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Updated: Nov 14, 2025

Driving Simulation in the Clinic: Testing Visual Exploratory Behavior in Daily Life Activities in Patients with Visual Field Defects
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Driving errors that predict simulated rear-end collisions in drivers with multiple sclerosis.

Sarah Krasniuk1, Sherrilene Classen2, Sarah A Morrow3

  • 1Health and Rehabilitation Sciences, University of Western Ontario, London, Ontario, Canada.

Traffic Injury Prevention
|March 10, 2021
PubMed
Summary

Drivers with Multiple Sclerosis (MS) showed increased crash risk due to impaired adjustment to stimuli, specifically shorter time to collision and faster mean speed. Driving simulator assessments can identify these deficits to aid in evaluating driving performance and visual-cognitive abilities in MS patients.

Keywords:
Multiple sclerosiscomputer simulationcrashdriver behaviorscreening

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Area of Science:

  • Neurology
  • Human Factors
  • Transportation Safety

Background:

  • Drivers with Multiple Sclerosis (MS) may face elevated crash risks.
  • Specific driving performance deficits contributing to these crashes remain incompletely understood.
  • Adjustment to stimuli errors are linked to failing on-road driving assessments.

Purpose of the Study:

  • To investigate if adjustment to stimuli errors in a driving simulator can predict collisions in drivers with MS.
  • To compare driving performance between individuals with MS and controls.

Main Methods:

  • A quasi-experimental design involving 38 participants with MS and 21 controls.
  • Participants completed visual-cognitive and driving simulator assessments.
  • Adjustment to stimuli was quantified by reaction time, time to collision, mean speed, and rear-end collision occurrence.

Main Results:

  • Drivers with MS exhibited a shorter time to collision (OR=.04) and faster mean speed (OR=1.32), increasing rear-end collision odds.
  • Time to collision and mean speed effectively differentiated between colliding and non-colliding participants in both groups (AUCs ranging from .76 to .94).
  • For MS drivers, a time to collision <1.81 seconds and mean speed >7.83 m/s predicted collisions with high accuracy.

Conclusions:

  • Adjustment to stimuli errors, measured by time to collision and mean speed in a driving simulator, accurately predict rear-end collisions in drivers with MS.
  • Driving simulator assessments focusing on adjustment to stimuli can help identify visual-cognitive deficits and inform driving performance evaluations for individuals with MS.