Driving Rehabilitation in Parkinson’s Disease

Driving is a complex task requiring the use of physical and cognitive functions. When the effects of Parkinson’s disease begin to limit one’s ability to operate a vehicle, driving rehabilitation can keep patients safely on the road longer. It would be important to note that though driving simulators provide a tool for maintaining driving fitness, not all skill loss or functional loss associated with this degenerative disease can be rehabilitated. Simulators can serve as a tool to identify when a patient’s impairments may put them at risk on the roadway and safe driving is no longer viable.

Parkinson’s disease is a complex neurodegenerative disorder. The effects of the disease will negatively impact a patient’s quality of life and interfere with activities of daily living, including the ability to safely operate a vehicle. Symptoms of the disease include tremor (often in hands or fingers), slowed movement, rigid muscles, impaired posture and balance, loss of automatic movements, speech changes, writing changes, and cognitive impairment. These symptoms can negatively impact a patient’s driving fitness without training.

“The progression of Parkinson’s disease varies among different individuals. Parkinson’s is chronic and slowly progressive, meaning that symptoms continue and worsen over a period of years. Parkinson’s is not considered a fatal disease,” according to the Parkinson’s Disease Foundation. Patients with PD do not have a reduced life expectancy, but the progressive nature of the disease will eventually lead to a loss of driving fitness.

A 2015 review article identified the critical on-road driving impairments and their associated visual, cognitive, and motor deficits for PD patients. Driving is a critical component of maintaining independence. Driving is the means of connection to social interaction, medical appointments, participation in religious activities, and other activities for maintaining independence like shopping or visiting the bank. “The use of alternative modes of transportation such as public transportation, professional taxi services, or support from friends and family, is usually unsatisfactory in replacing the mobility demands of those who have given up driving,” the review stated. “Individuals who have ceased driving are at an increased risk of institutionalization and even mortality due to a higher incidence of comorbidity, social isolation, and depression.”

Patients with PD are more likely to discontinue driving. Approximately 18% of patients who actively drove at the onset of the reviewed studies ceased driving two years later whereas only 3% of control drivers stopped driving over the same time span. “Considering the potential adverse social and health outcomes related to driving cessation, the development of an evidence-based program of retraining the driving skills of individuals with PD is urgently needed. Such a driving program should target driving knowledge, skill, and behavior with the ultimate goal to prolong long-term mobility, quality of life, and health.”

Utilizing virtual driving simulators is part of a contextual approach to driving rehabilitation programs. The use of driving simulators may help identify impairments in driving ability and develop safer driving strategies. Simulators can also identify potential areas where adaptations can be utilized to improve safety such as adding additional mirrors.

Hope Identified in Simulator Studies

A paper published by the Journal of NeuroRehabilitation, “Establishing an evidence-base framework for driving rehabilitation,” (H. Devos et al.) addressed the potential to retrain driving skills in patients with PD. This review showed hope for improvements in driving fitness in some cases for patients with the disease. At baseline, patients with PD performed worse on all global measures of driving ability compared to control groups. The percentage of patients that failed the baseline driving evaluation ranged from 30% to 56% compared to 0% to 24% of control groups. Patients with PD had difficulty with basic driving skills including signaling, lane position, steering wheel control, visual scanning, and adapting speed to traffic and obstacles. Compared to control groups, patients were able to identify fewer road signs and landmarks.

Difficulties were identified related to responding to traffic events, other road users, traffic lights or potentially hazardous situations. Patients exhibited difficulties approaching, yielding, and navigating intersections or roundabouts. Patients had more challenges maintaining headway distance, merging into traffic, and changing lanes. Finally, patients experienced more trouble while parking, reversing, and pulling away from a curb.

While patients with PD scored markedly lower than control groups in nearly every area tested for driving fitness, utilizing virtual driving simulators in studies aimed at measuring and proving driving fitness resulted in great improvements in many areas. For those patients that participated in simulator training, marked reductions were noted in crashes and total error counts. Improvements were noted in reaction times and overall improvements were seen in decision-making, hazard perception, and on-road driving performance. Significant effects were noted on general cognition and visual scanning. The studies reviewed by H. Devos et al. showed that improvements in simulation tests after training were indicators of improved real-world driving.

Improved Driving Improves Overall Well-Being

“To some extent, individuals with PD self-regulate their driving by shortening their trips, avoiding nighttime driving, and driving in inclement weather conditions, suggesting that drivers with PD are also able to compensate on the strategic level for their impairments on the operational and tactical level. These perceived levels of awareness, yet substantial difficulties with on-road driving, make individuals with PD a good target population for driving rehabilitation,” the review concluded.

The success of training programs may be affected by the unique aspects of each patient, including disease severity, longer disease duration, comorbidities, and motor subtype of the disease. Core components of the simulator training should focus on retraining operational and tactical driving skills focusing on lateral positioning and signaling, speed adaptations, visual scanning, and turning left. These core components showed a high correlation of success in real-world road tests.

DriveSafety’s clinical driving simulators provide therapists with powerful tools to assess and rehabilitate patient’s functional abilities. Virtual simulators at DriveSafety are used to enhance the cognitive, sensory, and physical functioning of a broad range of patients, including those with PD. The company’s simulation-based tools improve patient outcomes not only in the specialized area of driving rehabilitation, but also in the general therapeutic care of patients who have suffered functional losses that impact their independence and mobility.

In addition to evaluating a client’s sensory, cognitive, and motor functions, DriveSafety driving simulators’ realistic tools and scenarios provide a safe environment for testing a patient’s driving skills and allow therapists to make more accurate evaluations of a client’s readiness to drive.

Contact DriveSafety today to learn more about how clinical simulators can help maintain independence and quality of life for patients with PD.

Source citation: Devos, Hannes, et al. “Establishing an Evidence-Base Framework for Driving Rehabilitation.” NeuroRehabilitation, vol. 37, 2015, pp. 35–52.