Reliability of a road test after stroke. Effect of simulator training on driving after stroke Comparison of the Effect of Two Driving Retraining Programs on On-Road Performance After Stroke Retraining Moderately Impaired Stroke Survivors in Driving-Related Visual Attention Skills Effect of Simulator Training on Fitness-to-Drive After Stroke: A 5-Year Follow-up of a Randomized Controlled Trial Retraining visual processing skills to improve driving ability after stroke. Effectiveness of a visual attention retraining program on the driving performance of clients with stroke. Useful Field of View After Traumatic Brain Injury Development of the Adelaide Driving Self-Efficacy Scale
OBJECTIVE To determine the reliability of the road test performed by stroke patients . DESIGN Prospect i ve study of a 6-month predriving evaluation . SETTING Driving safety center in Belgium . PARTICIPANTS Thirty patients with sequelae of stroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Results of driving performance as judged by 2 assessors from the Center for Determination of Fitness to Drive and Car Adaptations ( CARA ) , in a car fitted with a video camera . A third assessor also evaluated all the video recordings .  Interrater reliability was evaluated by comparing results from real-life performance and video recording , as judged by the CARA assessors and video judgments between CARA assessors and the third assessor . RESULTS Most subitems of the road test showed more than 80 % scoring agreement between the various evaluations . Intraclass correlation coefficients ( ICCs ) of the items varied from -.08 to 1.0 . The ICC of the overall performance was.62 when real-life scores were compared with video evaluations and .80 in video versus video comparison . CONCLUSION The reliability of assessing overall performance of stroke patients in the road test is moderately high and better when assessed using the same evidence . Yet , the reliability of some items needs further attention Background : Neurologically impaired persons seem to benefit from driving-training programs , but there is no convincing evidence to support this notion . The authors therefore investigated the effect of simulator-based training on driving after stroke . Methods : Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training program in which they were r and omly allocated to either an experimental ( simulator-based training ) or control ( driving-related cognitive tasks ) group . Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training . Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered . Results : Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training . There were no significant differences between both groups in improvements from pre- to post-training except in the “ road sign recognition test ” in which the experimental subjects improved more . Significant improvements in the three-class decision ( “ fit to drive , ” “ temporarily unfit to drive , ” and “ unfit to drive ” ) were found in favor of the experimental group post-training . Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training . Significantly more experimental subjects ( 73 % ) than control subjects ( 42 % ) passed the follow-up official predriving assessment and were legally allowed to resume driving . Conclusions : Simulator-based driving training improved driving ability , especially for well educated and less disabled stroke patients . However , the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training 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 r and omized 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 . Context ual 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 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 vali date d test of driving-related visual attention skills . Method : Data from 69 first-ever , moderately impaired stroke survivors who participated in a r and omized 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 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 r and omized 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 assessment s. 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 UNLABELLED Crotty M , George S. Retraining visual processing skills to improve driving ability after stroke . OBJECTIVE To evaluate the effectiveness of retraining using the Dynavision on driving performance of people with stroke . DESIGN R and omized controlled trial . SETTING Outpatient rehabilitation clinic in Australia . PARTICIPANTS People with stroke ( N=26 ) referred for driving assessment . INTERVENTIONS Eligible participants were r and omized to either receive retraining with the Dynavision apparatus for 18 sessions or to receive no intervention and go onto a waitlist . MAIN OUTCOME MEASURES The primary outcome was an assessment of on-road ability . Secondary outcomes included measures of response speed , visual scanning , and self-efficacy . All assessment s were conducted by assessors blinded to group assignment . RESULTS No significant difference ( P=.223 ) was found between the intervention and control groups in results of on-road assessment in terms of pass or fail ; the primary outcome measure ; or the results on the secondary outcome measures of response speed , visual scanning , and self-efficacy . CONCLUSIONS In this small trial , training underlying skills ( such as executing a continuous wide scan , combining motor and visual processing into a motor response ) using the Dynavision apparatus did not improve the outcomes of an on-road assessment for people after strokes . Larger trials are needed to evaluate devices that cl aim to retrain underlying skills related to driving OBJECTIVE To compare the effectiveness of a visual attention retraining program using the Useful Field of View ( UFOV ) with a traditional visuoperception treatment program on the driving performance of clients with stroke . DESIGN R and omized controlled trial . SETTING Rehabilitation hospital located in Quebec , Canada . PARTICIPANTS Ninety-seven individuals referred for driving evaluation after a stroke . INTERVENTIONS Participants were r and omized to receive 20 sessions of either UFOV training of visual processing speed , divided attention , and selective attention or traditional computerized visuoperception retraining . MAIN OUTCOME MEASURES Subjects were evaluated with an on-road driving evaluation , visuoperception tests , and the Test of Everyday Attention . An occupational therapist unaware of group assignment conducted all evaluations . RESULTS Eighty-four participants completed the outcome evaluation . There were no significant differences between groups on any of the outcome measures . There was , however , almost a 2-fold increase ( 52.4 % vs 28.6 % ) in the rate of success on the on-road driving evaluation after UFOV training for subjects with right-sided lesions . CONCLUSIONS Rehabilitation that targets visual attention skills was not significantly more beneficial than traditional perceptual training in improving the outcome of an on-road driving evaluation . However , results suggest a potential improvement for subjects with right-sided lesions , indicating that training must target specific skills 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 Objective : To describe the development of the Adelaide  Driving Self-Efficacy Scale ( ADSES ) and to report on its reliability and validity . Methods : A set of 12 driving behaviours , developed through literature review , clinical experience and expert review , were rated for self-efficacy using a Likert scale . Internal consistency was investigated using a Cronbach 's alpha coefficient and construct validity by comparing ADSES scores of stroke and non-stroke drivers . Criterion-related validity was examined by comparing ADSES scores with the result on a st and ardized on-road assessment . Setting : A rehabilitation hospital in Adelaide , South Australia . Participants : Staff from the hospital and stroke patients from the rehabilitation unit . Data from a non-stroke sample ( n -/ 79 ) and stroke patients ( n -/ 81 ) were used to test internal consistency and construct validity . A separate group of 45 people recommended for a driving assessment , of whom 34 were stroke patients , were used to test criterion validity . Results : Cronbach 's alpha coefficient was 0.98 , indicating high internal consistency . The non-stroke and stroke groups showed significant differences in ADSES scores ( t(158)-/ 5.5 , P B < 0.05 ) , demonstrating construct validity . Differences in ADSES scores for those participants who passed or failed the on-road assessment were significant for both the entire driving assessment group ( t(43)-/ 3.2 , P B < 0.05 ) and the stroke subgroup ( t(43)-/ 3.2 , P B < 0.05 ) , indicating criterion validity . Conclusion : The ADSES has demonstrated internal consistency and construct validity with the stroke and non-stroke population . The scale demonstrated criterion validity in its relationship with outcome of an on-road driving assessment . It appears to be a reliable and valid measure of driving self-efficacy
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 .