Driving is a highly complex task that draws on a variety of visual, perceptual and physical sensory-motor and cognitive skills. Drivers are expected to not only operate a vehicle, but also successfully monitor the environment, interact with other participants and follow traffic rules when trying to reach from point A to point B. A decline in any set of sensory-motor and cognitive skills due to medical conditions, neuropsychological disorders, or sensory decline (for example vision) can be therefore reflected also in the driving performance of an individual. All of these become more prevalent with age, which has been rising concerns about the driving abilities and safety of older drivers. And while there is an international general consensus on the importance of performing fitness to drive assessments on drivers with potential or proven decline in specific skills necessary for driving, there is a great discrepancy in how these assessments should be performed, or are performed, in practice.

With the increased need for assessment of skills specifically for F2D assessment, researchers have tried to use cognitive theories that have inspired psychological tests for development of new screening tools specifically designed for drivers. A common denominator of these tests is their form of execution, which has moved from the paper-pen format to computer-based tasks, which enable dynamic content and offer the possibility also for sensory-motor assessment.

However, in an extensive meta-analysis of commonly used screening and assessment tools, it was revealed 1 that tools that assess only one skill are not sufficient to determine fitness to drive. Their results reveal that for a lot of researchers, on-road assessment is still deemed the most appropriate option, as it measures both the sensory-motor and cognitive aspects of driving. At the same time, in addition to their financial and time disadvantages and impracticality on a large scale, on-road assessments have also been criticized on the lack of objective, reliable and valid procedures for assessing fitness to drive and on-road driving competence. 

As a cost and time effective alternative, research has proposed the use of driving simulation 2, which has been shown to have high validity compared to real-world driving 3. High correlations were found also for simulated driving-based fitness to drive assessment compared to neuropsychological tests 4, 5. With the power of virtual reality and use of vehicle parts for operating them, simulations have been used to provide a close approximate of actual behind-the wheel driving experiences and situations and augmentation of traditional office-based driving fitness assessments. Compared to on-road testing, vehicle-based simulation devices are safer, more easily controlled and standardized, and allow for reproducible and easily modifiable conditions and scenarios.