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Alhashmi D, Lalor A, Fossey E. Methods to evaluate driving competence for people with acquired brain injury (ABI): A systematic review. FRONTIERS IN REHABILITATION SCIENCES 2023; 3:1020420. [PMID: 36684687 PMCID: PMC9846792 DOI: 10.3389/fresc.2022.1020420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/29/2022] [Indexed: 01/06/2023]
Abstract
Driving is essential for independence, community involvement and quality of life. Driving is the primary transportation method in Saudi Arabia. Despite the high rates of brain injuries and disability in Saudi Arabia, currently there are no guidelines regarding driver assessment and rehabilitation to facilitate people with brain injuries to resume driving. Therefore, this systematic review aimed to understand the assessment methods used internationally to evaluate driving competence for people with acquired brain injuries (ABI). A systematic search of six electronic databases was conducted by two authors and twenty-six studies were identified for review. Four main approaches to driver assessment: clinical assessments such as neuropsychological tests, off-road screening tools, simulator testing, and comprehensive driving assessment were identified. However, our findings revealed a lack of consistency in their use to assess driving competence after ABI. On-road driving performance tests were predominantly used to determine driving competence either independently or in combination with another method in over two-thirds of the reviewed studies. While clinical assessments of cognitive impairments showed some capacity to predict driving performance of people with ABI, they should be used with caution since they cannot replace on-road driving performance tests. Driver assessment should be part of rehabilitation following high prevalence conditions such as ABI. This systematic review offers guidance for Saudi clinicians, as well as policymakers, about providing rehabilitation services for people with ABI, and recommendations for further research and collaborations to improve this much-needed area of practice.
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Affiliation(s)
- Doha Alhashmi
- Department of Rehabilitation, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia,Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia,Correspondence: Doha Hassan Alhashmi
| | - Aislinn Lalor
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia,Rehabilitation, Ageing and Independent Living Research Centre, School of Primary and Allied Health Care, Monash University, Frankston, Victoria, Australia
| | - Ellie Fossey
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, Victoria, Australia,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
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Social Environmental Factors Related to Resuming Driving after Brain Injury: A Multicenter Retrospective Cohort Study. Healthcare (Basel) 2021; 9:healthcare9111469. [PMID: 34828515 PMCID: PMC8619320 DOI: 10.3390/healthcare9111469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/21/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Many patients resume driving after brain injury regardless of their ability to drive safely. Predictors for resuming driving in terms of actual resumption status and environmental factors are unclear. We evaluated the reasons for resuming driving after brain injury and examined whether social environmental factors are useful predictors of resuming driving. This retrospective cohort study was based on a multicenter questionnaire survey at least 18 months after discharge of brain injury patients with rehabilitation. A total of 206 brain injury patients (cerebrovascular disease and traumatic brain injury) were included in the study, which was conducted according to the International Classification of Functioning (ICF) items using log-binominal regression analysis, evaluating social environmental factors as associated factors of resuming driving after brain injury. Social environmental factors, inadequate public transport (risk ratio (RR), 1.38), and no alternative driver (RR, 1.53) were included as significant independent associated factors. We found that models using ICF categories were effective for investigating factors associated with resuming driving in patients after brain injury and significant association between resuming driving and social environmental factors. Therefore, social environmental factors should be considered when predicting driving resumption in patients after brain injury, which may lead to better counseling and environmental adjustment.
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Holowaychuk A, Parrott Y, Leung AWS. Exploring the Predictive Ability of the Motor-Free Visual Perception Test (MVPT) and Trail Making Test (TMT) for On-Road Driving Performance. Am J Occup Ther 2020; 74:7405205070p1-7405205070p8. [PMID: 32804625 DOI: 10.5014/ajot.119.040626] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Resuming driving after a change in functional ability is challenging for patients with a neurological condition. Although a combination of assessment tools has been suggested for use in driving evaluation, resources and availability of tools have been a problem. OBJECTIVE To examine the predictive ability of two commonly used tools, the Motor-Free Visual Perception Test (MVPT) and the Trail Making Test, Parts A and B (TMTA and TMTB), on on-road driving performance. DESIGN Retrospective chart review of 82 patient charts between 2015 and 2016. SETTING Local rehabilitation hospital. PARTICIPANTS Eighty-two patients with a primary neurological diagnosis (general neurological condition, n = 13; spinal cord injury, n = 11; stroke, n = 58). OUTCOMES AND MEASURES MVPT, TMTA, and TMTB. RESULTS Among the patients, 36 passed and 46 failed the on-road evaluation. The TMTA and TMTB scores were significantly different between those who passed or failed the on-road evaluation. Logistic regression analyses revealed that the TMTB completion time was the only significant predictor of on-road driving performance (for the all-patient model, 66% prediction accuracy, -2 log-likelihood [LL] = 93.47, exp β = 0.98; for the stroke-only model, 76% prediction accuracy, -2LL = 59.61, exp β = 0.97). CONCLUSIONS AND RELEVANCE Our findings suggest that the TMTB is a better predictor of on-road driving performance for patients with a neurological condition than the MVPT. The findings shed light on the importance of selecting proper tools when assessing driving performance. Future prospective studies with a wider array of predictive variables are recommended to support the present findings. WHAT THIS ARTICLE ADDS Occupational therapists should revisit the use of the MVPT in driving assessment and consider multiple assessment tools when evaluating and predicting driving performance.
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Affiliation(s)
- Ana Holowaychuk
- Ana Holowaychuk, MSc, OT(C), is Occupational Therapist, Department of Occupational Therapy, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Yolan Parrott
- Yolan Parrott, MSc, OT(C), is Occupational Therapist, Department of Occupational Therapy, Glenrose Rehabilitation Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Ada W S Leung
- Ada W. S. Leung, PhD, OT(C), is Associate Professor, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, and Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada;
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Frith J, James C, Hubbard I, Warren-Forward H. Australian health professionals' perceptions about the management of return to driving early after stroke: A mixed methods study. Top Stroke Rehabil 2020; 28:198-206. [PMID: 32787668 DOI: 10.1080/10749357.2020.1803570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Stroke can affect a person's ability to drive a motor vehicle. In Australia, there is a 4-week restriction in driving after stroke and a 2-week restriction after transient ischemic attack. Concerns exist as to whether people discharged home from the acute setting receive education about these driving restrictions. OBJECTIVES This study sought to investigate health professionals' knowledge about, and responsibilities for patients return-to-driving (RTD) education after stroke and TIA. METHODS A cross-sectional online survey was designed and included questions about health professional demographic characteristics and knowledge and opinions of RTD guidelines. An open-ended question at the end of the survey enabled respondents to provide additional, free text information. Descriptive analyses were used to describe respondents' demography and characteristics. Chi-square analysis was used to compare responses across the different professional groups. Significance was tested using a p-value of 0.05. Data obtained from the free text question were analyzed through an inductive thematic approach. RESULTS A total of 455 health professionals responded to the survey, with 45% being occupational therapists. Only 22% of health professionals correctly selected the 4-week restriction period after stroke and 27% selected the 2-week restriction period for those with TIA. Occupational therapists were identified by 85% of respondents as the profession responsible for providing RTD education, followed by doctors (72%). Health professionals lack clarity in RTD guidelines and often defer the responsibility of managing RTD to others. CONCLUSIONS Education of health professionals in RTD guidelines is recommended to improve the processes of care after stroke.
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Affiliation(s)
- Janet Frith
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Carole James
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia.,University of South Australia
| | - Isobel Hubbard
- School of Medicine and Public Health, Faculty of Health, University of Newcastle, Callaghan, Australia
| | - Helen Warren-Forward
- School of Health Sciences, Faculty of Health, University of Newcastle, Callaghan, Australia
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Sasaki T, Nogawa T, Yamada K, Kojima T, Kanaya K. Hazard perception of stroke drivers in a video-based Japanese hazard perception task. TRAFFIC INJURY PREVENTION 2019; 20:264-269. [PMID: 31013171 DOI: 10.1080/15389588.2019.1579906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 01/30/2019] [Accepted: 02/03/2019] [Indexed: 06/09/2023]
Abstract
Objective: Hazard perception (HP) is the ability to identify a hazardous situation while driving. Though HP has been well studied among neurologically intact populations, little is known about the HP of neurologically impaired populations (in this study, stroke patients). The purpose of this study is, first, to investigate the HP of stroke patients and, second, to verify the effect of lesion side (right or left hemisphere) on HP, from the viewpoint of hazard types. Methods: Sixty-seven neurologically intact age-matched older drivers and 63 stroke patients with valid driver's licenses conducted a video-based Japanese HP task. Participants were asked to indicate the hazardous events in the driving scenario. These events were classified into 3 types: (1) behavioral prediction hazards (BP), which are those where the cause is visible before it becomes a hazard; (2) environmental prediction hazards (EP), which are those where the ultimate hazard may be hidden from view; and (3) dividing and focusing attention hazards (DF), which are those where there is more than one potential hazard to monitor on approach.Participants also took part in the Trail Making Test (TMT) to evaluate visual information processing speed. Results: The results showed that the number of responses was significantly fewer for stroke patients than for age-matched drivers for all hazard types (P < .001), and this difference was not affected by lesion side (P > .05). It was also found that stroke patients showed a slower response time than age-matched drivers only for BP (P < .001). The lesion side did not affect response latency (P > .05). Results of the TMT revealed that age-matched drivers completed the task significantly faster than stroke patients (P < .001) and that neither TMT-A nor TMT-B differentiated between patients with left hemisphere damage and patients with right hemisphere damage (P > .05). Conclusions: Firstly, HP in stroke patients is low compared to age-matched drivers. Secondly, even if stroke patients notice hazards, their response may be delayed in a BP situation, due to a slower visual information processing speed. Thirdly, the lesion side does not appear to affect HP.
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Affiliation(s)
- Tsutomu Sasaki
- a Hokkaido Chitose College of Rehabilitation , Chitose , Japan
| | - Takashi Nogawa
- b Department of Clinical Psychology , Kakeyu Hospital, Kakeyu-Misayama Rehabilitation Center , Ueda , Japan
| | - Kyohei Yamada
- c Division of Occupational Therapy , Hokkaido Chitose College of Rehabilitation , Hokkaido , Japan
| | - Takao Kojima
- d Department of Rehabilitation , Shuyukai Hospital , Hokkaido , Japan
| | - Kunihiro Kanaya
- e Department of Rehabilitation Medicine , Sasson-Sugata Clinic , Hokkaido , Japan
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Strong JG, Jutai JW, Russell-Minda E, Evans M. Driving and Low Vision: Validity of Assessments for Predicting Performance of Drivers. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x0810200603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors conducted a systematic review to examine whether vision-related assessments can predict the driving performance of individuals who have low vision. The results indicate that measures of visual field, contrast sensitivity, cognitive and attention-based tests, and driver screening tools have variable utility for predicting real-world driving performance.
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Affiliation(s)
- J. Graham Strong
- Centre for Sight Enhancement and School of Optometry, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
| | - Jeffrey W. Jutai
- Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, 801 Commissioners Road East, Room B3002a, London, Ontario, Canada, N6C 5J1
| | - Elizabeth Russell-Minda
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, 801 Commissioners Road East, Room B-3016, London, Ontario, N6C 5J1, Canada
| | - Mal Evans
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, 801 Commissioners Road East, Room B-3016, London, Ontario, N6C 5J1, Canada
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Cammarata M, Mueller AS, Harris J, Vrkljan B. The Role of the Occupational Therapist in Driver Rehabilitation After Stroke. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2017. [DOI: 10.1080/02703181.2016.1277443] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Michael Cammarata
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Alexandra S. Mueller
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Jocelyn Harris
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Brenda Vrkljan
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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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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Dickerson AE, Meuel DB, Ridenour CD, Cooper K. Assessment tools predicting fitness to drive in older adults: a systematic review. Am J Occup Ther 2016; 68:670-80. [PMID: 25397762 DOI: 10.5014/ajot.2014.011833] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This systematic review synthesizes the research on screening and assessment tools used to determine older adults' fitness to drive. After a comprehensive search of the literature targeting tools commonly used by occupational therapists, 64 studies were reviewed and synthesized. The evidence demonstrated that a single tool measuring cognition, vision, perception, or physical ability individually is not sufficient to determine fitness to drive. Although some tools have stronger evidence than others, this review supports using different and focused assessment tools together for specific medical conditions. Results indicate that behind-the-wheel assessment remains the gold standard for driving evaluation; however, emerging evidence for observation of complex instrumental tasks of daily living and driving simulation supports further investigation with these tools.
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Affiliation(s)
- Anne E Dickerson
- Anne E. Dickerson, PhD, OTR/L, FAOTA, is Professor, Department of Occupational Therapy, East Carolina University, 3305 Health Sciences Building, Greenville, NC 27858;
| | - Danielle Brown Meuel
- Danielle Brown Meuel, MS, OTR, is Occupational Therapist, Alta Bates Medical Center, Berkeley, CA
| | - Cyrus David Ridenour
- Cyrus David Ridenour, MS, OTR, is Acute Care Therapist, Trinity Mother Francis Hospital, Tyler, TX
| | - Kristen Cooper
- Kristen Cooper, MS, OTR/L, is Occupational Therapist, TriStar StoneCrest Medical Center, Nashville, TN
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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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Oka N, Yoshino K, Yamamoto K, Takahashi H, Li S, Sugimachi T, Nakano K, Suda Y, Kato T. Greater Activity in the Frontal Cortex on Left Curves: A Vector-Based fNIRS Study of Left and Right Curve Driving. PLoS One 2015; 10:e0127594. [PMID: 25993263 PMCID: PMC4438050 DOI: 10.1371/journal.pone.0127594] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 04/16/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES In the brain, the mechanisms of attention to the left and the right are known to be different. It is possible that brain activity when driving also differs with different horizontal road alignments (left or right curves), but little is known about this. We found driver brain activity to be different when driving on left and right curves, in an experiment using a large-scale driving simulator and functional near-infrared spectroscopy (fNIRS). RESEARCH DESIGN AND METHODS The participants were fifteen healthy adults. We created a course simulating an expressway, comprising straight line driving and gentle left and right curves, and monitored the participants under driving conditions, in which they drove at a constant speed of 100 km/h, and under non-driving conditions, in which they simply watched the screen (visual task). Changes in hemoglobin concentrations were monitored at 48 channels including the prefrontal cortex, the premotor cortex, the primary motor cortex and the parietal cortex. From orthogonal vectors of changes in deoxyhemoglobin and changes in oxyhemoglobin, we calculated changes in cerebral oxygen exchange, reflecting neural activity, and statistically compared the resulting values from the right and left curve sections. RESULTS Under driving conditions, there were no sites where cerebral oxygen exchange increased significantly more during right curves than during left curves (p > 0.05), but cerebral oxygen exchange increased significantly more during left curves (p < 0.05) in the right premotor cortex, the right frontal eye field and the bilateral prefrontal cortex. Under non-driving conditions, increases were significantly greater during left curves (p < 0.05) only in the right frontal eye field. CONCLUSIONS Left curve driving was thus found to require more brain activity at multiple sites, suggesting that left curve driving may require more visual attention than right curve driving. The right frontal eye field was activated under both driving and non-driving conditions.
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Affiliation(s)
- Noriyuki Oka
- Department of Brain Environmental Research, KatoBrain Co., Ltd., Tokyo, Japan
| | - Kayoko Yoshino
- Department of Brain Environmental Research, KatoBrain Co., Ltd., Tokyo, Japan
| | - Kouji Yamamoto
- Department of Environment/Engineering, Tokyo Branch, Central Nippon Expressway Co., Ltd, Tokyo, Japan
| | - Hideki Takahashi
- Department of Environment/Engineering, Central Nippon Expressway Co., Ltd., Nagoya, Japan
| | - Shuguang Li
- Institute of Industrial Science, the University of Tokyo, Tokyo, Japan
| | | | - Kimihiko Nakano
- Institute of Industrial Science, the University of Tokyo, Tokyo, Japan
| | - Yoshihiro Suda
- Institute of Industrial Science, the University of Tokyo, Tokyo, Japan
| | - Toshinori Kato
- Department of Brain Environmental Research, KatoBrain Co., Ltd., Tokyo, Japan
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Marshall SC, Molnar F, Man-Son-Hing M, Blair R, Brosseau L, Finestone HM, Lamothe C, Korner-Bitensky N, Wilson KG. Predictors of Driving Ability Following Stroke: A Systematic Review. Top Stroke Rehabil 2014; 14:98-114. [PMID: 17311796 DOI: 10.1310/tsr1401-98] [Citation(s) in RCA: 125] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE The objective of this review is to identify the most consistent predictors of driving ability post stroke. METHOD A computerized search of numerous databases from 1966 forward was completed. Measured outcomes included voluntary driving cessation or results of on-road driving evaluation. Studies were evaluated using the Newcastle-Ottawa Quality Assessment Scale. RESULTS 17 eligible studies were identified. The most useful screening tests were tests assessing cognitive abilities. These included the Trail Making A and B tests, the Rey-Osterreith Complex Figure Design, and the Useful Field of View Test. CONCLUSION Cognitive tests that assess multiple cognitive domains relevant to driving appear to have the best reproducibility in predicting fitness to drive in stroke patients.
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Affiliation(s)
- Shawn C Marshall
- Physical Medicine and Rehabilitation, The Rehabilitation Centre, Elisabeth Bruyère Research Institute, University of Ottawa, Ottawa, Canada
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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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Murie-Fernandez M, Iturralde S, Cenoz M, Casado M, Teasell R. Capacidad de conducción tras un ictus: evaluación y recuperación. Neurologia 2014; 29:161-7. [DOI: 10.1016/j.nrl.2012.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 05/28/2012] [Indexed: 01/13/2023] Open
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Murie-Fernandez M, Iturralde S, Cenoz M, Casado M, Teasell R. Driving ability after a stroke: Evaluation and recovery. NEUROLOGÍA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.nrleng.2012.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Kasneci E, Sippel K, Aehling K, Heister M, Rosenstiel W, Schiefer U, Papageorgiou E. Driving with binocular visual field loss? A study on a supervised on-road parcours with simultaneous eye and head tracking. PLoS One 2014; 9:e87470. [PMID: 24523869 PMCID: PMC3921141 DOI: 10.1371/journal.pone.0087470] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 12/24/2013] [Indexed: 11/30/2022] Open
Abstract
Post-chiasmal visual pathway lesions and glaucomatous optic neuropathy cause binocular visual field defects (VFDs) that may critically interfere with quality of life and driving licensure. The aims of this study were (i) to assess the on-road driving performance of patients suffering from binocular visual field loss using a dual-brake vehicle, and (ii) to investigate the related compensatory mechanisms. A driving instructor, blinded to the participants' diagnosis, rated the driving performance (passed/failed) of ten patients with homonymous visual field defects (HP), including four patients with right (HR) and six patients with left homonymous visual field defects (HL), ten glaucoma patients (GP), and twenty age and gender-related ophthalmologically healthy control subjects (C) during a 40-minute driving task on a pre-specified public on-road parcours. In order to investigate the subjects' visual exploration ability, eye movements were recorded by means of a mobile eye tracker. Two additional cameras were used to monitor the driving scene and record head and shoulder movements. Thus this study is novel as a quantitative assessment of eye movements and an additional evaluation of head and shoulder was performed. Six out of ten HP and four out of ten GP were rated as fit to drive by the driving instructor, despite their binocular visual field loss. Three out of 20 control subjects failed the on-road assessment. The extent of the visual field defect was of minor importance with regard to the driving performance. The site of the homonymous visual field defect (HVFD) critically interfered with the driving ability: all failed HP subjects suffered from left homonymous visual field loss (HL) due to right hemispheric lesions. Patients who failed the driving assessment had mainly difficulties with lane keeping and gap judgment ability. Patients who passed the test displayed different exploration patterns than those who failed. Patients who passed focused longer on the central area of the visual field than patients who failed the test. In addition, patients who passed the test performed more glances towards the area of their visual field defect. In conclusion, our findings support the hypothesis that the extent of visual field per se cannot predict driving fitness, because some patients with HVFDs and advanced glaucoma can compensate for their deficit by effective visual scanning. Head movements appeared to be superior to eye and shoulder movements in predicting the outcome of the driving test under the present study scenario.
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Affiliation(s)
- Enkelejda Kasneci
- Computer Engineering Department, Wilhelm-Schickard-Institute of Computer Science, University of Tübingen, Tübingen, Germany
- * E-mail:
| | - Katrin Sippel
- Computer Engineering Department, Wilhelm-Schickard-Institute of Computer Science, University of Tübingen, Tübingen, Germany
| | - Kathrin Aehling
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Martin Heister
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
| | - Wolfgang Rosenstiel
- Computer Engineering Department, Wilhelm-Schickard-Institute of Computer Science, University of Tübingen, Tübingen, Germany
| | - Ulrich Schiefer
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
- Competence Centre “Vision Research”, Study Course “Ophthalmic Optics/Audiology”, University of Applied Sciences Aalen, Aalen, Germany
| | - Elena Papageorgiou
- Centre for Ophthalmology, Institute for Ophthalmic Research, University of Tübingen, Tübingen, Germany
- Department of Ophthalmology, University of Leicester, Leicester Royal Infirmary, Leicester, United Kingdom
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Dickerson AE. Driving Assessment Tools Used by Driver Rehabilitation Specialists: Survey of Use and Implications for Practice. Am J Occup Ther 2013; 67:564-73. [DOI: 10.5014/ajot.2013.007823] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
OBJECTIVE. This article describes the use of assessment tools by North American driver rehabilitation specialists (DRSs).
PARTICIPANTS. Participants were 227 self-identified DRSs from the combined databases of two national associations.
MEASURES. Information was solicited through a self-administered survey about the driving evaluation process, assessment tools, and process for making fitness-to-drive recommendations.
RESULTS. More than 80% of the DRSs reported testing visual acuity, range of motion, muscle strength, and fine motor coordination. The most consistently used cognitive–perceptual tests were the Trail Making Tests, Motor-Free Visual Perception Test–Revised, and short cognitive screening tests. A client’s behind-the-wheel performance was the main factor in making a fitness-to-drive recommendation. Few specialists are using computer-based tests or interactive driving simulators.
CONCLUSION. Although use of the Useful Field of View® has increased, there continues to be no consistency in cognitive assessments or guidelines for behind-the-wheel assessment. Implications for practice are discussed.
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Affiliation(s)
- Anne E. Dickerson
- Anne E. Dickerson, PhD, OTR/L, FAOTA, is Professor, Program Director of Research for Older Adult Driver Initiative, Occupational Therapy Department, East Carolina University, 3305 Health Sciences Building, Greenville, NC 27858;
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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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Papageorgiou E, Hardiess G, Ackermann H, Wiethoelter H, Dietz K, Mallot HA, Schiefer U. Collision avoidance in persons with homonymous visual field defects under virtual reality conditions. Vision Res 2012; 52:20-30. [PMID: 22100816 DOI: 10.1016/j.visres.2011.10.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Revised: 10/03/2011] [Accepted: 10/17/2011] [Indexed: 11/25/2022]
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21
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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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22
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Korner-Bitensky N, Audet T, Man-Son-Hing M, Benoit D, Kaizer F, Gelinas I. Test–Retest Reliability of the Preroad DriveABLE Competence Screen. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2011. [DOI: 10.3109/02703181.2011.573619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vrkljan BH, McGrath CE, Letts LJ. Assessment Tools for Evaluating Fitness to Drive: A Critical Appraisal of Evidence. The Canadian Journal of Occupational Therapy 2011; 78:80-96. [DOI: 10.2182/cjot.2011.78.2.3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background. Many office-based assessment tools are used by occupational therapists to predict fitness to drive. Purpose. To appraise psychometric properties of such tools, specifically predictive validity for on-road performance. Methods. A literature search was conducted to identify assessment tools and studies involving on-road outcomes (behind-the-wheel evaluation, crashes, traffic violations). Using a standardized appraisal process, reviewers rated each tool's psychometrric properties, including its predictive validity with on-road performance. Findings. Seventeen measures met the inclusion criteria. Evidence suggests many tools do not have cut-off scores linked with on-road outcomes, although some had stronger evidence than others. Implications. When making a determination regarding driver fitness, clinicians should consider the psychometric properties of the tool as well as existing evidence concerning its utility in predicting on-road performance. Caution is warranted in using any one office-based tool to predict driving fitness; rather, a multifactorial-based assessment approach that includes physical, cognitive, and visual-perceptual components, is recommended.
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Affiliation(s)
| | - Colleen E. McGrath
- Colleen E. McGrath, MSc, O.T. Reg. (Ont.), Occupational Therapist, is doing her PhD in Health and Rehabilitation Sciences at The University of Western Ontario, London, ON, Canada
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Akinwuntan AE, Devos H, Verheyden G, Baten G, Kiekens C, Feys H, De Weerdt W. Retraining moderately impaired stroke survivors in driving-related visual attention skills. Top Stroke Rehabil 2011; 17:328-36. [PMID: 21131257 DOI: 10.1310/tsr1705-328] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Visual inattention is a major cause of road accidents and is a problem commonly experienced after stroke. PURPOSE This study investigated the effects of 2 training programs on performance in the Useful Field of View (UFOV), a validated test of driving-related visual attention skills. METHOD Data from 69 first-ever, moderately impaired stroke survivors who participated in a randomized controlled trial (RCT) to determine the effects of simulator training on driving after stroke were analyzed. In addition to regular interventions at a rehabilitation center, participants received 15 hours of either simulator-based driving-related training or non-computer-based cognitive training over 5 weeks. RESULTS Total percentage reduction in UFOV and performance in divided and selective attention and speed of processing subtests were documented at 6 to 9 weeks (pretraining), 11 to 15 weeks (posttraining), and 6 months post stroke (follow-up). Generalized estimating equation (GEE) model revealed neither group effects nor significant interaction effects of group with time in the UFOV total score and the 3 subtests. However, there were significant within-group improvements from pre- through posttraining to follow-up for all the UFOV parameters. Post-hoc GEE analysis revealed that most improvement in both groups occurred from pre- to posttraining. CONCLUSION Both training programs significantly improved visual attention skills of moderately impaired stroke survivors after 15 hours of training and retention of benefit lasted up to 6 months after stroke. Neither of the training programs was better than the other.
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Affiliation(s)
- Abiodun E Akinwuntan
- Department of Physical Therapy, School of Allied Health Sciences, Medical College of Georgia, Augusta, Georgia
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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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Stapleton T, Connelly D. Occupational therapy practice in predriving assessment post stroke in the Irish context: findings from a nominal group technique meeting. Top Stroke Rehabil 2010; 17:58-68. [PMID: 20410013 DOI: 10.1310/tsr1701-58] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE Practice in the area of predriving assessment for people with stroke varies, and research findings are not always easily transferred into the clinical setting, particularly when such assessment is not conducted within a dedicated driver assessment programme. This article explores the clinical predriving assessment practices and recommendations of a group of Irish occupational therapists for people with stroke. METHOD A consensus meeting of occupational therapists was facilitated using a nominal group technique (NGT) to identify specific components of cognition, perception, and executive function that may influence fitness to return to driving and should be assessed prior to referral for on-road evaluation. Standardised assessments for use in predriving assessment were recommended. RESULTS Thirteen occupational therapists speed of processing; perceptual components of spatial awareness, depth perception, and visual inattention; and executive components of planning, problem solving, judgment, and self-awareness. Consensus emerged for the use of the following standardised tests: Behavioural Assessment of Dysexecutive Syndrome (BADS), Test of Everyday Attention (TEA), Brain Injury Visual Assessment Battery for Adults (biVABA), Rivermead Perceptual Assessment Battery (RPAB), and Motor Free Visual Perceptual Test (MVPT). CONCLUSION Tests were recommended that gave an indication of the patient's underlying component skills in the area of cognition, perception, and executive functions considered important for driving. Further research is needed in this area to develop clinical practice guidelines for occupational therapists for the assessment of fitness to return to driving after stroke.
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Affiliation(s)
- Tadhg Stapleton
- Department of Occupational Therapy, Trinity College Dublin, Dublin, Ireland
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27
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Functional compensation of visual field deficits in hemianopic patients under the influence of different task demands. Vision Res 2010; 50:1158-72. [PMID: 20381514 DOI: 10.1016/j.visres.2010.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 01/29/2010] [Accepted: 04/02/2010] [Indexed: 11/23/2022]
Abstract
We investigated the task-specific role of eye and head movements as a compensatory strategy in patients with homonymous visual field deficits (HVFDs) and in age-matched normal controls. All participants were tested in two tasks, i.e. a dot counting (DC) task requiring mostly simple visual scanning and a cognitively more demanding comparative visual search (CVS) task. The CVS task involved recognition and memory of geometrical objects and their configuration in two test fields. Based on task performance, patients were assigned to one of two groups, "adequate" (HVFD(A)) and "inadequate" (HVFD(I)); the group definitions based on either task turned out to be identical. With respect to the gaze related parameters in the DC task we obtained results in agreement with previous studies: the gaze pattern of HVFD(A) patients and normal controls did not differ significantly, while HVFD(I) patients showed increased gaze movement activity. In contrast, for the more complex CVS task we identified a deviating pattern of compensatory strategy use. Adequately performing subjects, who had used the same gaze strategies as normals in the DC task, now changed to increased gaze movement activity that allowed coping with the increasing task demands. Inadequately performing patients switched to a novel pattern of compensatory behavior in the CVS task. Different compensatory strategies are discussed with respect to the task-specific demands (in particular working memory involvement), the specific behavioral deficits of the patients, and the corresponding brain lesions.
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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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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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30
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Kay LG, Bundy AC, Clemson LM. Predicting Fitness to Drive in People With Cognitive Impairments by Using DriveSafe and DriveAware. Arch Phys Med Rehabil 2009; 90:1514-22. [PMID: 19735779 DOI: 10.1016/j.apmr.2009.03.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 11/21/2008] [Accepted: 03/05/2009] [Indexed: 10/20/2022]
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Korner-Bitensky N, Gélinas I, Man-Son-Hing M, Marshall S. Recommendations of the Canadian Consensus Conference on Driving Evaluation in Older Drivers. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2009. [DOI: 10.1080/j148v23n02_08] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Korner-Bitensky N, Sofer S. The DriveABLE Competence Screen as a predictor of on-road driving in a clinical sample. Aust Occup Ther J 2009; 56:200-5. [DOI: 10.1111/j.1440-1630.2008.00749.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Devos H, Akinwuntan AE, Nieuwboer A, Tant M, Truijen S, De Wit L, Kiekens C, De Weerdt W. Comparison of the Effect of Two Driving Retraining Programs on On-Road Performance After Stroke. Neurorehabil Neural Repair 2009; 23:699-705. [DOI: 10.1177/1545968309334208] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Several driving retraining programs have been developed to improve driving skills after stroke. Those programs rely on different rehabilitation concepts. Objectives. The current study sought to examine the specific carryover effect of driving skills of a comprehensive training program in a driving simulator when compared with a cognitive training program. Methods. Further analysis from a previous randomized controlled trial that investigated the effect of simulator training on driving after stroke. Forty-two participants received simulator-based driving training, whereas 41 participants received cognitive training for 15 hours. Overall performance in the on-road test and each of its 13 items were compared between groups immediately posttraining and at 6 months poststroke. Results. Generalized estimating equation analysis showed that the total score on the on-road test and each item score improved significantly over time for both groups. Those who received driving simulator training achieved better results when compared with the cognitive training group in the overall on-road score and the items of anticipation and perception of signs, visual behavior and communication, quality of traffic participation, and turning left. Most of the differences in improvement between the 2 interventions were observed at 6 months poststroke. Conclusions . Contextual training in a driving simulator appeared to be superior to cognitive training to treat impaired on-road driving skills after stroke. The effects were primarily seen in visuointegrative driving skills. Our results favor the implementation of driving simulator therapy in the conventional rehabilitation program of subacute stroke patients with mild deficits.
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Affiliation(s)
- Hannes Devos
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium,
| | - Abiodun Emmanuel Akinwuntan
- Department of Physical Therapy, School of Allied Health Sciences, Medical College of Georgia, Augusta, Georgia
| | - Alice Nieuwboer
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Mark Tant
- CARA Department, Belgian Road Safety Institute, Brussels, Belgium
| | - Steven Truijen
- Department of Health Care Sciences, Institute for Physiotherapy and Occupational Therapy, University College of Antwerp, Antwerp, Belgium
| | - Liesbet De Wit
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Carlotte Kiekens
- Department of Physical Medicine and Rehabilitation, University Hospital Leuven Campus Pellenberg, Leuven, Belgium
| | - Willy De Weerdt
- Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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Oswanski MF, Sharma OP, Raj SS, Vassar LA, Woods KL, Sargent WM, Pitock RJ. Evaluation of Two Assessment Tools in Predicting Driving Ability of Senior Drivers. Am J Phys Med Rehabil 2007; 86:190-9. [PMID: 17167349 DOI: 10.1097/phm.0b013e31802b7de5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate Motor Free Visual Perceptual Test (MVPT) and Clock Drawing Task (clock test) as quick assessment tools in predicting driving capability of senior drivers for an on-road driving test. DESIGN Senior drivers (> or = 55 yrs) referred for evaluation and recommendation for license renewal were given the MVPT, clock test, and an on-road driving test. Receiving operating characteristic (ROC) analysis and stepwise multivariate logistic regression (SMLR) were used to develop a probability model to differentiate between capable and incapable senior drivers. RESULTS Data for 232 seniors who had completed all written tests and the on-road driving test were analyzed. Of the 232 seniors, 131 (56%) were classified as capable and 101 (44%) as incapable drivers on the road test. Mean scores for capable and incapable drivers were MVPT 32.0 +/- 4.0 vs. 28.4 +/- 4.6 and mean clock test score 3.5 +/- 0.8 vs. 2.7 +/- 1.2, and mean processing time was 7.1 + 6.5 vs. 10.6 + 5.5. The means of the three measurements were significantly different between the two groups (P value <0.001). ROC curve analysis revealed an optimal cut point of > or = 32 for MVPT score with 60% sensitivity and 83% specificity. The optimal cut point for clock test scores is > or = 3 with 70% sensitivity and 65% specificity. The optimal cut point for processing times is < or = 6.27 secs with 60% sensitivity and 80% specificity. SMLR showed that the most significant predictor of seniors' driving capabilities are the MVPT test scores and clock test scores. CONCLUSION MVPT and clock test tools are significant predictors of driving capability on an on-road driving test.
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Affiliation(s)
- Michael F Oswanski
- Trauma Services Department, Toledo Hospital/The Toledo Children's Hospital, Toledo, Ohio 43606, USA
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Söderström ST, Pettersson RP, Leppert J. Prediction of driving ability after stroke and the effect of behind-the-wheel training. Scand J Psychol 2006; 47:419-29. [PMID: 16987211 DOI: 10.1111/j.1467-9450.2006.00550.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to examine the predictive value of a neuropsychological test battery relating to an on-the-road driving evaluation and to determine whether patients who failed the driving test could improve their driving through behind-the-wheel training. Thirty-four stroke patients were compared with 20 healthy, matched controls. Patients who failed the driving test were offered driving practice at a driving school and were then reassessed (neuropsychologically and practically). On most of the cognitive tests, patients performed significantly less well than control subjects. Almost 50% of the controls and the patients failed the driving evaluation. None of the neuropsychological tests was able to predict the driving outcome. Of the patients who failed the first driving evaluation, 85% passed the second evaluation after driving practice. There are few controlled studies focusing on the stroke population and the effect of behind-the-wheel training. It is suggested that more controlled studies are needed with more homogenous patient-groups and reliable and quantitative outcome measures.
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Affiliation(s)
- Staffan T Söderström
- Hjärnskadeenheten (Brain Injury Rehabilitation Unit), Centrallasarettet in Västerås, Sweden.
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Smith-Arena L, Edelstein L, Rabadi MH. Predictors of a successful driver evaluation in stroke patients after discharge based on an acute rehabilitation hospital evaluation. Am J Phys Med Rehabil 2006; 85:44-52. [PMID: 16357548 DOI: 10.1097/01.phm.0000184157.19912.96] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE One of the most common concerns of a stroke patient is the ability to drive. We aimed to determine which neurologic impairments on an acute rehabilitation admission evaluation predict the likelihood of a successful driver evaluation after discharge. DESIGN Prospective study in an acute stroke rehabilitation unit. RESULTS A total of 45 stroke patients undertook a driver evaluation at our institution. The mean age +/- standard deviation was 71.0 +/- 9.8 yrs, Mini-Mental State Examination score was 22.7 +/- 8.1, upper limb and lower limb Motricity Index scores were 63.7 +/- 34.8 and 71.8 +/- 24.3, Limb Placement Task was 4.6 +/- 3.6 inches, and admission total FIM score was 68.5 +/- 18. The admission variables differed between those who failed (n = 10) vs. those who passed the in-clinic driver evaluation (n = 29, 75%): Mini-Mental State Examination (17.5 +/- 9.7 vs. 24.6 +/- 6.7, P = 0.004), and upper limb (82 +/- 23.7 vs. 57.4 +/- 36.1, P = 0.05) and lower limb (87.6 +/- 11.8 vs. 66.4 +/- 25.2, P = 0.01) Motricity Index scores. CONCLUSIONS Patients who undertook and passed the in-clinic driver evaluation had, at admission, higher Mini-Mental State Examination and Motricity Index scores with normal visual field defects.
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Affiliation(s)
- Laureen Smith-Arena
- Weill Medical College of Cornell University at Burke Rehabilitation Hospital, White Plains, NY 10606, USA
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37
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Teasell RW, Foley NC, Bhogal SK, Speechley MR. An evidence-based review of stroke rehabilitation. Top Stroke Rehabil 2003; 10:29-58. [PMID: 12970830 DOI: 10.1310/8yna-1yhk-ymhb-xte1] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
A comprehensive evidence-based review of stroke rehabilitation was created to be an up-to-date review of the current evidence in stroke rehabilitation and to provide specific conclusions based on evidence that could be used to help direct stroke care at the bedside and at home. A literature search using multiple data-bases was used to identify all trials from 1968 to 2001. Methodological quality of the individual randomized controlled trials was assessed using the Physiotherapy Evidence Database (PEDro) quality assessment scale. A five-stage level-of-evidence approach was used to determine the best practice in stroke rehabilitation. Over 403 treatment-based articles investigating of various areas of stroke rehabilitation were identified. This included 272 randomized controlled trials.
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Affiliation(s)
- Robert W Teasell
- Department of Physical Medicine and Rehabilitation, St. Joseph's Health Care London and University of Western Ontario, London, Ontario, Canada.
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Fisk GD, Owsley C, Mennemeier M. Vision, attention, and self-reported driving behaviors in community-dwelling stroke survivors. Arch Phys Med Rehabil 2002; 83:469-77. [PMID: 11932847 DOI: 10.1053/apmr.2002.31179] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To elucidate the relationships among vision, attention, driving status, and self-reported driving behaviors in community-dwelling stroke survivors. DESIGN A cross-sectional design to compare stroke survivors to older adults without stroke on visual measures, attentional measures, and self-reported driving behaviors. SETTING Rehabilitation center at a university hospital. PARTICIPANTS Fifty stroke survivors and 105 older adults without neurologic or visual impairment. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Visual acuity, contrast sensitivity, peripheral vision, useful field of view (UFOV), Behavioral Inattention Test, and a driving habits questionnaire. RESULTS Stroke survivors had impaired contrast sensitivity, peripheral vision, and UFOV compared with older adults in good visual and neurologic health. Driving stroke survivors typically had less attentional impairment than nondrivers. Stroke survivors who returned to driving reported difficulty in challenging driving conditions, drove less, and relied more on other people for transportation than older adults without stroke. CONCLUSIONS These results suggest that vision and attention, both of which are important for driving, are often impaired in stroke survivors. The severity of these deficits could be an influence on driving status and driving behavior. Stroke survivors who return to driving strategically limit their driving exposure and rely on others for transportation, which suggests that they may deliberately self-regulate their driving behavior.
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Affiliation(s)
- Gary D Fisk
- Department of Psychology and Sociology, Georgia Southwestern State University, 800 Wheatley Street, Americus, GA 31709, USA.
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Abstract
BACKGROUND Traumatic brain injury (TBI) survivors often have sensory and cognitive impairments that may interfere with driving ability. The Useful Field of View (UFOV) is a measure of visual information processing that is a good predictor of vehicle crash risk in older adults. OBJECTIVE The objective of this study was to explore the possibility that UFOV is compromised after TBI. DESIGN UFOV performance of 23 TBI survivors and 18 young adults without neurological impairment were compared. CONCLUSION TBI survivors had higher UFOV scores than young adults, which indicated a greater functional loss of peripheral vision. The results suggest that the UFOV may be a valuable instrument for assessing driving readiness in TBI survivors.
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Affiliation(s)
- Gary D Fisk
- Department of Psychology and Sociology, Georgia Southwestern State University, Americus, Georgia 31709, USA.
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Abstract
BACKGROUND Practical issues facing rehabilitation clinicians working with survivors of brain injuries who wish to return to motor vehicle operations are considerable, and this challenge will likely only increase in the future. Although unpleasant, clinicians cannot avoid the legal and ethical issues associated with this aspect of rehabilitation. Clinicians also face numerous problems in terms of a variety of assessment and treatment strategies, most with limited demonstrated ecological validity, and few, if any, clear guidelines for rehabilitation of the driver. Clinicians may not have access to "driving tests," simulators and computer programs, specialized personnel, or adaptive driving programs. CONCLUSION Practical clinical issues such as these are reviewed, along with suggestions for a number of effective clinical approaches.
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Affiliation(s)
- C Alan Hopewell
- Psychiatric Consultants of Ft. Worth, Fort Worth, Texas 76107, USA
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