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Book Review Driver Rehabilitation and Community Mobility

Title: Driver Rehabilitation and Community Mobility: Principles and Practice

Editor: Joseph Michael Pellerito, Jr.

Publisher Elsevier Mosby, St. Louis, Missouri, USA, 2006

Other details: 26 chapters, glossary, 10 appendixes, alphabetical index and a CD-Rom.

Price: $ 59.95

According to the authors this is the first book on driver rehabilitation. It certainly is the first comprehensive book on this subject. The multi-authored book gives an almost exhaustive coverage of functional and activity limitations affecting driving, and how these limitations can be assessed and compensated given the state of the art in the various disciplines involved.

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Tips from TIP 1

Body Mass Index for screening Driver Day-time Sleepiness

In Israel professional drivers undergoing a routine medical examination for fitness to drive in 2003 and 2004 were refered to the Institute for Fatigue and Sleep Medicine if their Body Mass Index (BMI) was > 32. They were assessed for Excessive Day-time Sleepiness (EDS) and Obstructive Sleep Apnea (OSA) with the Multiple Sleep Latency Test (MSLT) and the Respiratory Disturbance Index (RDI) assesed polysomnographically during sleep. Also subjective reports of sleep disturbances and EDS were assessed. OSA was detected in 78 % of thedrivers and 19 % had severe sleepiness (MSLT < 5 min). None of the drivers complained about any sleep problem, including snoring, and all reported that they do not experience EDS indicating that their subjective reports of OSA or fatigue symptoms are not reliable. As it is very easy to obtain BMI, it is recommended to use this as a screening measure for further sleep study and decison about fitness to drive and referal for treatment. (BMI = W/L2 with W = weigth in kg and L = length in m ).

Based on: Dagan, Y., Doliansky, J.T., Green, A. and Weiner, A. (2006) Body Mass Index (BMI) as a first-line screening criterion for detection of excessive daytime sleepiness among professional drivers. Traffic Injury Prevention, Vol. 7 pp.44-48.

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Systematic Review of Cognitive Predictors of Fitness to Drive in persons with dementia

Molnar, Frank J. MDCM, Patel, Akhilesh BSc, Marshall, Shawn C. MD, Man-Son-Hing, Malcolm MD Wilson, Keith G. PhD . Clinical Utility of Office-Based Cognitive Predictors of Fitness to Drive in Persons with Dementia: A Systematic Review. Journal of the American Geriatrics Society Volume 54 Issue 12 Page 1809 - December 2006

Frank Molnar and coworkers systematically review evidence regarding in-office cognitive tests that differentiate safe and unsafe drivers with dementia of the Alzheimer type. In the 16 studies that met their criteria (dementia established and some fom of driving performance assessment, on-road or in a driving simulator). They found that only one paper reported cutoff scores and that tests recommended by AMA and CMA guidelines did not demonstrate robustly positive findings or were not included in the studies. Authors conclude that without validated cutoff scores it is impossible to employ tests in a standardized fashion in frontline clinical settings. They recommend that driving researchers routinely perform cutoff score anlyses and that stakeholder organizations (e.g. AMA, American Geriatrics Society) sponsor concensus fora to review driving research methodologies

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Systematic Review concerning the Optimal Frequency of Follow-up in Mildly Demented Drivers

Systematic Review of the Optimal Frequency of Follow-up in Persons With Mild Dementia Who Continue to Drive. Brief Reports Alzheimer Disease & Associated Disorders. 20(4):295-297, October/December 2006. Molnar, Frank J. MDCM, Patel, Akhilesh BSc, Marshall, Shawn C. MD, Man-Son-Hing, Malcolm MD Wilson, Keith G. PhD .

Abstract:

Fitness-to-drive guidelines commonly indicate that persons with mild dementia may be safe to drive but that periodic reevaluation is required. This paper presents the findings of a systematic review of primary evidence regarding the optimal timing of follow-up in persons with mild dementia who continue to drive. A search of Medline, CINAHL, PsychInfo, AARP Ageline, and Sociofile from 1984 to 2005 was performed. No published studies focus primarily on the timing of follow-up of drivers with mild dementia. Three studies present longitudinal data that the authors reference when recommending periodicity of follow-up. This study identifies a concerning research gap in the field of dementia and driving. To provide better evidence to guide recommendations for periodicity of follow-up, 3 recommendations are proposed: (1) that prospective cohort driving research be undertaken to follow patients with mild dementia who continue to drive, (2) that data from such longitudinal research be presented as survival analyses, and (3) that existing research on the progression rates of Alzheimer disease be employed as a default until the first 2 recommendations are realized.

The International Traffic and Medicine Association