Driving Rehabilitation in Parkinson's Disease

汽车驾驶是日常生活中的一个重要方面，但车祸对公众健康构成了严重的威胁 有问题。帕金森氏症(PD)影响着大约100万美国人，患有PD的司机面临着特殊的风险 用于因运动功能、认知和视力的进行性损害而停止驾驶或撞车。 在我们正在进行的关于预测PD(R01 NS044930，PI：UC)司机安全的研究中，我们发现司机 有帕金森病的老年司机在道路上执行的驾驶任务中的表现比没有神经疾病的老年司机差 仪表车(四)和高保真驾驶的实验驾驶场景 模拟器。即使是早期轻度帕金森病的司机，认知和视觉功能也会受到损害， 在驾驶、执行复杂的驾驶动作时显示多任务处理的特殊问题，并在 增加了碰撞的风险。认知障碍和视觉减退是导致不良驾驶的原因之一 性能和安全错误多于典型的帕金森病患者的运动障碍。 基于我们自己和其他研究人员对常见疾病的类型和情况的经验发现 安全错误，以及PD驾驶问题的根本原因和机制，我们有 为帕金森病高危司机设计了一种新的干预措施。干预措施包括对 受试者在IV中使用口头、视频和书面反馈进行自己的道路驾驶，然后进行模拟器培训 改善视觉注意力、执行复杂动作、在驾驶过程中多任务处理、危险 感知和避免碰撞。我们干预的概念基础是改善程序记忆 以及通过在模拟器中的反馈和练习而意识到错误，并期望这 改进将转移到在道路上驾驶。这是一项试点研究建议，旨在进一步发展和完善 我们的干预措施，并测试其短期效果，看看这种干预措施是否值得在第三阶段进一步测试 审判。 为帕金森病受损司机制定有效的康复计划将降低运动风险 车辆碰撞，并有助于保护和保存这些患者的机动性和生活质量。此外， 这一驾驶康复计划可用于其他神经疾病，如阿尔茨海默氏症 疾病、中风和创伤性脑损伤，这些情况在年长和年轻的退伍军人中都可以看到。

Automobile driving is a crucial aspect of everyday life, yet vehicular crashes pose a serious public health problem. Parkinson's disease (PD) affects about one million Americans, and drivers with PD are at special risk for driving cessation or crashes due to progressive impairments of motor function, cognition, and vision. In our ongoing study on predicting driver safety in PD (R01 NS044930, PI:Uc), we are finding that drivers with PD perform worse than elderly drivers without neurological disease in driving tasks conducted on-road in an instrumented vehicle (IV) and on experimental driving scenarios presented on a high-fidelity driving simulator. Even drivers with early PD of mild severity have impairments on cognitive and visual functions, and show particular problems with multitasking while driving, performing complex driving maneuvers, and are at increased risk of collisions. Cognitive impairment and reduced visual perception contribute to poor driving performance and safety errors more than the typical motor dysfunction of PD. Based on our own and other researchers' empirical findings on the types and circumstances of common safety errors, as well as on the underlying causes and mechanisms of driving problems in PD, we have devised a new intervention for at-risk drivers with PD. The intervention consists of a systematic review of the subject's own road drive in the IV using verbal, video, and written feedback, followed by simulator training sessions for improving visual attention, performing complex maneuvers, multitasking during driving, hazard perception, and collision avoidance. The conceptual basis of our intervention is improving procedural memory and error awareness through feedback and practice in the simulator, with the expectation that this improvement would transfer to driving on the road. This is a pilot study proposal to further develop and refine our intervention, and test its short term efficacy to see if this intervention merits further testing in a Phase III trial. Development of effective rehabilitation programs for impaired drivers with PD will reduce the risk of motor vehicle crashes and help protect and preserve the mobility and quality of life of these patients. Furthermore, this driving rehabilitation program can be adapted for use in other neurological disorders such as Alzheimer's disease, stroke, and traumatic brain injury, conditions seen in both older and younger veterans.