|Year : 2019 | Volume
| Issue : 3 | Page : 90-95
Comparison of efficacy of the Test of Visual Perceptual Skills-3 and the Rivermead Perceptual Assessment Battery with Performance of Indian drivers on driving simulator for determining off-road perceptual skills: A pilot study
Sheetal Shyamsunder Gupta, Anita Dipak Gupta, Sushmita Dinesh Ahirwal
Department of Occupational Therapy, All India Institute of Physical Medicine and Rehabilitation, Mumbai, Maharashtra, India
|Date of Submission||25-May-2019|
|Date of Acceptance||19-Aug-2019|
|Date of Web Publication||20-Sep-2019|
Dr. Sheetal Shyamsunder Gupta
All India Institute of Physical Medicine and Rehabilitation, Haji Ali, Mahalakshmi, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Driving simulator (DS) is frequently used in traffic research in order to study various traffic scenarios with related traffic phenomena. This current pilot study assesses off-road driving skills of Indian drivers using driving simulator and perceptual test batteries such as the Test of Visual Perceptual Skills-3 (TVPS-3) and the Rivermead Perceptual Assessment Battery (RPAB). Objectives: The objective of this study is to determine the off-road skills of Indian drivers using DS and comparing their performance on visual perceptual test batteries (TVPS-3 and RPAB). Study Design: An observational cross-sectional study design was chosen for the research. Methods: A sample size of 30 participants, based on convenient sampling method, who met the following inclusion criteria were included: participants with driving experience of ≥1 year, age range: 20–60 years, and no obvious visual and/or physical impairment or other such comorbidities. Participants underwent evaluation in two phases. Phase 1 included screening of participants for inclusion criteria and assessment of screened participants on DS. Driving Simulator: Participants were tested on “city driving test” for 10 min. In Phase 2, after completing assessment on driving simulator, participants were randomly assigned to either of the perceptual tests. By perceptual tests, participants' perceptual abilities were assessed either using RPAB or TVPS-3. Results: The RPAB group had 12 males and 3 females, whereas the TVPS-3 group had 11 males and 4 females. The mean age for the RPAB group was 40.33 ± 11.33 and for the TVPS-3 group was 40 ± 11.06. Pearson's correlation to compare the visual perceptual tests and performance on DS was found to be statistically significant (RPAB group: r = 0.80, P = 0.00, 95% confidence interval [CI]: 0.50–0.92 and TVPS-3 group: r = 0.82,P = 0.00, 95% CI: 0.56–0.93). The performance of Indian drivers on perceptual tests and driving simulator is highly correlated. Conclusion: There is a strong positive correlation between off-road driving skills (DS) with visual perceptual skills (tested on TVPS-3 and RPAB).
Keywords: Driving Simulator, Off-Road Driving Skills, Perceptual Abilities
|How to cite this article:|
Gupta SS, Gupta AD, Ahirwal SD. Comparison of efficacy of the Test of Visual Perceptual Skills-3 and the Rivermead Perceptual Assessment Battery with Performance of Indian drivers on driving simulator for determining off-road perceptual skills: A pilot study. Indian J Occup Ther 2019;51:90-5
|How to cite this URL:|
Gupta SS, Gupta AD, Ahirwal SD. Comparison of efficacy of the Test of Visual Perceptual Skills-3 and the Rivermead Perceptual Assessment Battery with Performance of Indian drivers on driving simulator for determining off-road perceptual skills: A pilot study. Indian J Occup Ther [serial online] 2019 [cited 2019 Dec 10];51:90-5. Available from: http://www.ijotonweb.org/text.asp?2019/51/3/90/267477
| Introduction|| |
Driving is an instrumental activity of daily living that plays an important role in modern society. An occupational therapist is skilled at evaluating a person's ability and potential to drive and providing comprehensive resources and training if driving. It has been estimated that 90% of the information input to the driver is visual, and therefore, the efficiency of a person's visual perceptual skills is likely to influence his competence on the road. The need to enhance driving safety has resulted in the development of off-road assessment for driver's fitness. The promise as an assessment tool has rested on the assumption that simulators approximate actual behind-the-wheel driving in their appearance as well as in their requirements for handling and operating.,
Among the available test, the Test of Visual Perceptual Skills-3 (TVPS-3) and the Rivermead Perceptual Assessment Battery (RPAB) were selected. TVPS-3 classifies perceptual skills as the test progresses and makes it easy for the therapist to define the area of perceptual dysfunction. Similarly, RPAB was selected for study for testing perceptual skills as it included three-dimensional (3D) components, and the performance on the item was timebound. The test components are based on block design arrangement putting emphasis on spatial analysis and position in space which are essential components of driving. This pilot study explores the relationship of perceptual and operational variables that form the basis for off-road evaluations of Indian drivers using driving simulator and perceptual tests.
The aim of the study was to analyze the performance on driving simulator (DS) and compare it with off-road visual perceptual skills in Indian drivers. The objectives of the study were to test the driving skills of Indian drivers using driving simulator and to compare these driving skills with performance on RPAB and on TVPS-3.
| Methods|| |
An observational cross-sectional pilot study was conducted at a rehabilitation center on Indian drivers. The study was conducted from August 2018 to October 2018 for a period of 3 months. Convenient sampling method was used to derive the sample size for the research.
The inclusion criteria for collecting the sample were participants:
- Having experience of driving four-wheeler for ≥1 year
- With age between 20 and 60 years
- Who had no obvious visual or physical impairment.
The participants were excluded if they:
- Expressed difficulty in reporting more than once for assessment
- Were unable to perform paper–pencil tasks.
After selecting the participants, written informed consent was taken from them in the best language understood by them before their testing started. The research was conducted adhering to the principles of the “Declaration of Helsinki” guidelines.
Data collection included demographics of each participant and their driving experience in years and the need for driving (frequency). Thereafter, the participants underwent evaluation in two phases.
- Phase 1: Participants were asked to perform on DS: “city driving test.” This test was administered for 10 min
- Phase 2: Participants were randomly assigned to the RPAB group (n = 15) and the TVPS-3 group (n = 15) using a true random number generator using www.random.org website.
The collected data were divided into two groups: RPAB group: RPAB and DS of 15 participants and TVPS-3 group: TVPS-3 and DS 15 participants [Table 1]. The total time taken by the participants to perform the tests in both the groups was approximately 90 min.
It is an equipment which has a driving dashboard which is interfaced with the computer, essentially used for assessment and training of driving skills, as shown in [Figure 1]. The dashboard replicates all the components existing in a four-wheeler (car), and the computer by virtue of its software produces real-life scenarios and generates scoring system based on an individual's performance. Driving modules are specially designed for novice drivers with a focus on car basics, traffic rules, and road signs. Experienced drivers can test and sharpen their driving skills in advance driving module which includes driving in extreme weather and road conditions. Emergency object intrusion allows a driver to test their reaction time and level of alertness while driving.
|Figure 1: Photograph of Participant Performing Driving on Driving Simulator|
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In our study, we have selected driving skills assessment in city area for 10 min. In city driving, the skills of drivers are scored in five components, i.e., high-risk collision, driver's compliance for signal lights, driver's divided attention, driver's compliance for major road signs, and driver's compliance for minor road signs. Error details were car collision, number of traffic lights jumped, no indicator while turning/lane changing, overspeeding, and honking in no honking zone. A number of errors were recorded by software during the performance. For one error, two points were deducted, and the total score was calculated out of 100, denoting that higher the score better the performance.
Rivermead Perceptual Assessment Battery
RPAB is a standardized instrument used to assess visual perceptual function in adults following brain damage. It consists of 16 subtests. These subtests are grouped into eight categories:
- Form constancy (picture matching, object matching, and size recognition)
- Color constancy (color matching)
- Sequencing (series and sequencing pictures)
- Object completion (animal halves and missing article)
- Figure-ground discrimination (figure-ground discrimination)
- Body image (body image and self-identification)
- Inattention (right and left (R/L) copying shapes, R/L copying words, and cancellation)
- Spatial awareness (three-dimensional (3D) copying and cube copying).
All the test items are scored according to the maximum number of tasks completed correctly within 3 or 5 min, depending on a particular subtest. Normative data are available for age 16–69 years. The inter-rater reliability ranges from 0.72 to 1.00, with only three subtests scoring <0.90. The test–retest reliability ranges from 0.27 to 1.00, with only four subtests scoring <0.75.
Test of Visual Perceptual Skills-3
TVPS-3 is the latest version of the family of visual perceptual test initially authored by Dr. Morrison F. Gardener. The TVPS-3 is used primarily with children, but the established norms for 18-year-olds can be used to evaluate adults according to its manual. The TVPS-3 utilizes 112 black and white designs. It has seven subtests as follows:
- Visual discrimination
- Visual memory
- Spatial relationships
- Form constancy
- Sequential memory
- Visual figure-ground
- Visual closure.
The items are presented in a multiple-choice format, and responses can be made vocally or by pointing to the answer choice. The internal consistency of TVPS-3 is 0.96, subscale scores range from 0.76 to 0.88. Also, test-retest reliability is 0.97 for the total test score, and subscale correlation scores range from 0.34 to 0.81.
Data were analyzed using NCSS is a statistics package produced and distributed by NCSS, LLC. Created in 1981 by Jerry L. Hintze, NCSS. 12th version is the current version, used for our study for data analysis. A total of 33 participants were included, of which three participants left without completing the test (dropout rate: 9.09%). The final analysis of thirty participants was done using the Shapiro–Wilk normality test, and data were found to be distributed normally. Basic descriptive and bivariate statistics (i.e., Pearson's r correlations) were used to examine the patterns of relationships between study variables; alpha was set at 0.05. Subgroup analysis of demographics was also done.
| Results|| |
Background Characteristics of the Sample
As shown in [Table 1], the majority of participants were males (23, 77%) as against females (7, 23%). The driving experience of participants ranged from 1 to 35 years. Of thirty participants, twenty were drivers who drove regularly to commute to their workplace and were defined as daily short drivers (daily short), six were professional drivers who drove regularly to earn their livings and were defined as daily long drivers (daily long), and the remaining four drivers drove occasionally during weekends. Hence “daily long” meant driving on road for >8 h and “daily short” meant driving for <2 h. Thirty participants were then divided into two groups (15 in each group):
- RPAB group: 12 males and 3 females (mean age = 40.33, standard deviation (SD) = ±11.81)
- TVPS-3 group: 11 males and 4 females (mean age = 40, SD = ±11.06).
Components of Driving Simulator in Both Groups
As shown in [Table 2] and [Table 3], the mean score of the components off-driving skills on DS varies for both the groups. The scores of errors are being highlighted in the table, which means that a higher score would mean poor performance. The mean score for high-risk collision ranges between 2.06 and 2.33 for both the groups. Furthermore, the mean scores for driver compliance for signal lights, driver divided attention, driver compliance for major road signs, and driver compliance for minor road signs are ranging in between 2 and 2.33, 5.8 and 6.6, 1.26, and 1.33 and 1.66, respectively, for the RPAB and TVPS-3 groups. The participants have scored high for driver divided attention.
|Table 2: Comparison of Scores of Driving Simulator and Rivermead Perceptual Assessment Battery and Their Correlation|
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|Table 3: Comparison of Scores of Driving Simulator and Test of Visual Perceptual Skills-3 and Their Correlation|
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Rivermead Perceptual Assessment Battery Group: Rivermead Perceptual Assessment Battery and Its Correlation with Driving Simulator
As shown in [Table 2], there is a mean score of components of RPAB; the score of four components ranges between 0 and 4 (form constancy, sequencing, object completion, and figure-ground discrimination); and body image, inattention, and spatial awareness scores were ranging from 0 to 12, 0 to 72, and 0 to 60, respectively. There is a wider range of performance among the participants for inattention component of RPAB. Pearson's correlation coefficient was found to be significant, with a value of 0.80, P = 0.00, 95% confidence interval (CI): 0.50–0.92, which is highly significant. [Figure 2]a shows the linear relationship between RPAB and DS.
|Figure 2: (a) Scatter Diagram of Rivermead Perceptual Assessment Battery versus Driving Simulator (DS). (b) Scatter Diagram of Test of Visual Perceptual Skills-3 versus Driving Simulator (DS)|
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Test of Visual Perceptual Skills-3 Group: Test of Visual Perceptual Skills-3 and Its Correlation with Driving Simulator
As shown in [Table 3], there is a mean score of components of TVPS-3; the score for all the components of TVPS-3 ranges between 0 and 16. The participants have obtained the highest score for visual discrimination (12.26 ± 1.83) and lowest for spatial relationship (7.33 ± 1.83). Pearson's correlation coefficient is found to be significant, with a value of 0.82, P = 0.00, 95% CI: 0.56–0.93. [Figure 2]b shows the linear relationship between TVPS-3 and DS.
| Discussion|| |
In the present work, we used visual perceptual scales and city driving area of driving simulator to determine whether the off-road perceptual abilities of Indian drivers are related with each other, and we found that visual perceptual ability is highly correlated with the performance on driving simulator [Table 2]. The driver's skill performance test was conducted by means of a driving simulator, the immediate problem observed was, that subjects had to become familiar with the simulator technology before the test began. Younger drivers were found to get accustomed easily to this kind of technology, while this was not the case with older drivers. This finding is supported by Susilowati and Yasukouchi in the study – the authors had found that young drivers only needed 10 min to practice while older drivers needed more than 1 h to get accustomed to the technology before taking the test. Nevertheless, the final results showed that almost all scores were significantly higher for young drivers as compared to older drivers.
Concerning data of [Table 1] which included demographics, perceptual abilities, and driving frequency variables, several associations with driving are worth considering. A study effect of practice on standardized learning outcomes in simulation-based medical education by William C McGaghie in 2006 found that there is a strong association (η2 = 0.46) between hours of practice on high-fidelity medical simulators and standardized learning outcomes. This association approximates a dose–response relationship. Of the total population, 20% of the participants were drivers, who drove for around 10 h/day which was associated with better performance on driving simulator. This is supported by Charles B. A. Musselwhite 2010 in the article, “Exploring older drivers” perceptions of driving. In addition, the rest of the participants (66.67%) used to drive as a mode of transportation from house to workplace. Remaining 13.33% drove occasionally, only when needed to go for vacations during weekends or for leisure. The skills of these drivers varied depending on the duration of driving. The participants who drove occasionally and had experience of <5 years did not perform well as compared to others in the study.
In this study, it was found that the occasional drivers who were around 50 years of age, while performing on the simulator, had difficulty maintaining the direction and following traffic signal rules due to delay in response at the particular situation. However, few drivers who were professional drivers have performed better. This can be because they have adapted their behavior to the external environment in a process which is often facilitated by learning. Megías et al. 2018 found that driving-related skills are developed step by step with the increase of mileage driven and the accumulation of practice in different traffic situations.
Further, we found the correlation between both perceptual tests and driving simulator. The correlation between TVPS-3 and DS was high as compared to RPAB and DS. However, this difference is negligible. Probably, if the study is conducted on a larger population, we will get a clearer picture. The findings from this study and a study by Reger 2004 make it clear that deficits in multiple aspects of perceptual abilities can contribute to unsafe driving. While analyzing the TVPS-3 components, it was found that the performance deteriorated toward the end of the test when the complexity increased. We found that the performance of participants of RPAB was lower in inattention and spatial awareness components, and their performance on driving simulator for driver divided attention was low, which is supported by the findings of Rizzo et al. who have found that weaknesses in certain cognitive abilities, including visuomotor abilities, executive functions, and memory, were particularly associated with poorer driving and increased the risk of crashing.
We used both the performance-based and norm-based scales in a single framework. While performing TVPS-3, it was found that some of the participants who became fatigued toward the end preferred to guess without analyzing the designs. This guesswork may not necessarily represent their performance, unlike RPAB which is based on performance, and participants get a score only on completion of a certain task/item.
In RPAB, the inattention component included R/L copying shapes, R/L copying words, and cancellation. Participants have scored less in these components, as they are paper–pencil tasks and involved the use of different dimensions, strokes, and words to copy in two-dimensional (2D) format. Furthermore, the cancellation components required scanning and cancellation of particular alphabet “E” in the entire sheet. This lower score in these components seems to be reflecting on participant's performance in driver divided attention of DS. The spatial awareness component, a component of RPAB, had 3D copying and cube copying, wherein the participants had to build 3D design using 3D blocks. The 3D component is a better indicator of spatial awareness which is supported by Tory et al., indicating that 3D displays can be very effective for approximate navigation and relative positioning when appropriate cues, such as shadows, are present. The participants who scored less on RPAB had high-risk collision and difficulty in the following road signs and signal on driving simulator.
While conduction of the test, we found that TVPS-3 is a 2D test where the participants had to choose the correct answer from the available options, whereas in RPAB, the tests were performance-based (2D and 3D) and there was no scope for ready options. All tests were scored after the participant had performed a particular test. Furthermore, RPAB components of inattention involved copying the illustration on paper, and spatial awareness component was a constructional task. Both required cognitive skills, like problem-solving which seems to be missing in TVPS-3 test. A Comparative Review of Visual Perception Assessment Tools for Adults with Brain Injury study done by Wohlfert et al. in 2018 reviewed Developmental Test of Visual Perception- Adolescent and Adult, Motor Free Visual Perceptual Test-3, and TVPS-3, and they suggested that the assessments in each study were found to be significantly correlating to each other, signifying that the three assessments in each study are interchangeable in practice. The DTVP-A, MVPT-3, and TVPS-3 are all similar in administration, cost, and time but do not use functional components when assessing visual perception and instead use abstract flipbooks. The study also compared dynamic loewenstein occupational therapy cognitive assessment (DLOTCA) and RPAB and found that DLOTCA is a long assessment with 26 subtests that focus heavily on cognition. The RPAB is not cost-effective and takes up to 60 min to administer.,, In this study, we found TVPS-3 convenient to administer due to less time taken for administration.
This study was conducted on a small sample size based on a convenient sampling method. The study was restricted to the population available in the institute. All the participants did not undergo a baseline cognitive assessment.
Since this study compares the scores without discriminating the subcomponents, it is necessary to study the impact of each visual perceptual skills on each component of driving skills. A similar study can be done on different population and can be compared with clinical conditions.
| Conclusion|| |
Driving simulator seems to be a comprehensive, practical, and stable assessment tool for assessing driving skills in Indian drivers. Driving skills performed on DS are compatible with perceptual skills measured on standard perceptual test batteries such as TVPS-3 and RPAB.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]