Determinants of On-Road Driving in Multiple Sclerosis.

OBJECTIVE: To investigate the cognitive, visual, and motor deficits underlying poor performance on different dimensions of on-road driving in individuals with multiple sclerosis (MS). DESIGN: Prospective cross-sectional study. SETTING: MS clinic and driving simulator lab. PARTICIPANTS: Active drivers (N=102) with various types of MS. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Off-road cognitive, visual, and motor functions, as well as 13 specific driving skills. These skills were categorized into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving. Stepwise regression analysis was used to determine the off-road functions influencing performance on the on-road test and each cluster. RESULTS: Visuospatial function (P=.002), inhibition (P=.008), binocular acuity (P=.04), vertical visual field (P=.02), and stereopsis (P=.03) best determined variance in total on-road score (unadjusted R2=.37). Attentional shift (P=.0004), stereopsis (P=.007), glare recovery (P=.047), and use of assistive devices (P=.03) best predicted the operational cluster (unadjusted R2=.28). Visuospatial function (P=.002), inhibition (P=.002), reasoning (P=.003), binocular acuity (P=.04), and stereopsis (P=.005) best determined the tactical cluster (unadjusted R2=.41). The visuo-integrative model (unadjusted R2=.12) comprised binocular acuity (P=.007) and stereopsis (P=.045). Inhibition (P=.0001) and binocular acuity (P=.001) provided the best model of the mixed cluster (unadjusted R2=.25). CONCLUSIONS: Our results provide more insights into the specific impairments that influence different dimensions of on-road driving and may be used as a framework for targeted driving intervention programs in MS.

A verbal cuing device for persons with brain injury: development and proof-of-concept case study.

The ability to successfully return to driving following neurologic injury is one of the most critical factors in re-establishing independence and the most notable safety concern of health providers and family members. This assistive technology study describes the development of a verbal cuing device called the Electronic Driving Coach used as an adjunct to driver training following brain injury. We review literature on rates of return to driving following brain injury and factors associated with predicting return to driving and driving ability. We then address critical factors to return to driving addressed by this emerging technology and describe how the verbal cuing device called the Electronic Driving Coach was designed. We provide a proof-of-concept case study that evaluates use of the verbal cuing device with a person who has experienced a traumatic brain injury. Last, we discuss practical considerations for developing and using assistive driving devices in persons with cognitive impairments, including drivers who have experienced a stroke.

A sip-and-puff wireless remote control for the Apple iPod.

This brief technical note describes the authors' efforts to modify an existing wireless remote control for the Apple iPod so it could be operated using sip-and-puff switches by individuals with limited upper extremity dexterity due to cervical level spinal cord injury. The authors were able to successfully interface the wireless controller with sip-and-puff switches so that users could play, pause, and fast forward through a song list on the iPod. Details of the interface are described, and limitations of the current system are discussed.