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AutO&Mobility: driving with a visual impairment in the Netherlands

AutO&Mobility: driving with a visual impairment in the Netherlands. SMS-conference December 5, 2012 København. dr. Bart Melis-Dankers PhD Royal Dutch Visio Centre of expertise for blind and partially sighted people. The Netherlands. 16.7 million inhabitants

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AutO&Mobility: driving with a visual impairment in the Netherlands

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  1. AutO&Mobility: driving with a visual impairment in the Netherlands SMS-conference December 5, 2012 København dr. Bart Melis-Dankers PhD Royal Dutch Visio Centre of expertise for blind and partially sighted people

  2. The Netherlands 16.7 million inhabitants 316,000 visually impaired people [1.9%] primary care: 700 optometrists and 2,500 opticians. secondary care: 707 ophthalmologists [1:23,600]. tertiary care: visual rehabilitation centres: -- Royal Dutch Visio: 3,200 employees -- Bartiméus: 2,200 employees Shared Space

  3. AutO-Mobility • Optimization of independent mobility is important for social participation. • Driving is the main form of transport in NL. 7.7 million passenger cars. • Driving itself is not the goal. Independent mobility is! • Safety first. Rehabilitation programme AutO-Mobility: Individual advice and training programme to optimize independent mobility, if possible in motorised vehicles. Shared Space

  4. fitness to drive: NL in 1998 medical • visual acuity: 0.5 in best eye [6/12, 20/40] • visual field: ≥ 140° practical • the ability to drive safely and smoothly despite one’s visual impairment. • on road driving test by the Netherlands Bureau of Driving Skills Certificates [CBR]. Shared Space

  5. VA = 0.2 visual acuity 0.5 : reading licence plate at 35m Shared Space

  6. Step 1: Coeckelbergh & Kooijman1998 – 2002 [Human Factors, 2004, 46(4): 748-760] • N = 67 participants. • Visual acuity loss and/or visual field defect. • All had insufficient medical fitness to drive. • Practical fitness to drive test [CBR]. Shared Space

  7. central central and peripheral peripheral Step 1: Coeckelbergh & Kooijman 1998 – 2002: data N = 67 participants Visual Field Defect (n=24) (n=36) (n=7) VA Snellen 0.23 0.74 0.19 horizontal field diameter (degrees) 142 84 91 practical fitness to drive: 6 (25%) 15 (42%) 2 (14%) passed 5 (86%) failed 18 (75%) 21 (58%) Shared Space

  8. Step 1: Coeckelbergh & Kooijman1998 – 2002: conclusion [Human Factors, 2004, 46(4): 748-760] • N = 67 • All had insufficient medical fitness to drive. • 34% passed practical fitness to drive test [CBR] The medical fitness to drive (visual acuity and visual field) provides not sufficient information to decide about the practical fitness to drive. Shared Space

  9. Step 2: build a consortium2000 - 2004 • Netherlands Bureau of Driving Skills Certificates [CBR] • Ministery of Transport • 2 driving schools • University Medical Center Opthalmology • Univeristy Medical Center Traffic Medicine • Royal Dutch Visio: clinical physicist optometrist occupational therapist neuro-psychologist Shared Space

  10. Step 3: development of training2004 - 2007 • Impaired visual acuity: Bioptic Telescope System [BTS] • Visual field defect: homonymous hemianopia Scanning Compensatory Therapy [SCT] Shared Space

  11. VA = 0.16 = 20/125 • Road design • Traffic signs / traffic lights • Route signs • Other road users

  12. Bioptic telescope system [BTS] monocular 2x - 3x magnification field of view: 15° weight: 12 gr. Shared Space

  13. Correct BTS use driving • road signs • crossings / traffic lights • pedestrians / cyclists • overtaking safety first • right moments • short • goal directed • in time (not too early) Shared Space

  14. Step 3a: pilot project BTS2004 - 2007 [Visual Impairment Research, 2008, 10: 1-6] [Visual Impairment Research, 2008, 10: 7-22] • inclusion: 0.16 <= BBCVA < 0.5 • BTS-programme: • assessment day • fitting BTS [optometrist] • O&M-training 4 x 3 hours [O&M-trainer] • driving lessons [driving instructor] • practical fitness to drive test [CBR] • 9 subjects passed fitness to drive test with BTS Shared Space

  15. The Effects of Compensatory Scanning Training on Driving for Hemianopia Patients Gera de Haan MSc. University of Groningen, The Netherlands Clinical and Developmental Neuropsychology

  16. Current study Aim: Examining the effect of compensatory scanning training on mobilityfor homonymous hemianopia. Compensatory Scanning Training: 1. Increase of awareness 2. Systematic scanning strategy 3. Transfer to mobility in daily life

  17. Systematic scanning strategy Right hemianopia: Based on training Pizzamiglio (1992) and Tant (2002) Scanning strategy: • Fixate straight ahead • Large saccade towards blind hemifield • Saccade back to seeing hemifield • Fixate straight ahead • . . .

  18. Participants in driving study RCT of 60 hemianopic patients with mobility problems Effect of Scanning Compensatory Training on mobility and Quality of Life ------------------------------------------------------------------------------- N = 27 adults reporting mobility problems because of a homonymous hemianopia, the hemianopia existing for at least 6 months N = 21 left-sided hemianopia, N = 6 right-sided hemianopia N = 18 male, N = 9 female M(age) = [27-71] M(TimeSinceLesion) = 24 months [6.5-122] No severe motor, neuropsychologic or hearing impairments No ophthalmologic dysfunctioning and binocular visual acuity > 0.5

  19. Design Control group T1 T2 T3 Training pre T1 Training Training group T2 post -3mth Tests on T1, T2 and T3: Impaired Mobility Questionnaire (IMQ; Turano, 1999) Tracking Task Obstacle course (with dual task) Hazardperception (Vlakveld, 2011)

  20. Design Control group T1 T2 T3 Training pre T1 Training Training group T2 post -3mth Tests on T1, T2 and T3: Impaired Mobility Questionnaire (IMQ; Turano, 1999) Tracking Task Obstacle course (with dual task) Hazardperception (Vlakveld, 2011) Driving simulator Fitness to drive

  21. Step 3b: scanning compensatory therapy2007 - 2012 • inclusion: homonymous hemianopia • SCT-programme: • assessment day • optimizing optics [optometrist] • SCT-training 10 x 1.5 hours [O&M-trainer] • driving lessons [driving instructor] • practical fitness to drive test [CBR] Shared Space

  22. Result

  23. Result

  24. Practical Fitness to drive: TRIP Test Ride for Investigating Practical fitness to drive 57 items: insufficient, doubtful, sufficient Driving test taken by ‘blind’ CBR-expert Factors: • VIS: visual factor • OPER: operational factor • TACT: tactical factor

  25. Fitness to drive 12 failed (44%) Before onset of training (N=27) 15 passed (56%) 6 failed After training (N=10) 4 passed N = 27 Hemianopia patients (total N = 57) N = 21 left-sided, N = 6 right-sided hemianopia N = 18 male, N = 9 female M(Age) = 52 [27-71] CBR (Dutch department of motor vehicles) 2 on-road driving assessments:

  26. Fitness to drive: TRIP TRIP-factors improve after training

  27. Conclusion Self-reported mobility in daily life improved (IMQ) Faster responses to stimuli in the blind periphery (Tracking Task) Higher walking speed in obstacle course with cognitive dual task Part of patients with hemianopiae is practical fit to drive, even without training. Visual aspects of driving are most problematic. Negative judgement due to insufficient viewing strategy, but also due to operational and tactical driving. Training improves visual and tactical aspects. No age-related effect found. -------------------------------------------------------------------------------------- Hemianopia does not necessarily impair fitness to drive

  28. Step 4: lobby to change regulations2007 - 2010 • report to the minister of Transport • decisions: May 2009 and February 2010 visual acuity impairment: • VA >= 0.50 : unrestricted driving license • 0.40 <= VA < 0.50 : CBR-test without BTS • 0.16 <= VA < 0.40 : CBR-test with BTS visual field defect: • HVF >= 120° : unrestricted driving license • 90° <= HVF < 120° : CBR-test Shared Space

  29. Step 5: extending consortium2009 - 2010 North NW • 4 regions: 12 locations • education of: • 9 information officers • 31 optometrists • 25 O&M trainers • 6 clinical physicists • 5 neuro-psychologists • 23 driving instructors • 8 CBR experts on practical fitness to drive • 12 CBR driving examiners • September 2010: AutO-Mobility nationally available SW ° South ° Shared Space

  30. Current situationDecember 2012 BTS: SCT: driving licenses issued: 70 19 not fit to drive: >250 >80 Remember: AutO&Mobility is about mobility (and not driving per se). ------------------------------------------------------------ 2012: BTS-program for nystagmus patients Shared Space

  31. Step 6: future developments2012 - 2015 New programmes for: mobility scooter [16 km/h = 10 miles/h] microcars [45 km/h = 30 miles/h] patients with combined acuity and field impairment patients with visual and neurological impairment Shared Space

  32. Interesting congresses ITMA 2012: May 19-22 International Traffic Medicine Association Hamburg www.trafficmedicine.org ----------------------------------------------------------------- ESLRR 2012: September 13-15 European Society for Low Vision Research and Rehabilitation Oxford www.eslrr.eu Shared Space

  33. Please contact Royal Dutch Visio www.auto-mobiliteit.org BartMelis@visio.org Shared Space

  34. Practical fitness to drive: TRIP Main reason for negative judgement

  35. ratings on the individual TRIP-items, split by factor (N=27)

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