Effect of Visual Information on Postural Control in Children with Autism Spectrum Disorder.

Visual information is crucial for postural control. Visual processing in children with autism spectrum disorder (ASD) was hypothesized to be less efficient and thus they would display a less stable standing posture than typically developing children. The present study compared the static standing responses and attentional demands of 15 children with ASD and 18 control participants in conditions of eyes open and eyes closed. The results showed that postural responses and attention invested in standing were similar between the participant groups in the two visual conditions. Both groups displayed a more stable posture when their eyes were open in comparison to eyes closed. The finding suggests that normal postural control development could occur in children with ASD.

Postural control adaptation to optic flow in children and adults with autism spectrum disorder.

BACKGROUND: Sensory reweighting is important for humans to flexibly up-weigh and down-weigh sensory information in dynamic environments. There is an element of time involved in the sensory reweighting process. A longer time spent on sensory reweighting may increase the destabilizing effect of postural control. Individuals with autism spectrum disorder (ASD) are reported to have poor postural control. It is uncertain if a different sensory reweighting process underlies the postural control deficit in children and adults with ASD. RESEARCH QUESTION: To explore the sensory reweighting capability in ASD, the present study examined whether the temporal domains of postural control differed in children and adults, with and without ASD under various optic flow conditions. METHODS: Thirty-three children (8-12 years old) and 33 adults (18-50 years old) with and without ASD underwent quiet standing in six radial optic flow conditions. Each condition lasted for 60 s and was shown twice to all participants. For each optic flow condition, changes in postural response within-trial and between-trials were measured. RESULTS: Under various optic flow illusions, both children with and without ASD took a longer time to restore their posture compared with adults with and without ASD. Nonetheless, all groups demonstrated comparable abilities to adjust their posture to one that is close to the baseline position after one exposure to the optic flow stimulation. SIGNIFICANCE: The present study showed that the temporal domains of postural control under different optic flow conditions were similar between individuals with and without ASD from the same age group. The ability to down-weigh visual information efficiently comes with the developmental progression of the sensory reweighting system. These findings suggest that the sensory reweighting process does not elucidate the postural control deficits in individuals with ASD and thus alternative explanations to determine the underlying mechanism for postural instability are needed.

Effect of Visual Information on Postural Control in Adults with Autism Spectrum Disorder.

Sensory processing difficulties affect the development of sensorimotor skills in individuals with autism spectrum disorder (ASD). However, the effect of sensory information on postural control is unclear in the ASD adult population. The present study examined the effect of visual information on postural control as well as the attentional demands associated with postural control in fourteen adults with ASD and seventeen typically developed adults. The results showed that postural sway and attention demands of postural control were larger in adults with ASD than in typically developed adults. These findings indicate that visual processing used for postural control may be different in adults with ASD. Further research in visual field processing and visual motion processing may elucidate these sensorimotor differences.

Effect of Optic Flow on Postural Control in Children and Adults with Autism Spectrum Disorder.

Individuals with autism spectrum disorder (ASD) have been associated with sensorimotor difficulties, commonly presented by poor postural control. Postural control is necessary for all motor behaviors. However, findings concerning the effect of visual motion on postural control and the age progression of postural control in individuals with ASD are inconsistent. The aims of the present study were to examine postural responses to optic flow in children and adults with and without ASD, postural responses to optic flow in the central and peripheral visual fields, and the changes in postural responses between the child and adult groups. Thirty-three children (8-12 years old) and 33 adults (18-50 years old) with and without ASD were assessed on quiet standing for 60 seconds under conditions of varying optic flow illusions, consisting of different combinations of optic flow directions and visual field display. The results showed that postural responses to most optic flow conditions were comparable between children with and without ASD and between adults with and without ASD. However, adults with ASD appeared more responsive to forward-moving optic flow in the peripheral visual field compared with typically developed adults. The findings suggest that children and adults with ASD may not display maladaptive postural responses all the time. In addition, adults in the ASD group may have difficulties prioritizing visual information in the central visual field over visual information in the peripheral visual field when in unfamiliar environments, which may have implications in understanding their motor behaviors in new surroundings.

Scoping Review of the Driving Behaviour of and Driver Training Programs for People on the Autism Spectrum.

Gaining a driver's licence represents increased independence and can lead to improved quality of life for individuals and their families. Learning to drive a motor vehicle and maintaining safe on-road skills are often more difficult for people on the autism spectrum. Many countries currently have no autism-specific licencing requirements for learner drivers, and there is a general lack of ASD-specific support and training packages for individuals, their families, and driving instructors. This review synthesises the peer-reviewed literature about the driving characteristics of drivers on the spectrum and driver training available for the cohort. The evidence in this review showed that individuals on the autism spectrum drive differently from their neurotypical counterparts. There are shortcomings in tactical skills of drivers on the autism spectrum, but the extent to which this affects their own safety or the safety of other road users is unclear. Tactical skills can be improved through training programs. There are few autism spectrum-specific learner training programs available. Development of an effective training program will benefit individuals on the spectrum to learn to drive, be independent, and be safe on the road.

Investigating cognitive ability and self-reported driving performance of post-stroke adults in a driving simulator.

Background Safe driving is a complex activity that requires calibration. This means the driver can accurately assess the level of task demand required for task completion and can accurately evaluate their driving capability. There is much debate on the calibration ability of post-stroke drivers. Objectives The aim of this study was to assess the cognition, self-rated performance, and estimation of task demand in a driving simulator with post-stroke drivers and controls. Methods A between-groups study design was employed, which included a post-stroke driver group and a group of similarly aged older control drivers. Both groups were observed driving in two simulator-based driving scenarios and asked to complete the NASA Task Load Index (TLX) to assess their perceived task demand and self-rate their driving performance. Participants also completed a battery of psychometric tasks to assess attention and executive function, which was used to determine whether post-stroke cognitive impairment impacted on calibration. Results There was no difference in the amount of perceived task demand required to complete the driving task. Despite impairments in cognition, the post-stroke drivers were not more likely to over-estimate their driving abilities than controls. On average, the post-stroke drivers self-rated themselves more poorly than the controls and this rating was related to cognitive ability. Conclusion This study suggests that post-stroke drivers may be aware of their deficits and adjust their driving behavior. Furthermore, using self-performance measures alongside a driving simulator and cognitive assessments may provide complementary fitness-to-drive assessments, as well as rehabilitation tools during post-stroke recovery.

Median nerve mobilization techniques in the treatment of carpal tunnel syndrome: A systematic review.

STUDY DESIGN: Systematic review. INTRODUCTION: Median nerve mobilization is one of the interventions used in the treatment of carpal tunnel syndrome (CTS). However, it is uncertain how many types of mobilization techniques are described in the current literature or the relative effectiveness of these techniques in treating CTS. PURPOSE OF THE STUDY: The aim of this review was to describe the types and effectiveness of median nerve mobilization techniques studied in the CTS literature. METHODS: Electronic searches of 5 databases and manual searches of references lists located randomized controlled trials studies published between 2000 and April 2015. Quality appraisal for each study was conducted using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields by 2 independent reviewers. RESULTS: Nine randomized controlled trial studies describing various median nerve mobilization techniques used in the treatment of CTS were included. All studies were rated as of "adequate", "good", or "strong" quality for the Standard Quality Assessment Criteria. Three techniques of median nerve mobilization were described. Treatment outcomes included measures of electrodiagnostic testing, functional performance, pain, physical examination, sensation, and strength. Standardized mean differences for the treatment outcomes ranged from very small to large (0.05-1.71). CONCLUSION: The findings are inconclusive regarding the effectiveness of each mobilization technique due to methodological limitations in the current body of research. Therefore, there is a clear need for high-quality controlled studies to examine various approaches to median nerve mobilization techniques in the treatment of CTS. LEVEL OF EVIDENCE: 2a.

Parent-Mediated Intervention Training Delivered Remotely for Children With Autism Spectrum Disorder Living Outside of Urban Areas: Systematic Review.

BACKGROUND: Parent training programs for families living outside of urban areas can be used to improve the social behavior and communication skills in children with autism spectrum disorder (ASD). However, no review has been conducted to investigate these programs. OBJECTIVE: The aim of this study was to (1) systematically review the existing evidence presented by studies on parent-mediated intervention training, delivered remotely for parents having children with ASD and living outside of urban areas; (2) provide an overview of current parent training interventions used with this population; (3) and provide an overview of the method of delivery of the parent training interventions used with this population. METHODS: Guided by the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, we conducted a comprehensive review across 5 electronic databases (CINAHL, Embase, ERIC, PsycINFO, and Pubmed) on July 4, 2016, searching for studies investigating parent-mediated intervention training for families living outside of urban centers who have a child diagnosed with ASD. Two independent researchers reviewed the articles for inclusion, and assessment of methodological quality was based on the Kmet appraisal checklist. RESULTS: Seven studies met the eligibility criteria, including 2 prepost cohort studies, 3 multiple baseline studies, and 2 randomized controlled trials (RCTs). Interventions included mostly self-guided websites: with and without therapist assistance (n=6), with training videos, written training manuals, and videoconferencing. Post intervention, studies reported significant improvements (P<.05) in parent knowledge (n=4), parent intervention fidelity (n=6), and improvements in children's social behavior and communication skills (n=3). A high risk of bias existed within all of the studies because of a range of factors including small sample sizes, limited use of standardized outcome measures, and a lack of control groups to negate confounding factors. CONCLUSIONS: There is preliminary evidence that parent-mediated intervention training delivered remotely may improve parent knowledge, increase parent intervention fidelity, and improve the social behavior and communication skills for children with ASD. A low number of RCTs, difficulty in defining the locality of the population, and a paucity of standardized measures limit the generalization of the findings to the target population. Future studies should investigate the appropriateness and feasibility of the interventions, include RCTs to control for bias, and utilize standard outcome measures.

Assessing Cognitive Ability and Simulator-Based Driving Performance in Poststroke Adults.

Driving is an important activity of daily living, which is increasingly relied upon as the population ages. It has been well-established that cognitive processes decline following a stroke and these processes may influence driving performance. There is much debate on the use of off-road neurological assessments and driving simulators as tools to predict driving performance; however, the majority of research uses unlicensed poststroke drivers, making the comparability of poststroke adults to that of a control group difficult. It stands to reason that in order to determine whether simulators and cognitive assessments can accurately assess driving performance, the baseline should be set by licenced drivers. Therefore, the aim of this study was to assess differences in cognitive ability and driving simulator performance in licensed community-dwelling poststroke drivers and controls. Two groups of licensed drivers (37 poststroke and 43 controls) were assessed using several cognitive tasks and using a driving simulator. The poststroke adults exhibited poorer cognitive ability; however, there were no differences in simulator performance between groups except that the poststroke drivers demonstrated less variability in driver headway. The application of these results as a prescreening toolbox for poststroke drivers is discussed.

Driving Behaviour Profile of Drivers with Autism Spectrum Disorder (ASD).

The symptomatology of autism spectrum disorder (ASD) can make driving risky, but little is known about the on-road driving behaviour of individuals with ASD. This study assessed and compared the on-road driving performance of drivers with and without ASD, and explored how the symptomatology of ASD hinders or facilitates on-road driving performance. Sixteen drivers with ASD and 21 typically-developed drivers participated in the study. Drivers with ASD underperformed in vehicle manoeuvring, especially at left-turns, right-turns and pedestrian crossings. However, drivers with ASD outperformed the TD group in aspects related to rule-following such as using the indicator at roundabouts and checking for cross-traffic when approaching intersections. Drivers with ASD in the current study presented with a range of capabilities and weaknesses during driving.

Developing Agentic Learners for 21st Century Practice: A Pedagogic Approach in Occupational Therapy.

In this paper, an approach to teaching occupational therapy students how to create orthoses, whilst at the same time developing higher-order critical thinking, reflective, and clinical reasoning skills is described. The scaffolded nature of the learning activities, incorporating Kolb's reflective learning cycle, was used to support students' capacity for clinical reasoning and better prepare them for clinical placement. The peer-assessment element was also designed to support the experiential learning by allowing students to test their evaluation of hand orthoses, compare their assessment with an expert's, and identify areas for improvement. Students who demonstrated higher grades for the written reflection assessment showed better agreement with the experts (smaller bias, p<0.01). This study concluded there was a correlation between students' capacity for reflective thinking and the development of clinical reasoning. Furthermore, the reflective writing exercise encouraged students to generalise their skills beyond the classroom. The approach and findings of this study are relevant to a range of allied health professions through providing a process to support the development of higher-order critical thinking, reflection, and reasoning skills. Furthermore, the study provides an evidence base to demonstrate that higher reflective skill capacity and critical thinking are crucial to creating agentic learners.

The role of occupational therapy in the recovery stage of disaster relief: a report from earthquake stricken areas in China.

Earthquakes and their destructive forces are unpredictable and difficult to prepare for. Unfortunately, another powerful earthquake of magnitude 7.2 had struck when this report was being prepared. The disabling events have long-term negative impacts on occupational performance of the individuals and communities being affected. Occupational therapy practitioners can use their professional expertise and power of engagement to restore life when individuals and communities are disrupted by natural disaster. The events of the Wenchuan Earthquake have raised awareness of the importance of rehabilitation services in remote areas of China and highlight the need to incorporate rehabilitation in response to the planning of future humanitarian catastrophes. With health agendas advancing rapidly in China, disaster rehabilitation cannot be left behind. Occupational therapists with their holistic, humanistic approach and scientific training can play an important role in restoring physical functions and enhancing occupation participation for survivors of the natural disasters. Active participation in and contribution to research and holistic management of disaster survivors should ensure the occupational therapy profession a seat at the table in future health policy and practice decisions on disaster management.

Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial.

This study investigated the effects of wearing a wrist support splint for 8 wk and receiving a formal education program on patients with carpal tunnel syndrome (CTS), as well as factors associated with patients' desire to seek surgical intervention. Participants were recruited from a hospital surgical wait list and randomly assigned to an intervention group (n = 30) or a control group (n = 24). Significant improvements in measures of symptom severity and functional status over the duration of the study appeared in the intervention group but not in the control group. Logistic regression for the intervention group showed that symptom severity (odds ratio [OR] = 1.53, 95% confidence interval [CI] [1.20-1.93]), functional deficits (OR = 1.31, 95% CI [1.08-1.57]), pain score (OR = 1.25, 95% CI [1.11-1.61]), and symptom duration (OR = 1.11, 95% CI [1.01-1.24]) were positively associated with the desire to seek surgical intervention. This conservative CTS treatment program conducted by occupational therapists can improve symptoms and hand function in CTS patients.

Is it reliable to assess visual attention of drivers affected by Parkinson's disease from the backseat?-a simulator study.

BACKGROUND: Current methods of determining licence retainment or cancellation is through on-road driving tests. Previous research has shown that occupational therapists frequently assess drivers' visual attention while sitting in the back seat on the opposite side of the driver. Since the eyes of the driver are not always visible, assessment by eye contact becomes problematic. Such procedural drawbacks may challenge validity and reliability of the visual attention assessments. In terms of correctly classified attention, the aim of the study was to establish the accuracy and the inter-rater reliability of driving assessments of visual attention from the back seat. Furthermore, by establishing eye contact between the assessor and the driver through an additional mirror on the wind screen, the present study aimed to establish how much such an intervention would enhance the accuracy of the visual attention assessment. METHODS: Two drivers with Parkinson's disease (PD) and six control drivers drove a fixed route in a driving simulator while wearing a head mounted eye tracker. The eye tracker data showed where the foveal visual attention actually was directed. These data were time stamped and compared with the simultaneous manual scoring of the visual attention of the drivers. In four of the drivers, one with Parkinson's disease, a mirror on the windscreen was set up to arrange for eye contact between the driver and the assessor. Inter-rater reliability was performed with one of the Parkinson drivers driving, but without the mirror. RESULTS: Without mirror, the overall accuracy was 56% when assessing the three control drivers and with mirror 83%. However, for the PD driver without mirror the accuracy was 94%, whereas for the PD driver with a mirror the accuracy was 90%. With respect to the inter-rater reliability, a 73% agreement was found. CONCLUSION: If the final outcome of a driving assessment is dependent on the subcategory of a protocol assessing visual attention, we suggest the use of an additional mirror to establish eye contact between the assessor and the driver. The clinicians' observations on-road should not be a standalone assessment in driving assessments. Instead, eye trackers should be employed for further analyses and correlation in cases where there is doubt about a driver's attention.

Older drivers: On-road and off-road test results.

Eighty-five volunteer drivers, 65-85 years old, without cognitive impairments impacting on their driving were examined, in order to investigate driving errors characteristic for older drivers. In addition, any relationships between cognitive off-road and on-road tests results, the latter being the gold standard, were identified. Performance measurements included Trail Making Test (TMT), Nordic Stroke Driver Screening Assessment (NorSDSA), Useful Field of View (UFOV), self-rating driving performance and the two on-road protocols P-Drive and ROA. Some of the older drivers displayed questionable driving behaviour. In total, 21% of the participants failed the on-road assessment. Some of the specific errors were more serious than others. The most common driving errors embraced speed; exceeding the speed limit or not controlling the speed. Correlations with the P-Drive protocol were established for NorSDSA total score (weak), UFOV subtest 2 (weak), and UFOV subtest 3 (moderate). Correlations with the ROA protocol were established for UFOV subtest 2 (weak) and UFOV subtest 3 (weak). P-Drive and self ratings correlated weakly, whereas no correlation between self ratings and the ROA protocol was found. The results suggest that specific problems or errors seen in an older person's driving can actually be "normal driving behaviours".

A comparison of the hazard perception ability of accident-involved and accident-free motorcycle riders.

Hazard perception is the ability to read the road and is closely related to involvement in traffic accidents. It consists of both cognitive and behavioral components. Within the cognitive component, visual attention is an important function of driving whereas driving behavior, which represents the behavioral component, can affect the hazard perception of the driver. Motorcycle riders are the most vulnerable types of road user. The primary purpose of this study was to deepen our understanding of the correlation of different subtypes of visual attention and driving violation behaviors and their effect on hazard perception between accident-free and accident-involved motorcycle riders. Sixty-three accident-free and 46 accident-involved motorcycle riders undertook four neuropsychological tests of attention (Digit Vigilance Test, Color Trails Test-1, Color Trails Test-2, and Symbol Digit Modalities Test), filled out the Chinese Motorcycle Rider Driving Violation (CMRDV) Questionnaire, and viewed a road-user-based hazard situation with an eye-tracking system to record the response latencies to potentially dangerous traffic situations. The results showed that both the divided and selective attention of accident-involved motorcycle riders were significantly inferior to those of accident-free motorcycle riders, and that accident-involved riders exhibited significantly higher driving violation behaviors and took longer to identify hazardous situations compared to their accident-free counterparts. However, the results of the regression analysis showed that aggressive driving violation CMRDV score significantly predicted hazard perception and accident involvement of motorcycle riders. Given that all participants were mature and experienced motorcycle riders, the most plausible explanation for the differences between them is their driving style (influenced by an undesirable driving attitude), rather than skill deficits per se. The present study points to the importance of conceptualizing the influence of different driving behaviors so as to enrich our understanding of the role of human factors in road accidents and consequently develop effective countermeasures to prevent traffic accidents involving motorcycles.

Driving assessment in Parkinson's disease--a novel predictor of performance?

Clinical symptoms of Parkinson's disease (PD) can make driving hazardous. The removal of the privilege to drive reduces independence; nevertheless, to protect public safety, medical practitioners require reliable screening tools to decide whether a PD driver should be on the road. The aims of this study were to examine whether clinical measures for PD patients and information provided by carers can be employed to predict impairment in driving performance. Fifty three idiopathic PD subjects and 129 age-matched controls were assessed on open roads. Prior to the driving assessment, participants were examined by a geriatrician. Various clinical measures of PD were recorded, and their carers filled out a questionnaire assessing driving ability of the patient. The driving performance of the participants declined with age (r = 0.89, P < 0.001). Drivers with PD were significantly less competent drivers than controls. The commonest errors committed on the road were indecisiveness in T-junctions and reduced usage of rear view and side mirrors. Only two of the clinical measures of PD patients showed links to driving performance. Information provided by carers was significantly related to driving performance of PD patients (F((4,48)) = 3.87, P-value < 0.01, R(2) = 0.557). PD drivers were less competent drivers than the age-matched control group; moreover, standard clinical measures of PD have little value in predicting their driving performance. Carers can provide valuable information to doctors in identifying unsafe PD drivers.

Identifying older drivers at risk of traffic violations by using a driving simulator: a 3-year longitudinal study.

OBJECTIVES: This prospective longitudinal study aims to determine which simulated driving tasks of a personal computer (PC)-based driving simulator can be used to identify problematic older drivers, using their 3-year driver violation points record as the outcome measure. METHODS: A total of 129 urban community-dwelling older drivers volunteered to participate in the study. Using a driving simulator, specific driving tasks were devised to test the performance of older drivers. Their officially recorded driver violation points were retrieved immediately after the simulated driving assessment and thereafter for the following 2 years. Self-reported driving records were also collected during the same period. Hierarchical Poisson regression analysis, adjusting for gender, age, and driving exposure (hours of driving per week), was then undertaken to determine those driving tasks that affected the frequency of traffic violations. RESULTS: All participants incurred at least one driver violation point during the 3-year period. The simulated driving tasks found to be significantly associated with the incidence of traffic violations were working memory and use of indicator. CONCLUSIONS: This longitudinal study demonstrated that the driving simulator was able to identify unsafe older drivers at risk of traffic violations if appropriate simulated driving tasks were used. Such a screening tool should be adopted prior to administering a more detailed but expensive road test.

Using a driving simulator to identify older drivers at inflated risk of motor vehicle crashes.

PROBLEM: To develop appropriate assessment criteria to measure the performance of older drivers using an interactive PC-based driving simulator, and to determine which measures were associated with the occurrence of motor-vehicle crash. METHOD: One hundred and twenty-nine older drivers residing in a metropolitan city volunteered to participate in this retrospective cohort study. Using the driving simulator, appropriate driving tasks were devised to test the older drivers, whose performances were assessed by 10 reliable assessment criteria. Logistic regression analysis was then undertaken to determine those criteria that influence the self-reported crash outcome. RESULTS: As expected, driving skill of older drivers was found to decline with age. Over 60% of the sample participants reported having at least one motor-vehicle crash during the past year. Adjusting for age in a logistic regression analysis, the cognitive abilities associated with the crash occurrence were working memory, decision making under pressure of time, and confidence in driving at high speed. SUMMARY: The findings of this retrospective study indicated those individuals at inflated risk of vehicle crashes could be identified using the PC-based interactive driving simulator. Prospective studies need to be undertaken to determine whether the driving simulator can predict future crash events. IMPACT ON INDUSTRY: This study demonstrated an economical driving simulator approach to screen out problematic or unsafe older drivers before a more detailed but expensive road test is considered.

Assessing the driving performance of older adult drivers: on-road versus simulated driving.

To validate a laboratory-based driving simulator in measuring on-road driving performance, 129 older adult drivers were assessed with both the simulator and an on-road test. The driving performance of the participants was gauged by appropriate and reliable age-specific assessment criteria, which were found to be negatively correlated with age. Using principal component analysis, two performance indices were developed from the criteria to represent the overall performance in simulated driving and the on-road assessment. There was significant positive association between the two indices, with the simulated driving performance index explaining over two-thirds of the variability of the on-road driving performance index, after adjustment for age and gender of the drivers. The results supported the validity of the driving simulator and it is a safer and more economical method than the on-road testing to assess the driving performance of older adult drivers.