[Relevance of a driving simulator in the assessment of handicapped individuals].
OBJECTIVE
To evaluate the value of our driving simulator in deciding whether or not to allow patients with physical and/or cognitive deficits to resuming driving and to analyze whether or not the medical expert's final decision is based more on the results of the driving simulator than those of the neuropsychological examination.


METHODS
One hundred and twenty-three patients were evaluated with the driving simulator. Thirty-five of those with cognitive deficits also underwent a neuropsychological examination prior to the medical expert's decision on driving aptitude. In cases of uncertainty or disagreement, a driving assessment in real conditions was performed by a driving instructor.


RESULTS
In cases of physical handicap, the medical expert's decision concurred with that of the occupational therapist. For brain-injured patients, there was a significant correlation between the neuropsychologist's opinion and that of the occupational therapist (kappa=0.33; P=0.01). However, the sensibility and specificity were only 55 and 80%, respectively. The correlation between an occupational therapy decision based on the driving simulator and that of the medical expert was very significant (kappa=0.81; P<0.0001) and the sensibility and specificity were 84 and 100%, respectively. In contrast, these values were lower (63 and 71%, respectively) for the correlation between the neuropsychologist's opinion and that of the medical expert.


CONCLUSIONS
Our driving simulator enables the danger-free evaluation of driving aptitude. The results mirror an in situ assessment and are more sensitive than neuropsychological examination. In fact, the neuropsychologist's opinion often is more negative or uncertain with respect to the patient's real driving aptitude. When taking a decision on a patient's driving aptitude, the medical expert is more inclined to trust the results of the driving simulator.
Service de réadaptation neurologique, clinique romande de réadaptation (Suvacare), avenue Grand-Champsec, 1950 Sion, Suisse.
A
A
Carroz
P-A
PA
Comte
D
D
Nicolo
O
O
Dériaz
P
P
Vuadens
D000293:Adolescent; D000328:Adult; D000368:Aged; D001333:Automobile Driver Examination; D001334:Automobile Driving; D003198:Computer Simulation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D066298:In Vitro Techniques; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D009788:Occupational Therapy; D012680:Sensitivity and Specificity