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Driving after stroke: a controlled laboratory investigation.

The importance of illness or disability for traffic safety is unknown. By means of a mock car, 46 individuals suffering from left-sided hemiparesis and 67 with right-sided hemiparesis after stroke were compared with 109 healthy controls. Only patients without complicating disorders were included in the study groups. They coped far worse than the control group in almost all respects. Reaction times were longer, not merely for the paretic but also for the contralateral extremities. Strength in the 'healthy' part of the body was also significantly reduced. Sometimes patients completely failed to react to given signals. In right-sided hemiparesis a high frequency of directional errors was observed. Neuropsychological functional disorders were well in accordance with the number of erroneous reactions, but to only a minor extent with reaction times. The results of the mock car test could not be predicted on the basis of mere clinical examination.

Adaptation, Psychological↗

Diabetes and driving: towards equitable, evidence-based decision-making.

In January 1998, the British government introduced new restrictions on licensing of people with insulin-treated diabetes mellitus to drive. These restrictions were based on the second EU driver licensing directive (91/4389) and looked to be costing insulin-treated diabetic individuals their entitlement to drive light goods and small passenger-carrying vehicles. In response to concerns expressed by the diabetes community in Britain, the British Diabetic Association commissioned a report examining and interpreting the available evidence of accident risk in insulin-treated diabetic patients, particularly that related to unexpected hypoglycaemia. The following article is drawn from that report.

Accidents, Traffic↗

The effects of driving age, driver education, and curfew laws on traffic fatalities of 15-17 year olds.

This study examines the effect of state driving age, learning permit, driver's education, and curfew laws on 15-17-year-old driver fatality rates. A multivariate regression model is estimated for 47 states and nine years. The minimum legal driving age and curfew laws are found to be important determinants of fatalities. Driver's education and learning permits have smaller effects. The relationship between rates of licensure and driving age, education, and curfew laws is also examined. In each case, a more restrictive policy is found to reduce licensure of 15-17 year olds. The results suggest that the imposition of curfew laws and higher minimum driving ages are particularly effective traffic safety policies.

Accidents, Traffic↗

[Problems in the assessment of driving capability in family practice].

More than half of the Swiss adult population possesses a valid driver's licence. To safely drive a car, certain medical demands are requested by law. Drivers of trucks, taxis and coaches and all drivers past the age of 70, must undergo a periodical medical examination. These examinations are usually performed by general practitioners. The most important legal foundations and the medical examination procedure are explained in this publication. Frequent diseases affecting the patient's driving ability such as poor vision, alcoholism, drug abuse, the early stages of dementia and other physical impairments are presented. Not to be neglected are the number of road traffic accidents resulting from medical reasons. The general practitioner is authorized to contact the authorities if he feels a patient is no longer capable of driving. For this reason, general practitioners should also be aware of the patient's driving capability other than during a periodical traffic examination. The individual's interests have to be carefully considered as opposed to that of society. The problems of general driving capability assessment performed by the general practitioner and possible procedures in case of patient's disagreement are presented.

Adult↗

Two new stereotests for long distance: examination of stereopsis with regard to the permission of driving.

Two differently constructed stereotests for a distance of 4 m are presented (tests A and B), which are based on the three-rod method of Helmholtz. In both tests, eight test objects are offered simultaneously, one of them being displaced toward the subject to a certain extent (100-10 s of arc). In test A the subject sees the eight test objects through eight holes, whereas in test B the test objects are seen directly. Each disparity is offered eight times. The threshold is defined as five of eight answers being correct. A total of 51 subjects without strabismus and with normal stereopsis in conventional tests achieved a mean stereo-acuity of 30 s of arc in test A and 10 s of arc in test B. The same subjects with one eye occluded and 49 patients with severe binocular defects reached chance scores only in test A, whereas in test B the success rate was improved slightly by monocular clues (P = 1/5). In examining stereopsis with regard to driving licenses, only tests for long distance should be used. Both new stereotests differentiate between normal and pathological candidates with high specificity and sensitivity.

Automobile Driver Examination↗

Utility of the UFOV test with mild traumatic brain injury.

Driving skills are socially important, easily disrupted by brain injury, and potentially risky and difficult to evaluate afterward. The Useful Field of View test has seen successful use with severe traumatic brain injury (TBI), but its use with mild TBI victims has not been examined. This study shows its ecological insensitivity among persons with mild TBI or no impairment and suggests its use be limited to more severely impaired persons.

Adolescent↗

The relationship of age and state license renewal policies to driving licensure rates.

We employ regression analysis to examine the relationship of state driver's license renewal requirements, population characteristics, and driving conditions to state driving licensure rates. Licensure rates are examined for the years 1985 through 1989. We separately examine all-age and senior licensed drivers. We find that license renewal requirements as well as population characteristics and driving conditions have systematic relationships to licensure rates. In particular, license renewal tests are associated with lower senior driving licensure rates.

Adolescent↗