Assessment of Driving Performance in Patients with Relapsing-Remitting Multiple Sclerosis by a Driving Simulator

Abstract

Objective: To compare the driving performance using a driving simulator with physical and cognitive functions as measured by the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC) in patients suffering from the relapsing-remitting form of multiple sclerosis (RRMS). Methods: 31 RRMS patients (18 women, 13 men, mean age 35.6 ± 8.3 years, EDSS 2.8 ± 1.4) were compared with 10 healthy controls (8 men, 2 woman, age 45.1 ± 7.8 years). Results: Compared with controls, the accident rate (5.3 ± 3.8 vs. 1.3 ± 1.5, p < 0.001) and concentration faults (21.1 ± 15.5 vs. 7.1 ± 2.6, p < 0.01) of RRMS patients using the driving simulator were increased. While there was no correlation with the EDSS score, the accident rate was correlated with the MSFC (r = –0.5, p < 0.05). Regarding the three dimensions of the MSFC, accidents were related to the number of correct answers and Z-score in the paced auditory serial addition test (PASAT) as a measure for cognitive function (r = –0.33, p < 0.05). Conclusion: The current study demonstrates the need to focus also on driving skills in MS patients. The risk of accidents should be evaluated after relapses in particular. However, there are great interindividual differences. In the MSFC, most deficits could be evaluated in the PASAT. As there was a significant correlation between the accident rate in the driving simulator and the PASAT results, accidents seem to be more influenced by cognitive decline than by physical impairment. This indicates that the MSFC is a broader, more dimensional scale than the EDSS and should be preferred in the case of driving assessment. At the present time, the driving simulator seems to be a useful instrument judging driving ability, especially in cases with ambiguous neuropsychological results.

Driving simulator and neuropyschological testing in OSAS before and under CPAP therapy

“…As no published results of sequential testing were available at the time of the study, sample size calculation was based on the following assumptions. For the neuropsychological testing, mean alertness reaction time was expected to be 431 ms with SD of 15% (60.6 ms) [21]. The study was then designed to establish a difference of 15% with an a-error of 5% and a b-error of 10% (minimal required sample size: n522).…”

Normative Values for Driving Simulation Parameters: A Pilot Study

“…Studies have shown that driving simulators are useful in the evaluation of on-road driving abilities of older individuals (Freund et al, 2002;Lee, Lee, 2005) and after neurological impairments (Kotterba et al, 2003;Devos et al, 2007). Some driving skills commonly assessed during simulator-based driving evaluations include lane tracking, gap estimation (time and range to collision), accident avoidance, compliance with speed limits and reaction time.…”

Object decision and multiple sclerosis: a preliminary study

“…An early intervention is in fact desirable for the benefits it can have on both clinical and neural outcomes, while delayed intervention can carry the risk of irreversible damage. An early intervention can indeed slow the progression of the disease and have effects on the quality of life of both patients and families, considering that cognitive deficits, and particularly deficits of verbal memory, information processing speed and executive functions, can predict professional status (Benedict et al, 2006) and have a significant impact on complex tasks in the home and on driving (Shawaryn et al, 2002;Kotterba et al, 2003;Schultheis et al, 2002). Moreover, clinical investigations have indicated that early intervention with disease-modifying therapies may help to prevent permanent damage, and appears to reduce the frequency and severity of clinical attacks, slow the accumulation of disability, and reduce the development of new lesions.…”