Mar aria ia T. . Schultheis eis, Ph Ph. D . D Associate P - - PowerPoint PPT Presentation

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Mar aria ia T. . Schultheis eis, Ph Ph. D . D Associate P - - PowerPoint PPT Presentation

Nov 10, 2022 584 likes •966 views

Driving and Multiple Sclerosis Mar aria ia T. . Schultheis eis, Ph Ph. D . D Associate P Professor Depa partment o of Psy Psychology Applied Neurotech Labs approach ..applied and focuses on functional everyday activities

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SLIDE 1

Depa partment o

  • f Psy

Psychology

Mar aria ia T. . Schultheis eis, Ph

  • Ph. D

. D Associate P Professor

Driving and Multiple Sclerosis

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Applied Neurotech Lab”s approach

 …..applied and focuses on

functional everyday activities relevant to overall quality of life

 Driving, return to work, decision-making,

etc.,

 ….. is interdisciplinary

 Neurologists, information technology,

engineers, rehabilitation specialist, driver specialist, family

 ……is scientist-practitioner

 Goal is to take the science from the lab

to the clinic

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Activities of Daily Living (ADL)

 Often addressed in rehabilitation  Many ways for define this term

 Basic ADL  Functional ADL

 Can be affected by

 Physical  Behavioral/emotional  cognitive

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“Driving is one of the most complex activities of daily living”

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Driving after neurological compromise

Physical

Road Knowledge

Behavior Cognitive ?

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The severity factor

MILD MODERATE SEVERE

?

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Multiple Sclerosis

  • Young adults (30-40)
  • Vocational and social disruption
  • Progressive disease
  • Presents with combination of

physical, cognitive and emotional impairments

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Multiple Sclerosis and driving

  • Higher number of traffic offenses

(Germany), Knecht,J. (1977)

  • Cognitive & emotional factors more

relevant than duration of illness and degree of neurological involvement (Norway), Schanke, Grimso, & Sundet (1995)

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MS and Cognition

  • Early thoughts, no cognitive involvement –

more recent studies identify cognitive disruption even at early stages

  • Common areas:
  • impaired visual-spatial skills
  • slowed information processing speed
  • executive dysfunction
  • decreased attention
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 Role of cognition?  Role of vision?  What clinical tools are useful?

Driving and MS (2002 – present)

 Type of driving behaviors?  Role of cognition?  Role of vision?  What clinical tools are useful?

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Important MS characteristics

 Community dwelling individuals  Stable medication regiment  All licensed drivers in NJ,PA,NY  No new drivers  No adaptive driving equipment  Majority vocationally active

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MS severity & driving

 Disease severity

defined with EDSS

 Low (1.5-3.0)  Mod (3.5-5.0)  High (5.5 – 6.5)

 Significant

difference in days per week but not miles

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Voluntary self-limit

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what does this tell us…

 If look at mean comparisons with HC-

may not see difference

 If examine across MS spectrum

 Drive less days  Begin to report self-limiting behaviors

Schultheis, Weisser, Manning et al, Archives of Physical Medicine & Rehab. 2009

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Driving and MS (2002 – present)

 Type of driving behaviors?  Role of cognition?  Role of vision?  What clinical tools are useful?  Type of driving behaviors?  Role of cognition?  Role of vision?  What clinical tools are useful?

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Attention Divided attention Sustained attention Choice reaction time Executive Functions Information processing Working memory Judgment inhibition Perception Visual-spatial Spatial-perception Visual problem-solving Visual processing Visual scanning Visual attention Visual reaction time

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HEALTHY MS (-) MS (+)

UFOV Overall Rating

Very Low-Low Risk Moderate Risk High Risk

100 % 86 % 14 % 29 % 64 % 7 %

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1000 2000 3000 4000 5000

HC MS(-) MS(+)

latency time (milliseconds)

NDT Latency Score p =.001

1 2 3 4

HC MS (-) MS(+)

Mean Number of Errors

p =.16

NDT Error Score

Neurocognitive Driving Test

  • Individuals with MS and

cognitive impairment show a greater time to make simulated “driving decisions”

  • However, they do not

necessarily commit more “driving errors”

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Accidents & Violations

1 2 3 4 5 6 7 8

0.5 1 1.5 2 2.5 3 3.5 4 4.5

1 or More ACCIDENTS 1 or More VIOLATIONS Frequency Frequency MS (+) MS (-) HC

Schultheis , Garay, Millis, DeLuca, Archives of

Physical Medicine & Rehab. 2002

  • Based on reports from

Department of Motor Vehicle – time driving with MS

  • Persons with MS and cognitive

impairment have a higher frequency of accidents

  • However, they do not have

more frequent driving violations

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MS severity & driving

PASS = No errors NO PASS = errors No Violations Violations Symbol Digit Modality Test SPART 7/24

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What does this tell us…

 Information processing speed and visual-

spatial learning are important predictors of driving

 Combined—initial evidence that the

presence of cognitive impairment alone can affects skills related to driving

Schultheis, Weisser, Ang et al, Archives of Physical Medicine & Rehab. 2010

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Driving and MS (2002 – present)

 Type of driving behaviors?  Role of cognition?  Role of vision?  What clinical tools are useful?  Type of driving behaviors?  Role of cognition?  Role of vision?  What clinical tools are useful?

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Vision and Driving

 Driving highly dependent on visual information  Main focus is on  Visual acuity

 (clearly see at 20ft what should be seen normally)

 Peripheral vision

 38 states in US rely on acuity alone

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Vision and MS

 Visual symptoms first in 50%  90% report illness-related vision

impairments

 Type and severity of visual problems vary  Difficult to characterize  Can see with 20/20 acuity

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What does this tell us…

 Self reported visual difficulties found

greater difference in color perception

 In our study color perception not

significant predictor of driving—but has been found in other studies

Schultheis, Manning, Weisser et al, Archives of Physical Medicine & Rehab. 2009

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PUTTING IT ALL TOGETHER

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Putting it all together for MS

 Cognition

 Even at early stage, slowed information

processing, visual spatial difficulties may indicate difficulties

 Vision

 Refer for comprehensive visual evaluation  Contrast sensitivity

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Putting it all together for MS

 Disease Progression

 Evidence driving changes at different stages (even

from mild to mod)

 Repeated testing is important

 Other

 Motor  Fatigue

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Helpful Hints

  • 1. Limit or minimize driving during

days when symptom increase

  • 2. Limit or minimize driving during

days of fatigue

  • 3. Minimize distractions while driving
  • 4. If experience visual difficulties or

fatigue minimize nighttime driving

  • 5. Motor difficulties can be assisted by

physical difficulties

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Driving evaluations referrals

  • Currently need a physician’s script to be

referred to driver evaluation program

http://www.driver-ed.org

  • Certified Driver Rehabilitation Specialist
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A peek at the future?

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Drexel VR Driving Simulator

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Maria T. Schultheis, Ph.D. Email: schultheis @ drexel.edu Phone: 215-895-6105