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Car Driving Performance in Hemianopia Patients: the Effect of Compensatory Scanning Training

Car Driving Performance in Hemianopia Patients: the Effect of Compensatory Scanning Training. Bart J.M. Melis- Dankers , PhD Special thanks to: Gera de Haan, Joost Heutink, Wiebo Brouwer University of Groningen – Clinical and Developmental Neuropsychology

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Car Driving Performance in Hemianopia Patients: the Effect of Compensatory Scanning Training

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  1. Car Driving Performance in Hemianopia Patients:the Effect of Compensatory Scanning Training Bart J.M. Melis- Dankers, PhD Special thanks to: Gera de Haan, Joost Heutink, Wiebo Brouwer University of Groningen – Clinical and Developmental Neuropsychology Royal Dutch Visio – Centre of expertise for blind and partially sighted people

  2. Regulations - NL Ministry of Transport, 2009/2010: Horizontal Visual Field (HVF): • HVF > 120° : unrestricted driving license -- at least 50° right/left, + 20° up/down -- no binocular scotoma in central 20° field • HVF < 90° : not fit to drive • 90°< HVF<120° : driving test possible

  3. Hemianopia - safe drivers • Tant (2002) - 4/28 (14%) • Brouwer (2013) - 7/17 (42%) • Racette&Casson (2005) - 8/20 (40%) • Owsley-group (2009/2011) - 23/30 (77%) • In general: • steering instability and unsuitable positioning on the road • difficulties with gap judgment • driving too slow or too fast • too much sudden braking • inconsequent viewing behavior • poor reaction to unexpected events

  4. Participants in driving study • N = 26 adults reporting mobility problems because of a homonymous hemianopia • M(TimeSinceLesion) = 14.8 months [6 - 41] • N = 21 left-sided, N = 5 right-sided hemianopia • N = 18 male, N = 8 female • M(age) = 52 [27-71, SD = 11.7] • M(DrivingExperience) = 29 years [3 – 53] • No severe motor, (neuro)psychologic or hearing disorders • No ophthalmologic dysfunctioning; • Binocular visual acuity ≥ 0.5

  5. 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) Obstacle course (with dual task) Tracking Task Hazardperception (Vlakveld, 2011) ----------------------------------------------------------------------------- Driving simulator Practical fitness to drive [CBR]

  6. Obstacle course(dual task)

  7. Result

  8. Tracking task

  9. Result

  10. Hazard perception Vlakveld-testWith eye movement recording

  11. Keep on going? Foot off gas pedal? Break?

  12. Keep on going? Foot off gas pedal? Break?

  13. Keep on going? Foot off gas pedal? Break?

  14. Driving simulator slightly winding road fixed speed (50 km/h) slightly winding road free speed slightly winding road instruction: in a hurry rural, 2-lane road + crossings fixed speed rural, 2-lane road + crossings free speed

  15. 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 Scores: • 1 = insufficient • 2 = doubtful • 3 = sufficient / good

  16. Fitness to drive 12 failed (46%) Before onset of training (N=26) 14 passed (54%) N = 26 Hemianopia patients (total N = 57) N = 21 left-sided, N = 5 right-sided hemianopia N = 18 male, N = 8 female M(Age) = 52 [27-71] CBR (Dutch department of motor vehicles) 2 on-road driving assessments:

  17. Fitness to drive: total group • VIS • Insufficient 15% • Doubtful 13% • Sufficient 72% • OPER • Insufficient 10% • Doubtful 11% • Sufficient 79% • TACT • Insufficient 11% • Doubtful 13% • Sufficient 76%

  18. Reasons for negative judgement

  19. Patient characteristics • No effect on TRIP subscales: • Age, Gender, and Years of driving experience • Time since onset, but: • longer time since onset > lower VIS (p=.072) • Time not driven (M=15 months, 0-72): • Trend for difference between the “fit” and “unfit” drivers (p=.060) • The more time the patient had not driven, the lower the scores on VIS (p=.014) and OPER (p=.010) • No significant correlation for TACT (p=.159)

  20. Compensatory Scanning Training • Royal Dutch Visio: 18 hours of training • Aimed at improving “slow mobility” 1. Increase insight 2. Systematic scanning strategy 3. Transfer to mobility in daily life

  21. Fitness to drive 12 failed (46%) Before onset of training (N=26) 14 passed (54%) 5 failed After training (N=9) 4 passed N = 26 Hemianopia patients (total N = 57) N = 21 left-sided, N = 5 right-sided hemianopia N = 18 male, N = 8 female M(Age) = 52 [27-71] CBR (Dutch department of motor vehicles) 2 on-road driving assessments:

  22. Fitness to drive: TRIP TRIP-factors improve after training (N = 9)

  23. Driving simulator

  24. Effect of training: VIS

  25. 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

  26. University of Groningen • Royal Dutch Visio, Bartiméus • CBR • ZonMw – InZicht • Gera de Haan • Joost Heutink • Wiebo Brouwer • Oliver Tucha Thank you for your attention Contact: BartMelis@visio.org

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