Rehabilitation for improving automobile driving after stroke

George, Stacey; Crotty, Maria; Gélinas, Isabelle; Devos, Hannes

doi:10.1002/14651858.cd008357.pub2

Cited by 37 publications

(26 citation statements)

References 48 publications

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“…Driving rehabilitation has shown promising effects on fitness-to-drive, on-road driving performance, and cognitive functions after stroke [6]. These driving interventions used a standard set of simulator scenarios, off-the-shelf cognitive games, or computerized training programs [7,8,9].…”

Section: Introductionmentioning

confidence: 99%

On-Road Driving Impairments and Associated Cognitive Deficits After Stroke

2014

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Background: Little is known about the critical on-road driving skills that get affected after a stroke. The purpose of this study was to investigate the key on-road driving impairments and their associated cognitive deficits after a stroke. A second aim was to investigate if lateralization of stroke impacts results of the cognitive and on-road driving tests. Methods: In this cross-sectional study, 99 participants with a first-ever stroke who were actively driving prior to stroke underwent a cognitive battery and a standardized road test that evaluated 13 specific on-road driving skills. These on-road driving skills were mapped onto an existing, theoretical framework that categorized the on-road items into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving skills. The total score on the road test and the on-road decision, made by a certified fitness-to-drive expert, decided the main outcome. The critical on-road driving skills predicting the on-road decision were identified using logistic regression analysis. Linear regression analysis was employed to determine the cognitive impairments leading to poor total on-road scores. Analyses were repeated for right- and left-sided strokes. Results: In all, 37 persons scored poorly on the road test. These participants performed worse in all hierarchic clusters of on-road driving. Performances on the operational cluster and the visuo-integrative cluster best predicted on-road decisions (R² = 0.60). ‘Lane changing' and ‘understanding, insight, and quality of traffic participation' were the critical skill deficits leading to poor performance on the road test (R² = 0.65). Divided attention was the main determinant of on-road scores in the total group (R² = 0.06). Participants with right-sided stroke performed worse on visual field, visual neglect, visual scanning, visuo-constructive skills, and divided attention compared with those with left-sided stroke. Divided attention was the main determinant of total on-road scores in the right-sided stroke group (R² = 0.10). A combination of visual scanning, speed of processing, and executive dysfunction yielded the best model to predict on-road scores in left-sided strokes (R² = 0.46). Conclusions: Poor performance in the road test after stroke is determined by critical operational and visuo-integrative driving impairments. Specific and different driving evaluation and training programs are needed for right- and left-sided strokes.

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Section: Introductionmentioning

confidence: 99%

On-Road Driving Impairments and Associated Cognitive Deficits After Stroke

2014

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“…The underlying brain injury may also cause other perceptual, attentional, cognitive and motor impairments that could adversely affect driving performance. [12][13][14][15] Motor impairments, such as hemiparesis, may be addressed by car modifications (such as adding a steering knob); however, by comparison, significant cognitive or attentional impairments are clear contraindications for driving. In particular, anosognosias (unawareness of the deficit) and hemispatial neglect, a failure to attend to the contralesional side of space, 16 present safety concerns.…”

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confidence: 99%

Driving with homonymous visual field loss: a review of the literature

Bowers

2016

Clinical and Experimental Optometry

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Driving is an important rehabilitation goal for patients with homonymous field defects (HFDs); however, whether or not people with HFDs should be permitted to drive is not clear. Over the last 15 years there has been a marked increase in the number of studies evaluating the effects of HFDs on driving performance. This review of the literature provides a much-needed summary for practitioners and researchers, addressing the following topics: regulations pertaining to driving with HFDs, self-reported driving difficulties, pass rates in on-road tests, the effects of HFDs on lane position and steering stability, the effects of HFDs on scanning and detection of potential hazards, screening for potential fitness to drive, evaluating practical fitness to drive, and the efficacy of interventions to improve driving of persons with HFDs. Although there is clear evidence from on-road studies that some people with HFDs may be rated as safe to drive, others are reported to have significant deficits in skills important for safe driving including taking a lane position too close to one side of the travel lane, unstable steering and inadequate viewing (scanning) behaviors. Driving simulator studies have provided strong evidence of a wide range in compensatory scanning abilities and detection performance, despite similar amounts of visual field loss. Conventional measurements of visual field extent (in which eye movements are not permitted) do not measure such compensatory abilities and are not predictive of on-road driving performance; thus, there is a need to develop better tests to screen for visual fitness to drive of people with HFDs. We are not yet at a point where we can predict which HFD patient is likely to be a safe driver. Therefore, it seems only fair to provide an opportunity for individualized assessments of practical fitness to drive either on the road and/or in a driving simulator.

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“…It should be noted that the simulator was used in conjunction with occupational therapy intervention, which raised self‐awareness of driving errors and coached the driver in strategies to address errors. In clinical practice in Australia, the most common occupational therapy intervention for driver rehabilitation is prescribed driving lessons with an instructor, despite there being a lack of evidence evaluating on‐road driving lessons as an intervention (George et al ., ; Unsworth & Baker, ). Given the complex nature of the intervention, it is difficult to determine if the results of the study were achieved by use of the simulator in training, occupational therapy input or the development of the tailored driver training.…”

Section: Commentarymentioning

confidence: 99%

“…There is growing use of driving simulation in occupational therapy driving intervention (Cox et al ., ). A systematic review of driver rehabilitation post‐stroke found only limited evidence for a driving simulator in improving abilities such as road sign recognition (George, Crotty, Gelinas & Devos, ). In the appraised study, the occupational therapists completed the evaluations and intervention with participants.…”

Section: Commentarymentioning

confidence: 99%