Driving Rehabilitation in Parkinson?s Disease

描述(由申请人提供)： 汽车驾驶是日常生活中的一个重要方面，但车祸却构成了严重的公共健康问题。帕金森氏症(PD)影响着大约100万美国人，由于运动功能、认知和视力的进行性损害，帕金森病司机面临着停止驾驶或撞车的特殊风险。在我们正在进行的关于预测PD驾驶员安全的研究(R01 NS044930，PI：UC)中，我们发现患有PD的驾驶员在用仪表车(IV)在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的表现比没有神经系统疾病的老年驾驶员差。即使是早期轻度帕金森病的司机也会损害认知和视觉功能，在进行复杂的驾驶动作时，在多任务处理方面表现出特别的问题，而且发生碰撞的风险也会增加。与帕金森病的典型运动障碍相比，认知障碍和视觉知觉下降更容易导致糟糕的驾驶性能和安全错误。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帕金森病驾驶问题的潜在原因和机制的经验发现，我们设计了一种新的针对帕金森病高危司机的干预措施。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，然后是提高视觉注意力、执行复杂机动、驾驶过程中的多任务、危险感知和碰撞避免的模拟器培训课程。我们干预的概念基础是通过在模拟器中的反馈和练习来提高程序记忆和错误意识，期望这种改善将转移到在道路上驾驶。这是一项试验性研究建议，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，以确定这种干预措施是否值得在第三阶段试验中进一步测试。为帕金森病受损司机开发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机动性和生活质量。此外，这种驾驶康复计划还可以用于其他神经疾病，如阿尔茨海默病、中风和创伤性脑损伤，这些疾病在年长和年轻的退伍军人中都可以看到。 公共卫生相关性： 帕金森氏症(PD)影响着大约100万美国人，其中包括许多年迈的退伍军人，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测录像的反馈，为帕金森氏症司机开发一个驾驶康复计划。这项初步研究建议的目标是进一步发展这种干预措施，并测试其短期疗效，以确定是否值得在更大规模的随机和对照临床试验中进一步测试。为患有帕金森氏症的不安全司机开发有效的康复计划将降低机动车碰撞的风险，并有助于保护和维护帕金森氏症患者的机动性和独立性。此外，这种驾驶康复计划还可以用于其他神经疾病，如阿尔茨海默病、中风和创伤性脑损伤，这些疾病在年长和年轻的退伍军人中都可以看到。

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.