Active training and driving-specific feedback improve older drivers' visual search prior to lane changes

Lavallière et al. BMC Geriatrics 2012, 12:5 http://www.biomedcentral.com/1471-2318/12/5 RESEARCH ARTICLE Open Access Active training and driving-specific feedback improve older drivers’ visual search prior to lane changes Martin Lavallière1,3*, Martin Simoneau1,3, Mathieu Tremblay1, Denis Laurendeau2 and Normand Teasdale1,3 Abstract Background: Driving retraining classes may offer an opportunity to attenuate some effects of aging that may alter driving skills. Unfortunately, there is evidence that classroom programs (driving refresher courses) do not improve the driving performance of older drivers. The aim of the current study was to evaluate if simulator training sessions with video-based feedback can modify visual search behaviors of older drivers while changing lanes in urban driving. Methods: In order to evaluate the effectiveness of the video-based feedback training, 10 older drivers who received a driving refresher course and feedback about their driving performance were tested with an on-road standardized evaluation before and after participating to a simulator training program (Feedback group). Their results were compared to a Control group (12 older drivers) who received the same refresher course and insimulator active practice as the Feedback group without receiving driving-specific feedback. Results: After attending the training program, the Control group showed no increase in the frequency of the visual inspection of three regions of interests (rear view and left side mirrors, and blind spot). In contrast, for the Feedback group, combining active training and driving-specific feedbacks increased the frequency of blind spot inspection by 100% (32.3 to 64.9% of verification before changing lanes). Conclusions: These results suggest that simulator training combined with driving-specific feedbacks helped older drivers to improve their visual inspection strategies, and that in-simulator training transferred positively to on-road driving. In order to be effective, it is claimed that driving programs should include active practice sessions with driving-specific feedbacks. Simulators offer a unique environment for developing such programs adapted to older drivers’ needs. Background More than ever, road safety is a public health concern. One cause for this concern arises from changes in demographics. It is expected that the number of older drivers will increase substantially in the next decades. Specifically, it is estimated that this number will double within the next 25 years from 27 million to nearly 60 million in the United States [1]. With ageing, sensorimotor and cognitive changes are known to reduce driving performance [2]. A host of changes in the visual * Correspondence: 1 Division de kinésiologie, GRAME, Département de Médecine Sociale et Préventive, Faculté de Médecine, Université Laval, 2300 rue de la Terrasse, Québec, Québec, G1V 0A6, Canada Full list of author information is available at the end of the article system occurs with ageing [3]. Moreover, some authors suggest that older drivers reduce their visual search patterns which results in a perceptual narrowing (or tunnel effect) [4]. An in-vehicle study conducted by Bao and Boyle [5] showed that compared to younger drivers (1825 and 35-55 years old), the road scanning of older drivers (65-80 years old) at intersections were primarily confined to areas located directly in front of or slightly to the right or left of the vehicle’s direction of motion. Similarly, Romoser and Fisher [6] examined if older drivers made a secondary look as often as younger drivers at the onset of the turn at an intersection. Their results revealed that, while turning, older drivers took less often that second look than younger drivers for potential hazards (6.9% vs. 22.2%, respectively). © 2012 Lavallière et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Lavallière et al. BMC Geriatrics 2012, 12:5 http://www.biomedcentral.com/1471-2318/12/5 Other studies have assessed visual search strategies while changing lanes but did not consider the age effect [7-9]. For instance, Kiefer and Hankey [10] evaluated two groups of drivers (40-50 and 60-70 years old). They reported visual inspections towards the blind spot for only 32 and 15% for the left and right lane changes, respectively. Unfortunately, no specific mention of blind spot inspection made by their older drivers is mentioned. Therefore, there is little information on how older drivers verify blind spot while changing lanes even though it is mentioned that it is a problematic and recurrent issue with older drivers during on-road evaluation [11,12]. In a simulator experiment, Lavallière et al. [13] showed that older drivers inspected their blind spot less frequently than younger drivers while changing lanes (41% vs. 86%, respectively). An important question that remains is whether or not older drivers will show similar frequency of visual inspections towards the blind spot on the road and if training could help improving older drivers’ visual search strategies in such situations. Several retraining programs adapted to older drivers have been developed and are now proposed to this category of drivers. These programs are mostly classroom oriented (refresher program) and aim at promoting safe driving as well as increasing older drivers’ confidence behind the wheel through a curriculum emphasizing awareness of traffic hazards, insisting on the need for anticipating the actions of other drivers and providing a general overview of traffic regulations. There are suggestions, however, that these refresher programs do not reduce crash occurrences [14] and do not modify older drivers behaviors. In a cohort of 884 older drivers (55 to 94 years old) who attended a classroom program, Nasvadi and Vavrik [15] found no significant decrease in crash rates in any age group. This might not come as a surprise because motor learning occurs as a direct result of active practice and concrete feedback on the motor performance. As suggested by many authors, physical practice is the preferred form of practice for optimizing learning [16]. Accordingly, several aspects of driving may not be optimized in conventional classroom oriented programs as learning general driving information does not result in sufficient modification to sensorimotor driving strategies. If inadequate visual search precedes a driving error, corrective feedback for this specific action and practice are needed if a decrease of such errors is to be achieved. The development of an effective and specific error-detection process likely translates into sensorimotor strategies related to driving. This key concept is often defined as transfer-appropriate practice [17]. I (...truncated)