A Case–Control Study Investigating Simulated Driving Errors in Ischemic Stroke and Subarachnoid Hemorrhage

Abstract

BackgroundStroke can affect a variety of cognitive, perceptual, and motor abilities that are important for safe driving. Results of studies assessing post-stroke driving ability are quite variable in the areas and degree of driving impairment among patients. This highlights the need to consider clinical characteristics, including stroke subtype, when assessing driving performance.MethodsWe compared the simulated driving performance of 30 chronic stroke patients (>3 months), including 15 patients with ischemic stroke (IS) and 15 patients with subarachnoid hemorrhage (SAH), and 20 age-matched controls. A preliminary analysis was performed, subdividing IS patients into right (n = 8) and left (n = 6) hemispheric lesions and SAH patients into middle cerebral artery (MCA, n = 5) and anterior communicating artery (n = 6) territory. A secondary analysis was conducted to investigate the cognitive correlates of driving.ResultsNine patients (30%) exhibited impaired simulated driving performance, including four patients with IS (26.7%) and five patients with SAH (33.3%). Both patients with IS (2.3 vs. 0.3, U = 76, p < 0.05) and SAH (1.5 vs. 0.3, U = 45, p < 0.001) exhibited difficulty with lane maintenance (% distance out of lane) compared to controls. In addition, patients with IS exhibited difficulty with speed maintenance (% distance over speed limit; 8.9 vs. 4.1, U = 81, p < 0.05), whereas SAH patients exhibited difficulty with turning performance (total turning errors; 5.4 vs. 1.6, U = 39.5, p < 0.001). The Trail Making Test (TMT) and Useful Field of View test were significantly associated with lane maintenance among patients with IS (rs > 0.6, p < 0.05). No cognitive tests showed utility among patients with SAH.ConclusionBoth IS and SAH exhibited difficulty with lane maintenance. Patients with IS additionally exhibited difficulty with speed maintenance, whereas SAH patients exhibited difficulty with turning performance. Current results support the importance of differentiating between stroke subtypes and considering other important clinical characteristics (e.g., side of lesion, vascular territory) when assessing driving performance and reinforce the importance of physicians discussing driving safety with patients after stroke.

Age-Related Diseases and Driving Safety

“…Stroke patients are almost twice as likely to cause an accident as healthy people, irrespective of their medical treatment [52]. Stroke patients can suffer from a variety of different symptoms and undergo different invasive and non-invasive treatments.…”

“…As to medication against poor sleep, benzodiazepines, which are also prescribed for sleep disorders, should be mentioned above all. Benzodiazepines are associated with a five-fold increase in the risk of accidents [52], and more so for men than for women [129]. Driving under the influence of benzodiazepines is assumed to be as impaired as 0.5‰ blood alcohol [130].…”

“…However, modern antihypertensive drugs differ in their influence on driving. McGwin and colleagues [52] investigated the effects of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, and diuretics on accident rates. After adjusting for age, sex, race, and annual miles driven, the odds of motor vehicle collision were 1.6 (95% CI 1.0, 2.7), 1.4 (95% CI 0.8, 2.3), and 0.9 (95% CI 0.5, 1.7) for ACE inhibitors, beta-blockers, and diuretics, respectively.…”

Cognitive and Motor Deficits Contribute to Longer Braking Time in Stroke

“…In our study, we demonstrate that stroke reduced the accuracy of ankle movements.The motor control of the ankle is important for accurate placement of the foot on the brake and gas pedals,applying precisebrake forces, and modulating the car speed. Simulated and on-road driving assessments show that stroke survivors are more likely to exceed speed limits, have poor speed adaptations, and have di culty maintaining safe trailing distance from the lead vehicle according to the driving speed (33,34). Lack of adequate motor controlin stroke can contribute to such driving errors.…”

Cognitive and Motor Deficits Contribute to Longer Braking Time in Stroke&nbsp;

“…The motor control of the ankle is important for accurate placement of the foot on the brake and gas pedals, applying precise brake forces, and modulating the car speed. Simulated and on-road driving assessments show that stroke survivors are more likely to exceed speed limits, have poor speed adaptations, and have di culty maintaining safe trailing distance from the lead vehicle according to the driving speed (33,34). Lack of adequate motor control in stroke can contribute to such driving errors.…”