auto-mobility: driving with a visual impairment in the netherlands bart j.m. melis-dankers, phd...
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AutO-Mobility: Driving with a visual impairmentin the Netherlands
Bart J.M. Melis-Dankers, PhD clinical physicistRoyal Dutch VisioCentre of expertise for blind and partially sighted people
April 2014SMS, Kalmar, Sweden
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16.7 million inhabitants 316,000 visually impaired people [1.9%] Driving is the main form of transport in NL.
7.7 million passenger cars. Elderly population is growing Co-morbidity
The Netherlands
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Optimization of independent mobility is important for
social participation. Driving itself is not the goal.
Independent mobility is! Safety first.
Rehabilitation programme AutO&Mobility:
Individual advice and training programme to optimize
independent mobility, if possible in motorised vehicles.
AutO&Mobility
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Driving: Skills, Fitness & Behaviour
Fitness to Drive: medical/biological preconditions that allow us to learn and exercise our driving skills
Driving Skills: steering, braking, handling, manoeuvring, making the right decisions.
Driving Behaviour: how we act in daily traffic
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Some examples of unwanted phenomena in each category
Fitness to Drive: -- epileptic insults-- visual impairments-- cognitive impairments
Driving Skills: -- not driving fast enough when joining traffic -- not adapting the distance to the car in front of you
Driving Behaviour: -- driving 80 km/h in an urban area -- overtaking at the wrong side
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Stereotype of people with brain injury, visually impairments or elderly driversFitness to Drive:
-- neuropsychological and medical impairmentsDriving Skills:
-- good in familiar situations, -- poor in unfamiliar or complex situations
Driving Behaviour: -- avoiding difficult and unfamiliar situations > self restriction-- slowing down > compensation in time
Driving Skills, Adapted Driving Behaviour and Visual Aids allow compensation for impaired Medical Fitness to Drive
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The hierarchical task structure of The hierarchical task structure of driving: driving: three levels (after Michon, 1985)three levels (after Michon, 1985)Strategic
(long time constant)
Goals, route planning;
Do I go by car or take the train?
What time of day?
How much time do I need?
Which route shall I take?
Tactical
(Seconds)
Intersection approach speed
Maintaining safe distance to other vehicles
Changing lanes in time
Operational
(milliseconds)
Maintaining course, steering braking
Avoiding an obstacle
Braking in time for a crossing cyclist
Driving behaviour
Driving skills
Fitness to drive
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fitness to drive: EU-directive
medical visual acuity: 0.5 in best eye [6/12, 20/40] visual field: ≥ 120°
practical the ability to drive safely and smoothly despite
one’s visual impairment. on road driving test by the Netherlands Bureau of
Driving Skills Certificates [CBR].
Considered as Golden Standard in NL
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VA = 0.2
visual acuity 0.5 : reading licence plate at 35m
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Step 1: Coeckelbergh & Kooijman
1998 – 2002
N = 67 participants. Visual acuity loss and/or visual field defect. All had insufficient medical fitness to drive. Practical fitness to drive test [CBR].
[Human Factors, 2004, 46(4): 748-760]
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Step 1: Coeckelbergh & Kooijman
1998 – 2002: conclusion
34% passed practical fitness to drive test [CBR]
The medical fitness to drive (visual acuity and visual
field) provides not sufficient information to decide about
the practical fitness to drive.
[Human Factors, 2004, 46(4): 748-760]
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Netherlands Bureau of Driving Skills Certificates [CBR] Ministery of Transport 2 driving schools University Medical Center Opthalmology Univeristy Medical Center Traffic Medicine Royal Dutch Visio: clinical physicist
optometrist
occupational therapist
neuro-psychologist
Step 2: build a consortium
2000 - 2004
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Impaired visual acuity:
Problem: reading signs, anticipate, overtaking
Bioptic Telescope System [BTS]
Visual field defect: homonymous hemianopia
Problem: overview
Scanning Compensatory Therapy [SCT]
Step 3: development of training
2004 - 2007
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Due to acquired post-chiasmatic brain
damage
Homonymous Hemianopia
field defect the same for both eyes
half of the visual field
no visual perception
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left hemianopia, gaze right Eli Peli
normal visual field
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Eli Peli
normal visual field
left hemianopia, gaze right
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Eli Peli
normal visual field
left hemianopia, gaze far right
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Training protocol (IH-CST)Training protocol (IH-CST) Designed by Royal Dutch Visio 18 hours (15 sessions) of face-to-face
training 10-15 weeks daily exercise Goal: improving “slow mobility” (walking,
cycling) Three phases:
1. Increase insight in visual deficit2. Systematic scanning strategy3. Step-by-step transfer to mobility in
daily life
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Increase insightIncrease insight
Awareness of impairment Exclusion neglect No co-morbidities: cognitive / visual Discriminate tasks: Mobility vs. reading Awareness of own responsibility / possibilities
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Systematic scanning Systematic scanning strategystrategyBased on training Pizzamiglio (1992) and
Tant (2002) Scanning strategy:
◦ Fixate straight forward◦ Large saccade towards blind hemifield◦ Saccade back to seeing hemifield
Frequency depending on situation
Right hemianopia:
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Scanning strategy: large Scanning strategy: large screenscreen
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Scanning strategy while Scanning strategy while walkingwalking
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Standardized search tasksStandardized search tasks
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Obstacle courseObstacle course(dual task)(dual task)
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inclusion: homonymous hemianopia SCT-programme:
assessment day optimizing optics [optometrist] SCT-training 10 x 1.5 hours [O&M-trainer] driving lessons [driving
instructor] practical fitness to drive test [CBR]
Step 3: scanning compensatory therapy
2007 - 2011
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Result
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Tracking taskTracking task
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Result
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Hazard perceptionHazard perceptionVlakveld-testVlakveld-testWith eye movement recordingWith eye movement recording
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Driving simulatorDriving simulator
slightly winding road fixed speed (50 km/h)
slightly winding road free speed slightly winding road instruction: in
a hurryrural, 2-lane road + crossings fixed speedrural, 2-lane road + crossings free speed
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Fitness to drive: TRIPFitness to drive: TRIPTRIP-factors improve after training
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report to the minister of Transport
decisions: May 2009 and February 2010
visual acuity impairment: VA >= 0.50 : unrestricted driving
license 0.40 <= VA < 0.50 : CBR-test without BTS 0.16 <= VA < 0.40 : CBR-test with BTS
visual field defect: HVF >= 120° : unrestricted driving license 90°<= HVF < 120° : CBR-test
Step 4: lobby to change regulations
2007 - 2010
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South
NWNorth
SW
Step 5: extending consortium
2009 - 2010
°
°
4 regions: 12 locations education of:
9 information officers 31 optometrists 32 O&M trainers 6 clinical physicists 5 neuro-psychologists 23 driving instructors 8 CBR experts on practical fitness to drive 12 CBR driving examiners
September 2010: AutO-Mobility nationally available
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applied for AutO-Mobility: 1027 -- BTS: 879
-- SCT: 148
included in AM-diagnostics: 641 -- BTS: 510
-- SCT: 131
driving licenses issued: >150 -- normal: >20
-- BTS: 79
-- SCT: >50
Self reported accidents 1 -- parking
REMEMBER: AutO&Mobility is about mobility, not about driving!
Current situation
April 2014
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New programmes for: mobility scooter [16 km/h = 10 miles/h] microcars [45 km/h = 30 miles/h] patients with combined acuity and field impairment patients with visual and neurological impairment driving simulator
Step 6: future developments
2014 - 2016
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Royal Dutch Visio
www.auto-mobiliteit.org
Please contact