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Gasne C, Ranchet M, Evennou M, Delebecque MC, Hoang I, Coignard P, Paire-Ficout L. Fitness-to-drive recommendations in post-stroke patients: a retrospective study. J Stroke Cerebrovasc Dis 2024; 33:107781. [PMID: 38772498 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 05/03/2024] [Accepted: 05/18/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Stroke sequelae can have an impact on daily life activities such as driving. French legislation stipulates that post-stroke patients should undergo a multi-professional fitness-to-drive assessment before being allowed to drive again. This retrospective study aims to explore the determinants of multi-professional fitness-to-drive recommendations. METHODS Sixty-six post-stroke patients assessed for fitness to drive in the Kerpape Center, France in 2019 were included. Favorable or unfavorable driving recommendations were attributed to patients following a joint decision by a multi-professional team. Individual characteristics obtained from medical records were compared. RESULTS Findings showed that 64% of stroke patients received a favorable fitness-to-drive recommendation. Across all demographic, clinical, and driving characteristics, the time interval between stroke and assessment was significantly longer for patients designated as unfit to drive than for those designated as fit to drive (P = .004). Furthermore, the proportion of instrumental sequelae was higher in patients designated as unfit to drive than in those designated as fit to drive (P = .022). Stepwise logistic regression showed that the presence of instrumental sequelae, mainly aphasia, was the best predictor of fitness-to-drive recommendations. CONCLUSIONS The post-stroke time interval and the presence of instrumental sequelae explained the difference between patients recommended as fit-to-drive and unfit-to-drive. Furthermore, aphasia was found be the best predictor of a fitness-to-drive recommendation. It is possible that aphasia impacts the understanding of instructions during on-road testing. These findings emphasize the need for a standardized multi-professional fitness-to-drive assessment, since the determinants of fitness-to-drive recommendation differ between studies.
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Affiliation(s)
- Clara Gasne
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, F-69675, Lyon, France.
| | - Maud Ranchet
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, F-69675, Lyon, France
| | - Myriam Evennou
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, F-69675, Lyon, France
| | - Marie-Caroline Delebecque
- Unité de conduite automobile adaptée du centre mutualiste de rééducation et réadaptation fonctionnelle de Kerpape, Ploemeur
| | - Isabelle Hoang
- TS2-LESCOT, Univ Gustave Eiffel, IFSTTAR, Univ Lyon, F-69675, Lyon, France
| | - Pauline Coignard
- Unité de conduite automobile adaptée du centre mutualiste de rééducation et réadaptation fonctionnelle de Kerpape, Ploemeur
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Wallace HE, Gullo HL, Copland DA, Rotherham A, Wallace SJ. Does aphasia impact on return to driving after stroke? A scoping review. Disabil Rehabil 2024:1-24. [PMID: 38415619 DOI: 10.1080/09638288.2024.2317989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 02/07/2024] [Indexed: 02/29/2024]
Abstract
PURPOSE Stroke can affect driving, an important activity of daily living. Little is known about whether aphasia (language impairment) impacts driving post-stroke. This scoping review explores impacts and perceived impacts of aphasia on driving performance, and the process of returning to driving post-stroke. MATERIALS AND METHODS Scoping review using Arksey and O'Malley's framework, reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Bibliographic databases were searched and international clinical practice guidelines were sourced online. Full-text articles were independently assessed by two reviewers. Results were tabulated and summarised using narrative synthesis. RESULTS Forty-three literature sources and 17 clinical practice guidelines were identified. Six studies investigated return to driving with aphasia post-stroke; 37 sources from the broader literature contributed to objectives. It remains unclear whether aphasia impacts fitness-to-drive; however, people with aphasia face barriers in returning to driving due to: (1) uncertainty regarding the role of language in driving; (2) poor awareness and knowledge of aphasia, and (3) communication demands in the patient-journey and assessment. CONCLUSIONS The current evidence base is limited, inconsistent, and lacking in quality and recency and there is a lack of guidelines to support clinical practice. People with aphasia face barriers in returning to driving; however, it is unclear if aphasia affects fitness-to-drive post-stroke. Implications for rehabilitationPeople with aphasia, their caregivers and clinicians have identified return to driving as a top 10 research priority.We do not know if aphasia affects fitness-to-drive post-stroke, but communication difficulties can make the process of returning to driving more difficult.Speech pathologists have an important role in ensuring that driving is discussed with people with aphasia post-stroke.Speech pathologists should support the multidisciplinary team to understand and meet the communication needs of people with aphasia throughout the driving evaluation process.
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Affiliation(s)
- Helen E Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Hannah L Gullo
- Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Metro North Health, Brisbane, Australia
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Annette Rotherham
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Surgical Treatment and Rehabilitation Service (STARS), Education and Research Alliance, The University of Queensland and Metro North Health, Brisbane, Australia
- NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
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Cheal B, Bundy A, Patomella AH. Performance Analysis of Driving Ability (P-Drive): Investigating Construct Validity and Concordance of Australasian Data. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024:15394492231221960. [PMID: 38268445 DOI: 10.1177/15394492231221960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
On-road assessment is optimal for determining medical fitness-to-drive but unreliable if determined by global pass/fail decisions alone. Occupational therapists need standardized, psychometrically sound on-road scoring procedures. Performance Analysis of Driving Ability (P-Drive) is a promising on-road test developed in Sweden, but it has not been standardized for Australasia. We investigated the psychometric properties and concordance with an on-road decision of data gathered with the Australasian version of P-Drive. P-Drive was administered to older and cognitively impaired drivers (N = 134) aged 18 to 91 years (mean age 68) who were referred to 10 driving clinics in Australia and New Zealand to determine driving performance. Rasch analysis provided evidence for construct validity and concordance of the data gathered. An optimal cut-off score of 85 was set, yielding evidence of good sensitivity at 88% and specificity at 88%. The Australasian version of P-Drive produces valid and reliable data regarding on-road driving performance.
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Affiliation(s)
- Beth Cheal
- The University of Sydney, Camperdown, New South Wales, Australia
- Western Sydney University, Campbelltown, New South Wales, Australia
| | - Anita Bundy
- The University of Sydney, Camperdown, New South Wales, Australia
- Colorado Stated University, Fort Collins, USA
| | - Ann-Helen Patomella
- The University of Sydney, Camperdown, New South Wales, Australia
- Karolinska Institutet, Huddinge, Sweden
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Kajiwara Y, Murata E. Effect of Behavioral Precaution on Braking Operation of Elderly Drivers under Cognitive Workloads. SENSORS (BASEL, SWITZERLAND) 2022; 22:5741. [PMID: 35957298 PMCID: PMC9371223 DOI: 10.3390/s22155741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 06/15/2023]
Abstract
The number of accidents by elderly drivers caused by the erroneous tread of a brake pedal or accelerator pedal has increased. A recent study reported that the number of accidents could be reduced by preparing for braking mistakes due to driving behavior by using a simulator. However, related studies have pointed out that driving behavior in simulators does not always reflect driving behavior in the real world. This paper focuses on the posture of the left foot as a behavioral precaution and provides insights into braking mistakes by comparing behavioral precautions taken on simulators and on public roads. In the experimental results, cognitive and action errors increased with age, but elderly drivers are less likely to have an accident when they are exposed to the risk of collision in situations with a mental workload by making space for the right foot to step on the brake pedal. Elderly drivers with coping skills had their left foot perpendicular to the ground and their body was unstable. This result was different from the driving behavior in the simulator, but it was not possible to identify that this difference was the cause of the collision accidents. Coping skills were predicted with 70% accuracy from the left foot posture of an elderly driver near the intersection. We expanded the system's range of use and enhanced its usefulness by predicting coping skills derived from natural driving behavior in the real world. The contributions of this study are as follows. We clarify the effect of behavioral precautions on the braking operation of elderly drivers when under a cognitive workload. We provide new insights into the use of behavioral precautions in older drivers' braking operations in the real world. We predicted coping skills from natural driving behavior near intersections in the real world.
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Cizman Staba U, Klun T, Stojmenova K, Jakus G, Sodnik J. Consistency of neuropsychological and driving simulator assessment after neurological impairment. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:829-838. [PMID: 32898437 DOI: 10.1080/23279095.2020.1815747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Deficits in attentional and executive functioning may interfere with driving ability and result in a lower level of fitness to drive. Studies show mixed results in relation to the consistency of neuropsychological and driving simulator assessment. The objective of this study was to investigate the consistency of both types of assessment. Ninety-nine patients with various neurological impairments (72 males; M = 48.98 years; SD = 17.27) performed a 30-minute drive in a driving simulation in three different road settings; a (non-)residential rural area, a highway and an urban area. They also underwent neuropsychological assessment of attention and executive function. An exploratory correlational analysis was conducted. We found weak, but significant correlations between attention and executive function measures and more efficient driving in the driving simulator. Distractibility was associated with the most simulator variables in all three simulated road settings. Participants who were better at maintaining attention, eliminating irrelevant information and suppressing inappropriate responses, were less likely to drive above the speed limit, produced a less jerky ride, and used the rearview mirror more regularly. A lack of moderate or strong significant correlations (inconsistency) between traditional neuropsychological and simulator assessment variables may indicate that they don't evaluate the same cognitive processes.
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Affiliation(s)
| | - Tara Klun
- SOCA University Rehabilitation Institute, Ljubljana, Slovenia
| | - Kristina Stojmenova
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Grega Jakus
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Jaka Sodnik
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
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Lodha N, Patel P, Shad JM, Casamento-Moran A, Christou EA. Cognitive and motor deficits contribute to longer braking time in stroke. J Neuroeng Rehabil 2021; 18:7. [PMID: 33436005 PMCID: PMC7805062 DOI: 10.1186/s12984-020-00802-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/20/2020] [Indexed: 01/13/2023] Open
Abstract
Background Braking is a critical determinant of safe driving that depends on the integrity of cognitive and motor processes. Following stroke, both cognitive and motor capabilities are impaired to varying degrees. The current study examines the combined impact of cognitive and motor impairments on braking time in chronic stroke. Methods Twenty stroke survivors and 20 aged-matched healthy controls performed cognitive, motor, and simulator driving assessments. Cognitive abilities were assessed with processing speed, divided attention, and selective attention. Motor abilities were assessed with maximum voluntary contraction (MVC) and motor accuracy of the paretic ankle. Driving performance was examined with the braking time in a driving simulator and self-reported driving behavior. Results Braking time was 16% longer in the stroke group compared with the control group. The self-reported driving behavior in stroke group was correlated with braking time (r = − 0.53, p = 0.02). The stroke group required significantly longer time for divided and selective attention tasks and showed significant decrease in motor accuracy. Together, selective attention time and motor accuracy contributed to braking time (R2 = 0.40, p = 0.01) in stroke survivors. Conclusions This study provides novel evidence that decline in selective attention and motor accuracy together contribute to slowed braking in stroke survivors. Driving rehabilitation after stroke may benefit from the assessment and training of attentional and motor skills to improve braking during driving.
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Affiliation(s)
- Neha Lodha
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA.
| | - Prakruti Patel
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA
| | - Joanna M Shad
- Department of Health and Exercise Science, Movement Neuroscience and Rehabilitation Laboratory, Colorado State University, Fort Collins, CA, 80523, USA
| | | | - Evangelos A Christou
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, USA
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León-Domínguez U, Solís-Marcos I, López-Delgado CA, Martín JMBY, León-Carrión J. A Frontal Neuropsychological Profile in Fitness to Drive. ACCIDENT; ANALYSIS AND PREVENTION 2020; 148:105807. [PMID: 33069156 DOI: 10.1016/j.aap.2020.105807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 07/24/2020] [Accepted: 09/27/2020] [Indexed: 06/11/2023]
Abstract
Traffic accidents are a global concern due to the elevated mortality rates of both drivers and pedestrians. The World Health Organization declared 2011-2020 as the Decade of Action for Road Safety, endorsing initiatives to reduce traffic-related deaths. Yet, despite these incentives, fatal accidents still occur. Different studies have linked deficits in executive functions to risky driving attitudes and crashes. The present study focuses on demographic, cognitive and personality factors, related to the prefrontal cortex, that are characteristic of drivers prone to risky behavior behind the wheel. The penalty Points System was used to classify drivers as "safe", with no point loss over a two-year period, or "risky", with full point loss during the same interval. A neuropsychological assessment of prefrontal cognitive functions was carried out on each group to identify variables associated with safe and risky behavior. Neuropsychological indexes were obtained from a continuous performance task without cue (Simple Attention), a continuous performance task with cue (Conditioned Attention), the Tower of Hanoi test and the Neurologically-related Changes in Personality Inventory (NECHAPI). A Discriminant Analysis (DA) found that education level, reaction times in Simple and Conditioned Attention, learning errors in the Tower of Hanoi and vulnerability in the personality test, best predicted whether drivers were likely to be in the safe or risky group. Finally, a cross-validation analysis performed on the same sample correctly classified 87.5% of the drivers. These data suggest that prefrontal dysfunction contributes to risky behavior behind the wheel. The inclusion of cognitive programs to identify and train drivers with this propensity could reduce risky driving, and consequently, save lives on the road.
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Affiliation(s)
- Umberto León-Domínguez
- Human Cognition and Brain Research lab, School of Psychology, University of Monterrey, San Pedro Garza, García, Mexico.
| | - Ignacio Solís-Marcos
- The Swedish National Road and Transport Research Institute (VTI) Linköping, Sweden
| | | | | | - José León-Carrión
- Department of Experimental Psychology, University of Seville, Seville, Spain; Center for Brain Injury Rehabilitation (CRECER), Seville, Spain
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Grundler W, Strasburger H. Visual attention outperforms visual-perceptual parameters required by law as an indicator of on-road driving performance. PLoS One 2020; 15:e0236147. [PMID: 32797082 PMCID: PMC7428082 DOI: 10.1371/journal.pone.0236147] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 06/30/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE A variety of visual and psychometric tests have been developed for assessing on-road driving performance and fitness to drive. The diagnostic power of a state of the art psychometric test battery (Vienna Test System) combined with a set of standard visual parameters recommended for assessing fitness to drive is investigated using an on-road driving test. The study aimed to determine whether a psychometric test battery could predict older adults' on-road driving performance. The relevance of visual standards required by law is discussed. METHODS Vision impairment is more prevalent in later adulthood and many studies on visual and cognitive impact on driving safety and performance therefore focus on adults above 60 years of age. We therefore acquired an extensive set of driving-related visual and psychometric performance parameters in a group of elderly drivers (N = 84, median age 69, SD 6.6 years). Visual assessment included foveal acuity, perimetric field size, and dynamic aspects of peripheral vision (termed "PP") in the computer-based Vienna Test System (VTS; Schuhfried), as well as letter contrast thresholds in foveal and parafoveal vision in a separate setup. A selection of psychometric driving-aptitude tests that demonstrated the battery's capacity to predict aspects of driving performance and safety were further conducted on the VTS. Driving performance was assessed in a standardized on-road driving test. Two independent observers rated driving performance using a fixed scoring system assessing the number of driving errors in pre-defined traffic situations. In addition, globalized driving competence scores were assigned on a 6-point scale. RESULTS The test battery performed excellent in identification of good drivers but failed in the prediction of bad driving performance. Visual performance indicators required by German law were less indicative of driving ability than psychometric assessment. Selective and divided attention turned out to be much more important for predicting fitness to drive than either visual acuity, size of the visual field, or contrast sensitivity. CONCLUSION Predicting fitness to drive by means of visual and psychometric tests is an ambitious challenge. On the one hand sensitivity of a multi-disciplinary test-battery is too low to predict reliable driving ability in diagnostic settings which require an unambiguous interpretation of test results for individual drivers. Low sensitivity and low predictive values are incompatible with that objective. On the other hand, the results are valuable for a routine screening of fitness to drive. For that case, the assessment of attentional abilities in particular appears to be promising. Performance measures of divided and selective attention showed themselves to be the most predictive for fitness to drive in a sample pre-screened for clear visual deficits. Visual performance parameters required by law, in contrast, had no meaningful impact on driving performance, indicating a gap between mandatory regulations of state authorities and research results. Our results suggest that visual acuity tests designed for clinical diagnosis and monitoring of eye diseases should not at all be the choice for a screening of fitness to drive.
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Affiliation(s)
| | - Hans Strasburger
- Department of Medical Psychology and Medical Sociology, Georg-August-Universität Göttingen, Göttingen, Germany
- Institute of Medical Psychology, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
- * E-mail:
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Estevis E, Noll KR, Bradshaw ME, Wefel JS. Driver safety in patients with primary brain tumors. Neurooncol Pract 2019; 6:490-498. [PMID: 31832220 PMCID: PMC6899044 DOI: 10.1093/nop/npz014] [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: 06/23/2024] Open
Abstract
BACKGROUND Operating a motor vehicle involves multiple cognitive and sensorimotor faculties. Neurological conditions pose driving risk, but this has not been examined in patients with primary brain tumors. METHODS Sixty-four patients with primary brain tumors (32 left hemisphere; 69% glioblastoma) completed the Cognitive Behavioral Driver's Inventory (CBDI). A subset also completed broader cognitive testing. Patient characteristics, CBDI measures, and broader neuropsychological test scores were compared between Passing and Nonpassing groups. Follow-up logistic regression analyses identified patient characteristics and CBDI measures predictive of Pass/Nonpass outcome. Point-biserial correlations determined associations between neuropsychological tests and CBDI outcome. RESULTS Sixty-nine percent of patients were classified as passing the CBDI. Nonpassing patients were older and more likely to have WHO grade IV and temporal lobe tumors. Age was the most salient predictor of CBDI performance. CBDI measures of speeded visual search and set-shifting, speeded response inhibition, vigilance and freedom from distractibility, and basic visual scanning speed were predictive of Pass/Nonpass outcome. Neuropsychological tests of memory in particular, but also speeded visual scanning and discrimination, executive function, basic visual attention, visuoconstruction, and manual dexterity (dominant hand), were associated with CBDI outcome. CONCLUSIONS A sizeable proportion of patients with primary brain tumors appear at risk of driving difficulty, particularly those with higher-grade tumors and of older age. Memory, visual attention, and executive difficulties appear to contribute most to driving safety risk as determined by the CBDI. These results highlight the importance of driving safety screening in this population.
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Affiliation(s)
| | - Kyle R Noll
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Mariana E Bradshaw
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Jeffrey S Wefel
- Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
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Park MO. Driving scene-based driving errors in brain injury patients and their relevance to cognitive-perceptual function and functional activity level: A cross-sectional study. Medicine (Baltimore) 2019; 98:e16315. [PMID: 31277175 PMCID: PMC6635235 DOI: 10.1097/md.0000000000016315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Driving is an essential activity for community engagement in patients with brain injury. However, brain injury patients have cognitive-perceptual deficits and low independence in daily activities. The aims of this study were to identify the driving errors of brain injury patients and determine their relevance to cognitive-perception function and daily activity level. This study was conducted at a single rehabilitation hospital. Thirty-one brain injury patients were included in the study. The patients underwent a driving-scene-based simulator evaluation in the rehabilitation clinic. Driving errors were checked using automatic software. Perceptual ability was measured using Motor-free Visual Perceptual Test (MVPT) and Cognitive-perceptual Assessment for Driving (CPAD). A linear relationship was found between the driving aptitude score, steering wheel and judgment, simultaneous operation items, total score of road course test, and cognitive-perceptual functions and daily activity levels of the participants (P <.05). The general factors that affected driving errors included driving experience, age, part of the hemispheric affected, and presence of vascular injury (P <.05). In addition, the Korean version of Mini-Mental State Examination (K-MMSE) score and the CPAD score correlated with driving errors (P <.05). The total error score of the participants correlated with the Korean version of the Modified Barthel Index (K-MBI) score (P <.05).These findings suggest that driving experience and age have more influence on driving error than perceptual level due to brain damage. In addition, it was found that the basic level of daily living influences overall operating errors.
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Ungewiss J, Kübler T, Sippel K, Aehling K, Heister M, Rosenstiel W, Kasneci E, Papageorgiou E. Agreement of driving simulator and on-road driving performance in patients with binocular visual field loss. Graefes Arch Clin Exp Ophthalmol 2018; 256:2429-2435. [PMID: 30251198 DOI: 10.1007/s00417-018-4148-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE On-road testing is considered the standard for assessment of driving performance; however, it lacks standardization. In contrast, driving simulators provide controlled experimental settings in a virtual reality environment. This study compares both testing conditions in patients with binocular visual field defects due to bilateral glaucomatous optic neuropathy or due to retro-chiasmal visual pathway lesions. METHODS Ten glaucoma patients (PG), ten patients with homonymous visual field defects (PH), and 20 age- and gender-matched ophthalmologically normal control subjects (CG and CH, respectively) participated in a 40-min on-road driving task using a dual brake vehicle. A subset of this sample (8 PG, 8 PH, 8 CG, and 7 CH) underwent a subsequent driving simulator test of similar duration. For both settings, pass/fail rates were assessed by a masked driving instructor. RESULTS For on-road driving, hemianopia patients (PH) and glaucoma patients (PG) showed worse performance than their controls (CH and CG groups): PH 40%, CH 30%, PG 60%, CG 0%, failure rate. Similar results were obtained for the driving simulator test: PH 50%, CH 29%, PG 38%, CG 0%, failure rate. Twenty-four out of 31 participants (77%) showed concordant results with regard to pass/fail under both test conditions (p > 0.05; McNemar test). CONCLUSIONS Driving simulator testing leads to results comparable to on-road driving, in terms of pass/fail rates in subjects with binocular (glaucomatous or retro-chiasmal lesion-induced) visual field defects. Driving simulator testing seems to be a well-standardized method, appropriate for assessment of driving performance in individuals with binocular visual field loss.
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Affiliation(s)
- Judith Ungewiss
- Study course Ophthalmic Optics, University of Applied Sciences, Aalen, Germany
| | - Thomas Kübler
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Katrin Sippel
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Kathrin Aehling
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Martin Heister
- Department of Ophthalmology, University of Tübingen, Tübingen, Germany
| | | | - Enkelejda Kasneci
- Department of Computer Science, University of Tübingen, Tübingen, Germany
| | - Eleni Papageorgiou
- Department of Ophthalmology, University Hospital of Larissa, Mezourlo Area, 41222, Larissa, Greece.
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Kato N, Saeki S, Okazaki T, Matsunaga K, Hachisuka K. Development of a simple driving simulator and determination of the reference range of normative performance. Brain Inj 2018; 32:644-651. [PMID: 29388857 DOI: 10.1080/02699052.2018.1432889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To establish the reference range for assessment items of the 'Simple Driving Simulator' (SiDS) in a normative population and to compare performance of age-matched young adults with a traumatic brain injury (TBI) to this reference data. METHODS AND PROCEDURES Normative ranges were calculated from the data of 445 participants in the control group. Three performance ranges were established: 'normal', 'borderline' and 'impaired' defined using standard deviation cutoff values in the control group. The performance of 28 patients with a TBI, aged 18-35 years, was evaluated. The performance score for the TBI group in the 'impaired range' was calculated for each test item and used to make a synthetic judgment regarding the clinical value of the SiDS. MAIN OUTCOMES AND RESULTS In the control group, only 0.6% of the participants exhibited a performance in the impaired range on >2 items, compared to 33.2% for the TBI group. CONCLUSIONS We provide evidence that impaired performance on ≤2 items of the SiDS provides a sensitive criterion of 'driving fitness' in young adults after a TBI.
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Affiliation(s)
- Noriaki Kato
- a Department of Rehabilitation Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Satoru Saeki
- a Department of Rehabilitation Medicine , University of Occupational and Environmental Health , Kitakyushu , Japan
| | - Tetsuya Okazaki
- b Department of Rehabilitation Medicine , Wakamatsu Hospital of the University of Occupational and Environmental Health , Kitakyushu , Japan
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Stolwyk RJ, Charlton JL, Ross PE, Bédard M, Marshall S, Gagnon S, Gooden JR, Ponsford JL. Characterizing on-road driving performance in individuals with traumatic brain injury who pass or fail an on-road driving assessment. Disabil Rehabil 2018; 41:1313-1320. [DOI: 10.1080/09638288.2018.1424955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Renerus J. Stolwyk
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Judith L. Charlton
- Monash University Accident Research Centre, Monash University, Clayton, Victoria, Australia
| | | | - Michel Bédard
- Centre for Research and Safe Driving, Lakehead University, Thunder Bay, Ontario, Canada
| | - Shawn Marshall
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Sylvain Gagnon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - James R. Gooden
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
| | - Jennie L. Ponsford
- Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Monash-Epworth Rehabilitation Research Centre, Richmond, Victoria, Australia
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Surman CBH, Fried R, Rhodewalt L, Boland H. Do Pharmaceuticals Improve Driving in Individuals with ADHD? A Review of the Literature and Evidence for Clinical Practice. CNS Drugs 2017; 31:857-866. [PMID: 29052031 DOI: 10.1007/s40263-017-0465-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is defined as a disorder of impaired attention and/or behavioral control. Studies suggest that the condition can dispose individuals to a higher risk of automobile accidents. ADHD symptoms respond to pharmacotherapy in a majority of uncomplicated cases. Evidence on how pharmacotherapies for ADHD impact driving behavior or outcomes could allow clinicians to support on-road safety rationally. We therefore undertook a review to identify the evidence base to date indicating positive or negative effects of pharmacotherapies on driving behavior in individuals with ADHD. Further, we evaluated the level of evidence for these effects, their specificity to ADHD, and how they may inform clinical care. We identified studies involving pharmacotherapy for ADHD that evaluated driving-related activities or outcomes. We then categorized these studies by the mode of measurement used and by the ADHD specificity of the driving behaviors measured. Finally, we extracted themes of interest to clinical practice in pharmacologic intervention. In total, 14 studies, involving 2-61 subjects diagnosed with ADHD, looked at computer-measured, observer-measured, or self-reported driving behavior correlates of pharmacotherapy during simulation or on-road driving. Of these studies, 13 involved psychostimulant agents and two used atomoxetine. All but three investigations (one of methylphenidate, one of mixed amphetamine salts, and one of atomoxetine) found favorable changes in measures such as steering and braking behaviors or reaction to unexpected events. One study found adverse effects on driving at hour 17 following mixed amphetamine salt administration. Four studies compared two pharmacotherapies, and each found differences in measured driving behavior between the therapies. One study explored impact on ADHD-specific driving impairments, and the same study was the only one to explore correlation of clinical measures (ADHD symptoms and self-reported driving behavior) with medication-associated changes-finding dissociation between changes in ADHD symptoms and changes in measured driving measures. While data to date are limited on the ADHD-specific effects of pharmacotherapies used for ADHD on driving, it is clear from our review that these agents have effects on driving-relevant behaviors. Further research is urgently needed to develop an evidence base for clinically predictable effects of pharmacotherapy on driving safety in individuals with ADHD. If possible, clinicians should evaluate the positive and negative effects of pharmacotherapy on driving in their clients.
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Affiliation(s)
- Craig B H Surman
- Harvard Medical School, Boston, USA. .,Adult ADHD Research Program, Massachusetts General Hospital, 55 Fruit Street, Warren 625, Boston, MA, 02114, USA.
| | - Ronna Fried
- Clinical and Research Programs for Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit Street, Warren, Boston, MA, 02114, USA
| | - Lauren Rhodewalt
- Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit Street, Warren 628, Boston, MA, 02114, USA
| | - Heidi Boland
- Pediatric Psychopharmacology, Massachusetts General Hospital, 55 Fruit Street, Warren 628, Boston, MA, 02114, USA
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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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Akinwuntan AE, Feys H, De Weerdt W, Baten G, Arno P, Kiekens C. Prediction of Driving after Stroke: A Prospective Study. Neurorehabil Neural Repair 2016; 20:417-23. [PMID: 16885428 DOI: 10.1177/1545968306287157] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The process of determining whether patients with stroke should drive again often involves off-road evaluations and road tests that usually take about 2 to 3 h to complete. Objectives. This prospective study sought to identify the combination of tests that best predicts fitness to drive after stroke. The main aim was to develop a short and predictive predriving assessment battery. Methods. Sixty-eight consecutive stroke patients were studied who performed a mandatory predriving assessment at the Belgian Road Safety Institute, Brussels, within 18 months. Performance in a predriving assessment included medical examination (when needed), visual and neuropsychological evaluations, and an on-road test. Based on these assessments, a physician, psychologist, and the driving safety expert who administered the tests decided if a subject was either “fit to drive,”“temporarily unfit to drive,” or “unfit to drive.” Results. Logistic regression analysis revealed a combination of visual neglect, figure of Rey, and on-road tests as the model that best predicted ( R2 = 0.73) fitness to drive after stroke. Using a discriminant function that included the 3 tests of the logistic model, the fitness to drive judgments of 59 (86.8%) subjects were correctly predicted. The sensitivity and specificity of the predictions were 79.4% and 94.1%, respectively. Conclusion. Fitness to drive after stroke can be predicted from performance on a few road-related tests with a high degree of accuracy. However, some individuals require extended assessments and further tests.
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Affiliation(s)
- A E Akinwuntan
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium.
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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: 1566] [Impact Index Per Article: 195.8] [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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Pauley T, Phadke CP, Kassam A, Ismail F, Boulias C, Devlin M. The influence of a concurrent cognitive task on lower limb reaction time among stroke survivors with right- or left-hemiplegia. Top Stroke Rehabil 2015; 22:342-8. [PMID: 26461879 DOI: 10.1179/1074935714z.0000000041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To determine the impact of cognitive interference on foot pedal reaction time among stroke survivors with right- (RH) or left-hemiplegia (LH). DESIGN Cross-sectional comparison without randomization. SUBJECTS/PATIENTS 10 patients post-stroke with RH, 10 with LH; 10 age-matched controls. METHODS Foot pedal response times were measured using three different reaction time (RT) paradigms: simple RT, dual-task RT (counting backward by serial 3 seconds), and choice RT (correct response contingent on stimuli to eliminate pre-programing). RH and LH used the non-paretic leg for all trials. Three 3 (RT task) × 3 (group) mixed-model factorial ANOVAs were used to compare RT, movement time (MT), total response time (TRT). RESULTS Overall controls demonstrated faster RT than RH (332 ± 73 versus 474 ± 144 ms, P < 0.001) or LH (402 ± 127 ms, P < 0.05); LH group demonstrated faster RT than those with RH (P < 0.05). Control subjects demonstrated significantly faster RT than RH for all RT conditions (P < 0.05 for all). In contrast, controls achieved significantly faster RT than LH for the choice RT condition only (P < 0.05), but not for the simple (P = 0.12) or dual-task RT conditions (P = 0.25). CONCLUSIONS Compared to controls, response time was significantly impaired among LH and RH when the response could not be pre-programmed. While current simple RT testing commonly employed by driver rehab specialists may be sufficient for detecting RT deficits in patients with RH, simple or dual-task RT tests alone may fail to detect RT deficiencies among LH, even when testing the non-paretic limb. Choice RT should be added to post-stroke driver fitness assessment, particularly for patients with LH.
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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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Fuermaier ABM, Tucha L, Evans BL, Koerts J, de Waard D, Brookhuis K, Aschenbrenner S, Thome J, Lange KW, Tucha O. Driving and attention deficit hyperactivity disorder. J Neural Transm (Vienna) 2015; 124:55-67. [PMID: 26419597 PMCID: PMC5281661 DOI: 10.1007/s00702-015-1465-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/18/2015] [Indexed: 12/01/2022]
Abstract
Adults with attention deficit hyperactivity disorder (ADHD) suffer from various impairments of cognitive, emotional and social functioning, which can have considerable consequences for many areas of daily living. One of those areas is driving a vehicle. Driving is an important activity of everyday life and requires an efficient interplay between multiple cognitive, perceptual, and motor skills. In the present study, a selective review of the literature on driving-related difficulties associated with ADHD is performed, seeking to answer whether individuals with ADHD show increased levels of unsafe driving behaviours, which cognitive (dys)functions of individuals with ADHD are related to driving difficulty, and whether pharmacological treatment significantly improves the driving behaviour of individuals with ADHD. The available research provides convincing evidence that individuals with ADHD have different and more adverse driving outcomes than individuals without the condition. However, it appears that not all individuals with ADHD are affected uniformly. Despite various cognitive functions being related with driving difficulties, these functions do not appear helpful in detecting high risk drivers with ADHD, nor in predicting driving outcomes in individuals with ADHD, since impairments in these functions are defining criteria for the diagnoses of ADHD (e.g., inattention and impulsivity). Pharmacological treatment of ADHD, in particular stimulant drug treatment, appears to be beneficial to the driving difficulties experienced by individuals with ADHD. However, additional research is needed, in particular further studies that address the numerous methodological weaknesses of many of the previous studies.
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Affiliation(s)
- Anselm B M Fuermaier
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands.
| | - Lara Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Ben Lewis Evans
- Traffic and Environmental Psychology Group, University of Groningen, Groningen, The Netherlands
| | - Janneke Koerts
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - Dick de Waard
- Traffic and Environmental Psychology Group, University of Groningen, Groningen, The Netherlands
| | - Karel Brookhuis
- Traffic and Environmental Psychology Group, University of Groningen, Groningen, The Netherlands
| | - Steffen Aschenbrenner
- Department of Clinical Psychology and Neuropsychology, SRH Clinic Karlsbad-Langensteinbach, Karlsbad-Langensteinbach, Germany
| | - Johannes Thome
- Department of Psychiatry and Psychotherapy, University of Rostock, Rostock, Germany
| | - Klaus W Lange
- Department of Experimental Psychology, University of Regensburg, Regensburg, Germany
| | - Oliver Tucha
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
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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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Emmanuel Akinwuntan A, Gantt D, Gibson G, Kimmons K, Ross V, Newman Rosen P, Wachtel J. United States Version of the Stroke Driver Screening Assessment: A Pilot Study. Top Stroke Rehabil 2015; 20:87-92. [DOI: 10.1310/tsr2001-87] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Cognitive, On-road, and Simulator-based Driving Assessment after Stroke. J Stroke Cerebrovasc Dis 2014; 23:2654-2670. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 05/21/2014] [Accepted: 06/10/2014] [Indexed: 11/21/2022] Open
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Classen S, Brooks J. Driving simulators for occupational therapy screening, assessment, and intervention. Occup Ther Health Care 2014; 28:154-162. [PMID: 24754764 DOI: 10.3109/07380577.2014.901590] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Simulation technology provides safe, objective, and repeatable performance measures pertaining to operational (e.g., avoiding a collision) or tactical (e.g., lane maintenance) driver behaviors. Many occupational therapy researchers and others are using driving simulators to test a variety of applications across diverse populations. A growing body of literature provides support for associations between simulated driving and actual on-road driving. One limitation of simulator technology is the occurrence of simulator sickness, but management strategies exist to curtail or mitigate its onset. Based on the literature review and a consensus process, five consensus statements are presented to support the use of driving simulation technology among occupational therapy practitioners. The evidence suggests that by using driving simulators occupational therapy practitioners may detect underlying impairments in driving performance, identify driving errors in at-risk drivers; differentiate between driving performance of impaired and healthy controls groups; show driving errors with absolute and relative validity compared to on-road studies; and mitigate the onset of simulator sickness. Much progress has been made among occupational therapy researchers and practitioners in the use of driving simulation technology; however, empirical support is needed to further justify the use of driving simulators in clinical practice settings as a valid, reliable, clinical useful, and cost effective tool for driving assessment and intervention.
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Affiliation(s)
- Sherrilene Classen
- 1School of Occupational Therapy, Elborn College, Western University, London, Ontario, Canada
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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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Parsey CM, Schmitter-Edgecombe M. Applications of technology in neuropsychological assessment. Clin Neuropsychol 2013; 27:1328-61. [PMID: 24041037 DOI: 10.1080/13854046.2013.834971] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Most neuropsychological assessments include at least one measure that is administered, scored, or interpreted by computers or other technologies. Despite supportive findings for these technology-based assessments, there is resistance in the field of neuropsychology to adopt additional measures that incorporate technology components. This literature review addresses the research findings of technology-based neuropsychological assessments, including computer- and virtual reality-based measures of cognitive and functional abilities. We evaluate the strengths and limitations of each approach, and examine the utility of technology-based assessments to obtain supplemental cognitive and behavioral information that may be otherwise undetected by traditional paper-and-pencil measures. We argue that the potential of technology use in neuropsychological assessment has not yet been realized, and continued adoption of new technologies could result in more comprehensive assessment of cognitive dysfunction and in turn, better informed diagnosis and treatments. Recommendations for future research are also provided.
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Affiliation(s)
- Carolyn M Parsey
- a Department of Psychology , Washington State University , Pullman , WA , USA
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27
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Kan K, Schweizer TA, Tam F, Graham SJ. Methodology for functional MRI of simulated driving. Med Phys 2012; 40:012301. [DOI: 10.1118/1.4769107] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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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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Hargrave DD, Nupp JM, Erickson RJ. Two brief measures of executive function in the prediction of driving ability after acquired brain injury. Neuropsychol Rehabil 2012; 22:489-500. [DOI: 10.1080/09602011.2012.662333] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lee HC, Yanting Chee D, Selander H, Falkmer T. Is it reliable to assess visual attention of drivers affected by Parkinson's disease from the backseat?-a simulator study. EMERGING HEALTH THREATS JOURNAL 2012; 5:EHTJ-5-15343. [PMID: 22461850 PMCID: PMC3290114 DOI: 10.3402/ehtj.v5i0.15343] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Revised: 01/29/2012] [Accepted: 01/31/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current methods of determining licence retainment or cancellation is through on-road driving tests. Previous research has shown that occupational therapists frequently assess drivers' visual attention while sitting in the back seat on the opposite side of the driver. Since the eyes of the driver are not always visible, assessment by eye contact becomes problematic. Such procedural drawbacks may challenge validity and reliability of the visual attention assessments. In terms of correctly classified attention, the aim of the study was to establish the accuracy and the inter-rater reliability of driving assessments of visual attention from the back seat. Furthermore, by establishing eye contact between the assessor and the driver through an additional mirror on the wind screen, the present study aimed to establish how much such an intervention would enhance the accuracy of the visual attention assessment. METHODS Two drivers with Parkinson's disease (PD) and six control drivers drove a fixed route in a driving simulator while wearing a head mounted eye tracker. The eye tracker data showed where the foveal visual attention actually was directed. These data were time stamped and compared with the simultaneous manual scoring of the visual attention of the drivers. In four of the drivers, one with Parkinson's disease, a mirror on the windscreen was set up to arrange for eye contact between the driver and the assessor. Inter-rater reliability was performed with one of the Parkinson drivers driving, but without the mirror. RESULTS Without mirror, the overall accuracy was 56% when assessing the three control drivers and with mirror 83%. However, for the PD driver without mirror the accuracy was 94%, whereas for the PD driver with a mirror the accuracy was 90%. With respect to the inter-rater reliability, a 73% agreement was found. CONCLUSION If the final outcome of a driving assessment is dependent on the subcategory of a protocol assessing visual attention, we suggest the use of an additional mirror to establish eye contact between the assessor and the driver. The clinicians' observations on-road should not be a standalone assessment in driving assessments. Instead, eye trackers should be employed for further analyses and correlation in cases where there is doubt about a driver's attention.
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Affiliation(s)
- Hoe C. Lee
- School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Derserri Yanting Chee
- School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
| | - Helena Selander
- School of Health Sciences, Jönköping University, Jönköping, Sweden
- Mobilitetscenter, Gothenburg, Sweden
| | - Torbjorn Falkmer
- School of Occupational Therapy and Social Work, Curtin Health Innovation Research Institute, Curtin University, Perth, WA, Australia
- School of Health Sciences, Jönköping University, Jönköping, Sweden
- Department of Rehabilitation Medicine, IKE, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- School of Occupational Therapy, La Trobe University, Melbourne, VIC, Australia
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Kay LG, Bundy AC, Clemson L, Cheal B, Glendenning T. Contribution of off-road tests to predicting on-road performance: A critical review of tests. Aust Occup Ther J 2011; 59:89-97. [DOI: 10.1111/j.1440-1630.2011.00989.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Unsworth CA, Baker A, Taitz C, Chan SP, Pallant JF, Russell KJ, Odell M. Development of a standardised Occupational Therapy--Driver Off-Road Assessment Battery to assess older and/or functionally impaired drivers. Aust Occup Ther J 2011; 59:23-36. [PMID: 22272880 DOI: 10.1111/j.1440-1630.2011.00979.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Research has been conducted over several years to develop a new off-road assessment battery referred to as the Occupational Therapy - Driver Off-Road Assessment Battery. This article documents the development of the Battery, and provides preliminary research evidence to support its content and predictive validity. METHODS Literature reviews and a focus group with nine driver assessor occupational therapists were undertaken, as well as data collection using the Occupational Therapy - Driver Off-Road Assessment Battery with 246 clients. A Classification and Regression Tree model was constructed to ascertain the predictive validity of the Battery, with fitness-to-drive as the outcome. RESULTS Twenty-one physical, 13 sensory and seven assessments of cognition/perception were identified as being reflective of the skills required for driving. Following rating of their psychometric properties, the best assessments were presented to focus group members. The driver assessors supported the inclusion of several assessments and encouraged the development of new assessments. A draft version of the Occupational Therapy - Driver Off-Road Assessment Battery was tested and found to have excellent predictive validity for client on-road performance of 82.6%. The Classification and Regression Tree model showed that client performance on tests included in the Battery should be used together, rather than in isolation, to support fitness-to-drive recommendations. CONCLUSION This research identified the most suitable physical, sensory and cognitive assessments to include in the Occupational Therapy - Driver Off-Road Assessment Battery, and provided support for its validity. The development of this standardised battery assists driver assessors to accurately and consistently assess and report the off-road driving capacity of clients.
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Affiliation(s)
- Carolyn A Unsworth
- Department of Occupational Therapy, La Trobe University, Melbourne, Australia.
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White JH, Miller B, Magin P, Attia J, Sturm J, Pollack M. Access and participation in the community: a prospective qualitative study of driving post-stroke. Disabil Rehabil 2011; 34:831-8. [DOI: 10.3109/09638288.2011.623754] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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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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Selander H, Lee HC, Johansson K, Falkmer T. Older drivers: On-road and off-road test results. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:1348-1354. [PMID: 21545864 DOI: 10.1016/j.aap.2011.02.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Revised: 02/04/2011] [Accepted: 02/06/2011] [Indexed: 05/30/2023]
Abstract
Eighty-five volunteer drivers, 65-85 years old, without cognitive impairments impacting on their driving were examined, in order to investigate driving errors characteristic for older drivers. In addition, any relationships between cognitive off-road and on-road tests results, the latter being the gold standard, were identified. Performance measurements included Trail Making Test (TMT), Nordic Stroke Driver Screening Assessment (NorSDSA), Useful Field of View (UFOV), self-rating driving performance and the two on-road protocols P-Drive and ROA. Some of the older drivers displayed questionable driving behaviour. In total, 21% of the participants failed the on-road assessment. Some of the specific errors were more serious than others. The most common driving errors embraced speed; exceeding the speed limit or not controlling the speed. Correlations with the P-Drive protocol were established for NorSDSA total score (weak), UFOV subtest 2 (weak), and UFOV subtest 3 (moderate). Correlations with the ROA protocol were established for UFOV subtest 2 (weak) and UFOV subtest 3 (weak). P-Drive and self ratings correlated weakly, whereas no correlation between self ratings and the ROA protocol was found. The results suggest that specific problems or errors seen in an older person's driving can actually be "normal driving behaviours".
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Bliokas VV, Taylor JE, Leung J, Deane FP. Neuropsychological assessment of fitness to drive following acquired cognitive impairment. Brain Inj 2011; 25:471-87. [PMID: 21456997 DOI: 10.3109/02699052.2011.559609] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PRIMARY OBJECTIVE The study evaluated a neuropsychological assessment battery used to assess fitness to drive in cognitively impaired individuals and hypothesized that the battery would be associated with on-road outcome measures. A secondary aim was to explore the relationships between individual neuropsychological tests and driving performance. RESEARCH DESIGN The study used a cross-sectional design in which a sample of individuals with various types of cognitive impairment completed the test battery and an on-road driving test. METHODS AND PROCEDURES Performance on the test battery was compared to on-road driving performance in 104 individuals with acquired cognitive impairment. MAIN OUTCOMES AND RESULTS The battery had 73% sensitivity and 76% specificity in terms of agreement with the 'pass/fail' classification of the on-road driving test. Scores on the battery accounted for 18% of the variance in the total number of corrective interventions performed by a driving instructor during the on-road test. Most tests correlated significantly with driving test outcomes. While one test, the Rey Complex Figure Test, emerged as an independent predictor of driving performance in multiple regression analyses, the variance explained by this single test was small. CONCLUSIONS The results provide support for the use of a battery approach to assess fitness to drive.
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Affiliation(s)
- Vida V Bliokas
- South East Sydney Illawarra Area Health Service, Port Kembla Hospital, Warrawong, NSW, Australia
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Davies GM. 25 years of Applied Cognitive Psychology. APPLIED COGNITIVE PSYCHOLOGY 2011. [DOI: 10.1002/acp.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Lundqvist A, Alinder J, Modig-Arding I, Samuelsson K. Driving after Brain Injury: A Clinical Model Based on a Quality Improvement Project. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/psych.2011.26094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Rabadi MH, Akinwuntan A, Gorelick P. The Safety of Driving a Commercial Motor Vehicle After a Stroke. Stroke 2010; 41:2991-6. [DOI: 10.1161/strokeaha.110.587196] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Meheroz H. Rabadi
- From the Department of Neurology (M.H.R.), Oklahoma University, Oklahoma City, Ok, and Department of Neurology and Neuro-rehabilitation, Oklahoma City VA Medical Center, Oklahoma City, Ok; Departments of Physical Therapy, Neurology, and Graduate Studies (A.A.), Medical College of Georgia, Augusta, Ga; Department of Neurology and Rehabilitation (P.G.), University of Illinois at Chicago, Chicago, Ill
| | - Abiodun Akinwuntan
- From the Department of Neurology (M.H.R.), Oklahoma University, Oklahoma City, Ok, and Department of Neurology and Neuro-rehabilitation, Oklahoma City VA Medical Center, Oklahoma City, Ok; Departments of Physical Therapy, Neurology, and Graduate Studies (A.A.), Medical College of Georgia, Augusta, Ga; Department of Neurology and Rehabilitation (P.G.), University of Illinois at Chicago, Chicago, Ill
| | - Philip Gorelick
- From the Department of Neurology (M.H.R.), Oklahoma University, Oklahoma City, Ok, and Department of Neurology and Neuro-rehabilitation, Oklahoma City VA Medical Center, Oklahoma City, Ok; Departments of Physical Therapy, Neurology, and Graduate Studies (A.A.), Medical College of Georgia, Augusta, Ga; Department of Neurology and Rehabilitation (P.G.), University of Illinois at Chicago, Chicago, Ill
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Devos H, Akinwuntan AE, Nieuwboer A, Ringoot I, Van Berghen K, Tant M, Kiekens C, De Weerdt W. Effect of Simulator Training on Fitness-to-Drive After Stroke: A 5-Year Follow-up of a Randomized Controlled Trial. Neurorehabil Neural Repair 2010; 24:843-50. [DOI: 10.1177/1545968310368687] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. No long-term studies have been reported on the effect of training programs on driving after stroke. Objectives. The authors’ primary aim was to determine the effect of simulator versus cognitive rehabilitation therapy on fitness-to-drive at 5 years poststroke. A second aim was to investigate differences in clinical characteristics between stroke survivors who resumed and stopped driving. Methods. In a previously reported randomized controlled trial, 83 stroke survivors received 15 hours of simulator training (n = 42) or cognitive therapy (n = 41). In this 5-year follow-up study, 61 participants were reassessed. Fitness-to-drive decisions were obtained from medical, visual, neuropsychological, and on-road tests; 44 participants (simulator group, n = 21; cognitive group, n = 23) completed all assessments. The primary outcome measures were fitness-to-drive decision and current driving status. Results. The authors found that 5 years after stroke, 18 of 30 participants (60%) in the simulator group were considered fit to drive, compared with 15 of 31 (48%) in the cognitive group ( P = .36); 34 of 61 (56%) participants were driving. Current drivers were younger ( P = .04), had higher Barthel scores ( P = .008), had less comorbidity ( P = .01), and were less severely depressed ( P = .02) than those who gave up driving. Conclusions. The advantage of simulator-based driving training over cognitive rehabilitation therapy, evident at 6 months poststroke, had faded 5 years later. Poststroke drivers were younger and less severely affected and depressed than nondrivers.
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Affiliation(s)
- Hannes Devos
- Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium,
| | | | - Alice Nieuwboer
- Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Isabelle Ringoot
- Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Karen Van Berghen
- Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mark Tant
- CARA Department, Belgian Road Safety Institute, Brussels, Belgium
| | | | - Willy De Weerdt
- Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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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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Patomella AH, Tham K, Johansson K, Kottorp A. P-Drive on-road: Internal scale validity and reliability of an assessment of on-road driving performance in people with neurological disorders. Scand J Occup Ther 2010. [DOI: 10.3109/11038120903071776] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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George S, Crotty M, Gelinas I, Devos H. Rehabilitation for improving automobile driving after stroke. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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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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Crotty M, George S. Retraining Visual Processing Skills To Improve Driving Ability After Stroke. Arch Phys Med Rehabil 2009; 90:2096-102. [PMID: 19969174 DOI: 10.1016/j.apmr.2009.08.143] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 08/25/2009] [Accepted: 08/25/2009] [Indexed: 11/28/2022]
Affiliation(s)
- Maria Crotty
- Department of Rehabilitation and Aged Care, Flinders University, South Australia, Australia
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Patomella AH, Johansson K, Tham K. Lived experience of driving ability following stroke. Disabil Rehabil 2009; 31:726-33. [PMID: 18946806 DOI: 10.1080/09638280802306539] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This study describes and expands our understanding of the lived-experience of driving ability after stroke in the context of being under a driving evaluation. METHOD Four men with stroke were interviewed on three occasions. The interviews were open-ended, taped and transcribed verbatim, and analysed using Karlsson's Empirical, Phenomenological and Psychological method. FINDINGS The findings revealed five main characteristics expressed in the participants' lived experiences: (1) the meaning of driving remained throughout life; (2) being questioned and advised not to drive--an untenable situation; (3) being out of control and violated by the driving evaluation; (4) driving safely (as usual) during the on-road test; and (5) perceiving consequences in everyday living. CONCLUSION The findings indicate that driving is important and taken for granted even after stroke. To lose the ability to drive was unexpected and aroused strong feelings and reactions. The present study contributes to a deeper understanding of how people with stroke experience their driving ability and the evaluation process, which can be integrated in clinical procedures to help improve information, emotional support and clinical procedures.
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Affiliation(s)
- Ann-Helen Patomella
- Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Karolinska Institutet, Huddinge, Sweden.
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Abstract
BACKGROUND Older drivers are at a higher risk of being involved in a motor vehicle accident. However, on-road assessments of all older drivers are impractical, highlighting the need to screen for potentially unsafe drivers. This study undertook a meta-analysis of research examining the cognitive predictors of driving ability in older drivers in order to provide an evidence-based method for screening drivers. METHODS Comprehensive searches were undertaken of the PubMed, PsycINFO, CINAHL, and Health-Source Nursing electronic databases between 1980 and 2007 in order to identify studies that examined cognitive differences between drivers aged over 55 years who either passed or failed a driving assessment. Twenty-one studies were eligible for inclusion. Weighted Cohen's d effect sizes, percentage overlap statistics, Fail-safe Ns and 95% CIs were calculated for all cognitive tests. RESULTS The best predictors of on-road driving were the Ergovision and Useful Field of View (UFOV) tests, a complex RT task, Paper Folding task, Dot Counting, WMS Visual Reproduction, and Computerized Visual Attention Task. Simulator driving performance was best predicted by the Benton Line Orientation Task, Clock Drawing, a Driver Scanning task, the UFOV, WAIS Picture Arrangement and MMSE. Finally, the Trail Making Test, Stroop, UFOV, WAIS Block Design, and Automated Psychophysical Test were good predictors of driving problems. CONCLUSIONS There are a variety of tests that appear suitable for screening older drivers, the exact choice of which depends on the "gold standard" for determining driving ability (on-road driving, driving simulator, driving problems) and whether a computerized or paper-and-pencil task is required.
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Patomella AH, Kottorp A, Tham K. Awareness of driving disability in people with stroke tested in a simulator. Scand J Occup Ther 2009; 15:184-92. [DOI: 10.1080/11038120802087600] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Lundqvist A, Alinder J. Driving after brain injury: Self-awareness and coping at the tactical level of control. Brain Inj 2009; 21:1109-17. [PMID: 17896210 DOI: 10.1080/02699050701651660] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To study whether metacognition is a prerequisite for coping at the tactical level of driving. RESEARCH DESIGN A consecutive series of 30 drivers with acquired brain injury were assessed concerning cognitive functions and driving performance. In addition the drivers assessed their driving performance through self-rating. RESULTS On average the drivers had cognitive impairments compared to a healthy reference group. The group that passed the driving test and the group that failed the driving test did not differ in terms of cognitive functions. Neither did they differ in their self-ratings of driving performance. However, the group that failed the driving test significantly over-estimated their performances as compared to the assessments made by the professional driving inspector, while the group that passed the test made more accurate self-ratings. CONCLUSIONS One interpretation of these results is that the group that made a more realistic evaluation of their driving performance were more aware of their cognitive capacity compared to those who failed the driving test. They seemed to have a better ability to adjust their driving behaviour at a tactical level. Thus, the subject's metacognition, awareness of his/her own cognitive capacity, is important for coping with cognitive impairments at tactical driving.
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Affiliation(s)
- Anna Lundqvist
- Department of Rehabilitation Medicine, University Hospital, Linköping, Sweden.
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