Fitness to drive in multiple sclerosis: Awareness of deficit moderates risk

Abstract

Fitness to drive was examined among 78 individuals with multiple sclerosis (MS) who participated with a knowledgeable informant. Illness severity, neuropsychological functioning, and external social influences each made unique contributions to the prediction of driving status. Among drivers, perceptions of social influences against driving accounted for the most variance in miles driven, whereas social influences, informants' perceptions of the patients' fitness to drive, and illness severity accounted for the most variance in adverse driving incidents. Importantly, awareness of deficit moderated fitness to drive: Drivers who were unaware of their deficits perceived less need to engage in compensatory behaviors; moreover, as perceived need to compensate decreased, miles driven and driving incidents increased. The findings have implications for interventions with persons with MS who drive.

Awareness of Deficits and On-Road Driving Performance

“…and driving outcomes (e.g., State Departments of Motor Vehicle records, onroad evaluations, etc. ; Coleman et al, 2002;Ryan et al, 2009). Another possible reason for the mixed results is failure to account for awareness of deficits among adults who resume driving.…”

“…Impaired self-awareness of limitations is common among people with ABI, including stroke, TBI, Alzheimer's disease, and MS (Prigatano, 2005;Ryan et al, 2009). The term anosognosia is often used to describe this condition in which persons with brain dysfunction ''do not recognize the presence or adequately appreciate the severity of deficits in sensory, perceptual, motor, affective, or cognitive functioning evident to clinicians and caregivers'' (Orfei, Robinson, Bria, Caltagirone, & Spalletta, 2008, p. 204).…”

“…Several studies have shown that neuropsychological tests can be good predictors of driving performance and driving outcomes in TBI (Coleman et al, 2002;Galski et al, 1992), stroke (Heikkila¨et al, 1999;Lundqvist, Gerdle, & Ro¨nnberg, 2000), multiple sclerosis (MS; Ryan et al, 2009), community-dwelling older adults (Clay et al, 2005), and dementia (Reger et al, 2004), as well as in studies of mixed neurological populations (Schanke & Sundet, 2000). Type and degree of cognitive impairment as assessed by neuropsychological tests have been shown to be better predictors of actual driving performance than are age or medical diagnosis among individuals with ABI (Fitten et al, 1995).…”

Driving Competences and Neuropsychological Factors Associated to Driving Counseling in Multiple Sclerosis

“…Unfortunately, few studies have used detailed neuropsychological test batteries to establish the association between driving and cognition in MS (Schultheis et al, 2001), and when a battery has been used, only a global score created from all tests was considered (Ryan et al, 2009). Schultheis et al (2001) investigated the relationship between cognitive impairment in MS and driving risks and observed that Correspondence and reprint requests to: Dolors Badenes, Hospital Universitari Mútua de Terrassa, Plaça Dr. Robert 1, 08221 Terrassa, Spain.…”

Contributo da avaliação psicológica no exame clínico de condutores com doença neurológica e psiquiátrica: revisão teórica

“…Em pessoas com EM a condução é considerada crucial na manutenção da mobilidade, independência e liberdade, constituindo também um símbolo de capacidade funcional. Aproximadamente 23% dos condutores com EM cessam a condução depois do diagnós-tico, e os que continuam a conduzir apresentam melhor funcionamento físico e cognitivo 80 . Apesar da tendência para reduzirem essa atividade, os condutores com EM correspondem a um grupo clínico com maior risco de acidente em comparação com condutores sem doença identificada 6,7 .…”