Automated Vehicles: Future Initiatives for Occupational Therapy Practitioners and Driver Rehabilitation Specialists.

This article addresses a critically important topic for the occupational therapy (OT) profession and driver rehabilitation specialists (DRS), related to the introduction and deployment of personal and public automated vehicles (AVs); and discusses the current and corresponding changing roles for these professionals. Within this commentary, we provide an overview of the relevant literature on AV regulations, policy, and legislation in North America, the various levels of AV technology, and inclusive and universal design principles to consider in AV deployment for people with disabilities. The role of the OT practitioner and DRS is described within the context of the person-environment-occupation-performance model, and within the guidelines of the Association for Driver Rehabilitation Specialists and the American Occupational Therapy Association. The article concludes with considerations for an extended clinical agenda, a new research agenda, and a call for action to OT practitioners and DRS, as well as to educators, certification bodies, professional organizations, and collaborators.

Automated Vehicles: Future Initiatives for Occupational Therapy Practitioners and Driver Rehabilitation SpecialistsThis article discusses a critical practice and scientific area for occupational therapy (OT) practitioners and driver rehabilitation specialists (DRS), namely the deployment of automated vehicles (AVs) in North America and its effect on the OT profession. The article situates driving, including driving AVs, within the context of a credible OT model, discusses the current and changing roles of the OT practitioner and DRS, stipulates the rules and regulations for AVs in North America, expounds on the different levels of AV technology and potential implications, requirements for accessible AVs for people with disabilities, and highlights guidelines from professional organizations pertaining driving as a practice area. The article concludes by suggesting new directions for clinical practice and research, and it calls on OT practitioners, DRS, educators, certification organizations, and collaborators to take action.

Older Drivers Reduced Engagement in Distracting Behaviors Over a Six-Year Period: Findings From the Candrive Longitudinal Study.

OBJECTIVES: Baltes and Baltes' "selective optimization with compensation" model is pertinent to driving but evidence about the use of compensation using longitudinal designs is scarce. Therefore, we sought to determine if older drivers reduced their engagement in distracting behaviors while driving, over a 6-year period. METHODS: We used data captured over several annual assessments from a cohort of 583 drivers aged 70 and older to determine if their engagement in 12 distracting behaviors (e.g., listening to the radio, talking with passengers) declined over time. We adjusted our multivariable model for several potential confounders of the association between our outcome variable and time. RESULTS: Overall, and after adjustment for potential confounders, the participants reduced their engagement in distracting behaviors over the study period (odds ratio [OR] = 0.96, 95% confidence interval [CI] = 0.95-0.97). Baseline age was negatively associated with engagement in distracting behaviors (OR = 0.95, 95% CI = 0.94-0.96). Men engaged in more distracting behaviors than women (OR = 1.15, 95% CI = 1.03-1.27), as did participants living in the largest urban centers compared to participants living in the smallest areas (OR = 1.21, 95% CI = 1.04-1.41). The number of kilometers driven per year (for every 10,000 km) was positively associated with the proportion of distracting behaviors drivers engaged in (OR = 1.13, 95% CI = 1.08-1.19). DISCUSSION: Drivers in our cohort reduced their engagement in distracting behaviors over the study period. This suggests that older drivers adjust their driving over time, which aligns with age-related theories and models about compensation.

[Sondage sur les pratiques des médecins de famille et sur la collaboration interprofessionnelle avec des ergothérapeutes en GMF quant au dépistage des conducteurs à risque].

Cette étude a sondé 46 médecins de famille québécois quant à leurs pratiques pour l'évaluation et le dépistage des conducteurs à risque afin 1) de mieux comprendre leur niveau de compétence perçu; 2) de recenser les difficultés rencontrées dans le processus de prise de décision et 3) de documenter leurs besoins et attitudes quant à une collaboration plus étroite avec les ergothérapeutes. Les participants (femmes : 84,8 %; moyenne d'expérience : 15,7 (±12,1) ans) ont répondu à un sondage en ligne de 30 questions. Les résultats de cette étude démontrent que malgré un certain confort à effectuer l'évaluation et le dépistage des conducteurs à risque, les médecins ne se considèrent pas comme les professionnels les mieux qualifiés pour ce faire. Ils reconnaissent également le rôle que jouent les ergothérapeutes dans le dépistage de cette clientèle et l'intervention auprès d'elle. Ils voient ainsi la pertinence d'avoir accès aux services de ces professionnels en soins de première ligne.

Nurse practitioners' preferences for online learning regarding driving and dementia.

ABSTRACT: With a growing population of older adults living with dementia in the community, nurse practitioners (NPs) are increasingly expected to address issues of medical fitness to drive (MFTD) and driving cessation within their clinical practice. With their expertise in clinical assessment and communication skills, NPs are well suited to this area of practice. Studies that examined MFTD and/or driving cessation suggest that NPs want and need further knowledge and training with this population. As part of our aim to develop an online educational program on driving and dementia for health care providers, including NPs, this mixed-methods study explored NPs' preferences regarding the format and content for the proposed online program. Results from an online survey completed by 90 NPs and interviews with six NPs highlighted key areas of focus for virtual modules, where communication strategies, tools to assess MFTD, and the reporting process for medically unfit drivers were emphasized. Reflecting on their team approach to care, participants in this study preferred a hybrid approach of asynchronous and synchronous learning delivery for this educational program. The next step will be to evaluate this program and its impact on both NP knowledge and skills in terms of its real-world application.

Candrive-Development of a Risk Stratification Tool for Older Drivers.

BACKGROUND: Assessing an older adult's fitness-to-drive is an important part of clinical decision making. However, most existing risk prediction tools only have a dichotomous design, which does not account for subtle differences in risk status for patients with complex medical conditions or changes over time. Our objective was to develop an older driver risk stratification tool (RST) to screen for medical fitness-to-drive in older adults. METHODS: Participants were active drivers aged 70 and older from 7 sites across 4 Canadian provinces. They underwent in-person assessments every 4 months with an annual comprehensive assessment. Participant vehicles were instrumented to provide vehicle and passive Global Positioning System (GPS) data. The primary outcome measure was police-reported, expert-validated, at-fault collision adjusted per annual kilometers driven. Predictor variables included physical, cognitive, and health assessment measures. RESULTS: A total of 928 older drivers were recruited for this study beginning in 2009. The average age at enrollment was 76.2 (standard deviation [SD] = 4.8) with 62.1% male participants. The mean duration for participation was 4.9 (SD = 1.6) years. The derived Candrive RST included 4 predictors. Out of 4 483 person-years of driving, 74.8% fell within the lowest risk category. Only 2.9% of person-years were in the highest risk category where the relative risk for at-fault collisions was 5.26 (95% confidence interval = 2.81-9.84) compared to the lowest risk group. CONCLUSIONS: For older drivers whose medical conditions create uncertainty regarding their fitness-to-drive, the Candrive RST may assist primary health care providers when initiating a conversation about driving and to guide further evaluation.

Developing the Driving and Dementia Roadmap: a knowledge-to-action process.

OBJECTIVES: Despite three decades of research, gaps remain in meeting the needs of people with dementia and their family/friend carers as they navigate the often-tumultuous process of driving cessation. This paper describes the process of using a knowledge-to-action (KTA) approach to develop an educational web-based resource (i.e. toolkit), called the Driving and Dementia Roadmap (DDR), aimed at addressing some of these gaps. DESIGN: Aligned with the KTA framework, knowledge creation and action cycle activities informed the development of the DDR. These activities included systematic reviews; meta-synthesis of qualitative studies; interviews and focus groups with key stakeholders; development of a Driving and Dementia Intervention Framework (DD-IF); and a review and curation of publicly available resources and tools. An Advisory Group comprised of people with dementia and family carers provided ongoing feedback on the DDR's content and design. RESULTS: The DDR is a multi-component online toolkit that contains separate portals for current and former drivers with dementia and their family/friend carers. Based on the DD-IF, various topics of driving cessation are presented to accommodate users' diverse stages and needs in their experiences of decision-making and transitioning to non-driving. CONCLUSION: Guided by the KTA framework that involved a systematic and iterative process of knowledge creation and translation, the resulting person-centered, individualized and flexible DDR can bring much-needed support to help people with dementia and their families maintain their mobility, community access, and social and emotional wellbeing during and post-driving cessation.

Needs, Barriers and Facilitators of Adolescents Participating in a Lifestyle Promotion Program in Oncology: Stakeholders, Adolescents and Parents' Perspective.

Treatments for adolescent cancer can cause debilitating side effects in the short- and long-term such as nausea and malnutrition but also cardiometabolic disturbances. Although the risk for cardiometabolic complications is greater for adolescents with cancer than younger ones, adolescents typically respond poorly to family-oriented health promotion programs. This study aims to assess the needs, barriers and facilitators to healthy lifestyle promotion interventions for adolescents with cancer and how to best adapt these interventions for them. Interviews were held with adolescents treated for cancer (n = 9) and parents (n = 6), focus groups were conducted with stakeholders working in oncology (n = 12) and self-report questionnaires were sent to stakeholders involved in a health promotion intervention (n = 6). At the time of interview, mean age of adolescent participants (40% female) was 17.0 ± 1.9 years (mean age at diagnosis: 14.6 ± 1.6 years). Verbatim and responses to questionnaires were coded and analyzed using qualitative methods. Stakeholder stated that adolescents with cancer need to access activities adapted to their age, to communicate with peers going through a similar experience, and to preserve their schooling and friendships. Barriers to intervention reported by adolescents, parents and stakeholders include lack of motivation, schedule conflicts, fatigue and treatment side effects. Some of the barriers mentioned by adolescents and parents include pain, post-surgery problems, school, physical deconditioning, and lack of time. Facilitators mentioned by adolescents and parents comprise trust in stakeholders' expertise, personalized approaches, scheduling flexibility. Stakeholders recommended to build trust in the relationship, favoring non-moralizing teachings, adapt interventions to adolescents' limited attention span and avoiding the use of long-term health benefits as a motivator.

Comparison of older and middle-aged drivers' driving performance in a naturalistic setting.

There is a concern in the public domain about driving safety among older drivers due the increase in age-associated medical conditions. It is not known how these medical changes impact driving performance and choice of driving environment. This study aimed to compare older drivers' (≥74 years) driving performance in a naturalistic setting to middle-aged drivers (35-64 years) on their chosen driving environment, and number, type and severity of errors. The effect of sex and perceived driving ability was also examined. Drivers' performance was studied using the electronic Driving Observation Schedule [eDOS]), a naturalistic observation approach. Fifty-three older (mean age = 80.6 years, 72% male) and 60 middle-aged (mean age = 50.0 years, 50% male) healthy drivers were recruited. Both groups made few driving errors that were mostly low-risk. Driving performance of older adults differed from middle-aged drivers; they drove on simpler routes (fewer intersections and lane changes) and made fewer errors. Findings are likely indicative of older drivers' use of adaptive strategies to maintain safe driving.

Complex behavioral interventions targeting physical activity and dietary behaviors in pediatric oncology: A scoping review.

As cancer and its treatment negatively impacts the long-term health and quality of life of survivors, there is a need to explore new avenues to prevent or minimize the impact of adverse effects in children with cancer and cancer survivors. Therefore, this scoping review aimed to report on the state of the evidence on the use and effects of complex behavioral interventions (CBI) targeting physical activity and/or dietary behaviors in pediatric oncology. Fourteen quantitative studies were included, evaluating interventions that used a combination of two or three different treatment modalities. Overall, studies demonstrated that it is feasible to implement CBI and that they can potentially improve physical activity and dietary behaviors as well as patient outcomes such as physical and psychological health. Unfortunately, due to a paucity of studies and the heterogeneity of the studies included in this review, no conclusive evidence favoring specific interventions were identified.

Personal and Clinical Factors Associated with Older Drivers' Self-Awareness of Driving Performance.

Most older adults perceive themselves as good drivers; however, their perception may not be accurate, and could negatively affect their driving safety. This study examined the accuracy of older drivers' self-awareness of driving ability in their everyday driving environment by determining the concordance between the perceived (assessed by the Perceived Driving Ability [PDA] questionnaire) and actual (assessed by electronic Driving Observation Schedule [eDOS]) driving performance. One hundred and eight older drivers (male: 67.6%; age: mean = 80.6 years, standard deviation [SD] = 4.9 years) who participated in the study were classified into three groups: underestimation (19%), accurate estimation (29%), and overestimation (53%). Using the demographic and clinical functioning information collected in the Candrive annual assessments, an ordinal regression showed that two factors were related to the accuracy of self-awareness: older drivers with better visuo-motor processing speed measured by the Trail Making Test (TMT)-A and fewer self-reported comorbid conditions tended to overestimate their driving ability, and vice versa.

Advantages of training with an adaptive driving device on a driving simulator compared to training only on the road.

PURPOSE: To compare the advantages of training on a driving simulator versus on the road, when learning to drive with new assistive technologies (AT) in individuals with motor impairments. METHOD: An experimental group (EXP = 16) that trained on a driving simulator was compared to a comparison group (CMP = 16) that received training only on the road. A post-training road test assessed driving performance. Analysis included proportion of participants who successfully completed the on-road driving test, number of training sessions, level of satisfaction, simulator sickness, advantages and discomforts. RESULTS: EXP and CMP were comparable for age (48 ± 17 years), sex (13 M, 3 F), and AT (3 steering wheel knobs with integrated switches, 4 left accelerators, 9 hand controls and steering wheel knobs). No significant difference was observed between groups in the proportion of participants who were found to be fit to drive (EXP: 9/16; CMP: 13/16; p = 0.126) or in the number of sessions completed (EXP: 4.3; CMP: 3.2; p = 0.061). For 6 of the 9 satisfaction variables, participants reported being satisfied/very satisfied with training on a simulator with driving assistive technologies 76% to 100% of the time. EXP was satisfied to have been able to use simulator sessions before going on the road (100%). Participants determined to be fit to drive on an on-road test following simulator training showed no significant difficulty continuing with the training. EXP reported temporary discomfort on the simulator during the initial session (88%). CONCLUSION: Simulators provide some advantages for training drivers with adaptive aids in a safe context.IMPLICATIONS FOR REHABILITATIONAmong individuals with motor impairments who used to drive: All participants reported a high level of satisfaction training on the simulator with assistive technologies.The simulator proved to be an interesting tool for initiating training with new driving AT in a safe environment at no cost to individuals.The few discomforts reported during the first session resolved over time when participants continued with the driving simulator protocol.Occupational therapists noticed that the difficulties observed on the simulator were the same as those observed during on-road testing.The simulator allowed participants to begin to learn how to operate a vehicle with new assistive technology in a safe context.

Trajectories of decline on instrumental activities of daily living prior to dementia in persons with mild cognitive impairment.

OBJECTIVES: The main objective was to determine the trajectory of instrumental activities of daily living (iADL) decline in persons with mild cognitive impairment (MCI) who progressed towards dementia relative to persons with MCI who remained stable. METHODS/DESIGN: At study entry, 121 participants met criteria for MCI. Based on the follow-up, 47 participants later converted to dementia and were identified as progressors. Sixteen participants, identified as decliners, presented a significant cognitive decline but did not reach the criteria for dementia within the study timeframe. Stable MCI remained cognitively stable during the 5-year follow-up; n = 58. Participants completed a yearly assessment using clinical tests/questionnaires, neuropsychological measures, and functional autonomy assessment until they met criteria for dementia. The average number of months for the follow-up was 34. RESULTS: Many years of stable performance followed by an accelerated decline just prior to diagnosis, was observed for complex activities for progressors. No change was found for stable MCI and a gradual linear decline characterized decliners. The housekeeping-related activities component showed a linear decline in progressors and did not change in stable and decliner MCI. We found a predictive model that includes significant predictors of dementia conversion with a high diagnostic accuracy the following year (area under the curve = 0.94 [95% confidence level; lower bound: 0.87, upper bound: 1]). CONCLUSIONS: It is critical to assess iADL that reflect complex activities in the evaluation of MCI individuals as their impairment, combined with change on cognitive markers, indicates a higher risk of dementia progression 1 or 2 years later.

Development of a weighted scoring system for the Electronic Driving Observation Schedule (eDOS).

The electronic Driving Observation Schedule (eDOS) is a novel approach to assessing older drivers' performance in their everyday driving environment on their chosen routes. The original eDOS total score is generated using the count of driving errors, which does not account for distinct risk levels of different types of driving errors made in different complexity of driving environments. This study was conducted to create one score to represent the complexity of driving route during each eDOS observation and one weighted eDOS total score to represent older drivers' performance accounting for the risk of driving errors by their type and the complexity of maneuvers in their corresponding environments. A literature review, a two-round survey with 13 experts in driving evaluation, and iterative discussions between primary investigators were conducted for generating these scores. Two formulae were created to calculate a weighted maneuver/environmental complexity score and a weighted eDOS total score. •An advanced weighted score is created to represent one's on-road driving performance in their everyday driving environment not only using the count of driving errors, but also accounting for the risk level of each error.•The complexity of driving maneuver and environment in each on-road driving trip can be systematically rated.

Changes in older drivers' self-awareness of driving ability over one year.

Older drivers' self-awareness of driving ability can prompt self-regulatory behaviors and modifications of their everyday driving performance. To date, studies have yet to examine how older drivers' self-awareness of changes in driving ability over time or identify the characteristics of those who can accurately monitor such changes. 64 older drivers (Age: Mean = 80.0 years, SD = 5.4; male: 70 %) were recruited and categorized into four groups based on the correspondence of changes in their perceived and actual driving ability over one year: 40 % of the participants were accurate in their stable or better driving ability over time, 30 % did not detect their driving performance had worsened and over-estimated their driving ability, and the remainder either accurately detected their performance had worsened or under-estimated their driving performance. No demographic or clinical factors were associated with older drivers' self-awareness of changes in driving ability over time, except the mental processing and executive functioning measured using the Trail Making Tests Part B, showed a marginal effect. Implications for clinical importance are discussed.

[Overview of the assessment practices of occupational therapists working in Quebec]. / Portrait des pratiques évaluatives des ergothérapeutes œuvrant au Québec.

BACKGROUND.: In occupational therapy practice, client assessments are essential for establishing treatment priorities and determining the effectiveness of interventions. However, occupational therapists' assessment practices are not well documented. PURPOSE.: This work aimed to provide an overview of the assessment practices of Quebec occupational therapists based on the person-environment-occupation components and clienteles. METHOD.: A cross-sectional survey was conducted using an online survey that was sent to occupational therapists in Quebec. FINDINGS.: In paediatrics, occupational therapists tend to use standardized tools to assess physical and neurological abilities. Adult assessment focuses mainly on physical abilities and productivity. For seniors, assessment focuses mainly on functional aspects (physical abilities, personal care, and home safety) and screening for cognitive difficulties. IMPLICATIONS.: Occupational therapy assessment mostly focuses on physicial abilities. To ensure a holistic approach, more occupational and environmental components should be included in the assessment practices.

DESCRIPTION.: L'évaluation du client est primordiale dans la pratique de l'ergothérapie, notamment pour établir les priorités de traitement et pour vérifier l'efficacité des interventions. Les pratiques évaluatives des ergothérapeutes sont cependant peu documentées. BUT.: Dresser un portrait des pratiques évaluatives des ergothérapeutes du Québec selon les dimensions personne-environnement-occupation et les clientèles. MÉTHODOLOGIE.: Une enquête transversale a été réalisée à l'aide d'un sondage en ligne envoyé aux ergothérapeutes du Québec. RÉSULTATS.: En pédiatrie, les ergothérapeutes utilisent majoritairement des outils standardisés des aptitudes physiques et neurologiques. L'évaluation d'adultes cible principalement les aptitudes physiques et la productivité. Auprès des aînés, l'évaluation repose surtout sur les aspects fonctionnels, particulièrement les aptitudes physiques, les soins personnels et la sécurité à domicile, et sur le dépistage des difficultés cognitives. IMPLICATIONS POUR LA PRATIQUE.: L'évaluation ergothérapique serait généralement axée sur les aptitudes physiques. Pour assurer une approche holistique, l'occupation et l'environnement devraient être davantage considérés dans l'évaluation.

Driving Behaviors 2-3 Years After Traumatic Brain Injury Rehabilitation: A Multicenter Case-Control Study.

Introduction: Driving an automobile is an important activity for the social participation of individuals with traumatic brain injury (TBI). Return to safe driving is usually addressed during rehabilitation, but we know little about driving behaviors in the years following TBI rehabilitation. Objective: To explore self-reported and objective (official driving records) post-rehabilitation driving behaviors and offenses in individuals with TBI: (a) having passed a driving evaluation, (b) who did not undergo a driving evaluation, and (c) non-injured controls. Methods: Cross-sectional design with 162 adults: (a) 48 participants with mild, moderate, or severe TBI whose drivers' license was suspended and reinstated following a driving evaluation during rehabilitation (TBI-DE; M = 42.2 years of age, SD = 11.5); (b) 24 participants with TBI who maintained their driving privileges without undergoing a driving evaluation (TBI-NE; M = 36.5 years of age, SD = 9.9); (c) 90 non-injured controls (M = 43.8 years of age, SD = 11.4). Participants with TBI were recruited from seven rehabilitation centers, 2-3 years after the end of rehabilitation in the province of Quebec, Canada. During a telephone interview, data were obtained regarding self-reported driving: (a) habits; (b) self-efficacy; (c) anger expression; (d) sensation-seeking; (e) violations/errors; (f) accidents, driving offenses, and demerit points for the two-year interval predating the study. Objective data for driving offenses, accidents, and demerit points were obtained from the automobile regulatory body for the same period and for the two-year interval before the injury for the TBI groups. Results: Compared to non-injured controls, the TBI-DE group reported significantly lower scores for self-reported verbal aggressive expression of anger and driving violations/errors. Conversely, their official driving records showed significantly more demerit points for the last 2 years, and a significantly higher frequency of serious post-rehabilitation accidents (10), compared to the TBI-NE group (one) and the control group (none). Compared to pre-injury levels, individuals with TBI had significantly more demerit points post-rehabilitation. Conclusions: Individuals with TBI may underestimate risky driving behaviors even if they have been deemed fit to drive. Reduced self-awareness, memory, and dysexecutive problems following TBI could influence self-report of driving behaviors and explain discrepancies between self-reported and objective driving-related behaviors. Recommendations for research and practice are provided.

Long-term use of the JACO robotic arm: a case series.

PURPOSE: Past research with JACO has principally focused on the short-term impacts on new users. Therefore, this study aims to document the long-term impacts of this assistive device on users and their family caregivers following prolonged use. METHODS: Users' characteristics, caregivers' characteristics and expenses related to JACO were documented with questionnaires designed for this study. Upper extremity performance was measured with an adaptation of an upper extremity performance test, the TEMPA, and accomplishment of life habits was documented in an interview based on the LIFE-H questionnaire. Satisfaction with JACO and psychosocial impacts of its use were measured with validated questionnaires, namely the QUEST and the PIADS-10. Impacts of JACO on family caregivers were documented with a validated questionnaire, the CATOM. Descriptive statistics were used to report the results. RESULTS: Seven users and five caregivers were recruited. One user had expenses related to JACO in the past two months. Users had a better upper extremity performance with JACO than without it and they used their robotic arm to accomplish certain life habits. Most users were satisfied with JACO and the psychosocial impacts were positive. Impacts on family caregivers were slight. CONCLUSIONS: JACO increased performance in manipulation and facilitated the accomplishment of certain life habits. Users' increased participation in their life habits may slightly decrease the amount of caregiver assistance required. Future studies are needed to clarify its economic potential, its impact on caregivers' burden, including paid caregivers, and the variability in the tasks performed using JACO. Implications for Rehabilitation The use of JACO may have positive impacts on its users in terms of upper extremity performance, accomplishment of life habits, satisfaction with the device and psychosocial impacts. More research is needed to quantify more accurately the economic potential of the long-term use of JACO, to explore the factors related to the variability in the tasks performed using JACO, and to clarify the impact of JACO on caregivers' burden, including paid caregivers.

Self-reported violations, errors and lapses for older drivers: Measuring the change in frequency of aberrant driving behaviours across five time-points.

The current study aimed to: 1. to confirm the 21-item, three-factor Driver Behaviour Questionnaire (DBQ) structure suggested by Koppel et al. (2018) within an independent sample of Canadian older drivers; 2. to examine whether the structure of the DBQ remained stable over a four-year period; 3. to conduct a latent growth analysis to determine whether older drivers' DBQ scores changed across time. Five hundred and sixty Canadian older drivers (males = 61.3%) from the Candrive/Ozcandrive longitudinal study completed the DBQ yearly for four years across five time-points that were approximately 12 months apart. In Year 1, the average age of the older drivers was 76.0 years (SD = 4.5 years; Range = 70-92 years). Findings from the study support the 21-item, three-factor DBQ structure suggested by Koppel and colleagues for an Australian sample of older drivers as being acceptable in an independent sample of Canadian older drivers. In addition, Canadian older drivers' responses to this version of the DBQ were stable across the five time-points. More specifically, there was very little change in older drivers' self-reported violations, and no significant change for self-reported errors or lapses. The findings from the current study add further support for this version of the DBQ as being a suitable tool for examining self-reported aberrant driving behaviours in older drivers. Future research should investigate the relationship between older drivers' self-reported aberrant driving behaviours and their performance on functional measures, their responses to other driving-related abilities and practice scales and/or questionnaires, as well their usual (or naturalistic) driving practices and/or performance on on-road driving tasks.

Cannabis use and driving-related performance in young recreational users: a within-subject randomized clinical trial.

BACKGROUND: With the legalization of cannabis in Canada, young adults, who are already at risk of automobile crashes, may increase their use of cannabis, which may further increase the risk of crashes. We examined the effects of inhaled cannabis on driving-related performance in healthy 18- to 24-year-old recreational cannabis users. METHODS: In this within-subject randomized study, participants completed tests in the no-cannabis state and at 1, 3 and 5 hours after inhalation of a standard 100-mg dose of cannabis. We then measured performance (in useful-field-of-view and driving-simulation tests) and self-reported perceptions (driving ability and safety, cannabis effects). Repeated-measures analysis of variance (for cannabis effects on continuous performance measures), Cochran Q tests (for performance-related crash risk and binary complex simulator task scores) and correlational analyses (for self-reported perceptions relative to performance) were employed. RESULTS: Forty-five participants completed all 180 testing sessions. Significant effects of cannabis (relative to no cannabis) were noted on complex useful-field-of-view tasks at 3 hours (complex divided-attention task: 70 ± 24 ms v. 37 ± 12 ms, 95% confidence intervals [CIs] 28-114 ms v. 29-45 ms, t = -2.98, df = 41, p = 0.005; complex selective-attention task: 102 ± 66 ms v. 64 ± 18 ms, 95% CIs 60-144 ms v. 53-75 ms, t = -2.42, df = 41, p = 0.02) and 5 hours (complex selective-attention task: 82 ± 29 ms v. 61 ± 19 ms, 95% CIs 62-100 ms v. 48-75 ms, t = -2.32, df = 41, p = 0.03) after cannabis use when the tasks were novel (performed in a cannabis state at the first session). Participants were significantly more likely to be classified as having a high crash risk (on the basis of simulator tasks) after cannabis use (χ 2 = 13.23, df = 1, p < 0.001, odds ratio 4.31, 95% CI 0.41-45.2) and reported significantly lower perceived driving ability and safety after cannabis use relative to non-use. INTERPRETATION: Among young recreational cannabis users, a 100-mg dose of cannabis by inhalation had no effect on simple driving-related tasks, but there was significant impairment on complex tasks, especially when these were novel. These effects, along with lower self-perceived driving ability and safety, lasted up to 5 hours after use. TRIAL REGISTRATION: The trial was registered with Health Canada (NOL [No Objection Letter] no. 215101).

Impacts of robotic arm use on individuals with upper extremity disabilities: A scoping review.

BACKGROUND.: Robotic arms may help users perform various activities. Even though robotic arms are commercially available, their impacts are still poorly understood. PURPOSE.: This scoping review aimed to identify the potential impacts of using robotic arms for individuals with upper-extremity disabilities and appraise the scientific quality of the selected studies. METHOD.: A search for studies published between 1970 and 2016 was conducted in PubMed, Embase, Compendex, and Scopus. The Canadian Model of Occupational Performance and Engagement was used to classify activities in which impacts were evaluated. The quality of each study was rated using McMaster University's critical review form for quantitative studies. FINDINGS.: Thirty-six studies were reviewed, which evaluated self-care (21), productivity (33), and leisure (8). The short-term impacts were more commonly documented than long-term impacts. The impacts identified were mostly positive. The studies' mean quality score was 8.8/15. IMPLICATIONS.: Additional studies with more rigorous conditions are needed to produce higher-quality scientific evidence of the long-term impacts of robotic arm use.