Driving Rehabilitation in Parkinson?s Disease

帕金森病的驾驶康复

• 批准号: 7750290
• 负责人: ERGUN Y UC
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7750290
• 关键词: Affect; Age; Aging; Alzheimer' s Disease; American; Automobile Driving; Awareness; Cognition; Cognitive; Complex; Development; Disease; Elderly; Evaluation; Feedback; Functional disorder; Future; Goals; Impaired cognition; Impairment; Intervention; Life; Motor; Neurological Models; Parkinson Disease; Participant; Patients; Perception; Performance; Phase III Clinical Trials; Pilot Projects; Preparation; Protocols documentation; Public Health; Quality of life; Randomized Controlled Clinical Trials; Rehabilitation therapy; Research Personnel; Risk; Safety; Severities; Stroke; Testing; Training; Training Programs; Traumatic Brain Injury; Vehicle crash; Veterans; Video Recording; Videotape; Vision; Visual Perception; Visual attention; Writing; base; cognitive function; efficacy testing; expectation; hazard; high risk; improved; indexing; instrument; intervention program; motor deficit; motor impairment; multitask; nervous system disorder; phase 3 study; post stroke; procedural memory; programs; public health relevance; rehabilitation strategy; research study; systematic review; visual motor

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: Parkinson's disease (PD) affects about 1 million Americans, including many aging veterans, and impairs cognitive, visual, and motor functions that are essential to safe automobile driving. Our long term goal is to develop a driving rehabilitation program for drivers with PD using training on a driving simulator and feedback from a videotaped road test. The goal of this pilot study proposal is to further develop this intervention and test its short term efficacy to see if it merits further testing in a larger randomized and controlled clinical trial. Developing effective rehabilitation programs for unsafe drivers with PD will reduce the risk of motor vehicle crashes and help protect and preserve the mobility and independence of PD 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.

描述（由申请人提供）： 汽车驾驶是日常生活的一个重要方面，但车辆碰撞事故却造成了严重的公共健康问题。帕金森病 (PD) 影响着大约一百万美国人，患有帕金森病的驾驶员由于运动功能、认知和视力的进行性损伤而面临停止驾驶或撞车的特殊风险。 在我们正在进行的预测 PD 驾驶员安全的研究中（R01 NS044930，PI：Uc），我们发现患有 PD 的驾驶员在仪表车辆 (IV) 道路上执行的驾驶任务以及在高保真驾驶模拟器上呈现的实验驾驶场景中比没有神经系统疾病的老年驾驶员表现更差。即使是轻度严重的早期帕金森病驾驶员，其认知和视觉功能也会受到损害，并且在执行复杂驾驶操作时会表现出多任务处理的特殊问题，并且发生碰撞的风险也会增加。与帕金森病典型的运动功能障碍相比，认知障碍和视觉感知能力下降更容易导致驾驶表现不佳和安全错误。 基于我们自己和其他研究人员对常见安全错误的类型和情况的实证研究结果，以及PD驾驶问题的根本原因和机制，我们为患有PD的高危驾驶员设计了一种新的干预措施。干预措施包括使用口头、视频和书面反馈对受试者自己在 IV 中的道路驾驶进行系统审查，然后进行模拟器培训课程，以提高视觉注意力、执行复杂的操作、驾驶过程中的多任务处理、危险感知和避免碰撞。我们干预的概念基础是通过模拟器中的反馈和练习来改善程序记忆和错误意识，并期望这种改进能够转移到道路上的驾驶中。这是一项试点研究提案，旨在进一步开发和完善我们的干预措施，并测试其短期疗效，以确定该干预措施是否值得在 III 期试验中进一步测试。 为患有帕金森病的受损驾驶员制定有效的康复计划将降低机动车辆事故的风险，并有助于保护和保持这些患者的活动能力和生活质量。此外，该驾驶康复计划还可适用于其他神经系统疾病，例如阿尔茨海默病、中风和创伤性脑损伤，这些疾病在老年和年轻退伍军人中都会出现。 公共卫生相关性： 帕金森病 (PD) 影响约 100 万美国人，其中包括许多老年退伍军人，并损害对安全汽车驾驶至关重要的认知、视觉和运动功能。我们的长期目标是利用驾驶模拟器上的培训和路试录像的反馈，为患有帕金森病的驾驶员制定驾驶康复计划。该试点研究提案的目标是进一步开发这种干预措施并测试其短期疗效，看看是否值得在更大规模的随机对照临床试验中进一步测试。为不安全的帕金森病驾驶员制定有效的康复计划将降低机动车碰撞的风险，并有助于保护和保持帕金森病患者的活动能力和独立性。此外，该驾驶康复计划还可适用于其他神经系统疾病，例如阿尔茨海默病、中风和创伤性脑损伤，这些疾病在老年和年轻退伍军人中都会出现。