Cognitive and motor deficits contribute to longer braking time in stroke

Abstract

Background Braking is a critical determinant of safe driving that depends on the integrity of cognitive and motor processes. Following stroke, both cognitive and motor capabilities are impaired to varying degrees. The current study examines the combined impact of cognitive and motor impairments on braking time in chronic stroke. Methods Twenty stroke survivors and 20 aged-matched healthy controls performed cognitive, motor, and simulator driving assessments. Cognitive abilities were assessed with processing speed, divided attention, and selective attention. Motor abilities were assessed with maximum voluntary contraction (MVC) and motor accuracy of the paretic ankle. Driving performance was examined with the braking time in a driving simulator and self-reported driving behavior. Results Braking time was 16% longer in the stroke group compared with the control group. The self-reported driving behavior in stroke group was correlated with braking time (r = − 0.53, p = 0.02). The stroke group required significantly longer time for divided and selective attention tasks and showed significant decrease in motor accuracy. Together, selective attention time and motor accuracy contributed to braking time (R2 = 0.40, p = 0.01) in stroke survivors. Conclusions This study provides novel evidence that decline in selective attention and motor accuracy together contribute to slowed braking in stroke survivors. Driving rehabilitation after stroke may benefit from the assessment and training of attentional and motor skills to improve braking during driving.

Post-stroke management

“…Case control studies comparing stroke patients with healthy age-matched controls using driving simulators found that stroke patients had difficulty maintaining their lanes, with ischaemic stroke patients having difficulty maintaining their speed (Hird et al., 2018). Braking time was 16% longer in the stroke patient group compared with control groups (Lodha et al., 2021). Cognitive assessments showed stroke patients took significantly longer to complete tasks relating to divided attention and selective attention when compared with controls (Lodha et al., 2021).…”

“…Braking time was 16% longer in the stroke patient group compared with control groups (Lodha et al, 2021). Cognitive assessments showed stroke patients took significantly longer to complete tasks relating to divided attention and selective attention when compared with controls (Lodha et al, 2021). A Cochrane review concluded there was insufficient evidence to determine whether any rehabilitation intervention improved patients' driving abilities after a stroke (George et al, 2014).…”

Motor Training After Stroke: A Novel Approach for Driving Rehabilitation

“…For example, post-stroke impairments in upper limb force control contribute to steering dysfunction ( 6 ). Likewise, stroke-related impairments in lower limb motor accuracy are linked to slower braking response ( 7 ). Unsurprisingly, therefore, the severity of motor impairments after stroke predicts an individual's likelihood of self-regulating driving after stroke and returning to driving 6 months post-stroke ( 2 , 4 , 8 ).…”

“…Well-timed braking response requires cognitive processing to recognize changes in the driving environment and motor capabilities for fast and accurate pedal manipulations. Accordingly, decline in cognitive speed of processing after stroke has been shown to delay the braking times ( 7 ). Although there is evidence that reduced muscle strength compromises braking speed in older adults ( 11 , 12 ), our recent findings suggest that braking performance in stroke survivors relates to reduced motor control but not to muscle strength ( 7 , 13 ).…”

“…Accordingly, decline in cognitive speed of processing after stroke has been shown to delay the braking times ( 7 ). Although there is evidence that reduced muscle strength compromises braking speed in older adults ( 11 , 12 ), our recent findings suggest that braking performance in stroke survivors relates to reduced motor control but not to muscle strength ( 7 , 13 ). Specifically, we found that accuracy of ankle movements in a visuomotor force tracking task predicted the braking reaction time in stroke.…”