Driving Rehabilitation in Parkinson's Disease

汽车驾驶是日常生活的一个重要方面，但车辆碰撞造成严重的公共健康 问题.帕金森病（PD）影响了大约一百万美国人，患有PD的司机处于特殊风险之中 用于因运动功能、认知和视觉的渐进性损伤而导致的驾驶停止或撞车。 在我们正在进行的关于预测PD中驾驶员安全性的研究（R01 NS 044930，PI：Uc）中，我们发现驾驶员 在道路上进行的驾驶任务中，PD患者的表现比无神经系统疾病的老年驾驶员差， 一个仪表车（四）和实验驾驶情况下提出的高保真驾驶 模拟器即使患有轻度早期PD的驾驶员也会损害认知和视觉功能， 显示了在驾驶时多任务处理的特殊问题，执行复杂的驾驶操作， 增加了碰撞的风险。认知障碍和视觉感知能力下降会导致驾驶不良 性能和安全性错误比典型的PD运动功能障碍更多。 基于我们自己和其他研究人员对常见问题的类型和情况的实证发现 安全错误，以及在PD驾驶问题的根本原因和机制，我们有 设计了一种新的干预措施，用于有PD风险的司机。干预措施包括系统回顾 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 提高视觉注意力的课程，执行复杂的操作，驾驶过程中的多任务处理，危险 感知和碰撞避免。我们干预的概念基础是改善程序性记忆 通过反馈和模拟器中的练习， 改善将转移到道路上驾驶。这是一项试点研究建议， 我们的干预，并测试其短期疗效，看看这种干预是否值得在第三阶段进一步测试， 审判 为患有PD的受损驾驶员制定有效的康复计划将降低运动障碍的风险。 车辆碰撞，并帮助保护和维护这些患者的流动性和生活质量。此外，委员会认为， 这种驾驶康复计划可以适用于其他神经系统疾病，如阿尔茨海默氏症， 疾病、中风和创伤性脑损伤，这些情况在老年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.