Introduction to Special Issue on Driving and Community Mobility

As editor of Occupational Therapy in Health Care and a researcher in driving and community mobility, I am delighted to introduce this special issue. With driving being the primary means of transportation in North America, research about how to differentiate drivers who are medically unfit to drive from those who are fit to drive is essential. In addition, developing strategies to assist those who are deemed unfit to transition successfully to a passenger is also critical to the process of maintaining social engagement for our older population. This special issue also addresses novice drivers, who are at risk for crashes due to their inexperience as well as those with autism. While on diverse topics, these papers all represent strong research highlighting the important instrumental activity of daily living—driving and community mobility—and how occupational therapy practitioners can improve this activity through evaluation and intervention.

The first four papers address the assessment of the medically-at-risk driver. First, Yamin and colleagues expand on previous work (Gibbons et al., 2017) on using serial trichotomization to assess fitness-to-drive using four common neuropsychological tests (Trail Making Part A and B, Clock Drawing Test, and the Modified Mini-Mental State Examination). In this study they use a retrospective chart review to classify participants as unfit, fit, or requiring further testing, providing more evidence that serial trichotomization can facilitate the assessment of fitness to drive by decreasing the necessity of on-road assessments.

The next two studies provide the validity of using the Vision Coach™, a large, flat light board mounted in which lights are hidden beneath a black membrane and appear randomly anywhere on the board. In the first paper, Dickerson and colleagues investigated the differences in visual-motor processing speed and reaction times across the age and sex of healthy adults. Results showed no differences between male/female or standing/sitting positions but showed statistically significant differences across age groups. This study provided the normative reaction times for the next study. In her study, Penna and colleagues used the Vision Coach™ to show the significant difference between healthy normal adults and medically at-risk drivers. Moreover, this study provided preliminary evidence of scores to differentiate drivers who are fit to drive without restrictions, those unfit to drive, and those who need restrictions.

In her study, Leonardo and colleagues used eye-tracking technology to examine hazard detection at night. Using a two (younger versus older) by two (stimulator versus on road) analysis of variance, this study examined pupil glances that were recorded with three roadway hazards on a driving simulator and on a roadway. Results showed that older adults detected hazards similarly to young adults, especially during the on-road drive. This study supports the use of driving simulators as a proxy for on-road night driving.

Driving simulators are the mode for the next two studies, although with younger drivers. In a randomized control trial, Torpil and Ildiz demonstrate that 14 days of game-based intervention enhanced the hazard perception and visual skills of novice drivers offering a low cost intervention for driving rehabilitation. Also using the driving simulator, Romer and colleagues explored the effect of music on the driving performance of young adult drivers with and without autism spectrum disorder (ASD) with at least three years of driving experience. Results did not demonstrate any effect with music, however, the drivers with ASD had higher performance means on a wayfinding scenario and for the scoring category of following “regulations.” Neurotypical teens performed better on the wayfinding scenario than the hazard scenario in “maneuvers” and being attentive to the environment. Although there was a small number of drivers with ASD, this was the first study to examine wayfinding skills with teens/young adults with and without ASD.

Addressing transitioning from driving to being a non-drive, Stinchombe and colleagues used thematic analysis to examine the perceived impact of driving cessation among current older adults in Canada. Their results showed diverse attitudes toward driving cessation from avoidance to acceptance, emphasizing the importance of tailored resources for drivers meeting their individual needs at various stages.

Finally, Jeghers and colleagues’ study addresses the challenge of training new driving rehabilitation specialists to correctly identify driving errors of drivers, in this study on a driving simulator. Through such studies, the training of driving rehabilitation specialists becomes solidly based on evidence-based research and improves the outcomes for this area of occupational therapy practice.

As an editor and an occupational therapist researcher with a passion for addressing driving and community mobility, it is my hope this special issue provides interesting reading. More importantly, I hope it provides an impetus for more research and development of occupational therapy practice in driving rehabilitation as well as generalist work in the IADL of driving and community mobility.

Declaration of interest

The author reports no conflicts of interest. The author alone is responsible for the content and writing of this paper.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Anne E. Dickerson

Dr. Anne Dickerson is Professor in East Carolina University’s Department of Occupational Therapy and Director of the Research for the Older Adult Driver Initiative (ROADI). As an occupational therapist, psychologist, and driving rehabilitation specialist, Dr. Dickerson is an international leader in research in areas of older adults, driving rehabilitation driver simulation, and teens/young adult drivers with autism spectrum disorder. She is also Editor of Occupational Therapy in Health Care.