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Classen S, Wang Y, Crizzle AM, Winter SM, Lanford DN. Predicting older driver on-road performance by means of the useful field of view and trail making test part B. Am J Occup Ther 2014; 67:574-82. [PMID: 23968796 DOI: 10.5014/ajot.2013.008136] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Useful Field of View(®) (UFOV) and Trail Making Test Part B (Trails B) are measures of divided attention. We determined which measure was more accurate in predicting on-road outcomes among drivers (N = 198, mean age = 73.86, standard deviation = 6.05). Receiver operating characteristic curves for the UFOV (Risk Index [RI] and Subtests 1-3) and Trails B significantly predicted on-road outcomes. Contrasting Trails B with the UFOV RI and subtests, the only difference was found between the UFOV RI and Trails B, indicating the UFOV RI was the best predictor of on-road outcomes. Misclassifications of drivers totaled 28 for the UFOV RI, 62 for Trails B, and 58 for UFOV Subtest 2. The UFOV RI is a superior test in predicting on-road outcomes, but the Trails B has acceptable accuracy and is comparable to the other UFOV subtests.
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Affiliation(s)
- Sherrilene Classen
- School of Occupational Therapy, Elborn College, Western University, London, Ontario, Canada, N6A 5B9.
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102
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Murie-Fernandez M, Iturralde S, Cenoz M, Casado M, Teasell R. Capacidad de conducción tras un ictus: evaluación y recuperación. Neurologia 2014; 29:161-7. [DOI: 10.1016/j.nrl.2012.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 05/28/2012] [Indexed: 01/13/2023] Open
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103
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Murie-Fernandez M, Iturralde S, Cenoz M, Casado M, Teasell R. Driving ability after a stroke: Evaluation and recovery. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2012.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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104
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Barco PP, Wallendorf MJ, Snellgrove CA, Ott BR, Carr DB. Predicting road test performance in drivers with stroke. Am J Occup Ther 2014; 68:221-9. [PMID: 24581409 DOI: 10.5014/ajot.2014.008938] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE. The aim of this study was to develop a brief screening battery to predict the on-road performance of drivers who had experienced a stroke. METHOD. We examined 72 people with stroke referred by community physicians to an academic rehabilitation center. The outcome variable was pass or fail on the modified Washington University Road Test. Predictor measures were tests of visual, motor, and cognitive functioning. RESULTS. The best predictive model for failure on the road test included Trail Making Test Part A and the Snellgrove Maze Task(®). CONCLUSION. A screening battery that can be performed in less than 5 min was able to assist in the prediction of road test performance in a sample of drivers with stroke. A probability of failure calculator may be useful for clinicians in their decision to refer clients with stroke for a comprehensive driving evaluation.
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Affiliation(s)
- Peggy P Barco
- Peggy P. Barco, OTD, OTR/L, SCDCM, is Instructor, Program in Occupational Therapy, Washington University School of Medicine, St. Louis, MO
| | - Michael J Wallendorf
- Michael J. Wallendorf, PhD, is Research Statistician, Division of Biostatistics, Washington University School of Medicine, St. Louis, MO
| | - Carol A Snellgrove
- Carol A. Snellgrove, PhD, is Chief Psychologist, South Australia Police Department, Adelaide, South Australia, Australia
| | - Brian R Ott
- Brian R. Ott, MD, is Professor, Department of Neurology, Warren Alpert Medical School, Brown University, and Director, Alzheimer's Disease and Memory Disorders Center, Rhode Island Hospital, Providence, RI
| | - David B Carr
- David B. Carr, MD, is Professor of Medicine and Neurology and Clinical Director, Division of Geriatrics and Nutritional Science, Washington University, 4488 Forest Park Boulevard, St. Louis, MO 63108;
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Abstract
BACKGROUND Interventions to improve driving ability after stroke, including driving simulation and retraining visual skills, have limited evaluation of their effectiveness to guide policy and practice. OBJECTIVES To determine whether any intervention, with the specific aim of maximising driving skills, improves the driving performance of people after stroke. SEARCH METHODS We searched the Cochrane Stroke Group Trials register (August 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 3), MEDLINE (1950 to October 2013), EMBASE (1980 to October 2013), and six additional databases. To identify further published, unpublished and ongoing trials, we handsearched relevant journals and conference proceedings, searched trials and research registers, checked reference lists and contacted key researchers in the area. SELECTION CRITERIA Randomised controlled trials (RCTs), quasi-randomised trials and cluster studies of rehabilitation interventions, with the specific aim of maximising driving skills or with an outcome of assessing driving skills in adults after stroke. The primary outcome of interest was the performance in an on-road assessment after training. SECONDARY OUTCOMES included assessments of vision, cognition and driving behaviour. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials based on pre-defined inclusion criteria, extracted the data and assessed risk of bias. A third review author moderated disagreements as required. The review authors contacted all investigators to obtain missing information. MAIN RESULTS We included four trials involving 245 participants in the review. Study sample sizes were generally small, and interventions, controls and outcome measures varied, and thus it was inappropriate to pool studies. Included studies were at a low risk of bias for the majority of domains, with a high/unclear risk of bias identified in the areas of: performance (participants not blinded to allocation), and attrition (incomplete outcome data due to withdrawal) bias. Intervention approaches included the contextual approach of driving simulation and underlying skill development approach, including the retraining of speed of visual processing and visual motor skills. The studies were conducted with people who were relatively young and the timing after stroke was varied. PRIMARY OUTCOME there was no clear evidence of improved on-road scores immediately after training in any of the four studies, or at six months (mean difference 15 points on the Test Ride for Investigating Practical Fitness to Drive - Belgian version, 95% confidence intervals (CI) 4.56 to 34.56, P value = 0.15, one study, 83 participants). SECONDARY OUTCOMES road sign recognition was better in people who underwent training compared with control (mean difference 1.69 points on the Road Sign Recognition Task of the Stroke Driver Screening Assessment, 95% CI 0.51 to 2.87, P value = 0.007, one study, 73 participants). Significant findings were in favour of a simulator-based driving rehabilitation programme (based on one study with 73 participants) but these results should be interpreted with caution as they were based on a single study. Adverse effects were not reported. There was insufficient evidence to draw conclusions on the effects on vision, other measures of cognition, motor and functional activities, and driving behaviour with the intervention. AUTHORS' CONCLUSIONS There was insufficient evidence to reach conclusions about the use of rehabilitation to improve on-road driving skills after stroke. We found limited evidence that the use of a driving simulator may be beneficial in improving visuocognitive abilities, such as road sign recognition that are related to driving. Moreover, we were unable to find any RCTs that evaluated on-road driving lessons as an intervention. At present, it is unclear which impairments that influence driving ability after stroke are amenable to rehabilitation, and whether the contextual or remedial approaches, or a combination of both, are more efficacious.
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Affiliation(s)
- Stacey George
- Flinders UniversityDepartment of Rehabilitation, Aged and Extended CareDaws RoadDaw ParkAustralia5041
| | - Maria Crotty
- Flinders University, Repatriation General HospitalDepartment of Rehabilitation and Aged CareDaws RoadDaw ParkAustralia5042
| | - Isabelle Gelinas
- McGill UniversitySchool of Physical and Occupational Therapy3654 Promenade Sir‐William‐OslerMontrealCanadaH3G 1Y5
| | - Hannes Devos
- Georgia Regents UniversityDepartment of Physical Therapy1120 15th StreetEC‐1304AugustaUSA30912
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106
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Carmody J, Michael C, Traynor V, Iverson D. Electronic discharge summary driving advice: Current practice and future directions. Australas Med J 2013; 6:419-24. [PMID: 24066020 PMCID: PMC3767912 DOI: 10.4066/amj.2013.1815] [Citation(s) in RCA: 2] [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 Driving is a complex task. Many older drivers are unaware of their obligation to inform authorities of conditions which may impact upon their driving safety. AIMS This study sought to establish the adequacy of driving advice in electronic discharge summaries from an Australian stroke unit. METHOD One month of in-patient electronic discharge summaries were reviewed. A predetermined list of items was used to assess each electronic discharge summary: age; gender; diagnosis; relevant co-morbidities; deficit at time of discharge; driving advice; length of stay; and discharge destination. RESULTS Of 41 participants, the mean age was 72 years. Twenty patients had a discharge diagnosis of stroke, nine of transient ischaemic attack, four of seizure and one of encephalitis. Of these, only eight discharge summaries included driving advice. CONCLUSION The documentation of driving advice in electronic discharge summaries is poor. This has important public health, ethical and medico-legal implications. Avenues for future research are explored.
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Affiliation(s)
- John Carmody
- Neurology Department, Wollongong Hospital, Wollongong
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong
| | - Carey Michael
- Graduate School of Medicine, University of Wollongong
| | - Victoria Traynor
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong
- Faculty of Science, Medicine and Health, University of Wollongong
| | - Don Iverson
- Illawarra Health and Medical Research Institute (IHMRI), Wollongong
- Faculty of Science, Medicine and Health, University of Wollongong
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107
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Gaudet J, Bélanger MF, Corriveau H, Mekary S, Hay D, Johnson MJ. Investigating the autonomic nervous system and cognitive functions as potential mediators of an association between cardiovascular disease and driving performance. Can J Physiol Pharmacol 2013; 91:346-52. [DOI: 10.1139/cjpp-2012-0342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cardiovascular disease (CVD) impacts the autonomic nervous system and cognitive functions related to activities of daily living, including driving an automobile. Although CVD has been linked to unsafe driving, mechanisms underlying this relationship remain elusive. The aim of this study was to examine the role of cognitive functions and the autonomic nervous system as potential mediators of driving performance. Nineteen individuals having recently suffered a cardiac event and 16 individuals with no history of CVD completed a simulated drive using a STISIM simulator to assess driving performance. Heart rate was recorded throughout testing using a Polar RS800CX heart rate monitor, and measures of executive, orienting, and alerting functions were obtained through the Attention Network Test. We used the Baron and Kenny analysis method to assess potential mediating effects of the relationship between CVD and driving performance. Executive function was the only potential mediator investigated to be associated with driving (p < 0.01) and CVD (p < 0.05); however, it did not appear to play a mediating role (p = 0.28). These results suggest that individuals with CVD exhibit decrements in complex cognitive tasks such as driving and that further research is needed to better understand the mechanisms underlying this relationship.
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Affiliation(s)
- Jeffrey Gaudet
- Université de Sherbrooke, 2500, boul. de l'Université, Sherbrooke , J1K 2R1, Canada
| | - Mathieu F. Bélanger
- Centre de formation médicale du Nouveau-Brunswick, 18 avenue Antonine-Maillet, Moncton, NB E1A 3E9, Canada
| | - Hélène Corriveau
- Université de Sherbrooke, 2500, boul. de l'Université, Sherbrooke , J1K 2R1, Canada
| | - Said Mekary
- Université de Moncton, CEPS Louis-J. Robichaud, 18 avenue Antonine-Maillet, Moncton, NB E1A 3E9, Canada
| | - Dean Hay
- Nipissing University, 100 College Drive, Box 5002, North Bay, ON P1B 8L7, Canada
| | - Michel J. Johnson
- Université de Moncton, CEPS Louis-J. Robichaud, 18 avenue Antonine-Maillet, Moncton, NB E1A 3E9, Canada
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108
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Aslaksen PM, Ørbo M, Elvestad R, Schäfer C, Anke A. Prediction of on-road driving ability after traumatic brain injury and stroke. Eur J Neurol 2013; 20:1227-33. [DOI: 10.1111/ene.12172] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Accepted: 03/11/2013] [Indexed: 01/13/2023]
Affiliation(s)
- P. M. Aslaksen
- Department of Rehabilitation; University Hospital North Norway; Tromsø Norway
- Department of Psychology; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
| | - M. Ørbo
- Department of Rehabilitation; University Hospital North Norway; Tromsø Norway
| | - R. Elvestad
- Department of Rehabilitation; University Hospital North Norway; Tromsø Norway
| | - C. Schäfer
- Department of Rehabilitation; University Hospital North Norway; Tromsø Norway
| | - A. Anke
- Department of Rehabilitation; University Hospital North Norway; Tromsø Norway
- Department of Clinical Medicine; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
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109
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Lipskaya-Velikovsky L, Kotler M, Weiss P, Kaspi M, Gamzo S, Ratzon N. Car driving in schizophrenia: can visual memory and organization make a difference? Disabil Rehabil 2013; 35:1734-9. [PMID: 23350755 DOI: 10.3109/09638288.2012.753116] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Driving is a meaningful occupation which is ascribed to functional independence in schizophrenia. Although it is estimated that individuals with schizophrenia have two times more traffic accidents, little research has been done in this field. Present research explores differences in mental status, visual working memory and visual organization between drivers and non-drivers with schizophrenia in comparison to healthy drivers. METHODS There were three groups in the study: 20 drivers with schizophrenia, 20 non-driving individuals with schizophrenia and 20 drivers without schizophrenia (DWS). Visual perception was measured with Rey-Osterrieth Complex Figure test and a general cognitive status with Mini-Mental State Examination. RESULTS The general cognitive status predicted actual driving situation in people with schizophrenia. No statistically significant differences were found between driving and non-driving persons with schizophrenia on any of the visual parameters tested, although these abilities were significantly lower than those of DWS. CONCLUSION The research demonstrates that impairment of visual abilities does not prevent people with schizophrenia from driving and emphasizes the importance of general cognitive status for complex and multidimensional everyday tasks. The findings support the need for further investigation in the field of car driving for this population - a move that will considerably contribute to the participation and well-being. Implication for Rehabilitation Unique approach for driving evaluation in schizophrenia should be designed since direct applications of knowledge and practice acquired from other populations are not reliable. This research demonstrates that visual perception deficits in schizophrenia do not prevent clients from driving, and general cognitive status appeared to be a valid determinant for actual driving. We recommended usage of a general test of cognition such as Mini-Mental State Examination, or conjunction number of cognitive factors such as executive functions (e.g., Trail Making Test) and attention (e.g., Continuous Performance Test) in addition to spatial-visual ability tests (e.g., Rey-Osterrieth Complex Figure test) for considering driving status in schizophrenia.
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Affiliation(s)
- Lena Lipskaya-Velikovsky
- Department of Occupational Therapy, Sackler Faculty of Medicine, School of Health Professions, Tel Aviv University , Tel Aviv , Israel
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110
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Pettersen R. Når styrmannen svikter. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:494. [DOI: 10.4045/tidsskr.13.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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111
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Bowers AR, Tant M, Peli E. A pilot evaluation of on-road detection performance by drivers with hemianopia using oblique peripheral prisms. Stroke Res Treat 2012; 2012:176806. [PMID: 23316415 PMCID: PMC3539405 DOI: 10.1155/2012/176806] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 10/24/2012] [Indexed: 01/13/2023] Open
Abstract
Aims. Homonymous hemianopia (HH), a severe visual consequence of stroke, causes difficulties in detecting obstacles on the nonseeing (blind) side. We conducted a pilot study to evaluate the effects of oblique peripheral prisms, a novel development in optical treatments for HH, on detection of unexpected hazards when driving. Methods. Twelve people with complete HH (median 49 years, range 29-68) completed road tests with sham oblique prism glasses (SP) and real oblique prism glasses (RP). A masked evaluator rated driving performance along the 25 km routes on busy streets in Ghent, Belgium. Results. The proportion of satisfactory responses to unexpected hazards on the blind side was higher in the RP than the SP drive (80% versus 30%; P = 0.001), but similar for unexpected hazards on the seeing side. Conclusions. These pilot data suggest that oblique peripheral prisms may improve responses of people with HH to blindside hazards when driving and provide the basis for a future, larger-sample clinical trial. Testing responses to unexpected hazards in areas of heavy vehicle and pedestrian traffic appears promising as a real-world outcome measure for future evaluations of HH rehabilitation interventions aimed at improving detection when driving.
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Affiliation(s)
- Alex R. Bowers
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Department of Ophthalmology, Harvard Medical School, 20 Staniford Street, Boston, MA 02114, USA
| | - Mark Tant
- CARA Department, Belgian Road Safety Institute, 1130 Brussels, Belgium
| | - Eli Peli
- Schepens Eye Research Institute, Massachusetts Eye and Ear, and Department of Ophthalmology, Harvard Medical School, 20 Staniford Street, Boston, MA 02114, USA
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112
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Akinwuntan AE, Wachtel J, Rosen PN. Driving Simulation for Evaluation and Rehabilitation of Driving After Stroke. J Stroke Cerebrovasc Dis 2012; 21:478-86. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.12.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 12/02/2010] [Indexed: 01/27/2023] Open
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113
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Asimakopulos J, Boychuck Z, Sondergaard D, Poulin V, Ménard I, Korner-Bitensky N. Assessing executive function in relation to fitness to drive: a review of tools and their ability to predict safe driving. Aust Occup Ther J 2011; 59:402-27. [PMID: 23174109 DOI: 10.1111/j.1440-1630.2011.00963.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND/AIM The assessment of executive functions is an integral component in determining fitness to drive. A structured review was conducted to identify assessment tools used to measure executive function in relation to driving and to describe these tools according to: (i) specific executive function components assessed; (ii) the tool's validity in predicting safe driving; and (iii) clinical utility. METHODS Sixty-nine articles were reviewed, identifying 53 executive function tools/assessments used in driving research. Each tool was critically appraised and the findings were compiled in a Driving Executive Function Tool Guide. RESULTS Among the 53 tools, there were 27 general assessments of cognition, 19 driving-specific and seven activities of daily living/instrumental activities of daily living assessments. No single tool measured all executive function components: working memory was the most common (n = 20/53). Several tools demonstrated strong predictive validity and clinical utility. For example, tools, such as the Trail Making Test and the Maze Task, have the shortest administration time (i.e. often less than 10 minutes) and the most easily accessible method of administration (i.e. pen and paper or verbal). Driving-specific tools range from short questionnaires, such as the 10-minute Manchester Driving Behaviour Questionnaire, to more complex tools requiring about 45 minutes to administer. CONCLUSIONS AND SIGNIFICANCE OF THE STUDY: The appropriateness of a tool depends on the individual being assessed and on practical constraints of the clinical context. The Driving Executive Function Tool Guide provides useful information that should facilitate decision-making and selection of appropriate executive function tools in relation to driving.
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Affiliation(s)
- Julia Asimakopulos
- School of Physical and Occupational Therapy, Faculty of Medicine, McGill University, Montréal, Quebec, Canada
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114
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Griffen JA, Rapport LJ, Bryer RC, Bieliauskas LA, Burt C. Awareness of Deficits and On-Road Driving Performance. Clin Neuropsychol 2011; 25:1158-78. [DOI: 10.1080/13854046.2011.609841] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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115
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Finestone HM, Gershkoff A, Watanabe T. Driving After Stroke: What Are the Appropriate Criteria? PM R 2011; 3:873-8. [DOI: 10.1016/j.pmrj.2011.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 08/09/2011] [Indexed: 11/28/2022]
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116
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Marshall SC, Man-Son-Hing M. Multiple chronic medical conditions and associated driving risk: a systematic review. TRAFFIC INJURY PREVENTION 2011; 12:142-148. [PMID: 21469021 DOI: 10.1080/15389588.2010.551225] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND Numerous medical conditions can affect one's ability to operate a motor vehicle. The likelihood of having multiple medical conditions increases with advancing age; however, the interplay of the associated impairments has not been previously addressed in the literature. OBJECTIVE To identify the incremental risks for the effects of multiple chronic medical conditions on driving ability and crash risk. METHODS A comprehensive English-language literature search using the keywords driving, motor vehicle crashes, accidents, multiple medical conditions, and chronic medical conditions was completed. To be included, the article had to address the effects of the combination of multiple chronic medical conditions on driving and include a relevant outcome, such as crashes, driving violations, on-road driving assessment, driving simulator assessment, or driving cessation/avoidance patterns. RESULTS The overall trend was for increasing number of chronic medical conditions to be associated with higher crash risk and higher likelihood of driving cessation. Although there is some evidence that impaired functional abilities are associated with poorer driving outcome, most of the studies do not support this. No studies were identified that evaluated compensation techniques for drivers with multiple chronic medical conditions with the exception of driving avoidance or self-restriction. CONCLUSIONS The evidence supports the view that drivers with more chronic medical conditions tend to cease driving or engage in driving avoidance. The myriad combinations of diseases and disease severity present a level of complexity that complicates making informed decisions about driving with multiple chronic medical conditions.
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Affiliation(s)
- Shawn C Marshall
- Division of Physical Medicine and Rehabilitation, The Ottawa Hospital, Ottawa, Ontario, Canada.
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117
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Vrkljan BH, McGrath CE, Letts LJ. Assessment Tools for Evaluating Fitness to Drive: A Critical Appraisal of Evidence. The Canadian Journal of Occupational Therapy 2011; 78:80-96. [DOI: 10.2182/cjot.2011.78.2.3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background. Many office-based assessment tools are used by occupational therapists to predict fitness to drive. Purpose. To appraise psychometric properties of such tools, specifically predictive validity for on-road performance. Methods. A literature search was conducted to identify assessment tools and studies involving on-road outcomes (behind-the-wheel evaluation, crashes, traffic violations). Using a standardized appraisal process, reviewers rated each tool's psychometrric properties, including its predictive validity with on-road performance. Findings. Seventeen measures met the inclusion criteria. Evidence suggests many tools do not have cut-off scores linked with on-road outcomes, although some had stronger evidence than others. Implications. When making a determination regarding driver fitness, clinicians should consider the psychometric properties of the tool as well as existing evidence concerning its utility in predicting on-road performance. Caution is warranted in using any one office-based tool to predict driving fitness; rather, a multifactorial-based assessment approach that includes physical, cognitive, and visual-perceptual components, is recommended.
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Affiliation(s)
| | - Colleen E. McGrath
- Colleen E. McGrath, MSc, O.T. Reg. (Ont.), Occupational Therapist, is doing her PhD in Health and Rehabilitation Sciences at The University of Western Ontario, London, ON, Canada
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118
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Akinwuntan AE, Devos H, Verheyden G, Baten G, Kiekens C, Feys H, De Weerdt W. Retraining moderately impaired stroke survivors in driving-related visual attention skills. Top Stroke Rehabil 2011; 17:328-36. [PMID: 21131257 DOI: 10.1310/tsr1705-328] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Visual inattention is a major cause of road accidents and is a problem commonly experienced after stroke. PURPOSE This study investigated the effects of 2 training programs on performance in the Useful Field of View (UFOV), a validated test of driving-related visual attention skills. METHOD Data from 69 first-ever, moderately impaired stroke survivors who participated in a randomized controlled trial (RCT) to determine the effects of simulator training on driving after stroke were analyzed. In addition to regular interventions at a rehabilitation center, participants received 15 hours of either simulator-based driving-related training or non-computer-based cognitive training over 5 weeks. RESULTS Total percentage reduction in UFOV and performance in divided and selective attention and speed of processing subtests were documented at 6 to 9 weeks (pretraining), 11 to 15 weeks (posttraining), and 6 months post stroke (follow-up). Generalized estimating equation (GEE) model revealed neither group effects nor significant interaction effects of group with time in the UFOV total score and the 3 subtests. However, there were significant within-group improvements from pre- through posttraining to follow-up for all the UFOV parameters. Post-hoc GEE analysis revealed that most improvement in both groups occurred from pre- to posttraining. CONCLUSION Both training programs significantly improved visual attention skills of moderately impaired stroke survivors after 15 hours of training and retention of benefit lasted up to 6 months after stroke. Neither of the training programs was better than the other.
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Affiliation(s)
- Abiodun E Akinwuntan
- Department of Physical Therapy, School of Allied Health Sciences, Medical College of Georgia, Augusta, Georgia
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119
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Petzold A, Korner-Bitensky N, Rochette A, Teasell R, Marshall S, Perrier MJ. Driving poststroke: problem identification, assessment use, and interventions offered by canadian occupational therapists. Top Stroke Rehabil 2011; 17:371-9. [PMID: 21131262 DOI: 10.1310/tsr1705-371] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND PURPOSE Driving is a key factor in maintaining autonomy and participation in life. Occupational therapists (OTs) are expected to assess individuals who want to resume driving post stroke and to provide retraining where appropriate. Research from the 1980s and 1990s indicated that patients were, for the most part, not being assessed and retrained. However, little is known about current practice management. Thus, this study examined clinicians' management of driving-related issues when treating clients with stroke. METHODS We performed a Canadawide telephone survey of 480 OTs providing stroke rehabilitation in both inpatient rehabilitation and community-based settings. Clinicians reported on problems they noted and assessments and interventions they would provide for a "typical patient" described in a vignette that matched their work setting. RESULTS 20% and 34% of clinicians responding to the inpatient rehabilitation and community-based vignettes, respectively, identified return to driving as a problem. Clinician and work environment variables significantly associated (P < .01) with identifying driving as a potential problem included being male, involvement in university teaching, research conducted in setting, and hosting student placements. The use of driving-specific assessments was under 12%. Less than 6% of clinicians offered driving retraining, and their desired use of retraining was low. CONCLUSION Few clinicians identified driving as a problem post stoke, raising concern that patients attempt to drive on their own or never resume driving because of a lack of attention to driving during their rehabilitation. Poststroke driver assessment and retraining is a critical component of poststroke community reintegration that requires greater awareness by clinicians.
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Affiliation(s)
- Anita Petzold
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
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Finestone HM, Guo M, O'Hara P, Greene-Finestone L, Marshall SC, Hunt L, Biggs J, Jessup A. Driving and Reintegration Into the Community in Patients After Stroke. PM R 2010; 2:497-503. [DOI: 10.1016/j.pmrj.2010.03.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 03/24/2010] [Accepted: 03/29/2010] [Indexed: 01/13/2023]
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Stapleton T, Connelly D. Occupational therapy practice in predriving assessment post stroke in the Irish context: findings from a nominal group technique meeting. Top Stroke Rehabil 2010; 17:58-68. [PMID: 20410013 DOI: 10.1310/tsr1701-58] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Practice in the area of predriving assessment for people with stroke varies, and research findings are not always easily transferred into the clinical setting, particularly when such assessment is not conducted within a dedicated driver assessment programme. This article explores the clinical predriving assessment practices and recommendations of a group of Irish occupational therapists for people with stroke. METHOD A consensus meeting of occupational therapists was facilitated using a nominal group technique (NGT) to identify specific components of cognition, perception, and executive function that may influence fitness to return to driving and should be assessed prior to referral for on-road evaluation. Standardised assessments for use in predriving assessment were recommended. RESULTS Thirteen occupational therapists speed of processing; perceptual components of spatial awareness, depth perception, and visual inattention; and executive components of planning, problem solving, judgment, and self-awareness. Consensus emerged for the use of the following standardised tests: Behavioural Assessment of Dysexecutive Syndrome (BADS), Test of Everyday Attention (TEA), Brain Injury Visual Assessment Battery for Adults (biVABA), Rivermead Perceptual Assessment Battery (RPAB), and Motor Free Visual Perceptual Test (MVPT). CONCLUSION Tests were recommended that gave an indication of the patient's underlying component skills in the area of cognition, perception, and executive functions considered important for driving. Further research is needed in this area to develop clinical practice guidelines for occupational therapists for the assessment of fitness to return to driving after stroke.
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Affiliation(s)
- Tadhg Stapleton
- Department of Occupational Therapy, Trinity College Dublin, Dublin, Ireland
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George S, Crotty M. Establishing criterion validity of the Useful Field of View assessment and Stroke Drivers' Screening Assessment: comparison to the result of on-road assessment. Am J Occup Ther 2010; 64:114-22. [PMID: 20131571 DOI: 10.5014/ajot.64.1.114] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES We sought to determine the criterion validity of the Useful Field of View (UFOV) assessment and Stroke Drivers' Screening Assessment (SDSA) through comparison to the results of on-road assessment. METHOD This was a prospective study with people with stroke. Outcome measures used were UFOV, SDSA, and the results of on-road assessment. RESULTS Both the results on UFOV (Divided Attention subtest, p<.01; Selective Attention subtest, p<.05) and SDSA (p<.05) were significantly related to the recommendation from on-road assessment. The Divided Attention subtest of the UFOV had the highest sensitivity value (88.9%). CONCLUSIONS UFOV and SDSA are valid assessments of driving ability for stroke. The Divided Attention subtest of the UFOV can guide decision making of occupational therapists in stroke driver rehabilitation and in determining those who require further assessment on road because they pose a safety risk. Screening assists people with stroke to decide whether they are ready to have an on-road assessment.
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Affiliation(s)
- Stacey George
- Flinders University, Department of Rehabilitation and Aged Care, Repatriation General Hospital, Daws Road, Daw Park, South Australia 5041, Australia.
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Examining the Relationship Between Cognition and Driving Performance in Multiple Sclerosis. Arch Phys Med Rehabil 2010; 91:465-73. [DOI: 10.1016/j.apmr.2009.09.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Revised: 09/09/2009] [Accepted: 09/09/2009] [Indexed: 01/13/2023]
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Hubley AM. Using the Rey-Osterrieth and Modified Taylor Complex Figures with Older Adults: A Preliminary Examination of Accuracy Score Comparability. Arch Clin Neuropsychol 2010; 25:197-203. [DOI: 10.1093/arclin/acq003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Sommer M, Heidinger C, Arendasy M, Schauer S, Schmitz-Gielsdorf J, Häusler J. Cognitive and Personality Determinants of Post-injury Driving Fitness. Arch Clin Neuropsychol 2010; 25:99-117. [PMID: 20080833 DOI: 10.1093/arclin/acp109] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Affiliation(s)
- M Sommer
- Department of Psychological Assessment, SCHUHFRIED GmbH, Mödling, Austria.
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Cyr AA, Stinchcombe A, Gagnon S, Marshall S, Hing MMS, Finestone H. Driving difficulties of brain-injured drivers in reaction to high-crash-risk simulated road events: A question of impaired divided attention? J Clin Exp Neuropsychol 2009; 31:472-82. [DOI: 10.1080/13803390802255627] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
| | | | - Sylvain Gagnon
- a University of Ottawa , Ottawa, ON, Canada
- b Elisabeth Bruyère Research Institute , Ottawa, ON, Canada
| | - Shawn Marshall
- b Elisabeth Bruyère Research Institute , Ottawa, ON, Canada
- c The Rehabilitation Centre of the Ottawa General Hospital , Ottawa, ON, Canada
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Edgley SR, Lew HL, Moroz A, Chae J, Lombard LA, Reddy CC. Stroke and Neurodegenerative Disorders: 4. Community Integration. PM R 2009; 1:S27-34. [DOI: 10.1016/j.pmrj.2009.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Marshall SC. The role of reduced fitness to drive due to medical impairments in explaining crashes involving older drivers. TRAFFIC INJURY PREVENTION 2008; 9:291-298. [PMID: 18696384 DOI: 10.1080/15389580801895244] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Medical conditions and associated impairments are known to be more prevalent with aging and can potentially impact the function and crash risk of older drivers. OBJECTIVES To evaluate the impact of specific medical conditions and associated impairments on older driver crash risk. METHODS A search identified reports and peer-reviewed publications evaluating the risk for medical conditions and associated crash risk. Medical conditions associated with older persons were reviewed to determine the associated relative risk of crash. RESULTS The review identified three recent comprehensive reviews of medical conditions or chronic illnesses and crash risk: Dobbs (2005); Vaa (2003); Charlton et al. (2004). Comparison of the reviews reveals a relatively high agreement where medical conditions considered to be at slightly to moderately increased relative risk of crash include alcohol abuse and dependence, cardiovascular disease, cerebrovascular disease/TBI, depression, dementia, diabetes mellitus, epilepsy, use of certain medications, musculoskeletal disorders, schizophrenia, obstructive sleep apnea, and vision disorders. However, determining fitness to drive at the individual level based on diagnosis has significant limitations related to factors such as multiple medical conditions as well as varying severity of disease and associated functional impairments. Medical conditions that may affect driving can serve as "red flags" to assist health care professionals and driving administrators to identify drivers who may need further evaluation. CONCLUSIONS Medical conditions overall, do impact the fitness to drive of older drivers; however, the crash risk tends to be only slightly to moderately increased. The conditions can serve as potential warnings for reduced fitness to drive, but many persons with these medical conditions would still be considered safe to continue driving.
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Affiliation(s)
- Shawn C Marshall
- SCO Health Service, Elisabeth Bruyere Research Institute, Ottawa, Ontario, Canada.
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