Driving Rehabilitation in Parkinson?s Disease

描述（由申请人提供）： 汽车驾驶是日常生活的一个重要方面，但车辆碰撞造成了严重的公共卫生问题。帕金森氏病（PD）影响了大约一百万美国人，并且患有PD的驾驶员由于运动功能，认知和视觉的进行性损伤而处于驾驶停止或撞车的特殊风险中。 在我们正在进行的关于预测PD驾驶员安全性的研究（R01 NS 044930，PI：Uc）中，我们发现患有PD的驾驶员在驾驶任务中的表现比没有神经系统疾病的老年驾驶员更差，这些驾驶任务在仪表车（IV）中进行，并在高保真驾驶模拟器上进行实验驾驶。即使患有轻度早期PD的驾驶员也会损害认知和视觉功能，并且在驾驶执行复杂驾驶操作时表现出多任务处理的特殊问题，并且碰撞风险增加。认知功能障碍和视觉感知能力下降比PD的典型运动功能障碍更容易导致驾驶性能差和安全错误。 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以及PD驾驶问题的根本原因和机制的实证研究结果，我们为PD风险驾驶员设计了一种新的干预措施。干预包括使用口头，视频和书面反馈对受试者在IV中的道路驾驶进行系统回顾，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，并期望这种改善能够转移到道路驾驶中。这是一项试点研究提案，旨在进一步发展和完善我们的干预措施，并测试其短期疗效，以确定这种干预措施是否值得在III期试验中进一步测试。 为患有PD的受损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这些患者的活动能力和生活质量。此外，这种驾驶康复计划可以适用于其他神经系统疾病，如阿尔茨海默病，中风和创伤性脑损伤，在老年人和年轻退伍军人中都可以看到的条件。 公共卫生相关性： 帕金森病（PD）影响了大约100万美国人，包括许多老年退伍军人，并损害了安全驾驶所必需的认知，视觉和运动功能。我们的长期目标是开发一个驾驶康复计划的司机与PD使用培训的驾驶模拟器和反馈，从录像路试。这项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，看看它是否值得在更大的随机对照临床试验中进一步测试。为不安全的PD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PD患者的移动性和独立性。此外，这种驾驶康复计划可以适用于其他神经系统疾病，如阿尔茨海默病，中风和创伤性脑损伤，在老年人和年轻退伍军人中都可以看到的条件。

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.