The University of Kansas Medical Center (KUMC) team discusses their 5-year research project, funded by the Mid-America Transportation Center (MATC) and the United States Department of Transportation (USDOT), to look at improving the cognitive and visual driving fitness of commercial drivers. Drivers are assessed using two tools: (1) participants fill out a self-assessment questionnaire, and (2) their driving log data is reviewed for near misses, speed violations, and accidents. Participants receive feedback that will assist them with identified concerns to help keep drivers safer, longer.

1. Assessing and Improving the
Cognitive and Visual Driving
Fitness of CDL Drivers

2. Team
Members
• PI: Dr. Shelley Bhattacharya, DO, MPH
• Co-PI: Dr. Abiodun Akinwuntan, PhD, MPH, MBA
• Co-I: Dr. Hannes Devos, PhD
• Research Coordinator: Iarina Devos, BA
• Research Assistant: Fernanda Ribas, M2
• Research Assistant: Rob Gibson, M1

3. Introduction
DR. SHELLEY BHATTACHARYA
PRESENTED BY <ORG NAME> AND <ORG NAME>

4. Study Introduction
• Driving is a highly dynamic task that requires intact cognitive and
visual skills to perform safely;
• Driving commercial vehicles that are loaded with hazardous
materials requires even more careful planning and consideration to
avoid unanticipated shifts in the center of gravity associated with
sharp turns while speeding (slushing) or liquid surge associated
with sharp braking. Such planning and consideration are highly
dependent on cognitive and visual skills for accuracy.

5. Study Introduction
• One of the cardinal missions of the Federal Motor Carrier Safety
Administration (FMCSA) of the United States Department of
Transportation is to improve safety on our nation's highways.
• That includes reducing the number of accidents that involve
commercial truck drivers, including hazardous and non-
hazardous material transportation.
• Such accidents have a high potential to cause serious harm to the
public and the environment.

6. Study Introduction
• We, at KUMed, are helping this mission by:
1) Determining the cognitive and visual fitness, and rehabilitating
pertinent components of drivers who drive commercial vehicles,
and thus improving driving fitness;
2) Developing a sensitive measure of cognitive and visual alertness
that can indicate cognitive overload capable of resulting in an
accident;
3) Designing an alert system that will notify all emergency medical
services within a specific radius of an accident of the nature of
the hazardous materials being hauled by the commercial vehicle
and the extent of damage.

7. Brief Literature Review
• There are approximately 1.7 million long-haul truck drivers in the
USA, either for hire or in private fleets. 1
• Truck driving is the second most common occupation in the USA
(following retail sales), employing 1 in 35 adult men. 2
• Commercial motor vehicle (CMV) drivers make up a substantial
proportion of the workforce, however, it is anticipated there will be
a shortage of drivers in the coming years in the USA. 2

8. How can we help CDL
drivers drive for
longer?

9. Study Purpose
1. Assess CDL drivers’ cognitive and visual fitness;
2. Identify the top 5 tests that correlate with on-the-road driving
safety for CDL drivers;
3. Evaluate the effect of an intervention program to improve
reduced visual, cognitive and driving skills to enable CDL drivers
to drive for longer.

10. Study Significance
• We anticipate that this study will be helpful in identifying CDL
drivers who have cognitive and/or visual impairments that may
make driving a commercial vehicle, including those carrying
hazardous materials, unsafe.
• A unique aspect of this part of the study is the possibility of
improving driving fitness by offering drivers with demonstrated
cognitive and visual deficits the opportunity to retrain and improve
such skills in a technologically advanced high fidelity simulator.
• By identifying the top testable predictors of on-the-road driving
safety of CDL drivers, medical providers who perform DOT annual
physicals will benefit on a national scale.

11. Study Significance
• This project also meets Mid-America Transportation Center
(MATC)’s research goal to make fundamental advancements in
basic and theoretical research related to improving the safety of
the US and Region VII transportation systems.
• A key focus is to ensure that the results from this study will be
implemented by medical providers taking care of CDL drivers and
regional and national transportation agencies.

12. Study Methods
PRESENTED BY <ORG NAME> AND <ORG NAME>

13. Procedure
• All assessments will take place on the same day.
• Assessments based on driving safety data:
• For all drivers and
• For drivers over 65. 3
• The total duration of the evaluation, including consent, takes 2 hours.
• Each subject completes 3 annual visits
• Sharing of each subject’s e-log data is encouraged
• Compensation: $50 per visit ($150 total)
• Each assessment completed by medical students on the team

14. Methods
• Goal: 85 subjects
• Demographic and Clinical Information
• Cognitive Assessment
• Visual Assessment
• Range of Motion & Gait Speed
• Simulation assessment
• Task Evoked Pupillary Response (TEPR)

15. Year 1
Cognitive,
Visual,
Mobility
(CVM)
tests
Pass
Year 2
annual CVM
tests
Year 3
annual CVM
tests
and
TEPR without
training
Year 4
Alert system
EMS
Intervention
Fail
Year 2
annual CVM
tests
and
TEPR with
training
Year 3
annual CVM
tests
and TEPR
without
training (if
there's
improvement
in the CVM
tests)
Year 4
Alert System for
TEPR
1. sensitive
enough?
2. Relay correct
info?
3. ? EMS
notification
EMS
Intervention
Year 3
annual CVM
tests and
TEPR with
training (if
there isn't any
improvement)
CVM=Cognitive/Visual/Mobility
TEPR=Task Evoked Pupillary

16. Cognitive Assessment
• Stroke Drivers Screening Assessment 4
• Useful Field of View
• The Montreal Cognitive Assessment
• Trail Making Tests A and B

19. “I would like you to put each road sign on the
picture of the road situation which it matches
best.”

20. Visual Assessment
• The Keystone vision screener will be used to assess visual acuity,
depth perception, visual field, glare recovery, color perception,
depth perception, and eye coordination (stereopsis).

21. MOCA: Test for Mild
Cognitive Impairment
http://www.mocatest.org

24. Motor Assessment
• Range of Motion
• Gait Speed

25. Driving Simulator
DR. ABIODUN AKINWUNTAN
PRESENTED BY <ORG NAME> AND <ORG NAME>

26. Simulator Assessment
• 20-30 minutes
• A drive in daily-life traffic while obeying the rules of the road
• Car following abilities under low and high cognitive demand
• Brake Response Time

27. Simulator Assessment
• Pupil recording; requires no extra time
• An eye tracker monitors the subject’s pupils
• The pupillary size gives an estimate of attention

28. Driving Simulator Test
• The subject’s brake response time, daily-life driving skills, and
attention will be assessed in a high-fidelity driving simulator.
• Protocol based on prior studies. 5
• After the subject is familiarized with the simulator, he/she will be
asked to drive several scenarios that will mimic daily-life driving,
car following, and brake responses.

29. Task Evoked Pupillary
Response (TEPR)
ABIODUN AKINWUNTAN
PRESENTED BY <ORG NAME> AND <ORG NAME>

30. Attentional Capacity Model
Healthy ND?

31. Pupillary Response
• Pupillary Response (PR) is a non-intrusive, neurophysiological
measure of cognitive workload (Kahneman 1973)
4 digit recall
5 digit recall
6 digit recall
*Obtained from Orlosky 2017

32. Recruitment
IARINA DEVOS
PRESENTED BY <ORG NAME> AND <ORG NAME>

33. Recruitment Materials
• Flyer
• Pamphlet
• Website
http://www.kumc.edu/landon-center-on-aging/research/truck-safety-
study.html

34. Recruitment Resources
• Recruitment began fall 2018
• Legal clearance had to be done during 2017-18
• Internal/ KUMC Database
• International and National Transportation Companies
• National and Local Supermarkets
• National and Local Truck Companies
• Truck Stops

35. • KS Highway Patrol
• KS Motor Carriers Association
• OOIDA: Owner Operator Independent Drivers
Association
• ATA: American Truckers Association
• KDOT
• WCA Town and Country Disposal
• Truck Carriers Association of America
• UPS
Contacted Companies/Associations
• Tyson Foods
• Teamsters 41
• Walmart
• Shatto Milk
• Quick Trip
• Casey’s
• Ferrell Gas
• Fedex
• Amazon

36. RedCap HERON Database
• Healthcare Enterprise Repository for Ontological Narration
• HERON is a search discovery tool that allows researchers to search de-
identified data from various hospital and medical center sources that
include but are not limited to Epic/O2 (the hospital electronic medical
record), IDX (the clinical billing system), KU Hospital Cancer Registry,
KU Biospecimen Repository, REDCap (selected projects), Social
Security Death Index, and University HealthSystem Consortium (Quality
Measure Data).
• HERON does not include any identifying information, such as a Medical
Record Number (MRN), name, address, or birth date. In an effort to
further de-identify the data, we shift dates to a random date within 365
days prior to the actual date. The same random time shift is applied to all
events for that patient.

37. RedCap HERON Database Recruitment
• Query: “truck driver”, “bus driver”
• List of 96 potential participants
• Called each, max 3x
• 11 participants were scheduled; 4 completed to date
• 4 more were interested, not scheduled yet
• 45 were not interested or didn’t qualify to be part of our study
• 22 couldn’t be reached
• Email sent to 14 potential participants

38. Collaborations
• Durham buses
• Price Chopper
• KU MedWest

39. KU MedWest Recruitment
• Conduct the majority of DOT physicals for 6 commercial companies
with CDL drivers
• Met with their Administrator, physician and lead clinic staff in April
2019
• Plan to integrate recruitment with their Electronic Medical Record
System

40. Visiting Truck Stops
• Love’s Travel Stop (close to Ottawa, KS)
• Flying J Travel Center (close to Emporia, KS)

41. Visiting Truck Stops
• Pilot Travel Center- Front Street
• On-the-Go Travel Center

42. Truck Stop Recruitment
• Gave donuts (under 50% took one!)
• Spoke to over 50 drivers
• 20 interested active CDL drivers

43. Conclusion
• This study should help in detecting testing parameters to predict
CDL on-the-road driving performance;
• Over 110 parameters will be tested on 85 subjects;
• Recruitment is improving and steady;
• We hope to help CDL drivers drive longer and safer with these
interventions!

44. References
1. Hege A, Perko M, Johnson A, Yu CH, Sönmez S, Apostolopoulos Y.
Surveying the Impact of Work Hours and Schedules on Commercial
Motor Vehicle Driver Sleep. Safety and Health at Work. 2015;6(2):104-
113.
2. Chen C, Xie Y. Modeling the safety impacts of driving hours and rest
breaks on truck drivers considering time-dependent covariates. Journal
of safety research. 2014;51(Supplement C):57-63.
3. Bhattacharya, S (2018). Assessing Well-Being in Older Drivers. Last
accessed: https://www.medscape.org/viewarticle/897520, July 6, 2018
4. Abiodun Emmanuel Akinwuntan, Diana Gantt, Gina Gibson, Kurt
Kimmons, Valerie Ross, Peter Newman Rosen & Jerry
Wachtel (2013) United States Version of the Stroke Driver Screening
Assessment: A Pilot Study, Topics in Stroke Rehabilitation, 20:1, 87-
92, DOI: 10.1310/tsr2001-87
5. Devos, H., Morgan, J., & Akinwuntan, A. E. The use of a driving
simulator to improve on-road driving performance and cognitive
functions in individuals with acquired brain injury: a pilot study. prepared
for submission.

45. THANK YOU!

46. QUESTIONS?