Objective Driving ability can be compromised in individuals with multiple sclerosis (MS); however, the progressive nature of multiple sclerosis makes it difficult for clinicians to assess when performance on functional tasks, such as driving, has started to decline. The aim of the study was to evaluate the relationship between two measures of multiple sclerosis severity, the Expanded Disability Status Scale and the Multiple Sclerosis Functional Composite, and minor driving errors in a virtual reality driving simulator. Design Symptom severity was measured in 31 active drivers with multiple sclerosis using the Expanded Disability Status Scale and Multiple Sclerosis Functional Composite. Driving performance was measured using a standardized virtual reality driving simulator route. Executive functioning, a cognitive function commonly related to driving, was evaluated using the Trail Making Test B. Results Greater impairment on the Multiple Sclerosis Functional Composite was related to increased difficulty maintaining lane positioning (r = −0.49, P = 0.01) and poorer executive functioning (r = −0.52, P < 0.01). In contrast, the Expanded Disability Status Scale was not related to either measure. Conclusions These findings suggest that poorer performance on the Multiple Sclerosis Functional Composite, and not the Expanded Disability Status Scale, may indicate vulnerability to minor driving errors as an early sign of driving compromise. The use of screening tools, such as the Multiple Sclerosis Functional Composite, could help clinicians identify increased driving risk and consider comprehensive driving evaluations earlier, before a major driving violation or accident occurs. To Claim CME Credits Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives Upon completion of this article, the reader should be able to: (1) Describe the relationship between symptom severity and driving performance in a virtual reality driving simulator, and how the relationship may vary based on which symptom severity measure is used; (2) Identify nuanced differences between two commonly used multiple sclerosis (MS) symptom severity measures when assessing functional abilities such as driving; and (3) Utilize symptom severity screeners that can assist in monitoring symptom progression and assessing whether further driving evaluation is needed. Level Advanced. Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Pure alexia is an acquired neuropsychological disorder that follows damage to the occipito-temporal lobe. This brain damage results in a severe reading impairment in which previously literate individuals are no longer able to efficiently read words, but are still able to perform other language tasks. The present study sought to identify factors of words that make it more difficult for pure alexic individuals to read, such as letter confusability and word length. Eye-tracking methodology was paired with a naming task to examine whether word length or letter confusability is a better predictor of processing difficulty. It was found that word length was a significant predictor of reading time, while summed letter confusability was not significant. This study contradicts some previous research and shows that when an orthogonal set of stimuli is used, letter confusability is not a significant factor driving this reading impairment in all individuals with pure alexia.

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