Devos Hannes, Ranchet Maud, Emmanuel Akinwuntan Abiodun, Uc Ergun Y
Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, GA, USA.
Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
NeuroRehabilitation. 2015;37(1):35-52. doi: 10.3233/NRE-151239.
Individuals with Parkinson's disease (PD) experience problems with on-road driving that can be targeted in driving rehabilitation programs.
To provide a framework for driving rehabilitation in PD by identifying the critical on-road driving impairments and their associated visual, cognitive, and motor deficits.
We conducted a systematic review of the literature on on-road driving and naturalistic driving practices in PD. Relevant databases including Pubmed, Medline, PsychINFO, ISI Web of Science, Cochrane library, and ClinicalTrials.gov, were reviewed using the key words Parkinson's disease, on-road driving, naturalistic driving, and their related entry words. On-road driving skills were mapped onto an existing theoretic model of operational, tactical, and strategic levels. The on-road and off-road cognitive, motor, and visual predictors of global on-road driving were summarized.
Twenty-seven studies were included. All but one study were prospective and Class II studies according to the American Academy of Neurology Classification Criteria. Participants were on average 68 years old and in the mild to moderate stages of PD. Drivers with PD were more likely to fail a driving assessment compared to age- and gender-matched controls. Compared with controls, drivers with PD experienced difficulties on all levels of driving skill. However, the compensation strategies on the strategic level showed that drivers with PD were aware of their diminished driving skills on the operational and strategic levels. Operational and tactical on-road driving skills best predicted global on-road driving. A combination of visual, cognitive, and motor deficits underlie impaired on-road driving performance in PD.
Driving rehabilitation strategies for individuals with PD should include training of operational and tactical driving skills or indirect comprehensive training program of visual, cognitive, and motor skills.
帕金森病（PD）患者在道路驾驶方面存在问题，这些问题可在驾驶康复项目中得到针对性解决。
通过识别关键的道路驾驶障碍及其相关的视觉、认知和运动缺陷，为帕金森病患者的驾驶康复提供一个框架。
我们对关于帕金森病患者道路驾驶和自然驾驶行为的文献进行了系统综述。使用关键词帕金森病、道路驾驶、自然驾驶及其相关词条对包括Pubmed、Medline、PsychINFO、ISI科学网、Cochrane图书馆和ClinicalTrials.gov在内的相关数据库进行了检索。将道路驾驶技能映射到一个现有的操作、战术和战略层面的理论模型上。总结了全球道路驾驶的道路和非道路认知、运动及视觉预测因素。
纳入了27项研究。根据美国神经病学学会分类标准，除一项研究外，所有研究均为前瞻性II类研究。参与者平均年龄为68岁，处于帕金森病的轻度至中度阶段。与年龄和性别匹配的对照组相比，帕金森病患者更有可能在驾驶评估中失败。与对照组相比，帕金森病患者在所有驾驶技能水平上都存在困难。然而，战略层面的补偿策略表明，帕金森病患者意识到他们在操作和战略层面的驾驶技能有所下降。操作和战术道路驾驶技能最能预测整体道路驾驶情况。视觉、认知和运动缺陷的综合作用导致帕金森病患者道路驾驶表现受损。
帕金森病患者的驾驶康复策略应包括操作和战术驾驶技能培训或视觉、认知和运动技能的间接综合培训项目。
