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PubMed1984

[New medical guidelines for fitness specifications for automobile driving (Tauvo K)--neurology/psychiatry specialty].

New medical guidelines for assessing the fitness of drivers came into force in the GDR on 1 June 1982. The aims and conception of the thorough revision this entailed are stated in respect of neurology and psychiatry. Dynamic fitness tests are characterized by an objective, unbiased individual prognosis that takes medical treatment, the side effects of drugs and both the psychological and physical ability to compensate for shortcomings into account. This leads to the differentiated assessment of the individual and permits the assessment "fit with reservations". Some of the 11 points contained in the neuropsychiatric part of the new guidelines are discussed briefly.

Automobile Driver Examination↗
PubMed2001

Variations of the level of vigilance and of behavioural activities during simulated automobile driving.

During a monotonous activity, certain behaviours occur that are not necessary to the performance of the task. These are subsidiary or collateral activities. Our purpose was to find out if the number of these behaviours tends to increase during a monotonous and prolonged activity. A study was carried out with 17 subjects performing a 2-h car drive on the Vigilance Analysis Driving Simulator. An analysis of the drivers' behaviour and of their state of vigilance allowed us to confirm the existence of a relation between the occurrence of these behaviours and the variations of the level of arousal. In addition, we determined for all produced behaviours, those that preceded, those that coincided with, and those that followed low vigilance phenomena. These results were interpreted in terms of behavioural signs, precursory of low vigilance, indicative of low vigilance, or reactivating the driver.

Adult↗
PubMed1993

[Multiparameter approach to undesirable effects of drugs that may represent risk for the automobile driving].

Drugs part in traffic accidents is not well known. We attempted to specify it taking out of pawn the adverse effects which could be liable: drowsiness; consciousness lose; dizziness; eye-sight troubles; hallucinations, hearing troubles; drunken feelings, behaviour modification; propensy to suicide, interference with alcohol. Drugs involving such effects were indexed; their therapeutic indications and their chemical structure were taking into account. Statistical classical count allowed us to quantify relative importance of this ten adverse effects category. Multivariate analysis worked out structuration this undesirable effects into 97 different profiles by the mean of the Minimum Spanning Tree method and established proximity links between the 409 active principles recorded. This results are reported here.

Automobile Driving↗
PubMed1998

[Automobile driving fitness of patients with nystagmus].

BACKGROUND: By law, applicants for driver's licenses not only have to have sufficient vision, but also have to use this sight reliably. The nystagmus patient takes advantage of ocularly induced head turns and other forms of compensation. In the approved test procedures he is deprived of such compensations. MATERIALS AND METHODS: The eye movements of a nystagmus patient were recorded oculographically. He was allowed to use compensatory mechanisms of body posture and movement for stabilization of vision. RESULTS: The nystagmus patient can achieve better visual performance when he is allowed to utilize complex segmental body movements for stabilization of vision. CONCLUSIONS: It is proposed that test procedures for visual performance in traffic be altered as follows: nystagmus and abnormal head postures are admittable if sufficient binocular vision is achieved. The test may use illustrations of traffic situations containing relevant details such as traffic signs. These are to be understood by the test person on triplicate presentation.

Adult↗
PubMed1996

[Change in automobile driving capacity assessment--a contribution to the correlation between diagnosis and therapy].

The repeated demand for the introduction of an organisational separation of medical-psychological assessment from drink rehabilitation of drink driving offenders and other types of offenders is mainly sustained by the fear of a possible loss of the experts' neutrality, objectivity and independence. In addition to that there is the fear of an economic conflict within an organisation offering both medical-psychological assessment and rehabilitation courses for drink driving offenders. In the event of a clash of interests resulting in the demand of a complete organisational separation, the consequences of such a separation would have to be dealt with. The separation of fields of work which, in substance, are closely related from the scientific point of view and in respect of the underlying conceptual basis would result in: a substantial reduction of experience of assessment experts (who will no longer be able to gather experience with rehabilitation and/or therapy) an equally substantial reduction of experience of therapists (who will no longer be able to be involved in diagnostics). As in other branches where there are opposing views from within the society, this development is avoidable. Instead of neglecting professional standards appropriate safety and control instruments should be installed in order to diminish economic conflicts. Quality management and control according to ISO 9000 would be an appropriate measure to enable the administrative body to exclude any misuse of the experts' role.

Alcoholism↗
PubMed1993

[Proof of alcoholic intoxication in automobile driving by breath alcohol content in Austria from the legal viewpoint].

In Austria, automobile drivers are obligated to undergo a breathalizer test if they are suspected of driving under the influence of alcohol. Drivers cannot be forced to take the test, but if they refuse, their conduct is then dealt with as a violation of civil law and is therefore punishable by law. If the Alcomat test yields an alcohol content of 0.4 ml/l, i.e. relevant amount, the suspect then has the right to demand that a blood test be carried out. If the authorities refuse to give him this test, then the suspect will not be held to have been in excess of the legal alcohol level by the civil authorities in the following proceedings. On the other hand, in a legal criminal proceeding, the suspect will then be found guilty of exceeding the legal alcohol level, if additional evidence--which must be examined by the judge within the framework of the free consideration of evidence (a principle recognized by Austrian law but not, for example, by American law)--suffices to show with relative certainty that the suspect exceeded the alcohol limit as defined in section 81 Z2StGB). If a blood test is completed and the results differ from those of the breathalizer, then the blood test results are used.

Accidents, Traffic↗
PubMedDate not supplied

Automobile driving performance of brain-injured patients with visual field defects.

The purpose of this study was to examine whether patients with visual field defects resulting from cerebral injury are handicapped in their driving ability, because visual field loss as assessed in standard perimetry is often the basis for withdrawal of a person's driving license. Driving performance was tested on a driving simulator to obtain standardized results and for safety reasons. The visual field was assessed both with standard automated perimetry and computer-based, high-resolution, qualitative perimetry. We investigated nine patients with purely cerebral field defects (mostly homonymous binocular defects) who had no further neuropsychological or ophthalmological deficits. Their performance (driving speed, reaction time, and driving error rate) was compared with that of a control group of ten subjects. We found no differences in any of the tested parameters between the visually impaired subjects and the normal participants. This suggests that individuals with visual field defects, including those who suffer from homonymous hemianopia, may perform as adequately as normal individuals in realistic driving scenarios. The perimetrically assessed visual field may, thus, be of limited value for the prediction of driving safety, and we conclude that patients who have field defects should not summarily be denied a driving license.

Adult↗
PubMed1995

[Dementia and automobile driving capacity].

There are only few investigations about the driving ability in demented patients. The available data point to an elevated risk of accident. Patients with very mild dementia, however, are often fit enough to drive. Unfortunately there are no tests available to identify demented drivers with a high risk of accidents. So it remains an individual decision of the doctor to assess the driving ability in demented patients. The caregiver's assessment of the driving competency and psychometric tests are helpful, if an in-car road test is not possible. Further investigations and simple tests are needed.

Accidents, Traffic↗
PubMed1995

[Congenital nystagmus in the ophthalmologic automobile driving fitness verdict].

BACKGROUND: A driver with congenital nystagmus (CN) is supposed to have a certain minimum visual acuity and a minimum velocity of reading, with the head directed straight ahead or 10 degrees laterally. The ability to perform different oculomotor tasks depends, however, on individual properties of nystagmus and compensatory mechanisms, as is demonstrated in 4 cases. METHODS: Detailed electrooculographic (EOG) recordings were performed in 4 CN patients, in addition to the examination of visual functions. RESULTS: The visual acuity of patient 1 is sufficient (0.6 on both eyes), yet his retinal image is intermittently destabilized by a periodic alternating nystagmus. Case 2 with high myopic astigmatism and severely reduced visual acuity (right eye: finger counting; left eye: 0.2) compensates for his vertical pendular nystagmus by head nodding and for his manifest-latent horizontal nystagmus by a head turn. The optimal visual acuity of patient 3 (horizontal pendular nystagmus) is 0.3, with an oblique head position and convergence. In other head and gaze positions he has a coarse jerk nystagmus beating in the direction of gaze. Patient 4, with a high myopic astigmatism, microstrabism and manifest-latent fixational nystagmus, has a visual acuity between 0.2 and 0.3 in both eyes. He had been a licensed professional car driver, in spite of contradicting national and international criteria: but his license was refused later. CONCLUSIONS: In patients with CN, the influence of head and gaze position, monocular fixation, convergence and self or object motion on nystagmus intensity and wave forms could be important for driving, because it might influence visual acuity and motion perception. The latter hypothesis still has to be proven in further studies, performed under conditions relevant for traffic.

Adult↗
PubMed1994

[Examination of automobile driving license eligibility from the viewpoint of drivers apprehended for alcohol infractions].

80 DUI-offenders whose aptitude had been judged insufficient after their first aptitude test, underwent a second, higher level test. They were then interviewed about the conduction of these drivers aptitude tests. The test duration of 1-2 hours was considered to be sufficient. Less than one third of all interviewees thought that an objective judgement of the questioning would not be possible. Exam anxiety occurred only very occasionally during the questioning. Explanations about general problems and about the testing objectives given at the beginning of the tests were said to have been very helpful. Such relevant information should be given not only to the participants but also to their solicitors and GPs.

Adult↗
PubMed1999

[Psychotropic drugs and automobile driving ability of elderly patients].

Many elderly patients are prescribed psychotropic medication, many of them are car drivers. Driving ability may be impaired by the underlying psychiatric disease, the medication or the combination of both. Psychoactive medications do not all influence driving ability to the same extent. Cyclic antidepressants impair driving performance to a higher degree than selective serotonin reuptake inhibitors (SSRI) or MAO inhibitors. In cases of severe psychiatric diseases like major depression an appropriate psychoactive medication may improve driving performance. The influence of psychoactive drugs on driving ability is not always taken into account. There are no data available that allow a reliable assessment of these drugs in elderly patients. To meet the challenge of this problem, patients and doctors have to be aware of this problem; studies about the impact of psychoactive drugs on driving ability are necessary.

Accidents, Traffic↗