Naturalistic Driving Study: Technical Coordination and Quality Control (2014)

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90 A p p e n d i x A SHRp 2 driver Assessment protocol Required Materials: • Paper with participant-specific barcode • CD or DVD (or same-sized object) • Pen, pencil, and fine point sharpie for Clock Drawing test • Clock Drawing Test • Username and Log-On for participant portal • Site Specific Log ins • Computer login: username and password specific to each user • MCS login and password NOTE: Research staff conducting the assessment tasks, must have successfully completed the Assessment Training Module and be familiar with the corresponding procedures for using the Jamar Hand Dynamometer, the Optec 6500. Text in italics should be read aloud by the experimenter. It is recommended that experimenters closely follow these scripts. If text is in italics and underlined, it should be read verbatim. Check Box Item Clock Drawing Test paper w/ participant ID bar code Provided Assessment Computer with Conner’s Continuous Performance Test (CPT II) and Driving Health Inventory software Optec 6500P Vision Test Apparatus Jamar Grip Strength Test Apparatus Computer with Internet connection to access questionnaires 1. Greet Participant: Thank you for coming here today. My name is [experimenter name] and I am a [job title] at [location]. I will be admin- istering a set of driver assessments which will include some tests and questionnaires on a computer, some on paper, and some physical tests including some vision tests, a hand grip test, and a walking test. These assessments may take anywhere between 1–3 hours, and some may be completed at home at your discretion. I will be offering breaks between certain tests; however, if you need to take a break or use the restroom at any other time just let me know. 2. Clock Drawing Test • Provide participant with the Clock Drawing Test form. • Provide participant with a fine point Sharpie. Assessment Protocols

91 Please draw the face of a clock using the circle provided and put in the numbers so that it looks like a clock. Then, add hands to the clock so that it indicates the time “ten minutes after eleven.” <participant draws clock; indicates s/he is finished> Thanks, you’re all done with this task. • If necessary, experimenter may repeat the instructions up to 2 times (for a total maximum of 3). • If participant asks to hear instructions a 4th time, experimenter response should be, “Just do the best you can.” • Set clock drawing sheet aside for now. 3. Conners’ Continuous Performance Test II (CPT II) Now I’d like you to perform a standard computerized test—remember, no particular computer skill or knowledge is required. The computer program displays letters of the alphabet on the screen and responses are to be made depending on the letter that appears. The entire test takes about 15 minutes. • Open the CPT II program (X-shaped icon) located on the computer desktop and click past the pop up windows. • Log in using the site-specific logins. • Click on “select client” at the top of screen. • Choose to search by “File ID.” • Place the cursor in the search field and scan the participant’s bar code by holding the button down on top of the scanner and sliding the paper with the barcode under the laser. • Click “Find now” to execute search. • Single click the appropriate participant from the search return box below. • Click the select button • After selecting your client, select “New Administration” at the top of the screen. • Read instructions on the screen to participant and allow participant to practice until participant is comfortable with the process. • Click “okay” after verifying participant ID in the pop-up box. Do not fill in any of the other information in the pop up box. I want you to be able to fully concentrate on this test, so while it is running, I will not be talking with you. Now let’s start the full program. • Click on the prompts to get to the full program instructions. • Read instructions for full program written on the screen. • Sit quietly out of the way so that you are out of the participant’s field of view. • If participant asks questions after the program starts, please respond quickly and shortly with: I can answer that after you are finished, please continue. • If participant gets distracted, you can verbally prompt him/her one, and only one, time during the test to continue, with Please be sure to press the space bar when you see any letter other than X • Note that no instructions or redirection should take place if a participant simply commits errors. • If participant wants to stop, simply sit back and allow program to continue on its own without input. • When CPT II is finished, a screen prompting a password will pop up • Use site specific username/password to proceed. • The participant should still be selected, if not, search for the participant and select them. • The status of their assessment will indicate complete, and the row will be highlighted

92 • Click “Score” at the top of the screen • The administrations details box will appear • Click “okay” after verifying the participant’s DOB and gender in the pop up box. • The assessment will indicate “scored” and the results column is no longer blank.

93 • In the Reports (left side) menu, click the “Profile” icon to generate the report • The report will appear in a separate window. In the report window’s menu bar, select File- Export- Portable Document Format (PDF)

94 • Select a location to save the file, and barcode the ParticpantID into the Filename field, click “Save” • Attach the saved (.pdf) document on the Participant’s Detail Page in Mission Control (MCS). • When the report has been attached in MCS, DELETE the file from its location on the PC.

95 • Close CPT II program. Thank you, this portion of the assessment is now finished. 4. <5 MINUTE BREAK> • Show participant the restroom if needed, or escort outside if participant would like to go outside for a few minutes. 5. Set Up the Optec 6500 and the Optec Scoring Sheet Survey Now I’d like to give you some vision assessments. It’ll just take a moment while I set up the equipment. • Turn on machine • Remove forehead strip • Navigate tomcs.shrp2nds.us • Enter your login/password • Click on “participants” on the left side of the screen • Scroll down and select the appropriate participant number from the list at the bottom of the screen. • Select the “test Optec Scoring Sheet” from the list of tests on the right side of the screen • Click on “next” • Angle the computer monitor away from the participant so they cannot see the answers prior to completing a test.

96 This device will be used to test your vision. Please lean forward and adjust the machine to your height. • Help participant adjust OPTEC by pressing the button on the right hand side and allowing the participant to move the machine to the correct height. • Vision Correction During Vision Tests: 4 Note that participants should wear vision correction that they typically would wear when driving while performing tests. 4 Since drivers don’t typically wear reading glasses while driving, participants should not wear them while performing any of the tests. 4 If the participant indicates that s/he wears specific glasses for night driving, s/he should wear them for the night con- dition vision tests. 4 Participants should not wear sunglasses for any of the vision tests. 6. Test Far Visual Acuity • Set up OPTEC 4 Right eye on 4 Left eye on 4 Far switch 4 Day lighting 4 Glare off 4 Dial 2 This first test measures your “Far” visual acuity—how well you see things far away. I will test both of your eyes together. Lean forward and look into the viewfinder. What is the lowest line you can read? Please read the letters on that line to me • Note that if the participant has progressive lenses, s/he may need to readjust to clearly see the slides on the Optec. • Refer to the online OPTEC scoring sheet for the correct responses. • Participant chooses initial line to read: 4 If fewer than 3 errors on initial line b Continue to read smaller lines until 3 or more errors on a single line b Record last line read with fewer than 3 errors on that line 4 If 3 or more errors on initial line b Read previous line(s) until fewer than 3 errors on a single line b Record last line read with fewer than 3 errors • Final score is the acuity level of the last line read with fewer than 3 errors • Enter the final score on the OPTEC scoring sheet 7. Test Near Visual Acuity • Set up OPTEC 4 Right eye on 4 Left eye on 4 Near switch 4 Day lighting 4 Glare off 4 Dial 4 -Near (you should not need to turn the dial, it should be at the correct setting from previous test) Now I will test your “Near” visual acuity—how well you can see things that are close. I will test both of your eyes together. Please lean forward and look into the viewfinder. What is the lowest line you can read? Please read the letters on that line. • Note that participants should not be wearing reading glasses for this test. • Refer to the online OPTEC scoring sheet for the correct responses

97 • Participant chooses initial line to read: 4 If fewer than 3 errors on initial line b Continue to read smaller lines until 3 or more errors on a single line b Record last line read with fewer than 3 errors on that line 4 If 3 or more errors on initial line b Read previous line(s) until fewer than 3 errors on a single line b Record last line read with fewer than 3 errors • Final score is the acuity level of the last line read with fewer than 3 errors • Enter the final score on the OPTEC scoring sheet 8. Test Contrast Sensitivity—Night Testing. No Glare. Right Eye. These contrast sensitivity assessments will test your ability to differentiate an object from the background. • Set Up OPTEC 4 Right eye on 4 Left eye off 4 Far switch 4 Night lighting 4 Glare off 4 Dial 5 • If participant indicates that s/he uses special glasses for night driving, s/he should wear them for this test. • Show participant sample patch and indicate examples of left, right, and up. • Instruct participant to lean into the OPTEC again. Please look at ROW A, starting with the first circle, state which way the top of the lines point, until you get to a circle that you cannot see lines in. • Refer to the online OPTEC scoring sheet for the correct responses • Mark the last correct response on the online OPTEC scoring form. • Repeat procedure for dials 6–9. All tests set on FAR for RIGHT eye, Night Testing Setting Frequency Dial 5 Row A 1.5 Dial 6 Row B 3 Dial 7 Row C 6 Dial 8 Row D 12 Dial 9 Row E 18 9. Test Contrast Sensitivity—Night Testing. No Glare. Left Eye • Set Up OPTEC 4 Right eye off 4 Left eye on 4 Far switch 4 Night lighting 4 Glare off 4 Dial 5

98 • If participant uses special glasses for night driving, s/he should wear them for this test. • Repeat above procedure in #8 for left eye. All tests set on FAR for LEFT eye, Night Testing Setting Frequency Dial 5 Row A 1.5 Dial 6 Row B 3 Dial 7 Row C 6 Dial 8 Row D 12 Dial 9 Row E 18 10. Test Stereo Depth Perception • Set up OPTEC 4 Right eye on 4 Left eye on 4 Far switch 4 Day lighting 4 Glare Off 4 Dial at 10 Study target #1. Do you see four rings, top, bottom, left and right? Does the bottom ring seem to be floating towards you? • If response is NO, document this on OPTEC scoring sheet and move on to next test. • If response is YES, proceed with following instructions In target #2, which ring is floating toward you? • Continue with all circles until participant can no longer see the floating rings. • When participant can no longer identify which ring is floating towards them, the last correct answer is the score. • Enter the final score on the online OPTEC scoring sheet. 11. Test Contrast Sensitivity—Day. No Glare. Right Eye • Set Up OPTEC 4 Right eye on 4 Left eye off 4 Far switch 4 Day lighting 4 Glare Off 4 Dial at 5 Now we will do another exercise looking at the circles with parallel lines. Please look at ROW A. Starting with the first circle, state which way the top of the lines point (left, up/down, or right). Continue until you get to a circle where you can no longer see the lines. • Refer to the online OPTEC scoring sheet for the correct responses • Mark the last correct response on the online OPTEC scoring form. • Repeat procedure for dials 6–9.

99 All tests set on FAR for RIGHT eye, Day Testing Setting Frequency Dial 5 Row A 1.5 Dial 6 Row B 3 Dial 7 Row C 6 Dial 8 Row D 12 Dial 9 Row E 18 12. Test Contrast Sensitivity—Day. No Glare. Left Eye • Set Up OPTEC 4 Right eye off 4 Left eye on 4 Far switch 4 Day lighting 4 Glare Off 4 Dial at 5 • Repeat above procedure in #11, but for left eye. All tests set on FAR for LEFT eye, Day Testing Setting Frequency Dial 5 Row A 1.5 Dial 6 Row B 3 Dial 7 Row C 6 Dial 8 Row D 12 Dial 9 Row E 18 13. Test Color Perception • Set Up OPTEC 4 Right eye on 4 Left eye on 4 Far switch 4 Day lighting 4 Glare off 4 Dial at 11 Please identify the numbers in each circle, beginning with A. • Refer to the online OPTEC scoring sheet for the correct responses • Select whether participant identified the correct number, other number, or could not see a number on the online Optec scoring sheet. 14. Test Contrast Sensitivity—Night testing. With Glare. Right Eye • Set Up OPTEC 4 Right eye on 4 Left eye off

100 4 Far switch 4 Night lighting 4 Glare on 4 Dial at 5 • If participant uses special glasses for night driving, s/he should wear them for this test. • **INFORM THE PARTICIPANT THAT THIS NEXT TEST WILL INCLUDE SOME ADDITIONAL LIGHTING. • Instruct participant to lean into the OPTEC again. There is one last set of exercises with the circles with lines in them. Please look at ROW A, starting with the first circle, state which way the top of the lines point, until you get to a circle that you cannot see lines in. • Refer to the online OPTEC scoring sheet for the correct responses • Mark the last correct response on the online OPTEC scoring form. • Repeat procedure for dials 6–9. • Participants may not wear sunglasses to mitigate the glare. If they are uncomfortable, they may choose to skip this test. All tests set on FAR for RIGHT eye, Night with Glare Testing Setting Frequency Dial 5 Row A 1.5 Dial 6 Row B 3 Dial 7 Row C 6 Dial 8 Row D 12 Dial 9 Row E 18 15. Test Contrast Sensitivity—Night testing. With Glare. Left Eye • Set Up OPTEC 4 Right eye off 4 Left eye on 4 Far switch 4 Night lighting 4 Glare on 4 Dial at 5 • If participant uses special glasses for night driving, s/he should wear them for this test. • Participants may not wear sunglasses to mitigate the glare. If they are uncomfortable, they may choose to skip this test. • Repeat above procedure in #14 but for left eye. All tests set on FAR for LEFT eye, Night with Glare Testing Setting Frequency Dial 5 Row A 1.5 Dial 6 Row B 3 Dial 7 Row C 6 Dial 8 Row D 12 Dial 9 Row E 18

101 16. Test Peripheral Vision-Right Eye • Set Up OPTEC 4 Right eye on 4 Left eye off 4 Far switch 4 Day lighting 4 Glare off ** Make sure to turn this off from the previous test 4 Any dial • Ask the participant to let you know when/if they see a light • Press the following buttons on the OPTEC control box one at a time 4 Nasal 4 55 4 70 4 85 • Check all angles that participant responds “yes” to on the online OPTEC scoring sheet. 17. Test Peripheral Vision-Left Eye • Set Up OPTEC 4 Right eye off 4 Left eye on 4 Far switch 4 Day lighting 4 Glare off 4 Any dial • Repeat procedures as noted above in #16- but for the left eye • Click “Submit” on the OPTEC scoring sheet and close the window (tab if using Firefox). 18. Set up for the Jamar Hand Dynamometer Test • Jamar should always be set on the second to narrowest grip distance (see figure 2) 4 Go to mcs.shrp2nds.us 4 Enter your login/password 4 Click on “participants” on the left side of the screen 4 Scroll down and select the appropriate participant number from the list at the bottom of the screen. 4 Select the “test Hand Strength Questionnaire” from the list of tests on the right side of the screen 4 Click on “next” • Ask participant to sit in chair. The standard position requires that the participant: 4 Sit in a straight-backed chair 4 Feet flat on the floor 4 Upper arms down by side of body 4 Arms unsupported 4 Elbows flexed at 90 degrees 4 Forearm rotation neutral (i.e., in a relaxed rotational position) 4 Wrist straight • Demonstrate to participant how to perform the Jamar assessment

102 Figure 2. Use the second narrowest grip distance for all participants, as illustrated above. Note that the apparatus Jamar should be recalibrated once per year (i.e., prior to the second round of installations)—see VTTI for details. Figure 1. Standard grip strength testing position. Variations from this position significantly influence results.

103 I’d like to measure your hand strength. This is a hand dynamometer. When you squeeze it like this (DEMONSTRATE) it measures the strength of your hand. You need to squeeze it as hard as you can for me to get an accurate reading, like this, with your arm and hand positioned like mine are. (DEMONSTRATE) • Ask the participant if they would like to remove any jewelry (rings). • Reset the red indicator to “0” by turning the silver dial on the face of the Jamar. • Ask the participant if they are right or left handed and enter this data in the online Jamar Scoring form. • Hand the participant the Jamar and ask them to use the wrist strap. 19. Perform Jamar Test on Right Hand • You will need to encourage the participant for approximately 5 seconds of exertion. Let’s start with your right hand. Squeeze it as hard as you can. . . . . harder, harder, <when you, the experimenter, see the needle begin to move in the other direction, say> good, now you can relax. • Record measurement on hand dynamometer, as noted by the red indicator needle, into the online Jamar scoring form using U.S. Standard Units (pounds, lbs). 20. Perform Jamar test on the left hand. • Wait at least 15 seconds between trials. • Remember to reset the red indicator to “0” between each trial. I’d like you to do this again with your left hand—Ready? Squeeze it as hard as you can. . . . harder, harder, <when you, the experimenter, see the needle begin to move in the other direction, say> good, now you can relax. • Record measurement on hand dynamometer, as noted by the red indicator needle, into the online Jamar scoring form using U.S. Standard Units (pounds, lbs). 21. Perform Jamar Test on Right Hand (2nd Time) • Follow protocol in #19 above 22. Perform Jamar Test on Left Hand (2nd Time) • Follow protocol in #20 above • Click on submit in the online survey and close the Hand Strength Questionnaire 23. Set up the DrivingHealth Inventory Program • Open DrivingHealth Inventory program located on the computer desktop • This program will be used to perform the Touch Screen Practice, Rapid Pace Walk, Visualizing Missing Information, Visual Information Processing Speed, and the Trail Making Tests The next part of the study includes 3 standardized, computer-based tests and a walking test – remember, no particular computer skill or knowledge is required. This computer is equipped with a touch screen. This means you will give your answers by touching the screen. After each test is complete, a “continue” button will appear. Please do not touch the “continue” button. Sit back, and allow the experimenter to press it, when ready. • Make sure “respond via touch screen” is selected on the welcome screen to the DHI program. • Select begin • Put cursor in participant name field and then scan barcode

104 • Put cursor in participant ID field and scan barcode again • Perform adjustments to screen calibration as specified in the program. • Note that throughout the assessments that use the Driver Health Inventory Program, the experimenter can abort tests and navigate through the suite of tests by holding down both mouse buttons until the navigation screen appears. 24. Administer Touch Screen Practice Session This first exercise gives you an opportunity to practice using the touch screen. • Go to Mouse/touch Practice and read instructions to participant. • Allow participant to practice touching the dots until the participant is proficient. • Because the next test is not used, abort it by holding down both mouse buttons until the “Abort This Test” option pops up 25. Administer Rapid Pace Walk (20 ft total distance—10 ft there and 10 ft back) • Program moves on automatically to the Rapid Pace Walk • Read onscreen instructions to participant Please stand here <@ start/end tape marking>. When I tell you to start, I’d like you to walk as quickly as you safely can to that line <@ 10 ft tape>, turn around, and then walk back to this spot <@ start/end tape>. Please keep in mind that we don’t want you to trip or fall, so don’t walk more quickly than you feel is safe for you. Please start when you are ready. • Click the “begin timer” on the screen when participant begins walking. • Stop the timer by clicking the “stop timer” button when participant returns to the starting point. • Data is stored automatically. • The next two tests are not needed, so abort them by holding down both mouse buttons until the Abort This Test option pops up 26. Administer the Visualizing Missing Information Test • Open Visualizing Missing Information Test • Read onscreen instructions to participant exactly as printed on screen. • Clarify if necessary. • Let participant know we do not use the “sounds” in the assessments • Begin test by hitting continue • Data is recorded automatically. 27. Administer the Visual Information Processing Speed (UFOV®) Test • The monitor needs to be roughly 18 inches away from the participant • Note that the UFOV® part of the program advances on its own through the instruction pages. Experimenters need to be ready to read the instructions as soon as it has been opened. If participant asks questions or is distracted and the experi- menter needs to start again, press both mouse buttons to get to the navigation page and restart the test. • Open Useful Field of View and read instructions to participant exactly as printed on screen- though clarify that the sound will not be on. • Begin practice session. • If more practice is suggested by the program, a screen will appear after practice suggesting a repeating of the instructions 4 If participant chooses to repeat the instructions/practice, click “Repeat Instructions” 4 If participant chooses to continue in spite of the suggested repeated instructions/practice, click “continue” • Participant may go through the practice session up to 3 times as desired by the participant. • Click “continue” to begin the test

105 28. Administer Trail Making Tests • Open Trail Making Tests • Read instructions to participant exactly as printed on screen. Clarify if necessary. You may only use one hand and one finger to perform this test. • Begin test. • Permit participant to take the full time to complete the test which will automatically time out after 5 minutes if not completed by then. • At end of test have participant stop before pressing the continue button. Pressing this button will move on to the next screen which presents the scores. If participant does hit continue, turn the monitor off right away so that participant does not see his/her scores. • Exit the program. 29. 5 Minute Break • Show participant the restroom, walk participant outside, get participant water, etc. 30. Log into Participant Portal • Go to www.shrp2nds.us • Have participant log in to the participant portal using their User ID and their password as shown on the sheet in the participant packet. • Indicate to participant where to change password within the participant portal. 31. Have Participant Complete Questionnaires During the third and final part of the study, you will be answering a series of questionnaires. As noted in the Informed Consent form, your answers on these questionnaires and all your data in this study will be treated as confidential and will never be associated with your name or identity. For these questionnaires, you will be reading the instructions on your own and following the directions. • Onsite—On computer (OPTION 1) 4 Navigate to www.shrp2nds.us 4 Have participant log in to the participant portal using their User ID and their password as shown on the sheet in the participant packet. 4 Note that in Windows 7, clicking on a link for a new questionnaire opens the questionnaire in a new window accessed by hovering the mouse over the Internet Explorer icon in the task bar and selecting the appropriate window. 4 Have participant complete questionnaires • If participant requires the use of paper surveys (OPTION 2) 4 Give them the printed out versions and ask them to fill them in—disregard onsite computer surveys. 4 If questionnaires are not finished while participant is present on-site, give participant an addressed and stamped envelope along with the unfinished questionnaires so that they can be easily returned. 4 Remind participant that compensation for this study will begin when all of the questionnaires have been completed and received by the testing site. 4 These surveys will need to be later transcribed by a researcher into the online versions by proxy. • Offsite—On computer (Option 3) We have a set of online questionnaires for you to complete after you leave here today. You will be provided a link to the ques- tionnaires. The link will take you to a website where you can put in your participant number and a password of your choice. This website will give you the list of questionnaires to complete. You do not have to complete them all at the same time, as

106 you will be able to save what you have completed and then return later to finish them. The website is secure so that no one else will be able to access your questionnaires after you complete them except the experimenters in the study. As noted in the Informed Consent form, your answers on these questionnaires and all your data in this study will be treated as confidential and will never be associated with your name or identity. Remember, your compensation for this study will begin when you complete all questionnaires. Do you have any questions? 32. Contact Installation Tech • Arrange to meet Installation Tech at the vehicle with the participant 33. Installation Tech will collect simulated night/dark reference images of participant in the vehicle using the provided blankets for occlusion in the darkened vehicle 34. Installation Tech reviews vehicle installation and vehicle checklist with the participant. 35. Review Instrumentation in vehicle with participant • Point out incident button • Show the glove box letter 36. Dismiss the participant and offer thanks for their time and participation. 37. Scan and upload the clock drawing test using the provided scanner and MCS software • www.mcs.shrp2nds.us • Delete clock drawing scan from hard drive after verifying it was uploaded 38. Upload the CPT score sheet using the MCS software Check Box Item Questionnaires to complete Sensation Seeking Scale Barkley’s Quick Screen Demographics Questionnaire Perception of Risk Driving History Driving Knowledge Frequency of Risky Behavior Integrated Features Identification Medical Conditions and Medications Modified Manchester Driver Behavior Sleep Questionnaire