced visual perception were both significantly correlated with reduced driving skills. Conclusions: This exploratory study indicated that drivers with traumatic brain injury who failed on-road assessment demonstrated a heterogeneous pattern of impaired driving manoeuvres, characterised by skill deficits across both operational (e.g., basic car control and lane position) and tactical domains (e.g., following distance, gap selection, and observation) of driving. These preliminary findings can be used for implementation of future driving assessments and rehabilitation programs.Implications for rehabilitationClinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries.Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres.Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury.Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury. Clinicians should be aware that the majority of individuals with traumatic brain injury were deemed fit to resume driving following formal on-road assessment, despite having moderate to very severe traumatic brain injuries. Drivers with traumatic brain injury who failed an on-road assessment demonstrated a heterogeneous pattern of impaired skills including errors with observation, speed regulation, gap selection, and vehicle control and accordingly had difficulty executing a diverse range of common driving manoeuvres. Comprehensive, formal on-road assessments, incorporating a range of skills, and manoeuvres, are needed to evaluate readiness to return to driving following traumatic brain injury. Individually tailored driver rehabilitation programs need to address these heterogeneous skill deficits to best support individuals to make a successful return to driving post-traumatic brain injury.

OBJECTIVE: This study used medicolegal data to investigate fatal older road user (ORU) crash circumstances and risk factors relating to four key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity. METHODS: The Coroners Court of Victoria's Surveillance Database was searched to identify coronial records with at least one deceased ORU in the state of Victoria, Australia, for 2013-2014. Information relating to the ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed. RESULTS: The average rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI] 6.0-10.2), which was more than double the average rate of fatal middle-aged road user crashes (3.6, 95% CI 2.5-4.6). There was a significant relationship between age group and deceased road user type (χ2(15, N = 226) = 3.56, p < 0.001). The proportion of deceased drivers decreased with age, whereas the proportion of deceased pedestrians increased with age. The majority of fatal ORU crashes involved a counterpart (another vehicle: 59.4%; fixed/stationary object: 25.4%), and occurred "on road" (87.0%), on roads that were paved (94.2%), dry (74.2%), and had light traffic volume (38.3%). Road user error was identified by the police and/or coroner for the majority of fatal ORU crashes (57.9%), with a significant proportion of deceased ORU deemed to have "misjudged" (40.9%) or "failed to yield" (37.9%). CONCLUSIONS: Road user error was the most significant risk factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the Victorian road system to fully accommodate road user errors. Initiatives related to safer roads and roadsides, vehicles, and speed zones, as well as behavioral approaches, are key areas of priority for targeted activity to prevent fatal older road user crashes in the future.

To examine pre- and post-injury self-reported driver behaviour and safety in individuals with traumatic brain injury (TBI) who returned to driving after occupational therapy driver assessment and on-road rehabilitation.A self-report questionnaire, administered at an average of 4.5 years after completing an on-road driver assessment, documenting pre- and post-injury crash rates, near-crashes, frequency of driving, distances driven, driving conditions avoided and navigation skills, was completed by 106 participants, who had either passed the initial driver assessment (pass group n = 74), or required driver rehabilitation, prior to subsequent assessments (rehabilitation group n = 32).No significant difference was found between pre- and post-injury crash rates. Compared to pre-injury, 36.8% of drivers reported limiting driving time, 40.6% drove more slowly, 41.5% reported greater difficulty with navigating and 20.0% reported more near-crashes. The rehabilitation group (with greater injury severity) was significantly more likely to drive less frequently, shorter distances, avoid: driving with passengers, busy traffic, night and freeway driving than the pass group.Many drivers with moderate/severe TBI who completed a driver assessment and rehabilitation program at least 3 months post-injury, reported modifying their driving behaviour, and did not report more crashes compared to pre-injury. On-road driver training and training in navigation may be important interventions in driver rehabilitation programs.Driver assessment and on-road retraining are important aspects of rehabilitation following traumatic brain injury. Many drivers with moderate/severe TBI, reported modifying their driving behaviour to compensate for ongoing impairment and continued to drive safely in the longer term. Navigational difficulties were commonly experienced following TBI, suggesting that training in navigation may be an important aspect of driver rehabilitation.

To determine the extent and nature of driving self-regulation in drivers with Parkinson disease (PD) and factors associated with self-regulatory practices.Although people with PD have consistently been shown to have driving impairments, few studies have examined self-regulatory driving practices and their relationship to driving performance.We used a self-report driving questionnaire to examine driving self-regulation in 37 drivers with PD and 37 healthy age-matched controls. We also analyzed factors associated with self-regulatory practices, primarily demographic, disease-related, psychological, and simulated driving performance variables.The drivers with PD reported significantly higher rates of self-perceived decline in their driving ability (P=0.008) and driving significantly shorter distances per week (P=0.004) than controls. Unfamiliar situations (P=0.009), in-car distractions (P0.001), low visibility conditions (P=0.004), and long journeys (P=0.003) were particularly challenging for the drivers with PD, and their pattern of driving avoidance mirrored these difficulties. The use of self-regulatory strategies among drivers with PD was associated with female sex (rho=0.42, P=0.009) and perceived decline in driving ability (rho=-0.55, P0.001), but not with age or objective measures of disease severity, cognition, or simulated driving performance.Drivers with PD reported driving less overall and restricting their driving to avoid particularly difficult circumstances. Further research is warranted on effective use of self-regulation strategies to improve driving performance in people with PD.

This paper describes the development and evaluation of an on-road procedure, the Driving Observation Schedule (DOS), for monitoring individual driving behavior. DOS was developed for use in the Candrive/Ozcandrive five-year prospective study of older drivers. Key features included observations in drivers’ own vehicles, in familiar environments chosen by the driver, with start/end points at their own homes. Participants were 33 drivers aged 75+ years, who drove their selected route with observations recorded during intersection negotiation, lane-changing, merging, low speed maneuvers and maneuver-free driving. Driving behaviors were scored by a specialist occupational therapy driving assessor and another trained observer. Drivers also completed a post-drive survey about the acceptability of DOS. Vehicle position, speed, distance and specific roadways traveled were recorded by an in-vehicle device installed in the participant's vehicle; this device was also used to monitor participants’ driving over several months, allowing comparison of DOS trips with their everyday driving. Inter-rater reliability and DOS feasibility, acceptability and ecological validity are reported here. On average, drivers completed the DOS trip in 30.48 min (SD = 7.99). Inter-rater reliability measures indicated strong agreement between the trained and the expert observers: intra-class correlations (ICC) = 0.905, CI 95% 0.747–0.965, p < 0.0001; Pearson product correlation, r (18) = .83, p < 0.05. Standard error of the measurement (SEM), method error (ME) and coefficient of variation (CV) measures were consistently small (3.0, 2.9 & 3.3%, respectively). Most participants reported being ‘completely at ease’ (82%) with the driving task and ‘highly familiar with the route’ (97%). Vehicle data showed that DOS trips were similar to participants’ everyday driving trips in roads used, roadway speed limits, drivers’ average speed and speed limit compliance. In summary, preliminary findings suggest that DOS can be scored reliably, is of feasible duration, is acceptable to drivers and representative of everyday driving. Pending further research with a larger sample and other observers, DOS holds promise as a means of quantifying and monitoring changes in older drivers’ performance in environments typical of their everyday driving.

A cyclist crash with an open vehicle door can result in serious injury, sometimes fatal, outcomes. However, little is known about the frequency and range of injury outcomes of this crash type or the contributing factors. In this study, the factors associated with cyclist-open vehicle door collisions in Victoria, Australia were investigated using three complementary data sources: (1) police reported crashes (2000–2011); (2) hospital presentations (2000–2010), and (3) a sample of video footage from a naturalistic study of commuter cyclists in Melbourne (2009–2010). A total of 1247 police reported cyclist crashes and 401 hospital emergency department presentations were analysed. As a proportion of all cyclist crashes, cyclist-open vehicle door crashes accounted for 3.1% (hospital) and 8.4% (police). The majority of cyclists injured were: male (police: 67.1%; hospital: 65.8%); adults aged 18 years or older (police: 97.5%; hospital: 96.3%), and crashes occurred in speed zones up to 60 kph (police: 93.1%). From the naturalistic cycling study, there were 13 door-related events with a rate of 0.59 events per trip. No collisions occurred and in all cases, a potential collision was avoided by the cyclists’ evasive action. Most drivers did not look in the direction of the cyclist before opening the door. While the number of reported crashes is relatively low, cyclists’ exposure to events with potential for this crash type is high. Potential countermeasures to reduce the risk of this interaction/crash type are discussed and include road environment design improvements and road user behaviour programs.

Some older drivers experience difficulties driving whilst wayfinding in unfamiliar areas. Difficulties in wayfinding have been associated with poorer driving performance and reduced driving mobility. The objective of the current study was to identify cognitive and demographic predictors in older drivers of perceived wayfinding difficulty, avoidance of unfamiliar areas and the use of wayfinding strategies. Five hundred and thirty-four drivers aged 65 years and over (excluding those with dementia or Parkinson's disease) completed a mail-out survey. Drivers commonly reported difficulties with wayfinding, with 59.5% reporting their abilities as poor or fair rather than good. Those significantly more likely to report difficulty were older, reported poorer health and cognition, and had less driving experience. A small proportion of drivers reported regularly avoiding unfamiliar areas (13.8%); these drivers were significantly more likely to be female and to report poorer wayfinding abilities. The most common wayfinding strategies regularly used by older drivers were using a street directory whilst driving (61.9%) and pulling over to check the map (55.1%). Regular passenger guidance (23.9%) or use of a navigation system (9.9%) was less common. The implications of this study are wide and include collecting further information about: (1) the role of cognitive processes in wayfinding ability; (2) the relationship between perceived wayfinding difficulty and restriction of driving in unfamiliar areas; and (3) older drivers' preferences for different wayfinding strategies.

The current study aimed to investigate the incidence of child restraint system (CRS) misuse and/or inappropriate use of CRS through an Australian CRS inspection program conducted by CRS fitting specialists between October 2004 and October 2011 and to determine whether CRS misuse and/or inappropriate use of CRS changed following new Australian legislation regarding CRS and motor vehicle restraint use for children aged 7 years and under.Participants were recruited through an advertisement for free CRS inspections displayed at childcare centers, kindergartens, community centers, hospitals, and child expos. At each inspection, a CRS fitting specialist inspected each child in their CRS while in their vehicle and reported to the owner of the CRS on the installation of the child restraint(s) and/or system(s) and any fitting faults and/or concerns with the fitting and/or use of the child restraint(s) and or system(s).Results are based on the inspection of 2674 CRS. Of all of the CRS inspected, the majority (79%) were reported as having at least one instance of misuse and/or inappropriate use. The most common forms of CRS misuse and/or inappropriate use observed were harness strap errors (twisted, poorly adjusted, and/or incorrectly positioned, 41%), seat belt errors (incorrectly routed, twisted, and/or incorrectly adjusted, 32%), and a missing or incorrect fitting of the gated buckle/locking clip (24%). Significant differences were found across the proportion of CRS misuse and/or inappropriate use across restraint types (infant restraint/forward-facing CRS/convertible [birth to 18 kg] CRS/convertible [8-26 kg] CRS/boosters [booster seat/cushion/booster with harness combination]), χ(2)(4) = 147.852, P.001. CRS misuse and/or inappropriate use were most prevalent among convertible CRS (birth to 18 kg; 87%), forward-facing CRS (85%), and convertible CRS (8-26 kg; 81%), compared to infant restraints (73%) and booster seats (booster seats/cushions/boosters with H-harness combination; 65%). There was no significant difference in the proportion of CRS with misuse and/or inappropriate use across the pre- and post-legislation period (80% vs. 77%), χ(2)(1) = 1.545, P.5.Based on the findings of the current study, it was concluded that, despite the introduction of new, definitive CRS legislation, CRS misuse and/or inappropriate use remains widespread in Australia. The findings highlight the need for CRS education and legislation that include information on correct CRS use, as well as information on appropriate CRS use, in order to provide specialized protection for child vehicle occupants in the event of a motor vehicle crash.

To describe the goals, processes, resources and outcomes of on-road training lessons provided to drivers with traumatic brain injury (TBI) who failed an initial occupational therapy (OT) driver assessment.Descriptive cohort study using file audit design of 340 drivers with mild to severe TBI. Measures included; number and goals of on-road training lessons and reassessments, time from injury to independent driving, license restrictions, years licensed, physical/visual impairments and injury severity.Initial OT driver assessment was passed by 72% (n = 246) cases. Of the 28% (n = 94) who failed, 93% (n = 87) resumed driving following on-road training; 42 (45%) with an open licence, 45 (48%) with restricted licence and seven (7%) failed to meet licencing standards. Individuals required, on average, 7.0 driving lessons (14 driving instructor hours), and 2.5 on-road reassessments, (9.8 OT and 3.8 driving instructor hours). Lesson goals were recommended to develop compensatory strategies for cognitive impairments (64%), improve previously learned driving skills (57%), improve confidence (53%), and address physical (26%) or visual impairment (16%).Investment in on-road training lessons addressing individual goals, followed by reassessment and use of restricted licenses, can achieve successful return to driving following TBI. Implications for Rehabilitation Driver rehabilitation specialists should offer on-road driver training to individuals with moderate to severe TBI who fail an initial driver assessment. Goal directed driving lessons can train individuals with moderate to severe TBI to compensate for cognitive, physical, visual, and psychological barriers to driving, enabling them to pass a reassessment and return to driving. Restricted licences may enable some drivers with TBI to meet their driving needs and achieve safe return to driving.

• Older drivers’ on-road driving behavior was observed on two occasions approximately 12 months apart (Times 1 and 2) to determine whether the self-selected driving routes changed over time or whether their driving behavior changed over time.

In many parts of the world, licensing guidelines state that drivers with medical conditions such as epilepsy are restricted or prohibited from driving. These guidelines are sometimes subjective and not strongly evidence-based, rendering the task of assessing fitness to drive a complex one. Determining fitness to drive is not only essential for maintaining the safety of individual drivers but has implications for the community at large. It is therefore important to review the current state of knowledge regarding epilepsy and driving in order to aid health professionals required to assess fitness to drive and to guide future research directions. This review outlines the functional impairments related to epilepsy and driving, treatment and management issues, motor vehicle crash risk for drivers with epilepsy, estimates of predicted seizure occurrence and concludes with a discussion of the international licensing guidelines and relevant legal issues. More comprehensive research, including investigation into the effects of antiepileptic medication on driving, could aid in the development of policies and guidelines for assessing fitness to drive.

This study sought to investigate the impact of external cue validity on simulated driving performance in 19 Parkinson's disease (PD) patients and 19 healthy age-matched controls. Braking points and distance between deceleration point and braking point were analysed for red traffic signals preceded either by Valid Cues (correctly predicting signal), Invalid Cues (incorrectly predicting signal), and No Cues. Results showed that PD drivers braked significantly later and travelled significantly further between deceleration and braking points compared with controls for Invalid and No-Cue conditions. No significant group differences were observed for driving performance in response to Valid Cues. The benefit of Valid Cues relative to Invalid Cues and No Cues was significantly greater for PD drivers compared with controls. Trail Making Test (B-A) scores correlated with driving performance for PDs only. These results highlight the importance of external cues and higher cognitive functioning for driving performance in mild to moderate PD.

Guidelines for assessing fitness to drive in individuals with neurodegenerative disorders, such as Parkinson's disease (PD), are subjective. It is therefore timely to review the current status of the literature not only for health professionals who are required to assess fitness to drive, but also for the development of future research directions. This review, in the context of PD, outlines the complex changes in driving behaviours, motor vehicle crash rates, driving simulator and on-road driving ability assessments, the relationship between disease severity, duration, medication dose and driving performance, the relationship between driving and neuropsychological test performance, and the effect of dopaminergic medications on driving. While it provides a current overview of the ongoing research, more comprehensive research is required for the full and proper development of policies and guidelines for assessing fitness to drive in PD.

This study investigated the factors associated with the premature graduation into seatbelts for Australian children aged 4-11 years. From 699 child restraint use questionnaires, 195 children were identified as meeting the booster seat height-weight criteria (height: 100-145 cm and weight: 14-26 kg). Of these children, 44% were correctly traveling in a booster seat, while 56% had been moved prematurely into a seatbelt. A multivariable logistic regression model showed that there were a number of key predictors associated with the premature graduation to seatbelts. For example, children who were moved prematurely into a seatbelt were more likely to be older, have other children travelling in the vehicle and have younger parents compared to children appropriately restrained in a booster seat. In addition, there was a significant interaction between vehicle type and parent's household income. Based on the findings of this study, a number of recommendations are made for strategies to enhance appropriate restraint use for this age group, as well as for future research.

Background : Medical illnesses are associated with a modest increase in crash risk, although many individuals with acute or chronic conditions may remain safe to drive, or pose only temporary risks. Despite the extensive use of national guidelines about driving with medical illness, the quality of these guidelines has not been formally appraised. Aim: To systematically evaluate the quality of selected national guidelines about driving with medical illness. Design: A literature search of bibliographic databases and Internet resources was conducted to identify the guidelines, each of which was formally appraised. Methods: Eighteen physicians or researchers from Canada, Australia, Ireland, USA and UK appraised nine national guidelines, applying the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument. Results: Relative strengths were found in AGREE II scores for the domains of scope and purpose, stakeholder involvement and clarity of presentation. However, all guidelines were given low ratings on rigour of development, applicability and documentation of editorial independence. Overall quality ratings ranged from 2.25 to 5.00 out of 7.00, with modifications recommended for 7 of the guidelines. Intra-class coefficients demonstrated fair to excellent appraiser agreement (0.57–0.79). Conclusions: This study represents the first systematic evaluation of national-level guidelines for determining medical fitness to drive. There is substantive variability in the quality of these guidelines, and rigour of development was a relative weakness. There is a need for rigorous, empirically derived guidance for physicians and licensing authorities when assessing driving in the medically ill.

Hypertension and lipid disorders in type II diabetes contribute to increased coronary risk, but optimal drug therapy has not been defined. We investigated primary care physicians choices of antihypertensive and lipid-lowering therapy for subjects with type II diabetes diagnosed with hypertension. Subjects were registered with 105 UK general practices in the General Practice Research Database and prescribed oral hypoglycaemic drugs for the first time between January 1993 and December 2001. We evaluated prescriptions for antihypertensive drugs in subjects with secondary diagnoses of hypertension in the first year following initiation of oral hypoglycaemic therapy. Data were analysed for 4519 diabetic subjects with diagnosed hypertension. Between 1993 and 2001, the proportion prescribed thiazide diuretics increased from 20 to 30%; angiotensin-converting enzyme (ACE) inhibitors from 35 to 45% and angiotensin receptor blockers from 0 to 8%. The proportion of subjects prescribed lipid-lowering therapy increased from 8% in 1993 to 33% in 2001, with the proportion prescribed statins increasing from 1 to 30%. At different general practices, the proportion prescribed thiazide diuretics ranged from 0 to 52%, beta-blockers from 5 to 60%, ACE inhibitors from 15 to 81%, and statins from 0 to 50%. Variation between practices was not explained by adjusting for age, sex, prevalent coronary heart disease or study year. Trends in drug utilisation were consistent with the evolving evidence base but there were wide variations in drug utilisation between practices. A more consistent approach to drug selection might be associated with improved patient outcomes.

This study examines the relationship between age and the injury outcomes for belted drivers in road vehicle crashes in the United Kingdom. The sample of 1,541 drivers was divided into three age groups: 889 drivers were aged 17–39 years (young drivers); 515 were 40–64 years (middle-aged), and 137 aged 65–84 years (older drivers). Both frontal and side impact crashes in which the vehicles sustained sufficient damage to be towed away from the scene are considered. In-depth information obtained from examinations of the crashed vehicles was combined with clinical data obtained from hospitals to throw light on the mechanisms that led to the injuries. Results show that in crashes of approximately equal severity, older drivers were significantly more likely than middle-aged and young drivers to be fatally injured in both frontal (p

An analysis was undertaken of police reported crashes and in-depth studies of crashes involving injured children in modern passenger cars to illustrate the extent and severity of injuries to children in current child restraints. The findings show that children are generally well protected when properly restrained in a child seat in the rear seat of a passenger car. These data reveal the pattern of crashes and crash severities associated with child injuries and provide direction for further improvement of child safety.

This paper describes changes in driving patterns for a cohort of older Australians. In-vehicle data-loggers installed in participants’ own vehicles monitored spatio-temporal characteristics of driving trips across three years for 164 participants aged 75+ years (Year 1: Male = 68.9%; Mean Age = 79.5 years, SD = 3.4 years, Range = 75 - 88 years). The majority (60–65%) of trips were within 5km from home across the three years. On average, in Year 1, participants drove 1,276 trips (SD = 479), totalling 9,468km (SD = 5,215) annually, decreasing significnatly to 1,175 trips (SD = 541) and 8,253km (SD = 4,813) annually in Year 3. Generalised Estimating Equations revealed that reduced driving (annual distance, trip frequency, night-time trips, peak-traffic trips) were associated with: increased age, being female, reduced cognitive function, poorer contrast sensitivity, and those that discontinued driving for health reasons. Results are considered in terms of implications for safe mobility.

Objective: This pilot study aimed to investigate physiological responses during an on-road driving task for older and younger drivers.Methods: Five older drivers (Mean age = 74.60 years [2.97]) and five younger drivers (Mean age = 30.00 years [3.08]) completed a series of cognitive assessments (Montreal Cognitive Assessment [MoCA], Mini Mental Status Examination [MMSE]; Trail Making Test [Trails A and Trails B]) and an on-road driving task along a pre-determined, standardized urban route in their own vehicle. Driving performance was observed and scored by a single trained observer using a standardized procedure, where driving behaviors (appropriate and inappropriate) were scored for intersection negotiation, lane changing and merging. During the on-road driving task, participants’ HR was monitored with an unobtrusive physiological monitor.Results: Younger drivers performed significantly better on all cognitive assessments compared to older drivers (MoCA: t(8) = 3.882, p < 0.01; MMSE: t(8) = 2.954, p < 0.05; Trails A: t(8) = -2.499, p < 0.05; Trails B: t(8) = - 3.262, p < 0.05). Analyses of participants’ performance during the on-road driving task revealed a high level of appropriate overall driving behavior (M = 87%, SD = 7.62, Range = 73-95%), including intersection negotiation (M = 89%, SD = 8.37%), lane changing (M = 100%), and merging (M = 53%, SD = 28.28%). The overall proportion of appropriate driving behavior did not significantly differ across age groups (Younger drivers: M = 87.6%, SD = 9.04; Older drivers: M = 87.0%, SD = 6.96; t(8) = .118, p = 0.91).Conclusions: Although older drivers scored lower than younger drivers on the cognitive assessments, there was no indication of ‘cognitive overload’ among older drivers based on HR response to the on-road driving task. The results provide preliminary evidence that mild age-related cognitive impairment may not pose a motor vehicle crash hazard for the wider older driver population. To maintain safe mobility of the aging population, further research into the specific crash risk factors in the older driver population is warranted.

The Candrive II/Ozcandrive study, a multicentre prospective cohort study examining the predictive validity of tools for assessing fitness to drive, aims to develop an in-office screening tool that will help clinicians identify older drivers who may be unsafe to drive. This paper describes the study protocol. We are following a cohort of drivers aged ≥70 years for up to 4 years. Starting in 2009, 928 participants have been recruited in seven cities in four Canadian provinces, as well as 302 participants in two sites in Melbourne, Australia and Wellington, New Zealand. Participants underwent a comprehensive assessment at baseline and repeat the assessment yearly thereafter, as well as a brief follow-up assessment at 4 and 8 months each year. A recording device is installed in participants' vehicles to assess driving patterns, and driving records are obtained from licensing authorities to determine the outcomes: at-fault crashes per kilometre driven and violations. To date, the protocol has been generally well adhered to, with 1230 participants, and barriers and challenges are being addressed, as necessary. The Candrive II/Ozcandrive study is unique owing to its size, duration, partnerships with Canadian, Australian and New Zealand stakeholders, and international research collaboration.

While there is a large body of research indicating that individuals with moderate to severe dementia are unfit to drive, relatively little is known about the driving performance of older drivers with mild cognitive impairment (MCI). The aim of the current study was to examine the driving performance of older drivers with MCI on approach to intersections, and to investigate how their healthy counterparts perform on the same driving tasks using a portable driving simulator. Fourteen drivers with MCI and 14 age-matched healthy older drivers (aged 65-87 years) completed a 10-min simulator drive in an urban environment. The simulator drive consisted of stop-sign controlled and signal-controlled intersections. Drivers were required to stop at the stop-sign controlled intersections and to decide whether or not to proceed through a critical light change at the signal-controlled intersections. The specific performance measures included; approach speed, number of brake applications on approach to the intersection (either excessive or minimal), failure to comply with stop signs, and slower braking response times on approach to a critical light change. MCI patients in our sample performed more poorly than controls across a number of variables. However, because the trends failed to reach statistical significance it will be important to replicate the study using a larger sample to qualify whether the results can be generalised to the broader population.

A range of medical conditions can lead to visual impairments either through effects on the eye or the visual pathways and brain. The prevalence of visual impairment increases with age. Furthermore, research evidence has shown that aging is related to a number of other processes that can lead to changes in cognitive functioning and sensory perception that may adversely affect driving (Marottoli and Drickamer, 1993; Stelmach and Nahom, 1992). This combination of factors is thought to contribute to older driver crash risk (Hakamies-Blomqvist, 1993; Stutts et al., 1998). Licensing authorities are the primary entity responsible for monitoring the medical fitness of their license holders. While it is important for licensing bodies to identify drivers who have conditions that place them at a heightened risk for crashes, at the same time, they should not unfairly restrict the mobility of disabled or aging drivers. Therefore, it is important that the licensing criteria for visual fitness to drive are based on scientific evidence establishing their effectiveness and predictive value for poor driving performance and unacceptable crash risk. The aim of this paper is to assess whether current licensing guidelines are consistent with the available scientific evidence on the effect of visual impairment on driving with a specific focus on older drivers.This article describes current licensing guidelines for vision from selected Western jurisdictions and reviews the available scientific evidence on visual impairment and driving performance on which such licensing decisions are based.The findings of the review indicate that the predictive values of the vision tests commonly used for licensing decisions by the selected authorities are inconclusive.The functional attributes of vision currently assessed for licensing do not adequately explain unsafe driving performance. Differences were observed across vision requirements for the selected jurisdictions, possibly reflecting the equivocal and inconclusive findings linking specific visual functions and impairment with crash risk. Setting benchmarks or performance thresholds on selected visual tests may be problematic for older drivers in particular, who are most vulnerable to underperforming. Driving involves a complex set of skills, and it is proposed that decisions about vision for safe driving need to be considered in the context of the driver's overall health and other functional abilities.

INTRODUCTION: Internal driver events such as emotional arousal do not consistently elicit observable behaviors. However, heart rate (HR) offers promise as a surrogate measure for predicting these states in drivers. Imaging photoplethysmography (IPPG) can measure HR from face video recorded in static, indoor settings, but has yet to be examined in an in-vehicle driving environment. METHODS: Participants (N=10) completed an on-road driving task whilst wearing a commercial, chest-strap style heart rate monitor ("baseline"). IPPG was applied to driver face video to estimate HR and the two measures of HR were compared. RESULTS: For 4 of 10 participants, IPPG produced a valid HR signal (±5BPM of baseline) between 48 and 75% of trip duration. For the remaining participants, IPPG accuracy was poor (CONCLUSIONS: In-vehicle IPPG is achievable, but significant challenges remain. PRACTICAL APPLICATIONS: The relationship between IPPG accuracy and various confounding factors was quantified for future refinement. Language: en

Numerous studies previously have reported reduced driving performance in people with Parkinson's disease (PD). Few studies to date, however, have examined how specific cognitive difficulties associated with PD impact on specific aspects of driving performance in this population. In this study, the impact of a concurrent task on driving performance was examined. A simulator was used to measure the driving behavior of 18 current drivers with PD and 18 matched controls. The presence of a concurrent task was manipulated between conditions. Results showed that, although groups were similarly affected by the concurrent task on most driving measures, participants with PD were disproportionately affected on operational level driving behavior. It also appears that participants with PD sacrificed concurrent task performance to maintain driving performance. These results further support the hypothesis that cognitive difficulties associated with PD compromise driving performance in this population, even in the mild to moderate stages of the disease.

In this study the association between cognitive symptoms of PD and driving performance was investigated by examining the correlation between neuropsychological test performance and driving simulator behavior. Eighteen participants with PD and 18 healthy participants in a matched comparison group completed a range of neuropsychological measures. These data were correlated with driving simulator performance results from an earlier study. Significant correlations were found between several measures of neuropsychological test performance and driving behavior in participants with PD. In contrast, few significant correlations were obtained in the comparison group. Results suggest that executive difficulties in people with PD such as working memory, planning and set shifting are associated with reduced tactical level driving performance such as speed adaptation and complex curve navigation. Impaired information processing, visual attention and visual perception in people with PD appears associated with reduced operational level driving performance, such as reacting to road obstacles and maintaining constant lane position. Few correlations were found between measures of physical mobility and psychomotor speed with driving measures. Overall, this study highlights the important role of cognitive function in driving performance within the PD population. Comprehensive assessment of cognitive function should be included when assessing driving competency in people with PD.

Numerous aspects of driving performance seem compromised in people with Parkinson's disease (PD). Measures of cognitive impairment consistently correlate with poor driving simulator performance in this population; however, the effects of specific cognitive difficulties on discrete aspects of driving behavior have not been investigated thoroughly. Previous studies have demonstrated that people with PD exhibit difficulties internally cueing cognitive processes. This study examined the impact of impaired internal cueing on specific driving behaviors. A simulator measured the driving behavior of 18 current drivers in the mild-to-moderate stages of PD and 18 matched controls. Participants navigated through different driving conditions where the opportunity to use internal and external cues was manipulated. People with PD exhibited difficulties using internal cues to regulate driving behavior around traffic signals and curves. Instead of using internal cues, participants with PD were more reliant on external cues to regulate driving behavior. They were also less able to adapt their driving behavior to suit driving conditions. Because all participants with PD were current drivers in the mild-to-moderate stages of the disease, findings challenge the widely-held assumption that cognitive difficulties only impact on driving performance in the moderate-to-severe stages of PD.

This article reviews recent scientific literature relating to vehicle design and the safety of older road users. The review describes the protection offered by recent technologies and features as well as future vehicle design recommendations. Recent research has identified that many older people are not well informed about vehicle safety issues and do not consider safety as a high priority when purchasing vehicles. Crash statistics suggest that older drivers are not involved in a large number of crashes, but when figures are adjusted for their shorter travel distances, it is clear that they are over-represented in serious injury and fatal crashes compared with younger drivers. Much of this risk can be attributed to their vulnerability or lower injury tolerance once involved in a crash. Compared with younger occupants, older vehicle occupants who sustain injuries, particularly to the chest, are likely to experience more serious consequences and require longer recovery times. The review highlights the need for better vehicle safety design to protect older occupants and better promotion of the benefits of vehicle safety amongst older road users.