An Introduction to Driving Lab, LLC

A bit of background

As of 2000, there were about 191 million licensed drivers in the United States (70% of the entire population), an increase of approximately 24% since 1980 and 12% since 1990. The increase is especially high for older drivers, with those aged 70 and above, who represented only 9% of all drivers in 1980, recording a 111% increase (to 20%) by 2000. Demographers tell us that this trend will continue as life expectancy continues to increase and people remain healthy longer. By 2020, if the trend of these national statistics is maintained, older drivers, over age 70, will increase to 38 million from 13 million today. When coupled with non-elderly drivers who have or will experience medical problems which may compromise the cognitive abilities necessary for safe driving, one can speculate that the number of drivers requiring assessments of their fitness to drive will increase significantly. For clinicians (physicians, therapists, driving assessment experts and others) in this field, their challenges will grow along with the population needing their services.

Who are we?

Driving Lab, LLC (DLL) was formed in 2007 by three partners who share a vision and a commitment to the enhancement of road safety through the valid assessment, diagnosis, and treatment of those who’s driving skills and abilities may have suffered due to cognitive impairment. Abiodun Emmanuel Akinwuntan, a neuro-rehabilitation expert, Peter Rosen, an ophthalmologist, and Jerry Wachtel, a human factors psychologist, have been involved in the application of advanced simulation technologies for assessment and rehabilitation of driving for several years. These experts have been concerned with the fragmented, non-standardized approach to this critical area, especially the employment of non-standardized, non-driving based off-road tests to determine fitness to perform an on-road test or advising patients on their fitness to resume or continue driving.

Why are we doing this?

DLL was formed to address a large, difficult and growing problem: the need for a reliable, valid, clinician-friendly tool for the assessment of driving impairment due to temporary, permanent, or progressive cognitive impairments. Impaired cognitive skills leading to driving difficulties may occur at all ages and across a wide variety of medical conditions. DLL has conceptualized a standardized, state of the art, affordable driving simulator, as part of a fully integrated toolkit for use in clinical, research and DMV settings.

What problems are we trying to address?

The number of persons who require DMV and on-road evaluations is large and projected to keep growing. In addition to very elderly drivers who exhibit slowed reaction, information processing and motor response times, stroke survivors, patients with traumatic brain injury, Alzheimer’s or Parkinson’s disease also require thorough driving evaluations. In all driver age groups, Attention Deficit Disorder, Obstructive Sleep and substance abuse are examples of conditions that may require comprehensive evaluation of driver fitness. Disorders such as cardiac arrhythmias, diabetes, end stage liver and kidney disease, and others, can also affect the cognitive skills necessary for safe driving. Collectively, these conditions affect more than 25 million people in the United States. Alzheimer’s disease alone afflicts 70 million people worldwide. With an aging population in the U.S. and most developed nations, Alzheimer’s is expected to increase more than 50 percent by the year 2030. Currently, assessors of on-road driving performance are overwhelmed by the number of evaluations to be conducted and the waiting time for the drivers to be tested is getting longer and unbearable. The DLL “tool kit” is a potential solution that will be of benefit to clinicians, patients and on-road assessors. It is a more readily available system capable of providing face valid assessment in a safe and controllable environment before only those with good chances of passing progress to perform on-road test. For those with only fair to no chance of passing the on-road test, the “tool kit” has the capability to train deficient driving skills.

Driving difficulties due to cognitive impairment are difficult to evaluate because current methods of, visual and neuropsychological testing are less than ideal due to a lack of standards and often poor correlation with or predictive validity of driving errors and crash causation. Driving is a complex activity involving a high degree of synchronization between perceptual, cognitive and motor control (PCM) processes, often carried out under the pressure of time, and occasionally under demanding road, traffic, or weather conditions. On-road testing is often considered the “gold standard” for safety evaluation, but it lacks standardization and is rarely conducted under conditions likely to contribute to crashes even though such conditions may occur at any time. Driving simulators can reliably evoke and mimic PCM processes used in driving, and offer state–of-the-art methods of evaluating driving behaviors under challenging driving conditions, without the real-world consequences of error. It may also be used to provide re-training of driving skills and use of aids as required. But simulator-based evaluation also suffers from a lack of standardization, and difficulties in use and in patient and clinician acceptance. Clinical paper and pencil or computer based cognitive test batteries can have been used to identifying impairments but cannot also stand alone when the need is the assessment of fitness to drive, and the goal is to return the patient to driving whenever possible,

How is Driving Lab different?

Driving simulators have the potential to address many of the limitations of static vision and cognitive tests and behind the wheel driving tests often conducted in an unrealistic, risk-reduced environment. But even the most sophisticated driving simulators are not a panacea, and cannot stand alone. With our years of hands-on experience in clinical settings, and our in-depth interactions with the clinicians at the front lines of driver assessment, we have a unique perspective on the hardware, software, and other systems needed for a fully integrated approach to such assessment; an approach that works without being fussy.

DLL has positioned itself at the critical decision node in the evaluation of driver fitness - between laboratory-based vision and neuropsychological assessments and behind-the- wheel evaluations. A key goal of the DLL approach is to reduce the cohort of those who, as a result of evaluation, cannot be clearly identified as those who should cease driving from those who can move on to a road test. In other words, the DLL system will combine our advanced simulation with an integrated set of proven clinical tests to make a clearer determination that a patient is fit to drive (subject to road test) or so severely disabled that a behind-the-wheel test is unnecessary. In the latter case, the DLL protocol can result in reduced stress (in both patient and clinician), lower costs, and a shorter time period before the patient can be recommended for counseling or on-road assessment. For those patients who may be temporarily unfit to drive, the DLL tool kit can be used to re-train driving risky situations with time-dependent decision making requirements. The DLL system is optimized for use by the clinician in the re-training of deficient driving skills and to improve cognitive functioning and situational awareness, much in the same way that we use treadmills to improve cardiovascular and pulmonary function.

In short, with a focus on improving the efficacy and cost-effectiveness of evaluating and treating cognitively impaired drivers, the DLL system adds value by improving assessment and treatment outcomes and enhancing decision making for clinical and resource allocation alternatives. It allows clinicians and administrators to work smarter, not harder, in ways that improve functional, psychological, social and economic outcomes for patients, while reducing the burden on friends, families, and caregivers, and enhancing road safety for all.

What skills will we assess?

There is broad, although not universal, agreement among researchers and clinicians about the cognitive skills most important for safe driving under all conditions. The DLL system is designed to assess these capabilities:

-Attention: Sustained, divided, selective, focused and alternating

-Spatial orientation and organization

-Executive reasoning: Perception, prioritizing, planning, judgment, decision-making and execution

-Simple and Complex reaction times

-Speed of mental processing

-Compensatory strategies

-Visual search

-Contrast sensitivity

-Distractibility

-Static and dynamic visual acuity

-Working memory

-Perceptual-motor control

What markets will we serve?

Medical

-Rehabilitation Centers

-Neurologists

-Geriatricians

-Sleep and Attention Deficit Disorder centers

Research

-Cognitive Sciences

-Ergonomics

-Psychology

DMVs and government agencies

-DMV

-Military/VA

-NASA

-Criminal Justice

Insurance companies

-Workman’s compensation

-Auto Liability

-Health Care

Pharmaceutical and device manufacturers

-PHARMA

-Rehabilitation equipment manufacturers (Neurocom, HeartMath)

What are the core principles of the Driving Lab system?

-Affordability

-Standardization

-Construct/predictive validity

-Turn-key operability

-Shallow learning curve for clinical staff

-Play-back features for patient learning, insight, and training

-Randomized, equivalent form scenarios to avoid practice effects

-Clinically relevant results reporting to guide patient-specific decision making

-Secure HIPPA-compliant Data Repository for bench-marking and trend analysis

-Treatment plans tailored to patient ability, skill level and condition

-Integration of key psychophysiological measures :

-Bio-feedback (heart-rate variability, respiration, GSR, EEG)

-Eye tracking

-Divided attention/secondary/distraction tasks

What is at the heart of the Driving Lab system?


The Driving Lab system is a state-of-the-art driving simulator, custom designed and built to DLL’s specifications. This simulation system is designed for easy, turn-key operability by the clinician, and comfortable, easy acclimation by the patient. At the heart of the system is a large inventory of visually, cognitively and motor tasking driving scenarios tailored for the needs of the clinician and the specific assessment and training requirements of the patient. These scenarios, with several equivalent forms to eliminate any benefit from a practice effect, have been developed and copywrited by the DLL partners specifically for application to our target population.


The scenarios, when used as part of the DLL assessment battery, allow the clinician to dynamically evaluate driver fitness by challenging the patient’s ability to control speed, lane position and heading while performing driving tasks requiring high degrees of judgment. Examples of driving tasks incorporated into DLL’s scenarios include, but are not limited to:

•Left-hand intersection turn against traffic (gap estimation and acceptance, time to crash)

•Overtaking on single lane highway with oncoming traffic (gap estimation, time to crash, speed and steering control, mirror use)

•Car following (time to crash, speed control, impatience)

•Merging (steering and speed control, time to crash, mirror use)

•Path intrusions (steering and speed control, reaction time, divided attention)

•Hazard avoidance (steering and speed control, reaction time, sustained and divided attention)

•Road curvature (steering and speed control, direction of heading, lane keeping)

•Required sudden stop (reaction time)

•Pedestrian and bicyclist crossings (alternating and divided attention, reaction time)

•Work zones (compensatory strategies, speed of mental processing

•Road closures (executive reasoning, planning, judgment, compensatory strategies)

•Adverse weather – rain, snow, fog, ice (perception, judgment, reaction time)

•Varying lighting conditions (contrast sensitivity)

•Varying roadside environment (visual search, change blindness)

•Driving in dense traffic (speed maintenance, gap estimation, mirror use, lane keeping, impatience)

•Route navigation, wayfinding (working memory)


For each scenario and all competencies tested, a weighted scoring system will produce a report, at two levels of detail, immediately usable by the clinician and the patient to judge evaluate and rate the patient’s performance. The clinician can then make his or her decisions and recommendations based on these presented results. To ensure comparability across all patients, and to maintain high levels of validity, the scenarios and assessment module are protected against modification at the end user level. This, too, sets the Driving Lab system apart from others.

An additional, unique and major benefit of the Driving Lab system is its ability to contribute to the research knowledge base about driving competencies with cognitive impairment. The system is capable of collecting and analyzing driving performance for more parameters and at finer levels of detail than will be needed by the clinician and the patient. With the agreement of clinician and patient, the system can record and store this data, separated from any patient or clinic identifying information, through DLL’s HIPPA compliant centralized data base. These voluminous, relevant, and standardized data will be merged with identical data collected at other DLL sites to develop and grow, for the first time, a comprehensive picture of the relationship between cognitive functioning and driver fitness.

A “treadmill” for the brain

The DLL system is designed to measure and assess cognitive performance relevant to safe driving at a system, not component, level. Much the way a treadmill integrates cardiac functions to provide the clinician with the “big picture,” so the DLL system integrates brain functions and behavioral outputs that are critical to safe driving.


To take one example, the seemingly simple “car following task” when integrated into a scenario developed and validated by DLL, provides a highly sensitive test that reveals memory refresh rates; reaction time; VPS; optic flow; spatial orientation; kinetic depth perception; situation awareness; volitional control. As in all other scenarios incorporated into the modular DLL system, the data outputs from the car following task are automatically and immediately collated, formatted, and delivered to the clinician in a format immediately usable for review with the patient.



How can Driving Lab accomplish all of this?

The DLL partners bring together a unique blend of education and experience in the core competencies needed for the professional assessment, training and advisement, in both clinical and research environments, of persons with cognitive impairments who wish to continue or resume driving.

•Human factors/cognitive science

•Ophthalmology

•Neuropsychology

•Simulation and scenario development

•Research/experimental design

•Data analysis/modeling

•Clinical experience

•Academic and business networking


Who will advise us?

Through their years of work in this field, the partners of DLL had the privilege of working with the best and the brightest folks in the field of driver assessment, advisement, and training. We have asked several of these experts to serve in an advisory capacity to us as we bring our vision to fruition. In the next several weeks, we will be announcing the make-up of our Advisory Board, which will include highly respected individuals in this field. We are excited to have them as part of our team.