Driving Rehabilitation in Parkinson's Disease

帕金森病的驾驶康复

基本信息

批准号：
7888194
负责人：
ERGUN Y UC
金额：
--
依托单位：
IOWA CITY VA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-07-01 至 2011-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7888194
关键词：
Affect Age Aging Alzheimer&apos s Disease American Automobile Driving Awareness Cognition Cognitive Complex Development Disease Elderly Evaluation Feedback Functional disorder Future Goals Impaired cognition Impairment Intervention Life Motor Neurological Models Parkinson Disease Participant Patients Perception Performance Phase III Clinical Trials Pilot Projects Preparation Protocols documentation Public Health Quality of life Randomized Controlled Clinical Trials Rehabilitation therapy Research Personnel Risk Safety Severities Stroke Testing Training Training Programs Traumatic Brain Injury Vehicle crash Veterans Video Recording Videotape Vision Visual Perception Visual attention Writing base cognitive function efficacy testing expectation hazard high risk improved indexing instrument intervention program motor deficit motor impairment multitask nervous system disorder post stroke procedural memory programs rehabilitation strategy research study systematic review visual motor

项目摘要

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.

汽车驾驶是日常生活的一个重要方面，但车辆碰撞事故却对公共健康造成严重影响问题。帕金森病 (PD) 影响约 100 万美国人，患有帕金森病的驾驶员面临特殊风险由于运动功能、认知和视力逐渐受损而导致的停止驾驶或碰撞。在我们正在进行的预测 PD 驾驶员安全的研究中（R01 NS044930，PI：Uc），我们发现驾驶员在道路驾驶任务中，患有帕金森症的驾驶员比没有神经系统疾病的老年驾驶员表现更差仪表车辆 (IV) 和高保真驾驶实验驾驶场景模拟器。即使患有轻微严重程度的早期帕金森病的驾驶员也会出现认知和视觉功能障碍，并且在驾驶时表现出多任务处理、执行复杂驾驶操作的特殊问题，并且处于增加碰撞风险。认知障碍和视觉感知能力下降导致不良驾驶表现和安全错误多于典型的PD运动功能障碍。基于我们自己和其他研究人员对常见疾病类型和情况的实证研究结果安全失误，以及PD驾驶问题的根本原因和机制，我们有为患有帕金森病的高危驾驶员设计了一种新的干预措施。干预措施包括对使用口头、视频和书面反馈在 IV 中进行受试者自己的道路驾驶，然后进行模拟器训练提高视觉注意力、执行复杂操作、驾驶过程中的多任务处理、危险的课程感知和避免碰撞。我们干预的概念基础是改善程序记忆通过反馈和模拟器中的练习来认识错误，并期望这改进将转移到路上驾驶。这是一项试点研究提案，旨在进一步开发和完善我们的干预措施，并测试其短期疗效，看看该干预措施是否值得在 III 期进一步测试审判。为患有帕金森病的受损驾驶员制定有效的康复计划将降低运动风险车辆碰撞事故，有助于保护和维持这些患者的行动能力和生活质量。此外，该驾驶康复计划可适用于其他神经系统疾病，例如阿尔茨海默病疾病、中风和创伤性脑损伤，这些情况在老年和年轻退伍军人中都会出现。