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Samuelsson K, Tropp M, Lundqvist A, Wressle E. Development, concurrent validity and internal consistency of a simulator tool for assessing continued car driving after a brain injury/disease. Br J Occup Ther 2019. [DOI: 10.1177/0308022619836935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Kersti Samuelsson
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Tropp
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Anna Lundqvist
- Department of Rehabilitation Medicine and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ewa Wressle
- Department of Acute Internal Medicine and Geriatrics and Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
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Hutchinson C, Berndt A, Gilbert-Hunt S, George S, Ratcliffe J. Modified motor vehicles: the experiences of drivers with disabilities. Disabil Rehabil 2019; 42:3043-3051. [PMID: 30907156 DOI: 10.1080/09638288.2019.1583778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Purpose: Driving is often a rehabilitation goal of people with acquired disability, and vehicle modifications are typically required to facilitate this outcome. Though there have been several survey studies on vehicle modifications for people with disability, there has been no qualitative work on understanding people with disabilities' experiences of being a modified vehicle driver.Method: An interpretative phenomenological approach was used to understand the lived experiences of drivers with disability. Semi-structured interviews were conducted (n = 8) with drivers who used a variety of vehicle modifications from simple to highly complex. Using NVivo, Stage 1 of the coding involved case by case analysis and Stage 2 cross case analysis to identify themes that best captured drivers' experiences.Results: Four core themes were identified: knowing vs. challenging limitations, making complex driving considerations, considering undesired alternative transportation options, and responding emotionally to temporary vehicle loss. The Person-Environment-Occupation model was used as an orientating framework to discuss findings.Conclusions: This explorative small scale study highlights that less than full utilisation of modified vehicles is not a result of driver choice, but rather a complex interface between drivers' physical and psychological limitations, and physical environments that do not support the needs of drivers with disability.Implications for RehabilitationThe development of resources that identify environmental factors in public spaces (e.g., number and location of parking for people with disability, steps, slopes, ticket machines and their height and location) could support the driving choices of people with disabilities.It is important to assess psychological limitations of driving as well as physical limitations.Driving goals and driving capacity across different locations requires periodic review post-rehabilitation.More advocacy for improving community accessibility is required.
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Affiliation(s)
- Claire Hutchinson
- School of Commerce, University of South Australia, Adelaide, SA, Australia.,College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Angela Berndt
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Susan Gilbert-Hunt
- School of Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - Stacey George
- Rehabilitation and Aged Care, Flinders University, Adelaide, SA, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.,Institute for Choice, University of South Australia, Adelaide, SA, Australia
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Farrell HJ, Andrews SC, Ryan NP, Davis MC, Gordon S, Stout JC, Fisher F. Cognitive Fitness to Drive in Huntington's Disease: Assessing the Clinical Utility of DriveSafe DriveAware. J Huntingtons Dis 2019; 8:87-95. [PMID: 30776017 DOI: 10.3233/jhd-180323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND DriveSafe DriveAware (DSDA) has been validated as an off-road screening tool for predicting on-road driving performance in clinical populations, but its utility in people with Huntington's disease (HD) is unknown. OBJECTIVE Our aim was to evaluate the utility of DSDA in people with HD by demonstrating sensitivity of DSDA scores to HD progression and exploring associations between DSDA performance and cognitive functions that are essential to driving and impaired in people with HD. METHODS We administered the iPad application version of DSDA to 26 pre-symptomatic and symptomatic participants with HD. Disease progression was assessed via measures of motor impairment, disease burden and functional capacity. Standardised neuropsychological tests were used to assess cognitive function across several domains including attention, processing speed, planning, and visuoperception. RESULTS Results underscore the sensitivity of DSDA to HD progression and cognitive impairment; that is, poorer DSDA performance was associated with greater HD severity and poorer cognitive ability across the domains of attention, processing speed, and planning. Nevertheless, we identified a proportion of participants with HD who were predicted to pass on-road testing based on DSDA, but scored in the impaired range on multiple cognitive tests. These participants tended to score closer to the cut-off score used by DSDA to categorise pass/fail outcomes. CONCLUSIONS Our findings demonstrate potential for use of DSDA in the HD population, however, significant variability in cognitive performance among those predicted to 'pass' on-road driving assessment suggests the screening tool requires further development for use with HD drivers.
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Affiliation(s)
- Hayden J Farrell
- School of Psychological Sciences, and, Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Sophie C Andrews
- School of Psychological Sciences, and, Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Nicholas P Ryan
- Calvary Health Care Bethlehem, Statewide Progressive Neurological Disease Service, Caulfield South, VIC, Australia.,Cognitive Neuroscience Unit, School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Marie-Claire Davis
- Calvary Health Care Bethlehem, Statewide Progressive Neurological Disease Service, Caulfield South, VIC, Australia
| | - Stephanie Gordon
- School of Psychological Sciences, and, Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Julie C Stout
- School of Psychological Sciences, and, Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Fiona Fisher
- Calvary Health Care Bethlehem, Statewide Progressive Neurological Disease Service, Caulfield South, VIC, Australia
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Lodha N, Patel P, Casamento-Moran A, Hays E, Poisson SN, Christou EA. Strength or Motor Control: What Matters in High-Functioning Stroke? Front Neurol 2019; 9:1160. [PMID: 30687217 PMCID: PMC6333669 DOI: 10.3389/fneur.2018.01160] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 12/14/2018] [Indexed: 01/13/2023] Open
Abstract
Background: The two primary motor impairments that hinder function after stroke are declines in strength and motor control. The impact of motor impairments on functional capacity may vary with the severity of stroke motor impairments. In this study, we focus on high-functioning stroke individuals who experience mild to moderate motor impairments and often resume prior activities or return to work. These tasks require the ability to move independently, placing high demands on their functional mobility. Therefore, the purpose of this study was to quantify impairments in strength and motor control and their contribution to functional mobility in high-functioning stroke. Methods:Twenty-one high-functioning stroke individuals (Fugl Meyer Lower Extremity Score = 28.67 ± 4.85; Functional Activity Index = 28.47 ± 7.04) and 21 age-matched healthy controls participated in this study. To examine motor impairments in strength and motor control, participants performed the following tasks with the paretic ankle (1) maximum voluntary contractions (MVC) and (2) visuomotor tracking of a sinusoidal trajectory. Strength was quantified as the maximum force produced during ankle plantarflexion and dorsiflexion. Motor control was quantified as (a) the accuracy and (b) variability of ankle movement during the visuomotor tracking task. For functional mobility, participants performed (1) overground walking for 7 meters and (2) simulated driving task. Functional mobility was determined by walking speed, stride length variability, and braking reaction time. Results: Compared with the controls, the stroke group showed decreased plantarflexion strength, decreased accuracy, and increased variability of ankle movement. In addition, the stroke group demonstrated decreased walking speed, increased stride length variability, and increased braking reaction time. The multiple-linear regression model revealed that motor accuracy was a significant predictor of the walking speed and braking reaction time. Further, motor variability was a significant predictor of stride length variability. Finally, the dorsiflexion or plantarflexion strength did not predict walking speed, stride length variability or braking reaction time. Conclusions: The impairments in motor control but not strength predict functional deficits in walking and driving in high-functioning stroke individuals. Therefore, rehabilitation interventions assessing and improving motor control will potentially enhance functional outcomes in high-functioning stroke survivors.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Prakruti Patel
- Department of Health and Exercise Science, Colorado State University, Fort Collins, CO, United States
| | - Agostina Casamento-Moran
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Emily Hays
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Sharon N Poisson
- Department of Neurology, University of Colorado, Aurora, CO, United States
| | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
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55
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Inoue T, Ooba H, Hirano M, Takehara I, Watanabe S, Hitosugi M. Assessment for resumed driving in stroke patients via Functional Independence Measure1. Work 2019; 60:393-399. [PMID: 30040778 DOI: 10.3233/wor-182747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Some stroke survivors hope to resume driving after hospital discharge. For those who had driven frequently before their stroke, a normal daily life depends on being able to drive. OBJECTIVE Our objective was to determine whether Functional Independence Measure (FIM) scores predict patient driving ability, which would make them a suitable index for determining if a stroke patient can resume driving. METHODS This was a retrospective study of 71 patients who suffered from stroke. We divided them into three groups based on their driving status after discharge: (1) resumed driving (Driver), (2) wish to resume driving (Wisher), and (3) no wish to resume driving (Non-wisher). We compared total FIM scores and subcategories of FIM scores across groups. RESULTS Scores on the Motor-FIM and Cognitive-FIM were highest in the Driver group, followed by the Wisher and Non-wisher groups. Moreover, scores on the 'problem solving' and 'memory' subcategories of the Cognitive-FIM were significantly higher in the Driver group than in the Wisher group. CONCLUSIONS The FIM could be a useful assessment tool for determining whether or not stroke patients can resume driving. Moreover, among the Cognitive-FIM sub-categories, problem solving and memory ability might be the scores most relevant for this decision.
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Affiliation(s)
- Takuya Inoue
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, Japan.,Department of Legal Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Hideki Ooba
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | | | - Itaru Takehara
- Tokyo Metropolitan Rehabilitation Hospital, Tokyo, Japan
| | - Shu Watanabe
- The Jikei University School of Medicine, Tokyo, Japan
| | - Masahito Hitosugi
- Department of Legal Medicine, Shiga University of Medical Science, Shiga, Japan
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Lund P, Moir C, Kristalovich L, Ben Mortenson W. Evaluating the Measurement Properties of the ScanCourse, a Dual-Task Assessment of Visual Scanning. Am J Occup Ther 2019; 74:7401185040p1-7401185040p7. [PMID: 34781361 DOI: 10.5014/ajot.2020.032052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE The ScanCourse is used by occupational therapists to evaluate visual scanning ability during locomotion. Its measurement properties have not been examined. OBJECTIVE To assess the interrater reliability, test-retest reliability, and construct validity of the ScanCourse. DESIGN This study involved data collection at two time points. To assess test-retest reliability, the ScanCourse was administered twice within a 2-week period. To assess interrater reliability, a second rater was present for one session. To assess level of agreement, a Bland-Altman plot was created. To assess absolute reliability, the standard error of measurement was calculated. To evaluate construct validity, the results of the ScanCourse were compared with results of the Bells Test and Trail Making Test A and B. SETTING Rehabilitation hospital. PARTICIPANTS Forty-one patients with neurological impairments. Outcomes and Measures: The ScanCourse (participants identify numbered cards placed on both sides of a hallway at various heights during locomotion). RESULTS The ScanCourse was found to have excellent interrater reliability (intraclass correlation coefficient [ICC] [1,1] = .998; 95% confidence interval [CI] [.996-.999]), test-retest reliability (ICC [1,1] = .912; 95% CI [.811-.959]), a high level of agreement, and a low standard error of measurement (.503), and it was found to be significantly correlated with Trails A (rs = -.436, p = .009) and B (rs = -.364, p = .029). CONCLUSIONS AND RELEVANCE The assessment was found to have strong measurement properties, and it is therefore an appropriate tool for assessing dual-task visual scanning among those with neurological impairments. What This Article Adds: This research demonstrates that the ScanCourse is reliable between raters and over time and that scores on the measure vary as anticipated with scores on a related measure, which provides evidence of its validity. These findings support its use in practice.
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Affiliation(s)
- Paige Lund
- Paige Lund, BSc, MOT, is Occupational Therapist, Family Resource Association, Parksville, British Columbia, Canada
| | - Caitlyn Moir
- Caitlyn Moir, BA, MOT, is Occupational Therapist, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Lisa Kristalovich
- Lisa Kristalovich, BMR (OT), MRSc, is Clinical Faculty, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada, and Occupational Therapist, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - W Ben Mortenson
- W. Ben Mortenson, BScOT, MSc, PhD, is Associate Professor, Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada; Principal Investigator, Rehabilitation Research Program, Vancouver Coastal Health Research Institute (VCHRI), Vancouver, British Columbia, Canada; and Principal Investigator, International Collaboration on Repair Discoveries, VCHRI, Vancouver, British Columbia, Canada;
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57
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Tse G, Gong M, Li CKH, Leung KSK, Georgopoulos S, Bazoukis G, Letsas KP, Sawant AC, Mugnai G, Wong MC, Yan GX, Brugada P, Chierchia G, de Asmundis C, Baranchuk A, Liu T. T peak-T end, T peak-T end/QT ratio and T peak-T end dispersion for risk stratification in Brugada Syndrome: A systematic review and meta-analysis. J Arrhythm 2018; 34:587-597. [PMID: 30555602 PMCID: PMC6288557 DOI: 10.1002/joa3.12118] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Brugada syndrome is an ion channelopathy that predisposes affected subjects to ventricular tachycardia/fibrillation (VT/VF), potentially leading to sudden cardiac death (SCD). Tpeak-Tend intervals, (Tpeak-Tend)/QT ratio and Tpeak-Tend dispersion have been proposed for risk stratification, but their predictive values in Brugada syndrome have been challenged recently. METHODS A systematic review and meta-analysis was conducted to examine their values in predicting arrhythmic and mortality outcomes in Brugada Syndrome. PubMed and Embase databases were searched until 1 May 2018, identifying 29 and 57 studies. RESULTS Nine studies involving 1740 subjects (mean age 45 years old, 80% male, mean follow-up duration was 68 ± 27 months) were included. The mean Tpeak-Tend interval was 98.9 ms (95% CI: 90.5-107.2 ms) for patients with adverse events (ventricular arrhythmias or SCD) compared to 87.7 ms (95% CI: 80.5-94.9 ms) for those without such events, with a mean difference of 11.9 ms (95% CI: 3.6-20.2 ms, P = 0.005; I 2 = 86%). Higher (Tpeak-Tend)/QT ratios (mean difference = 0.019, 95% CI: 0.003-0.036, P = 0.024; I 2 = 74%) and Tpeak-Tend dispersion (mean difference = 7.8 ms, 95% CI: 2.1-13.4 ms, P = 0.007; I 2 = 80%) were observed for the event-positive group. CONCLUSION Tpeak-Tend interval, (Tpeak-Tend)/QT ratio and Tpeak-Tend dispersion were higher in high-risk than low-risk Brugada subjects, and thus offer incremental value for risk stratification.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of MedicineChinese University of Hong KongHong KongChina
- Li Ka Shing Institute of Health Sciences, Faculty of MedicineChinese University of Hong KongHong KongChina
- Shenzhen Research InstituteThe Chinese University of Hong KongShenzhenChina
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of CardiologyTianjin Institute of Cardiology, Second Hospital of Tianjin Medical UniversityTianjinChina
| | - Christien Ka Hou Li
- Department of Medicine and Therapeutics, Faculty of MedicineChinese University of Hong KongHong KongChina
- Li Ka Shing Institute of Health Sciences, Faculty of MedicineChinese University of Hong KongHong KongChina
- Shenzhen Research InstituteThe Chinese University of Hong KongShenzhenChina
- Faculty of MedicineNewcastle UniversityNewcastleUK
| | - Keith Sai Kit Leung
- Department of Medicine and Therapeutics, Faculty of MedicineChinese University of Hong KongHong KongChina
- Li Ka Shing Institute of Health Sciences, Faculty of MedicineChinese University of Hong KongHong KongChina
- Shenzhen Research InstituteThe Chinese University of Hong KongShenzhenChina
- Aston Medical SchoolAston UniversityBirminghamUK
| | - Stamatis Georgopoulos
- Second Department of Cardiology, Laboratory of Cardiac ElectrophysiologyEvangelismos General Hospital of AthensAthensGreece
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac ElectrophysiologyEvangelismos General Hospital of AthensAthensGreece
| | - Konstantinos P. Letsas
- Second Department of Cardiology, Laboratory of Cardiac ElectrophysiologyEvangelismos General Hospital of AthensAthensGreece
| | - Abhishek C. Sawant
- Division of Cardiology, Department of Internal MedicineState University of New York at BuffaloBuffaloNew York
| | - Giacomo Mugnai
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and PacingUniversitair Ziekenhuis Brussel‐Vrije Universiteit BrusselBrusselsBelgium
| | - Martin C.S. Wong
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong KongChina
| | - Gan Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical CenterWynnewoodPennsylvania
- Beijing Anzhen Hospital, Capital Medical UniversityBeijingChina
| | - Pedro Brugada
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and PacingUniversitair Ziekenhuis Brussel‐Vrije Universiteit BrusselBrusselsBelgium
| | - Gian‐Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and PacingUniversitair Ziekenhuis Brussel‐Vrije Universiteit BrusselBrusselsBelgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and PacingUniversitair Ziekenhuis Brussel‐Vrije Universiteit BrusselBrusselsBelgium
| | - Adrian Baranchuk
- Division of CardiologyKingston General Hospital, Queen's UniversityKingstonONCanada
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease, Department of CardiologyTianjin Institute of Cardiology, Second Hospital of Tianjin Medical UniversityTianjinChina
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Zhang N, Fan C, Gong M, Liang X, Zhang W, Li G, Tse G, Liu T. Leucocyte telomere length and paroxysmal atrial fibrillation: A prospective cohort study and systematic review with meta-analysis. J Clin Lab Anal 2018; 32:e22599. [PMID: 29943516 PMCID: PMC6816961 DOI: 10.1002/jcla.22599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/02/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Telomere length is a surrogate marker of biological aging. Whether telomere length predicts the risk of atrial fibrillation (AF) independently of biological aging is controversial. We conducted a cohort study to examine the relationship between telomere length and paroxysmal AF (PAF), followed by a systematic review and meta-analysis of the published literature, incorporating our own data. METHODS DNA was extracted from peripheral blood. Leucocyte telomere length was measured by a real-time polymerase chain reaction-based method, normalized to a single copy gene, and presented as telomere/single gene ratio (t/s). RESULTS A total of 100 non-AF patients and 50 PAF patients (mean age: 61.0 ± 9.4 and 64.0 ± 10.7 years, respectively) were included. T/s for subjects without AF tended to be shorter than for those with AF (0.21 [0.06-0.36] vs 0.28 [0.11-0.71], P = .077). T/s was associated with a 1.60-fold increase in the risk of AF but this was not significant (95% CI: 0.988-2.597, P = .056). Our meta-analysis confirms no difference in telomere length between AF and non-AF patients and t/s was not associated with higher risk of AF in multivariate analysis. CONCLUSIONS Our prospective data showed that leucocyte telomere length was similar between AF and non-AF patients but was significantly longer in male patients with PAF than those without AF in our subgroup analysis. Our meta-analysis found that t/s did not predict AF. These findings support the notion that chronological aging, but not markers of biological aging, predicts the risk of AF.
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Affiliation(s)
- Nixiao Zhang
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Chong Fan
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Xue Liang
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Weili Zhang
- State Key Laboratory of Cardiovascular DiseasesFuwai HospitalNational Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Guangping Li
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Gary Tse
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong Kong, SARChina
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong Kong, SARChina
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular DiseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
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Bernstein JP, Calamia M, Meth MZ, Tranel D. Recommendations for Driving After Neuropsychological Assessment: A Survey of Neuropsychologists. Clin Neuropsychol 2018; 33:971-987. [DOI: 10.1080/13854046.2018.1518490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | - Matthew Calamia
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA
| | - Molly Z. Meth
- Providence Veterans Affairs Medical Center, Providence, RI, USA
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Daniel Tranel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- Department of Neurology, University of Iowa College of Medicine, Iowa City, IA, USA
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60
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Braga MM, Nickel R, Lange M, Piovesan ÉJ. Driving and visual deficits in stroke patients. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:85-88. [PMID: 29489961 DOI: 10.1590/0004-282x20170184] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE The aim of the present study was to conduct an exploratory assessment of visual impairment following stroke, and to discuss the possibilities of reintroducing patients to the activity of driving. METHODS The Useful Field of View test was used to assess visual processing and visual attention. RESULTS A total of 18 patients were included in the study, and were assigned to either the drive group (n = 9) or the intention group (n = 9). In the drive group, one patient was categorized as moderate-to-high risk; whereas, in the intention group, one patient was categorized as low-to-moderate risk. Additionally, two patients in the intention group were categorized as high risk. The patients did not perceive their visual deficits as a limitation. CONCLUSION Visual attention is an interference factor in terms of the safe performance of driving after a stroke. All patients showed a high level of interest for the independence provided through being able to drive.
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Affiliation(s)
- Marina Marcondes Braga
- Universidade Federal do Paraná, Hospital de Clínicas, Terapia Ocupacional, Curitiba PR, Brasil
| | - Renato Nickel
- Universidade Federal do Paraná, Hospital de Clínicas, Terapia Ocupacional, Curitiba PR, Brasil
| | - Marcos Lange
- Universidade Federal do Paraná, Hospital de Clínicas, Terapia Ocupacional, Curitiba PR, Brasil
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61
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Bazoukis G, Brilakis ES, Tse G, Letsas KP, Kitsoulis P, Liu T, Baranchuk A, Sideris A, Tsioufis C, Stavrakis S. The efficacy of coronary sinus reducer in patients with refractory angina-A systematic review of the literature. J Interv Cardiol 2018; 31:775-779. [PMID: 30191622 DOI: 10.1111/joic.12560] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The aim of our systematic review was to investigate the efficacy of coronary sinus (CS) reducer device in patients with refractory angina. BACKGROUND The CS reducer device provides a therapeutic option for patients with coronary artery disease who are not suitable for revascularization. METHODS Two independent investigators (GB and GT) systematically searched the Medline and Cochrane library databases for studies describing the efficacy and safety of the CS reducer in patients with refractory angina from January 1, 2000 until May 12, 2018 using the following terms: "coronary sinus (reducer OR reducing) device." Efficacy was defined as ≥1 unit improvement in the Canadian cardiovascular society (CCS) score. RESULTS Our search strategy provided six studies (five observational studies and one randomized clinical trial) with 196 patients. The CS reducer device was effective in 146/186 (78.5%) patients. CCS score improved from 3.2 at baseline to 1.9 after 8.6 months of follow-up. The efficacy of CS reducer device was also demonstrated as an improvement in Seattle Angina Questionnaire score, dobutamine echocardiography, thalium single-photon emission computed tomography perfusion studies, 6-min-walk test and myocardial perfusion reserve index. Implantation failed in 4 of 196 (2%) patients and 5 patients (2.5%) had a complication during 30-day follow-up. CONCLUSIONS The CS reducer is a promising treatment option for patients with refractory angina who are not candidates for revascularization. However, larger randomized control trials with long-term follow-up are needed to elucidate its role.
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Affiliation(s)
- George Bazoukis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, P. R. China.,Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, SAR, P. R. China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Panagiotis Kitsoulis
- Laboratory of Anatomy-Histology-Embryology, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, P. R. China
| | - Adrian Baranchuk
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | - Antonios Sideris
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, Athens, Greece
| | - Stavros Stavrakis
- Department of Medicine, Cardiovascular Section, Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Tse G, Gong M, Meng L, Wong CW, Bazoukis G, Chan MTV, Wong MCS, Letsas KP, Baranchuk A, Yan GX, Liu T, Wu WKK. Predictive Value of T peak - T end Indices for Adverse Outcomes in Acquired QT Prolongation: A Meta-Analysis. Front Physiol 2018; 9:1226. [PMID: 30233403 PMCID: PMC6129769 DOI: 10.3389/fphys.2018.01226] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/14/2018] [Indexed: 01/13/2023] Open
Abstract
Background: Acquired QT interval prolongation has been linked with malignant ventricular arrhythmias, such as torsade de pointes, in turn predisposing to sudden cardiac death. Increased dispersion of repolarization has been identified as a pro-arrhythmic factor and can be observed as longer Tpeak - Tend interval and higher Tpeak - Tend/QT ratio on the electrocardiogram. However, the values of these repolarization indices for predicting adverse outcomes in this context have not been systematically evaluated. Method: PubMed, Embase and Cochrane Library databases were searched until 14th February 2018, identifying 232 studies. Results: Five studies on acquired QT prolongation met the inclusion criteria and 308 subjects with drug-induced LQTS patients (mean age: 66 ± 18 years old; 46% male) were included in this meta-analysis. Tpeak - Tend intervals were longer [mean difference [MD]: 76 ms, standard error [SE]: 26 ms, P = 0.003; I2 = 98%] and Tpeak - Tend/QT ratios were higher (MD: 0.14, SE: 0.03, P = 0.000; I2 = 29%) in patients with torsade de pointes compared to those without these events. Conclusion: Tpeak - Tend interval and Tpeak - Tend/QT ratio were higher in patients with acquired QT prolongation suffering from torsade de pointes compared to those who did not. These repolarization indices may provide additional predictive value for identifying high-risk individuals.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong.,Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, Hong Kong
| | - Lei Meng
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, Hong Kong
| | - Cheuk W Wong
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Matthew T V Chan
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Martin C S Wong
- JC School of Public Health and Primary Care, Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, Canada
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, PA, United States.,Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, Hong Kong
| | - William K K Wu
- Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Hong Kong, Hong Kong
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Impact of Coronary Artery Chronic Total Occlusion on Arrhythmic and Mortality Outcomes: A Systematic Review and Meta-Analysis. JACC Clin Electrophysiol 2018; 4:1214-1223. [PMID: 30236396 DOI: 10.1016/j.jacep.2018.06.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/03/2018] [Accepted: 06/07/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to examine the relationship between chronic coronary artery total occlusion (CTO) status and the occurrence of ventricular tachycardia (VT)/ventricular fibrillation (VF) or appropriate implantable cardioverter-defibrillator (ICD) therapy. BACKGROUND CTO is a significant problem in patients with ischemic heart disease. However, the extent to which it predisposes affected individuals to VT/VF and whether these arrhythmic events could be prevented by revascularization are unclear. Therefore, a systematic review and meta-analysis were conducted to examine the relationship between CTO status and the occurrence of VT/VF or appropriate ICD therapy. METHODS PubMed and Embase databases were searched until November 16, 2017, identifying 137 studies. RESULTS Seventeen studies involving 54,594 subjects (mean age, 61 ± 21 years of age, 81% male) with a mean follow-up of 43 ± 31 months were included. The presence of CTO was associated with higher risk of VT/VF or appropriate ICD therapy (adjusted hazard ratio [aHR]: 1.99; 95% confidence interval (CI): 1.53 to 2.59; p < 0.0001, I2 = 3%) but not in cardiac mortality (aHR: 2.59; 95% CI: 0.64 to 10.59; p = 0.18, I2 = 86%) or in all-cause mortality (aHR: 1.70; 95% CI: 0.84 to 3.46; p = 0.14; I2 = 64%). Compared to patients with non-infarct-related CTOs, those with infarct-related CTOs have a higher risk of VT/VF or appropriate ICD therapy (aHR: 2.47; 95% CI: 1.76 to 3.46; p < 0.0001; I2 = 14%), cardiac mortality (aHR: 2.73; 95% CI: 1.02 to 7.30; p < 0.05; I2 = 79%) and higher all-cause mortality (aHR: 1.69; 95% CI: 1.19 to 2.40; p < 0.01; I2 = 40%). Nonrevascularization of CTOs tended to be associated with an increased risk of all-cause mortality compared to successful revascularization (unadjusted HR: 1.52; 95% CI: 0.96 to 2.43; p = 0.08; I2 = 76). CONCLUSIONS CTOs, especially infarct-related, are associated with high risk of VT/VF or appropriate ICD therapy and mortality. ICD implantation could be beneficial. However, it is not clear that revascularization has an impact on the outcome of patients with CTOs.
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Bazoukis G, Tse G, Naka KK, Kalfakakou V, Vlachos K, Saplaouras A, Letsas KP, Korantzopoulos P, Thomopoulos C, Michelongona P, Bazoukis X, González-Salvado V, Liu T, Michalis LK, Baranchuk A, Itoh T, Efremidis M, Tsioufis C, Stavrakis S. Impact of major earthquakes on the incidence of acute coronary syndromes - A systematic review of the literature. Hellenic J Cardiol 2018; 59:262-267. [PMID: 29807192 DOI: 10.1016/j.hjc.2018.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/11/2018] [Accepted: 05/18/2018] [Indexed: 01/13/2023] Open
Abstract
Natural disasters such as tsunami, hurricanes, and earthquakes may have a negative impact on cardiac health. The aim of our systematic review is to evaluate the impact of earthquakes on the incidence of acute coronary syndromes and cardiac mortality and to examine the impact of the time of earthquakes on the incidence of acute coronary syndromes. MEDLINE and Cochrane databases were searched for studies assessing the impact of earthquakes on acute coronary syndromes from inception until December 20, 2017. Reference lists of all included studies and relevant review studies were also searched. A total of 26 studies on 12 earthquake disasters were included in the systematic review. The existing data show a significant negative impact of the Great East Japan, Christchurch, Niigata-Chuetsu, Northridge, Great Hanshin-Awaji, Sichuan, Athens, Armenia, and Noto Peninsula earthquakes on the incidence of acute coronary syndromes. By contrast, studies on the Newcastle, Loma Prieta, and Thessaloniki earthquakes did not show a significant correlation with myocardial infarction and cardiac mortality. In conclusion, earthquakes may be associated with increased incidence of acute coronary syndromes and cardiovascular mortality. There are conflicting data about the impact of the timing of earthquakes on the occurrence of acute coronary syndromes. Preventive measures to promote the adjustment of healthcare systems to treat cardiovascular diseases after natural disasters should be immediately implemented particularly in high-risk regions.
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Affiliation(s)
- George Bazoukis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece.
| | - Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
| | - Katerina K Naka
- Second Department of Cardiology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Vasiliki Kalfakakou
- Laboratory of Physiology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Konstantinos Vlachos
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Athanasios Saplaouras
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Konstantinos P Letsas
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | | | | | | | - Xenophon Bazoukis
- Department of Cardiology, 'G. Hatzikosta' General Hospital, Ioannina, Greece
| | - Violeta González-Salvado
- Cardiology Department, University Clinical Hospital of Santiago, Universidade de Santiago de Compostela, Santiago de Compostela, Spain; Institute of Health Research of Santiago (IDIS), Spain
| | - Tong Liu
- Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, People's Republic of China
| | - Lampros K Michalis
- Second Department of Cardiology, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Adrian Baranchuk
- Division of Cardiology, Electrophysiology and Pacing, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada.
| | - Tomonori Itoh
- Department of Internal Medicine, Iwate Medical University, Uchimaru, Morioka, 020-8505, Japan
| | - Michael Efremidis
- Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, Hippokration Hospital, University of Athens, 114 Vas.Sofias Ave., 11527, Athens, Greece
| | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
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Jaywant A, Toglia J, Gunning FM, O'Dell MW. The clinical utility of a 30-minute neuropsychological assessment battery in inpatient stroke rehabilitation. J Neurol Sci 2018; 390:54-62. [PMID: 29801908 DOI: 10.1016/j.jns.2018.04.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 04/06/2018] [Accepted: 04/08/2018] [Indexed: 01/13/2023]
Abstract
Cognitive assessment is an important component of inpatient stroke rehabilitation. Few studies have empirically evaluated the clinical utility of specific neuropsychological measures in this setting. We investigated the psychometric properties and clinical utility of a 30-minute neuropsychological battery developed by the National Institute of Neurologic Disorders and Stroke (NINDS) and the Canadian Stroke Network (CSN). Clinical data were analyzed from 100 individuals with mild-moderate stroke severity on an acute inpatient rehabilitation unit who completed the NINDS-CSN battery at admission. The battery comprised the Symbol-Digit Modalities Test (SDMT), Trail Making Test, Controlled Oral Word Association Test, Animal Naming, and the Hopkins Verbal Learning Test-Revised. We evaluated the battery's distribution of scores, frequency of impaired performance, internal consistency, and ability to predict rehabilitation gain and independence in cognitively-based instrumental activities of daily living (IADL) at discharge. Results indicated that the NINDS-CSN battery was sensitive to cognitive impairment, demonstrated moderately strong internal consistency, and predicted discharge IADL. The SDMT demonstrated the strongest sensitivity to impairment and predictive validity. The NINDS-CSN battery is a clinically useful assessment battery in acute inpatient stroke rehabilitation. Complex attention and processing speed performance may be most informative in predicting amount of rehabilitation gain and IADL functioning at discharge.
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Affiliation(s)
- Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th St, New York, NY 10065, United States; Department of Psychiatry, Weill Cornell Medicine, 525 East 68th St, New York, NY 10065, United States; NewYork-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th St, New York, NY 10065, United States.
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th St, New York, NY 10065, United States; School of Health and Natural Sciences, Mercy College, 555 Broadway, Dobbs Ferry, NY 10522, United States; NewYork-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th St, New York, NY 10065, United States.
| | - Faith M Gunning
- Department of Psychiatry, Weill Cornell Medicine, 525 East 68th St, New York, NY 10065, United States; NewYork-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th St, New York, NY 10065, United States.
| | - Michael W O'Dell
- Department of Rehabilitation Medicine, Weill Cornell Medicine, 525 East 68th St, New York, NY 10065, United States; NewYork-Presbyterian Hospital, Weill Cornell Medical Center, 525 East 68th St, New York, NY 10065, United States.
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Driving habits and behaviors of patients with brain tumors: a self-report, cognitive and driving simulation study. Sci Rep 2018; 8:4635. [PMID: 29545606 PMCID: PMC5854700 DOI: 10.1038/s41598-018-22937-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/05/2018] [Indexed: 01/13/2023] Open
Abstract
The purpose of the study is to determine driving habits and behaviors of patients with brain tumors in order to better inform discussions around driving safety in this population. Eight-four patients with brain tumors participated in a survey on their driving behaviors since their diagnosis. Thirteen of these patients and thirteen sex- and age-matched healthy controls participated in cognitive testing and several driving simulation scenarios in order to objectively assess driving performance. Survey responses demonstrated that patients with brain tumors engage in a variety of driving scenarios with little subjectve difficulty. On the driving simulation tasks, patients and healthy controls performed similarly except that patients had more speed exceedances (U = 41, p < 0.05) and a greater variability in speed (U = 57, p < 0.05). Performance on the selective attention component of the UFOV was significantly associated with greater total errors in the Bus Following task for patients with brain tumors compared to healthy controls (rs = 0.722, p < 0.05, CI [0.080, 0.957]). Better comprehensive driving assessments are needed to identify patients with driving behaviors that put themselves and others at risk on the road.
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Meta-analysis of T peak-T end and T peak-T end/QT ratio for risk stratification in congenital long QT syndrome. J Electrocardiol 2018; 51:396-401. [PMID: 29550106 DOI: 10.1016/j.jelectrocard.2018.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/13/2018] [Accepted: 03/06/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Congenital long QT syndrome (LQTS) predisposes affected individuals to ventricular tachycardia/fibrillation (VF/VF), potentially resulting in sudden cardiac death. The Tpeak-Tend interval and the Tpeak-Tend/QT ratio, electrocardiographic markers of dispersion of ventricular repolarization, were proposed for risk stratification but their predictive values in LQTS have been controversial. A systematic review and meta-analysis was conducted to examine the value of Tpeak-Tend intervals and Tpeak-Tend/QT ratios in predicting arrhythmic and mortality outcomes in congenital LQTS. METHOD PubMed and Embase databases were searched until 9th May 2017, identifying 199 studies. RESULTS Five studies on long QT syndrome were included in the final meta-analysis. Tpeak-Tend intervals were longer (mean difference [MD]: 13ms, standard error [SE]: 4ms, P=0.002; I2=34%) in congenital LQTS patients with adverse events [syncope, ventricular arrhythmias or sudden cardiac death] compared to LQTS patients without such events. By contrast, Tpeak-Tend/QT ratios were not significantly different between the two groups (MD: 0.02, SE: 0.02, P=0.26; I2=0%). CONCLUSION This meta-analysis showed that Tpeak-Tend interval is significant higher in individuals who are at elevated risk of adverse events in congenital LQTS, offering incremental value for risk stratification.
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68
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McNamara A, John Barr C, Bond MJ, George S. A pilot study: Can the UFOV assessment be used as a repeated measure to determine timing of on-road assessment in stroke? Aust Occup Ther J 2018; 66:5-12. [PMID: 29460955 DOI: 10.1111/1440-1630.12456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND/AIMS Useful Field of View scores are predictive of on-road performance post-stroke. No objective data exist to determine if the Useful Field of View (UFOV) assessment can be used as a repeated measure in the post-stroke population to determine timing of occupational therapy on-road assessment as recovery occurs. The aims of this study were to determine whether there is a practice effect if the UFOV is administered at one, two and three months' post-stroke and to assess optimal time post-stroke to refer to an on-road assessment. METHOD Forty-two participants, 17 men (40.5%), with a mean age of 71 years (SD 9.33) were randomly allocated to 1. Assessment group - UFOV at one, two and three months' post-stroke, 2. Control group-UFOV at three months' post-stroke. Parametric and non-parametric tests were utilised depending on data distribution. RESULTS No significance was found between; three months' subtest 1 (P = 0.463), three months' subtest 2 (P = 0.729) and three months' subtest 3 (P = 0.534) between the assessment and control groups. Both group's scores were combined to examine pass/fail rates of UFOV assessment to indicate timing of referral to on-road assessments. At one month, 16.9% stroke survivors passed the UFOV, when reassessed at three months 69.1% passed and 28.6% again failed. CONCLUSION Improvements in scores at one month intervals over three months are due to improvements in abilities assessed by the UFOV as no practice effect was found to influence scores. UFOV scores performed at monthly intervals post-stroke can be used to guide the timing of an occupational therapy on-road assessment, with an increased likelihood of passing, as recovery occurs. This repeated use of the UFOV assessment can assist referral practices that best utilise driving rehabilitation programmes. Larger studies need to be conducted to confirm these results.
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Affiliation(s)
- Annabel McNamara
- College of Nursing and Health Sciences, Rehabilitation and Aged Studies Unit, Bedford Park, South Australia, Australia
| | - Christopher John Barr
- College of Nursing and Health Sciences, Rehabilitation and Aged Studies Unit, Bedford Park, South Australia, Australia
| | - Malcolm J Bond
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Rehabilitation and Aged Studies Unit, Bedford Park, South Australia, Australia
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Hird MA, Vesely KA, Tasneem T, Saposnik G, Macdonald RL, Schweizer TA. A Case-Control Study Investigating Simulated Driving Errors in Ischemic Stroke and Subarachnoid Hemorrhage. Front Neurol 2018; 9:54. [PMID: 29487561 PMCID: PMC5816745 DOI: 10.3389/fneur.2018.00054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/22/2018] [Indexed: 01/13/2023] Open
Abstract
Background Stroke 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. Methods We 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. Results Nine 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. Conclusion Both 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.
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Affiliation(s)
- Megan A Hird
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Kristin A Vesely
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Tahira Tasneem
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Gustavo Saposnik
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Stroke Research Unit, Mobility Program, St. Michael's Hospital, Toronto, ON, Canada.,Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - R Loch Macdonald
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, ON, Canada
| | - Tom A Schweizer
- Neuroscience Research Program, Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Surgery, Neurosurgery Division, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, ON, Canada
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70
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Blane A, Falkmer T, Lee HC, Dukic Willstrand T. Investigating cognitive ability and self-reported driving performance of post-stroke adults in a driving simulator. Top Stroke Rehabil 2017; 25:44-53. [PMID: 29022422 DOI: 10.1080/10749357.2017.1373929] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background Safe driving is a complex activity that requires calibration. This means the driver can accurately assess the level of task demand required for task completion and can accurately evaluate their driving capability. There is much debate on the calibration ability of post-stroke drivers. Objectives The aim of this study was to assess the cognition, self-rated performance, and estimation of task demand in a driving simulator with post-stroke drivers and controls. Methods A between-groups study design was employed, which included a post-stroke driver group and a group of similarly aged older control drivers. Both groups were observed driving in two simulator-based driving scenarios and asked to complete the NASA Task Load Index (TLX) to assess their perceived task demand and self-rate their driving performance. Participants also completed a battery of psychometric tasks to assess attention and executive function, which was used to determine whether post-stroke cognitive impairment impacted on calibration. Results There was no difference in the amount of perceived task demand required to complete the driving task. Despite impairments in cognition, the post-stroke drivers were not more likely to over-estimate their driving abilities than controls. On average, the post-stroke drivers self-rated themselves more poorly than the controls and this rating was related to cognitive ability. Conclusion This study suggests that post-stroke drivers may be aware of their deficits and adjust their driving behavior. Furthermore, using self-performance measures alongside a driving simulator and cognitive assessments may provide complementary fitness-to-drive assessments, as well as rehabilitation tools during post-stroke recovery.
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Affiliation(s)
- Alison Blane
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Torbjörn Falkmer
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia.,b School of Health Sciences , Jönköping University , Jönköping , Sweden.,c Rehabilitation Medicine, Faculty of Health Sciences, Department of Medicine and Health Sciences (IMH) , Linköping University & Pain and Rehabilitation Centre, UHL, County Council , Linköping , Sweden.,d School of Occupational Therapy , La Trobe University , Melbourne , Australia
| | - Hoe C Lee
- a School of Occupational Therapy and Social Work , Curtin University , Perth , Australia
| | - Tania Dukic Willstrand
- e Human Factors , Swedish National Road and Transport Research Institute (VTI) , Göteborg , Sweden
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Tse G, Wong CW, Gong M, Wong WT, Bazoukis G, Wong SH, Li G, Wu WKK, Tse LA, Lampropoulos K, Xia Y, Liu T, Baranchuk A. Predictive value of inter-atrial block for new onset or recurrent atrial fibrillation: A systematic review and meta-analysis. Int J Cardiol 2017; 250:152-156. [PMID: 29017777 DOI: 10.1016/j.ijcard.2017.09.176] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 09/18/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Inter-atrial block (IAB) is characterized by a delay of inter-atrial conduction and is defined electrocardiographically by a P-wave duration (PWD)>120ms. Several studies have implicated IAB in the development of new onset atrial fibrillation (AF), whereas others have reported no significant associations. Moreover, there has been no systematic evaluation of the predictive value of IAB in AF recurrence. Therefore, we conducted a systematic review and meta-analysis to examine whether IAB predicts new onset AF or AF recurrence. METHODS PubMed and Embase databases were searched through 30th July 2017 for studies investigating the relationship between IAB and AF. RESULTS The initial search identified 260 studies, of which 16 studies met the inclusion criteria. This meta-analysis included 18,204 patients (mean age 56±13, 48% male) with a mean follow-up period of 15.1years. IAB significantly predicted new onset AF (hazard ratio [HR]: 2.42, 95% confidence interval [CI]: 1.44 to 4.07, P=0.001; 84%). For partial IAB, the risk of new onset AF did not reach statistical significance (HR: 1.42, 95% CI: 0.85 to 2.34; P=0.18; I2=13%). Contrastingly, advanced IAB was a significant predictor of new onset AF with a pooled HR of 2.58 (95% CI: 1.35 to 4.96; P<0.01; I2=67%). IAB also predicted AF recurrence after ablation (HR: 2.59, 95% CI: 1.35 to 4.96; P<0.01; I2=67%). CONCLUSIONS IAB is a significant predictor of both new onset AF and AF recurrence.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China.
| | - Cheuk Wai Wong
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Sunny Hei Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Guangping Li
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - William K K Wu
- Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China; Department of Anaesthesia and Intensive Care, State Key Laboratory of Digestive Disease, LKS Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Lap Ah Tse
- Division of Occupational and Environmental Health, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Konstantinos Lampropoulos
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Adrian Baranchuk
- Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
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72
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Johnson NX, Marquine MJ, Flores I, Umlauf A, Baum CM, Wong AWK, Young AC, Manly JJ, Heinemann AW, Magasi S, Heaton RK. Racial Differences in Neurocognitive Outcomes Post-Stroke: The Impact of Healthcare Variables. J Int Neuropsychol Soc 2017; 23:640-652. [PMID: 28660849 PMCID: PMC5703208 DOI: 10.1017/s1355617717000480] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The present study examined differences in neurocognitive outcomes among non-Hispanic Black and White stroke survivors using the NIH Toolbox-Cognition Battery (NIHTB-CB), and investigated the roles of healthcare variables in explaining racial differences in neurocognitive outcomes post-stroke. METHODS One-hundred seventy adults (91 Black; 79 White), who participated in a multisite study were included (age: M=56.4; SD=12.6; education: M=13.7; SD=2.5; 50% male; years post-stroke: 1-18; stroke type: 72% ischemic, 28% hemorrhagic). Neurocognitive function was assessed with the NIHTB-CB, using demographically corrected norms. Participants completed measures of socio-demographic characteristics, health literacy, and healthcare use and access. Stroke severity was assessed with the Modified Rankin Scale. RESULTS An independent samples t test indicated Blacks showed more neurocognitive impairment (NIHTB-CB Fluid Composite T-score: M=37.63; SD=11.67) than Whites (Fluid T-score: M=42.59, SD=11.54; p=.006). This difference remained significant after adjusting for reading level (NIHTB-CB Oral Reading), and when stratified by stroke severity. Blacks also scored lower on health literacy, reported differences in insurance type, and reported decreased confidence in the doctors treating them. Multivariable models adjusting for reading level and injury severity showed that health literacy and insurance type were statistically significant predictors of the Fluid cognitive composite (p<.001 and p=.02, respectively) and significantly mediated racial differences on neurocognitive impairment. CONCLUSIONS We replicated prior work showing that Blacks are at increased risk for poorer neurocognitive outcomes post-stroke than Whites. Health literacy and insurance type might be important modifiable factors influencing these differences. (JINS, 2017, 23, 640-652).
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Affiliation(s)
- Neco X Johnson
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Maria J Marquine
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Ilse Flores
- 1San Diego State University,Department of Psychology,San Diego,California
| | - Anya Umlauf
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
| | - Carolyn M Baum
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alex W K Wong
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | - Alexis C Young
- 3Washington University in St. Louis,Program in Occupational Therapy,St. Louis,Missouri
| | | | - Allen W Heinemann
- 5Northwestern University,Feinberg School of Medicine,Department of Physical Medicine & Rehabilitation and Rehabilitation Institute of Chicago,Chicago,Illinois
| | - Susan Magasi
- 6University of Illinois at Chicago,Department of Occupational Therapy,Chicago,Illinois
| | - Robert K Heaton
- 2University of California,San Diego,Department of Psychiatry,San Diego,California
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73
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Electrophysiological evidence for pre-attention information processing improvement in patients with central hemiplegic after peripheral nerve rewiring: a pilot study. Sci Rep 2017; 7:6888. [PMID: 28761096 PMCID: PMC5537276 DOI: 10.1038/s41598-017-07263-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 06/28/2017] [Indexed: 12/03/2022] Open
Abstract
Central neurologic injury (CNI) causes dysfunctions not only in limbs but also in cognitive ability. We applied a novel peripheral nerve rewiring (PNR) surgical procedure to restore limb function. Here, we conducted a prospective study to develop estimates for the extent of preattentive processes to cognitive function changes in CNI patients after PNR. Auditory mismatch negativity (MMN) was measured in CNI patients who received the PNR surgery plus conventional rehabilitation treatment. During the 2-year follow-up, the MMN was enhanced with increased amplitude in the PNR plus rehabilitation group compared to the rehabilitation-only group as the experiment progressed, and progressive improvement in behavioural examination tests was also observed. Furthermore, we found a significant correlation between the changes in Fugl-Meyer assessment scale scores and in MMN amplitudes. These results suggested that PNR could affect the efficiency of pre-attention information processing synchronously with the recovery of motor function in the paralyzed arm of the in chronic CNI patients. Such electroencephalographic measures might provide a biological approach with which to distinguish patient subgroups after surgery, and the change in MMN may serve as an objective auxiliary index, indicating the degree of motor recovery and brain cognitive function.
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74
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Influence of the rehabilitation outcome on returning to drive after neurological impairment. Int J Rehabil Res 2017; 40:107-111. [DOI: 10.1097/mrr.0000000000000213] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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75
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Fields SM, Unsworth CA. Revision of the Competency Standards for Occupational Therapy Driver Assessors: An overview of the evidence for the inclusion of cognitive and perceptual assessments within fitness-to-drive evaluations. Aust Occup Ther J 2017; 64:328-339. [DOI: 10.1111/1440-1630.12379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Sally M. Fields
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast Queensland Australia
| | - Carolyn A. Unsworth
- Occupational Therapy; School of Health; Medical and Applied Sciences; Central Queensland University; Melbourne Victoria Australia
- Department of Rehabilitation; School of Health Sciences; Jönköping University; Jönköping Sweden
- Faculty of Health Sciences; Curtin University; Bentley Western Australia Australia
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76
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Assessing Cognitive Ability and Simulator-Based Driving Performance in Poststroke Adults. Behav Neurol 2017; 2017:1378308. [PMID: 28559646 PMCID: PMC5438860 DOI: 10.1155/2017/1378308] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/14/2017] [Indexed: 01/13/2023] Open
Abstract
Driving is an important activity of daily living, which is increasingly relied upon as the population ages. It has been well-established that cognitive processes decline following a stroke and these processes may influence driving performance. There is much debate on the use of off-road neurological assessments and driving simulators as tools to predict driving performance; however, the majority of research uses unlicensed poststroke drivers, making the comparability of poststroke adults to that of a control group difficult. It stands to reason that in order to determine whether simulators and cognitive assessments can accurately assess driving performance, the baseline should be set by licenced drivers. Therefore, the aim of this study was to assess differences in cognitive ability and driving simulator performance in licensed community-dwelling poststroke drivers and controls. Two groups of licensed drivers (37 poststroke and 43 controls) were assessed using several cognitive tasks and using a driving simulator. The poststroke adults exhibited poorer cognitive ability; however, there were no differences in simulator performance between groups except that the poststroke drivers demonstrated less variability in driver headway. The application of these results as a prescreening toolbox for poststroke drivers is discussed.
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77
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Executive Function Is Associated With Off-Line Motor Learning in People With Chronic Stroke. J Neurol Phys Ther 2017; 41:101-106. [DOI: 10.1097/npt.0000000000000170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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78
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Rike PO, Johansen HJ, Ulleberg P, Lundqvist A, Schanke AK. Exploring associations between self-regulatory mechanisms and neuropsychological functioning and driver behaviour after brain injury. Neuropsychol Rehabil 2017; 28:466-490. [PMID: 28278592 DOI: 10.1080/09602011.2016.1170702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of this prospective one-year follow-up study was to explore the associations between self-regulatory mechanisms and neuropsychological tests as well as baseline and follow-up ratings of driver behaviour. The participants were a cohort of subjects with stroke and traumatic brain injury (TBI) who were found fit to drive after a multi-disciplinary driver assessment (baseline). Baseline measures included neuropsychological tests and ratings of self-regulatory mechanisms, i.e., executive functions (Behavior Rating Inventory of Executive Function-Adult Version; BRIEF-A) and impulsive personality traits (UPPS Impulsive Behavior Scale). The participants rated pre-injury driving behaviour on the Driver Behaviour Qestionnaire (DBQ) retrospectively at baseline and after one year of post-injury driving (follow-up). Better performance on neuropsychological tests was significantly associated with more post-injury DBQ Violations. The BRIEF-A main indexes were significantly associated with baseline and follow-up ratings of DBQ Mistakes and follow-up DBQ Inattention. UPPS (lack of) Perseverance was significantly associated with baseline DBQ Inattention, whereas UPPS Urgency was significantly associated with baseline DBQ Inexperience and post-injury DBQ Mistakes. There were no significant changes in DBQ ratings from baseline (pre-injury) to follow-up (post-injury). It was concluded that neuropsychological functioning and self-regulatory mechanisms are related to driver behaviour. Some aspects of driver behaviour do not necessarily change after brain injury, reflecting the influence of premorbid driving behaviour or impaired awareness of deficits on post-injury driving behaviour. Further evidence is required to predict the role of self-regulatory mechanisms on driver behaviour and crashes or near misses.
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Affiliation(s)
- Per-Ola Rike
- a Sunnaas Rehabilitation Hospital , Nesodden , Norway
| | | | - Pål Ulleberg
- c Department of Psychology , University of Oslo , Oslo , Norway
| | - Anna Lundqvist
- d Department of Rehabilitation Medicine , University Hospital , Linköping , Sweden
| | - Anne-Kristine Schanke
- a Sunnaas Rehabilitation Hospital , Nesodden , Norway.,c Department of Psychology , University of Oslo , Oslo , Norway
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79
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Gibbons C, Smith N, Middleton R, Clack J, Weaver B, Dubois S, Bédard M. Using Serial Trichotomization With Common Cognitive Tests to Screen for Fitness to Drive. Am J Occup Ther 2017; 71:7102260010p1-7102260010p8. [PMID: 28218592 DOI: 10.5014/ajot.2017.019695] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive. METHOD We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails B], and an on-road driving test) from 83 people referred for a driving evaluation. We identified cutpoints for 100% sensitivity and specificity for each test; the driving test was the gold standard. Using serial trichotomization, we classified drivers as either "Pass," "Fail," or "Indeterminate." RESULTS Trails B had the best sensitivity and specificity (66.3% of participants correctly classified). After applying serial trichotomization, we correctly identified the driving test outcome for 78.3% of participants. CONCLUSION A screening strategy using serial trichotomization of multiple test results may reduce uncertainty about fitness to drive.
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Affiliation(s)
- Carrie Gibbons
- Carrie Gibbons, MPH, is Research Coordinator, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Nathan Smith
- Nathan Smith, MPH, is Research Assistant, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada
| | - Randy Middleton
- Randy Middleton, MScOT, is Occupational Therapist, St. Joseph's Hospital, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - John Clack
- John Clack, MScOT, is Occupational Therapist, St. Joseph's Hospital, St. Joseph's Care Group, Thunder Bay, ON, Canada
| | - Bruce Weaver
- Bruce Weaver, MSc, is Research Associate, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada, and Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Sacha Dubois
- Sacha Dubois, MPH, is Research Statistician, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada; Adjunct Professor, Lakehead University, Thunder Bay, ON, Canada; and Assistant Professor, Northern Ontario School of Medicine, Thunder Bay, ON, Canada
| | - Michel Bédard
- Michel Bédard, PhD, is Professor, Lakehead University and Northern Ontario School of Medicine, Thunder Bay, ON, Canada; Director, Centre for Research on Safe Driving, Lakehead University, Thunder Bay, ON, Canada; and Scientific Director, Centre for Applied Health Research, St. Joseph's Care Group, Thunder Bay, ON, Canada;
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80
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Cammarata M, Mueller AS, Harris J, Vrkljan B. The Role of the Occupational Therapist in Driver Rehabilitation After Stroke. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017. [DOI: 10.1080/02703181.2016.1277443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Michael Cammarata
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra S. Mueller
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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81
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Choi SY, Lee JS. Cognitive basis about risk level classifications for the self-assessment of older drivers. J Phys Ther Sci 2017; 29:401-404. [PMID: 28356619 PMCID: PMC5360998 DOI: 10.1589/jpts.29.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/22/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study analyzed the cognitive functions according to risk level for the
Driver 65 Plus measure, and examined the cognitive basis of self-assessment for screening
the driving risk of elderly drivers. [Subjects and Methods] A total of 46 older drivers
with a driver’s license participated in this study. All participants were evaluated with
Driver 65 Plus. They were classified into three groups of “safe,” “caution” and “stop,”
and examined for cognitive functions with Trail Making Test and Montreal Cognitive
Assessment-K. The cognitive test results of the three groups were compared. [Results]
Trail Making Test-A, Trail Making Test-B, and Montreal Cognitive Assessment-K showed a
significant difference between the three groups. The safe group showed significantly
higher ability than the caution and stop groups in the three cognitive tests. In addition,
cognitive functions of naming, attention, language, and delayed recall were significantly
different between the three groups. [Conclusion] Self-assessment of older drivers is a
useful tool for screening the cognitive aspects of driving risk. The cognitive functions,
such as attention and recall, are the critical factors for screening the driving risk of
elderly drivers.
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Affiliation(s)
- Seong Youl Choi
- Department of Occupational Therapy, Kwangju Women's University, Republic of Korea
| | - Jae Shin Lee
- Department of Occupational Therapy, Konyang University: 158 Gwanjeodong-ro, Seo-gu, Daejeon 302-832, Republic of Korea
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82
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Devos H, Ranchet M, Backus D, Abisamra M, Anschutz J, Allison CD, Mathur S, Akinwuntan AE. Determinants of On-Road Driving in Multiple Sclerosis. Arch Phys Med Rehabil 2016; 98:1332-1338.e2. [PMID: 27840131 DOI: 10.1016/j.apmr.2016.10.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 10/18/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the cognitive, visual, and motor deficits underlying poor performance on different dimensions of on-road driving in individuals with multiple sclerosis (MS). DESIGN Prospective cross-sectional study. SETTING MS clinic and driving simulator lab. PARTICIPANTS Active drivers (N=102) with various types of MS. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Off-road cognitive, visual, and motor functions, as well as 13 specific driving skills. These skills were categorized into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving. Stepwise regression analysis was used to determine the off-road functions influencing performance on the on-road test and each cluster. RESULTS Visuospatial function (P=.002), inhibition (P=.008), binocular acuity (P=.04), vertical visual field (P=.02), and stereopsis (P=.03) best determined variance in total on-road score (unadjusted R2=.37). Attentional shift (P=.0004), stereopsis (P=.007), glare recovery (P=.047), and use of assistive devices (P=.03) best predicted the operational cluster (unadjusted R2=.28). Visuospatial function (P=.002), inhibition (P=.002), reasoning (P=.003), binocular acuity (P=.04), and stereopsis (P=.005) best determined the tactical cluster (unadjusted R2=.41). The visuo-integrative model (unadjusted R2=.12) comprised binocular acuity (P=.007) and stereopsis (P=.045). Inhibition (P=.0001) and binocular acuity (P=.001) provided the best model of the mixed cluster (unadjusted R2=.25). CONCLUSIONS Our results provide more insights into the specific impairments that influence different dimensions of on-road driving and may be used as a framework for targeted driving intervention programs in MS.
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Affiliation(s)
- Hannes Devos
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS; Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA.
| | - Maud Ranchet
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA; French Institute of Science and Technology for Transport, Development and Networks (IFSTTAR), Laboratory of Ergonomic and Cognitive Sciences for Transports (TS2-LESCOT), Bron, France
| | | | | | | | | | - Sunil Mathur
- Biostatistics Department, Medical College of Georgia, Augusta University, Augusta, GA
| | - Abiodun E Akinwuntan
- Department of Physical Therapy, College of Allied Health Sciences, Augusta University, Augusta, GA; Dean's Office, School of Health Professions, University of Kansas Medical Center, Kansas City, KS
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83
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Bowers AR. Driving with homonymous visual field loss: a review of the literature. Clin Exp Optom 2016; 99:402-18. [PMID: 27535208 DOI: 10.1111/cxo.12425] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 02/02/2016] [Accepted: 02/26/2016] [Indexed: 01/13/2023] Open
Abstract
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) behaviour. 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 people with HFDs for visual fitness to drive. 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 individualised assessments of practical fitness to drive either on the road and/or in a driving simulator.
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Affiliation(s)
- Alex R Bowers
- Schepens Eye Research Institute, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.
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84
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Choi SY, Lee JS, Oh YJ. Cut-off point for the trail making test to predict unsafe driving after stroke. J Phys Ther Sci 2016; 28:2110-3. [PMID: 27512277 PMCID: PMC4968518 DOI: 10.1589/jpts.28.2110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/07/2016] [Indexed: 01/13/2023] Open
Abstract
[Purpose] This study examined the cut-off point of the Trail Making Test in predicting
the risk of unsafe driving in stroke patients. [Subjects and Methods] A total of 81 stroke
patients with a driver’s license participated in this study. The DriveABLE Cognitive
Assessment Tool, Trail Making Test-A, and Trail Making Test-B evaluations were conducted
in all participants. All participants were classified into the safety or risk groups based
on the DriveABLE Cognitive Assessment Tool evaluation results. The Trail Making Test
results underwent a receiver operating characteristic analysis in each group. [Results]
The results of the receiver operating characteristic curve analysis showed that the
cut-off point for Trail Making Test-A was 32 seconds and the cut-off point for Trail
Making Test-B was 79 seconds. The positive predictive values of the Trail Making Test-A
and Trail Making Test-B were 98.3% and 98.3%, respectively, and the negative predictive
values of the Trail Making Test-A and Trail Making Test-B were 81.0% and 73.9%,
respectively. [Conclusion] The Trail Making Test is a useful tool for predicting the risk
of unsafe driving in stroke patients. This tool is expected to be used more actively for
screening stroke drivers with respect to their cognitive function.
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Affiliation(s)
- Seong Youl Choi
- Department of Occupational Therapy, Youngdong University, Republic of Korea
| | - Jae Shin Lee
- Department of Occupational Therapy, Konyang University, Republic of Korea
| | - Young Ju Oh
- Department of Occupational Therapy, Konyang University Hospital, Republic of Korea
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Song CS, Choi YI, Hong SY. Validity and reliability of the safe driving behavior measure in community-dwelling self-drivers with stroke. J Phys Ther Sci 2016; 28:1640-3. [PMID: 27313389 PMCID: PMC4905928 DOI: 10.1589/jpts.28.1640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/06/2016] [Indexed: 01/13/2023] Open
Abstract
[Purpose] Driving is a vital component of recovery for stroke survivors facilitating
restoration of their family roles and reintegration back into their communities and
associations. The purpose of this study was to evaluate the validity and reliability of
the Safe Driving Behavior Measure (SDBM) in community-dwelling self-drivers post-stroke.
[Subjects and Methods] Participants were sixty-seven community-dwelling self-drivers who
had received a diagnosis of first stroke in the past twelve months. To investigate the
validity and reliability of the SDBM, this study evaluated two sessions, held three days
apart in a quiet and well-organized assessment room. Cronbach’s alpha and the Intraclass
Correlation Coefficient [ICC (2.1)] were used to evaluate statistically concurrent
validity and reliability of the overall and three domain scores. Pearson’s correlations
were used to quantify the bivariate associations among the three domains. [Results] The
Cronbach’s alpha coefficients for the three domains of person-vehicle (0.989),
person-environment (0.997), and person-vehicle-environment (0.968) of the SDBM indicated
high internal consistency in community-dwelling self-drivers with stroke, in addition to
excellent rest-retest reliability. [Conclusion] The results of this study suggest that the
SDBM could be a reliable measure to evaluate automobile driving in community-dwelling
self-drivers with stroke.
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Affiliation(s)
- Chiang-Soon Song
- Department of Occupational Therapy, College of Health Science, Chosun University, Republic of Korea
| | - Yoo-Im Choi
- Department of Occupational Therapy, School of Medicine and Institute for Health Improvement, Wonkwang University, Republic of Korea
| | - So-Young Hong
- Department of Occupational Therapy, Division of Health Science, Baekseok University, Republic of Korea
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86
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Ranchet M, Akinwuntan AE, Tant M, Salch A, Neal E, Devos H. Fitness-to-drive agreements after stroke: medical versus practical recommendations. Eur J Neurol 2016; 23:1408-14. [DOI: 10.1111/ene.13050] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 04/21/2016] [Indexed: 01/25/2023]
Affiliation(s)
- M. Ranchet
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - A. E. Akinwuntan
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
- Dean's Office; School of Health Professions; The University of Kansas Medical Center; Kansas City KS USA
| | - M. Tant
- CARA; Belgian Road Safety Institute; Brussels Belgium
| | - A. Salch
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - E. Neal
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
| | - H. Devos
- Department of Physical Therapy; College of Allied Health Sciences; Augusta University; Augusta GA USA
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Winstein CJ, Stein J, Arena R, Bates B, Cherney LR, Cramer SC, Deruyter F, Eng JJ, Fisher B, Harvey RL, Lang CE, MacKay-Lyons M, Ottenbacher KJ, Pugh S, Reeves MJ, Richards LG, Stiers W, Zorowitz RD. Guidelines for Adult Stroke Rehabilitation and Recovery: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2016; 47:e98-e169. [PMID: 27145936 DOI: 10.1161/str.0000000000000098] [Citation(s) in RCA: 1571] [Impact Index Per Article: 196.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. METHODS Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. RESULTS Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness and efficiency of rehabilitation and underlie this entire guideline. Without communication and coordination, isolated efforts to rehabilitate the stroke survivor are unlikely to achieve their full potential. CONCLUSIONS As systems of care evolve in response to healthcare reform efforts, postacute care and rehabilitation are often considered a costly area of care to be trimmed but without recognition of their clinical impact and ability to reduce the risk of downstream medical morbidity resulting from immobility, depression, loss of autonomy, and reduced functional independence. The provision of comprehensive rehabilitation programs with adequate resources, dose, and duration is an essential aspect of stroke care and should be a priority in these redesign efforts. (Stroke.2016;47:e98-e169. DOI: 10.1161/STR.0000000000000098.).
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88
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Dickerson AE, Meuel DB, Ridenour CD, Cooper K. Assessment tools predicting fitness to drive in older adults: a systematic review. Am J Occup Ther 2016; 68:670-80. [PMID: 25397762 DOI: 10.5014/ajot.2014.011833] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic review synthesizes the research on screening and assessment tools used to determine older adults' fitness to drive. After a comprehensive search of the literature targeting tools commonly used by occupational therapists, 64 studies were reviewed and synthesized. The evidence demonstrated that a single tool measuring cognition, vision, perception, or physical ability individually is not sufficient to determine fitness to drive. Although some tools have stronger evidence than others, this review supports using different and focused assessment tools together for specific medical conditions. Results indicate that behind-the-wheel assessment remains the gold standard for driving evaluation; however, emerging evidence for observation of complex instrumental tasks of daily living and driving simulation supports further investigation with these tools.
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Affiliation(s)
- Anne E Dickerson
- Anne E. Dickerson, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, East Carolina University, 3305 Health Sciences Building, Greenville, NC 27858;
| | - Danielle Brown Meuel
- Danielle Brown Meuel, MS, OTR, is Occupational Therapist, Alta Bates Medical Center, Berkeley, CA
| | - Cyrus David Ridenour
- Cyrus David Ridenour, MS, OTR, is Acute Care Therapist, Trinity Mother Francis Hospital, Tyler, TX
| | - Kristen Cooper
- Kristen Cooper, MS, OTR/L, is Occupational Therapist, TriStar StoneCrest Medical Center, Nashville, TN
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Park MO, Jung BK. Effect of activities of daily living status on resuming driving after stroke. J Phys Ther Sci 2015; 27:3759-61. [PMID: 26834346 PMCID: PMC4713785 DOI: 10.1589/jpts.27.3759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 09/17/2015] [Indexed: 01/13/2023] Open
Abstract
[Purpose] This study aimed to investigate the effect of the activities of daily living status on resuming driving after stroke. [Subjects] Thirty-one participants with stroke, who visited in Korean national rehabilitation centers, were included in this study. [Methods] The activities of daily living performance and the driving ability of the participants were assessed with the Korean-Modified Barthel Index in combination with the results obtained by using a driving simulator. [Results] Significant correlations were noted among the Korean-Modified Barthel Index, on-road driving total score, reaction time, speed anticipation tests, judgment tests, and steering wheel-pedal operation tests. Results of Stepwise multiple regression also revealed that the Korean-Modified Barthel Index total score and speed anticipation, with an R(2) of 52.9%. In other words, as the Korean-Modified Barthel Index total score and speed anticipation score increased and the driving performance score also increased in patients who had suffered a stroke. [Conclusion] The activities of daily living status was positively correlated with the patients' post stroke driving ability.
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Affiliation(s)
- Myoung-Ok Park
- Department of Occupational Therapy, Division of Health
Science, Baekseok University, Repubilc of Korea
| | - Bong-Keun Jung
- Department of Occupational Therapy, Division of Health
Science, Baekseok University, Repubilc of Korea
| | - OTD
- Department of Occupational Therapy, College of Medical
Science, Soonchunhyang University, Republic
of Korea
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90
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Choi SY, Yoo DH, Lee JS. Usefulness of the driveABLE cognitive assessment in predicting the driving risk factor of stroke patients. J Phys Ther Sci 2015; 27:3133-5. [PMID: 26644660 PMCID: PMC4668151 DOI: 10.1589/jpts.27.3133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 07/10/2015] [Indexed: 01/13/2023] Open
Abstract
[Purpose] This study examined the usefulness of the DriveABLE cognitive assessment tool
(DCAT) in predicting the driving risk factor of stroke patients, and compared the
cognitive and driving functions of two groups discriminated by DCAT. [Subjects and
Methods] A total of forty-two stroke patients with a driver’s license participated in this
study. Two participants with communication problems were excluded. DCAT was used to
evaluate the risk potential to the driver, and the subjects were classified into two
groups according to the probability of driving risk estimated by the DCAT evaluation. The
safe driver group (SDG) and unsafe driver group (USDG) underwent a driving simulator and
cognitive function assessments. [Results] The results of the SDG and USDG were compared.
The SDG showed higher cognitive function than the USDG. In addition, the SDG showed higher
ability than the USDG in most of the tests associated with the driving function (pedal
reaction time, average reaction time, centerline crossing, road edge excursion, off-road
accidents, collisions). [Conclusion] DCAT is a useful tool for predicting the risk of
driving. In addition, it can predict the driving ability of stroke patients related to the
cognitive function. Nevertheless, a multi-faceted study of associated with driving and
cognitive functions for safe driving will be needed.
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Affiliation(s)
- Seong Youl Choi
- Department of Occupational Therapy, Youngdong University, Republic of Korea
| | - Doo Han Yoo
- Department of Occupational Therapy, Konyang University, Republic of Korea
| | - Jae Shin Lee
- Department of Occupational Therapy, Konyang University, Republic of Korea
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91
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Dickerson AE. Screening and assessment tools for determining fitness to drive: a review of the literature for the pathways project. Occup Ther Health Care 2015; 28:82-121. [PMID: 24754758 DOI: 10.3109/07380577.2014.904535] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
With a brief introduction, 10 tables summarize the findings from the literature describing screening and assessment tools used with older adults to identify risk or determine fitness to drive. With a focus on occupational therapy's duty to address driving as a valued activity, this paper offers information about tools used by occupational therapy practitioners across practice settings and specialists in driver rehabilitation. The tables are organized into groups of key research studies of assessment tools, screening batteries, tools used in combination (i.e., as a battery), driving simulation as an assessment tool, and screening/assessment for individuals with stroke, vision impairment, Parkinson's disease, dementia, and aging. Each table has a summary of important concepts to consider as occupational therapists choose the methods and tools to evaluate fitness to drive.
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Affiliation(s)
- Anne E Dickerson
- Occupational Therapy, East Carolina University , Greenville, North Carolina , USA
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92
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Hird MA, Vesely KA, Christie LE, Alves MA, Pongmoragot J, Saposnik G, Schweizer TA. Is it safe to drive after acute mild stroke? A preliminary report. J Neurol Sci 2015; 354:46-50. [DOI: 10.1016/j.jns.2015.04.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 04/07/2015] [Accepted: 04/27/2015] [Indexed: 01/13/2023]
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Frith J, Hubbard IJ, James CL, Warren-Forward H. Returning to driving after stroke: A systematic review of adherence to guidelines and legislation. Br J Occup Ther 2015. [DOI: 10.1177/0308022614562795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction This systematic review aimed to determine whether stroke survivors routinely received return-to-driving education in the acute hospital setting prior to discharge home; and if education was provided, were the restrictions in driving guidelines adhered to. Method A systematic search was conducted of PubMed, Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Web of Science, Scopus, Pedro and OTseeker databases for original research reporting findings on the adherence to return-to-driving legislation and clinical guidelines after stroke, and return-to-driving behaviours in stroke survivors up to 1 month post stroke. Results Three studies met the inclusion criteria and reported on a combined total of 252 stroke survivors living in the United Kingdom. Forty-eight per cent of stroke survivors received education on the 1 month driving restriction. A total of 61.4% of participants waited 1 month prior to returning to driving. Conclusion This review found that there is limited literature available on the management of return to driving following acute stroke but there is evidence that education may not be routinely provided in the acute hospital setting and that many stroke survivors could be returning to driving within the 1 month restriction.
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Affiliation(s)
- Janet Frith
- Occupational Therapist and Researcher, University of Newcastle, Callaghan, NSW, Australia
| | | | - Carole L James
- Senior Lecturer, University of Newcastle, Callaghan, NSW, Australia
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Kwok JCW, Gélinas I, Benoit D, Chilingaryan G. Predictive validity of the Montreal Cognitive Assessment (MoCA) as a screening tool for on-road driving performance. Br J Occup Ther 2015. [DOI: 10.1177/0308022614562399] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction The objectives of this study are to determine (1) the ability of the Montreal Cognitive Assessment to predict on-road driving performance in drivers with a neurological condition and elderly drivers with suspected cognitive decline, and (2) the association between the performance on the Useful Field of View and the performance on the Montreal Cognitive Assessment. Method This study used a retrospective design. Clients were included who had completed the Montreal Cognitive Assessment and the on-road driving evaluation from November 2006 to May 2009 ( n = 154) in a driving rehabilitation program in the Montreal Area. Total scores on the Montreal Cognitive Assessment, Useful Field of View risk categories, pass or fail outcomes from an on-road evaluation, as well as demographic and clinical characteristics were recorded from participants’ medical charts. Results The Montreal Cognitive Assessment was found to have a sensitivity of 84.5% and a specificity of 50% with a cut-off of ≤25. It was significantly associated with the Useful Field of View risk category. Conclusion The Montreal Cognitive Assessment could be a valuable screening tool. However, its predictive validity is not strong enough to recommend its use as the sole instrument for identifying unfit drivers.
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Affiliation(s)
- Jade Chiu Wai Kwok
- Occupational Therapist, CHUM Hopital Notre-Dame, Montreal, Quebec, Canada
| | - Isabelle Gélinas
- Associate Professor and Graduate Program Director, McGill University, Montreal, Quebec, Canada
| | - Dana Benoit
- Occupational Therapist, Constance-Lethbridge Rehabilitation Center, Montreal, Quebec, Canada
| | - Gevorg Chilingaryan
- Statistician, Jewish Rehabilitation Hospital, Feil & Oberfeld Research Centre, Montreal, Quebec, Canada
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Griffen JA, Rapport LJ, Coleman Bryer R, Scott CA. Driving Status and Community Integration After Stroke. Top Stroke Rehabil 2015; 16:212-21. [DOI: 10.1310/tsr1603-212] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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97
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Devos H, Tant M, Akinwuntan AE. On-Road Driving Impairments and Associated Cognitive Deficits After Stroke. Cerebrovasc Dis 2014; 38:226-32. [DOI: 10.1159/000368219] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/09/2014] [Indexed: 11/19/2022] Open
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98
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Neuropsychological Performance, Brain Imaging, and Driving Violations in Multiple Sclerosis. Arch Phys Med Rehabil 2014; 95:1818-23. [DOI: 10.1016/j.apmr.2014.05.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 05/14/2014] [Accepted: 05/27/2014] [Indexed: 01/13/2023]
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99
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Rike PO, Ulleberg P, Schultheis MT, Lundqvist A, Schanke AK. Behavioural ratings of self-regulatory mechanisms and driving behaviour after an acquired brain injury. Brain Inj 2014; 28:1687-99. [PMID: 25158241 DOI: 10.3109/02699052.2014.947632] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To explore whether measurements of self-regulatory mechanisms and cognition predict driving behaviour after an acquired brain injury (ABI). DESIGN Consecutive follow-up study. PARTICIPANTS At baseline participants included 77 persons with stroke and 32 persons with a traumatic brain injury (TBI), all of whom completed a multidisciplinary driving assessment (MDA). A follow-up cohort of 34 persons that succeeded the MDA was included. Baseline measurements: Neuropsychological tests and measurements of self-regulatory mechanisms (BRIEF-A and UPPS Impulsive Behaviour Scale), driving behaviour (DBQ) and pre-injury driving characteristics (mileage, compensatory driving strategies and accident rates). Follow-up measurements: Post-injury driving characteristics were collected by mailed questionnaires from the participants who succeeded the MDA. METHODS A MDA, which included a medical examination, neuropsychological testing and an on-road driving test, was considered in the decision for or against granting a driver's license. Self-regulatory mechanisms and driving behaviour were examined for research purposes only. RESULTS At baseline, self-regulatory mechanisms were significantly associated to aberrant driving behaviour, but not with neuropsychological data or with the outcome of the on-road driving test. Aspects of self-regulation were associated to driving behaviour at follow-up. CONCLUSION It is recommended that self-regulatory measurements should regularly be considered in the driving assessments after ABI.
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Affiliation(s)
- Per-Ola Rike
- Sunnaas Rehabilitation Hospital , Nesodden , Norway
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100
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Motta K, Lee H, Falkmer T. Post-stroke driving: examining the effect of executive dysfunction. JOURNAL OF SAFETY RESEARCH 2014; 49:33-38. [PMID: 24913483 DOI: 10.1016/j.jsr.2014.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 02/19/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Executive dysfunction can refer to both neurocognitive deficits and behavioral symptoms that include impaired judgment, slow decision making, disorganization, impulsiveness, and risk-taking behaviors. Executive dysfunction is relatively common in the post-stroke population but is often undetected. The impact of executive dysfunction on post-stroke driving is unclear but it may pose a risk to affected drivers and other road users. AIM The aim of this study was to investigate the relationship between executive functioning following stroke and driving performance. METHODOLOGY A case-control study design was used. Purposive sampling was used to recruit stroke participants (n=19) and healthy controls (n=22). Participants were screened using a battery of psychometric assessments including the Montreal Cognitive Assessment and the Benton Judgment of Line Orientation. Driving performance was assessed using the STISIM driving simulator. Executive function was assessed using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and the Trail Making Test Part B. RESULTS The control participants performed better than the stroke participants on the driving assessment and psychometric assessments. There was an association between the scores of the Trail Making Test Part B (Rho=0.34, p=0.034) and the Key Search Test of the BADS (Rho=-0.61, p=0.005), and the driving assessment scores. However, there was no association between the overall BADS scores and the driving assessment scores of the stroke participants. CONCLUSIONS The stroke participants underperformed in the driving assessment and the psychometric assessments that detected neurocognitive deficits, which included executive function. The Trail Making Test Part B and Key Search Test of the BADS were related to identify participants' deterioration in driving performance. Practical Applications: In clinical practice, the latter could be used as an indication of a post-stroke driver's performance.
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Affiliation(s)
- Karen Motta
- School of Occupational Therapy and Social Work, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia
| | - Hoe Lee
- School of Occupational Therapy and Social Work, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Torbjorn Falkmer
- School of Occupational Therapy and Social Work, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia; Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, UHL, County Council, Linköping, Sweden; School of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia
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