Date Presented 04/02/2022

Understanding the relationship between age and pedal use is crucial for accurate recommendations in driving. This study examined the relationship between age and foot pressure inaccuracy in healthy adults ages 30 to 60 years. The results showed no significant difference between foot pressure inaccuracy and age, but what does this mean to the clinician? This presentation will provide clinical implications as well as other important points to consider when assessing pedal use in clients.

Primary Author and Speaker: Mary Culshaw

Additional Authors and Speakers: Susan Martin Touchinsky, Maria Nagle, Ashley Swackhamer, Emily Szuter

Driving is an important occupation, with over 220 million licensed drivers nationwide in 2018. With the prevalence of driving comes a risk for serious injury. In 2019 there were 6,756,000 vehicular crashes with 2,740,000 injuries and 36,096 deaths were reported across the United States. Pedal regulation is an important performance skill needed for safe operating a motor vehicle. It requires integration of several client factors including motor control, range of motion, sensation, and proprioception. Occupational therapists frequently provide recommendations regarding pedal use, including the cessation of traditional pedals and while there is literature regarding pedal use in older adults, little is known regarding middle aged adults. Additionally, there is a paucity of information on the relationship between age and effective pedal use. Knowledge of performance patterns in pedal use for this age group will support clinician driving recommendations to clients across the lifespan (Brooks et al., 2017; Perazzolo et al., 2019; Perazzolo et al., 2020). Within this study of pedal use was a review on the use of driving simulators in assessment and intervention of driving skills (Gibbons et al., 2014). Driving simulators are one tool available to clinicians in the assessment and intervention of driving skills. Clinicians are able to assess and provide intervention for the underlying client factors in driving within a safe environment. The use of driving simulators in the clinical environment is not consistent, so providing guidance on general pedal use can be beneficial for all clinicians involved in driving. The purpose of this research study was to examine the relationship between age and foot pressure inaccuracy on the gas and brake pedals of a driving simulator in middle aged adults. Multiple trials served the purpose of decreasing performance error and detecting performance patterns such as increased rates of accuracy through repetition. The data calculated the percentage of time as well as the number of times spent above, below, and inside a projected target zone. Forty-seven participants completed the study and were recruited through non-probability snowball sampling involving social media and word of mouth. The participants completed a demographic survey to determine eligibility followed by pedal tasks on a commercial driving simulator. The analysis included basic descriptive statistics tests and the Kruskal-Wallis one-way analysis of variance. The research showed no significant difference in percentage of error time between individuals aged 30-39, 40-49 and 50-60 across ten gas and brake pedal task trials. Descriptive statistical analysis provided measures of central tendency and confirmed that participant performance improved with trial repetition. The Kruskal-Wallis proved no significant difference in pedal performance as it relates to foot pressure inaccuracy among healthy adults between 30 and 60 years of age. The study concluded that age is not a confounding factor in pedal performance in middle aged adults. The presenters will discuss the importance of these findings and the generalizability to the broad scope of occupational therapy. As well, important points to consider in the use of driving simulators and assessment of pedal use in driving.The reference point of performance in healthy middle aged adults may be considered for future assessment of pedal use as it pertains to driving safety in individuals.


Brooks, J., Seeanner, J., Hennessy, S., Manganelli, J., Crisler, M., Rosopa, P., Jenkins, C., Anderson, M., Drouin, N., Belle, L., Truesdail, C., & Tanner, S. (2017). Interactive tools for measuring visual scanning performance and reaction time. American Journal of Occupational Therapy, 71, 7102350010.

Gibbons, C., Mullen, N., Weaver, B., Reguly, P., & Bédard, M. (2014). One- and three-screen driving simulator approaches to evaluate driving capacity: Evidence of congruence and participants’ endorsement. American Journal of Occupational Therapy, 68, 344–352.

Perazzolo, M., Reeves, N. D., Bowling, F. L., Boulton, A. J. M., Raffi, M., & Marple-Horvat, D. E. (2019). Altered accelerator pedal control in a driving simulator in people with diabetic peripheral neuropathy. Diabetic Medicine, 37, 335–342.

Perazzolo, M., Reeves, N. D., Bowling, F. L., Boulton, A. J. M., Raffi, M., & Marple-Horvat, D. E. (2020). A new approach to identifying the effect of diabetic peripheral neuropathy on the ability to drive safely. Transportation Research Part F: Traffic Psychology and Behaviour, 69, 324–334.