Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Health and Rehabilitation Sciences

Supervisor

Classen, S.

Affiliation

University of Florida

2nd Supervisor

Morrow, S. A.

Affiliation

London Health Sciences Centre

Co-Supervisor

Abstract

Drivers with Multiple Sclerosis (MS) experience visual-cognitive impairment that may impact their fitness to drive. Fitness to drive is the ability to control a motor vehicle, as determined via a comprehensive driving evaluation, with in-clinic and on-road driving assessments. However, the on-road driving assessment may pose a crash risk to medically at-risk drivers. Instead, a driving simulator assessment that targets the driving performance deficits of drivers may inform fitness to drive decisions. However, utilizing clinical tests to indicate driving simulator performance in drivers with MS is not fully understood.

Through three aims, this dissertation will examine the clinical utility of visual-cognitive tests to indicate driving simulator performance in drivers with MS. Aim 1 will examine the study’s feasibility via evaluating recruitment capability, sample characteristics, data collection procedures, outcome measures, participants’ acceptability and suitability of the driving simulator, resources to implement the study, and preliminary test results. Aim 2 will quantify if visual-cognitive tests can predict driving simulator performance in drivers with MS, when compared to control drivers without MS. Aim 3 will examine if adjustment to stimuli errors can predict the occurrence of rear-end collisions on a driving simulator.

Aim 1 findings provided the foundation for determining clinical predictions of driving simulator performance, but also identified challenges such as lower than proposed recruitment rates, missing data on the driving simulator, participants’ varied responses toward the driving simulator’s acceptability, and the onset of simulator sickness. Aim 2 findings showed that deficits in immediate verbal/auditory recall and divided attention can indicate driving performance deficits in drivers with MS. Aim 3 findings showed that adjustment to stimuli errors, in urban environments, and that require intermittent problem-solving and decision-making to respond and avoid collisions, may underlie driving performance deficits.

This dissertation supports the notion that it would be feasible to utilize clinical tests to indicate driving performance deficits in drivers with MS. Tests of immediate verbal/auditory recall and divided attention may be useful screening tools. Adjustment to stimuli errors in urban environments may underlie driving performance deficits in drivers with MS and can be detected on a driving simulator.

Summary for Lay Audience

Drivers with Multiple Sclerosis (MS) experience visual-cognitive impairment (e.g., blurry or double vision, difficulty with thinking, remembering, reacting) that may impact their on-road driving performance. However, assessing on-road driving performance may pose a crash risk to medically at-risk drivers. Instead, a computer-based driving simulator assessment with realistic driving scenarios, and that target the driving performance deficits of drivers, may be useful for making decisions about one’s driving performance. However, using clinical tests to indicate driving simulator performance in drivers with MS is not fully understood.

Through three aims, this dissertation will examine if using visual-cognitive clinical tests can indicate driving simulator performance in drivers with MS. Aim 1 will examine the study’s advantages and disadvantages via evaluating participant recruitment strategies and characteristics, data collection procedures, outcome measures, participants’ acceptability and suitability of the driving simulator, resources to implement the study, and preliminary test results. Aim 2 will examine if visual-cognitive clinical tests can detect driving simulator performance in drivers with MS, when compared to drivers without MS. Aim 3 will examine if simulated driving errors can detect those who may experience a rear-end collision on the driving simulator.

Aim 1 findings provided the foundation for determining clinical tests that can identify driving simulator performance, but also identified challenges such as lower than proposed recruitment rates, missing data on the driving simulator, participants’ varied responses toward the driving simulator’s acceptability, and participants experiencing discomfort on the driving simulator. Aim 2 findings showed that difficulty with remembering verbal information and divided attention can detect driving performance deficits in drivers with MS. Aim 3 findings showed that driving errors that require thinking and making decisions to respond and avoid collisions may underlie driving performance deficits in drivers with MS.

This dissertation supports the notion that it would be feasible to use clinical tests to indicate driving performance deficits in drivers with MS. Tests of verbal memory and divided attention may identify driving performance deficits. Driving errors that require thinking and making decisions to respond and avoid collisions may underlie driving performance deficits and can be detected on a driving simulator.

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