Clinical Predictors of Driving Simulator Performance in Drivers with Multiple Sclerosis

Drivers with Multiple Sclerosis (MS) experience visual-cognitive impairment that may impact their fitness to drive. Fitness to drive is the ability to control a motor vehicle, as determined via a comprehensive driving evaluation, with in-clinic and on-road driving assessments. However, the on-road driving assessment may pose a crash risk to medically at-risk drivers. Instead, a driving simulator assessment that targets the driving performance deficits of drivers may inform fitness to drive decisions. However, utilizing clinical tests to indicate driving simulator performance in drivers with MS is not fully understood. Through three aims, this dissertation will examine the clinical utility of visual-cognitive tests to indicate driving simulator performance in drivers with MS. Aim 1 will examine the study’s feasibility via evaluating recruitment capability, sample characteristics, data collection procedures, outcome measures, participants’ acceptability and suitability of the driving simulator, resources to implement the study, and preliminary test results. Aim 2 will quantify if visual-cognitive tests can predict driving simulator performance in drivers with MS, when compared to control drivers without MS. Aim 3 will examine if adjustment to stimuli errors can predict the occurrence of rear-end collisions on a driving simulator. Aim 1 findings provided the foundation for determining clinical predictions of driving simulator performance, but also identified challenges such as lower than proposed recruitment rates, missing data on the driving simulator, participants’ varied responses toward the driving simulator’s acceptability, and the onset of simulator sickness. Aim 2 findings showed that deficits in immediate verbal/auditory recall and divided attention can indicate driving performance deficits in drivers with MS. Aim 3 findings showed that adjustment to stimuli errors, in urban environments, and that require intermittent problem-solving and decision-making to respond and avoid collisions, may underlie driving performance deficits. This dissertation supports the notion that it would be feasible to utilize clinical tests to indicate driving performance deficits in drivers with MS. Tests of immediate verbal/auditory recall and divided attention may be useful screening tools. Adjustment to stimuli errors in urban environments may underlie driving performance deficits in drivers with MS and can be detected on a driving simulator