Multiple sclerosis (MS) is a demyelinating disease that can result in numerous sequelae. Although spasticity and cognitive dysfunction are common in MS, few studies have examined the impact of both factors on driving abilities in persons with physical impairments. The present study assessed driving performance in control participants and MS patients with documented spasticity using two brief simulations designed to measure lane tracking (under high cognitive load) and car following behavior. Seventeen MS patients and 9 controls participated in the study. The MS cohort exhibited a broad range of cognitive functioning (normal to significant impairment) and disability (Expanded Disability Status Scale scores of 3.0 to 7.5). Eight ofthe MS patients had significant spasticity in their right knee based uponthe Modified Ashworth Spasticity Scale. MS patients had greater difficulty than controls on the simulations, particularly on the car following task. MS participants also tended to drive at higher speeds than the control participants. Within the MS cohort, cognitive dysfunction was most stronglyassociated with lane tracking decrements, whereas the possible relationship between cognitive function and car following behavior was eclipsed by lower limb spasticity. Spastic individuals had greater difficulty mirroringspeed changes in the lead car, and were approximately one second slower in responding to its accelerations and decelerations. The current simulations provide important data regarding the impact various MS sequelae may have on driving performance, and may ultimately lead to clinical recommendations regarding specific driving behaviors and their associated risks.
Abstract