On-road driving impairments and associated cognitive deficits after stroke

Hannes Devos, Mark Tant, Abiodun E. Akinwuntan

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Little is known about the critical on-road driving skills that get affected after a stroke. The purpose of this study was to investigate the key on-road driving impairments and their associated cognitive deficits after a stroke. A second aim was to investigate if lateralization of stroke impacts results of the cognitive and on-road driving tests. Methods: In this cross-sectional study, 99 participants with a first-ever stroke who were actively driving prior to stroke underwent a cognitive battery and a standardized road test that evaluated 13 specific on-road driving skills. These onroad driving skills were mapped onto an existing, theoretical framework that categorized the on-road items into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving skills. The total score on the road test and the on-road decision, made by a certified fitness-to-drive expert, decided the main outcome. The critical on-road driving skills predicting the on-road decision were identified using logistic regression analysis. Linear regression analysis was employed to determine the cognitive impairments leading to poor total on-road scores. Analyses were repeated for rightand left-sided strokes.

Results: In all, 37 persons scored poorly on the road test. These participants performed worse in all hierarchic clusters of on-road driving. Performances on the operational cluster and the visuo-integrative cluster best predicted on-road decisions (R 2 = 0.60). 'Lane changing' and 'understanding, insight, and quality of traffic participation' were the critical skill deficits leading to poor performance on the road test (R2 = 0.65). Divided attention was the main determinant of on-road scores in the total group (R2 = 0.06). Participants with right-sided stroke performed worse on visual field, visual neglect, visual scanning, visuo-constructive skills, and divided attention compared with those with left-sided stroke. Divided attention was the main determinant of total on-road scores in the right-sided stroke group (R2 = 0.10). A combination of visual scanning, speed of processing, and executive dysfunction yielded the best model to predict on-road scores in left-sided strokes (R2 = 0.46).

Conclusions: Poor performance in the road test after stroke is determined by critical operational and visuo-integrative driving impairments. Specific and different driving evaluation and training programs are needed for right- and leftsided strokes.

Original languageEnglish (US)
Pages (from-to)226-232
Number of pages7
JournalCerebrovascular Diseases
Volume38
Issue number3
DOIs
StatePublished - Jan 1 2014

Fingerprint

Stroke
Cognitive Dysfunction
Regression Analysis
Visual Fields
Linear Models
Cross-Sectional Studies
Logistic Models
Education

Keywords

  • Activities of daily living
  • Neuropsychology
  • Neurorehabilitation
  • Occupational therapy
  • Physical therapy
  • Stroke
  • Stroke rehabilitation

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

On-road driving impairments and associated cognitive deficits after stroke. / Devos, Hannes; Tant, Mark; Akinwuntan, Abiodun E.

In: Cerebrovascular Diseases, Vol. 38, No. 3, 01.01.2014, p. 226-232.

Research output: Contribution to journalArticle

Devos, Hannes ; Tant, Mark ; Akinwuntan, Abiodun E. / On-road driving impairments and associated cognitive deficits after stroke. In: Cerebrovascular Diseases. 2014 ; Vol. 38, No. 3. pp. 226-232.
@article{82314e4ae33541b6b7998270553a3848,
title = "On-road driving impairments and associated cognitive deficits after stroke",
abstract = "Background: Little is known about the critical on-road driving skills that get affected after a stroke. The purpose of this study was to investigate the key on-road driving impairments and their associated cognitive deficits after a stroke. A second aim was to investigate if lateralization of stroke impacts results of the cognitive and on-road driving tests. Methods: In this cross-sectional study, 99 participants with a first-ever stroke who were actively driving prior to stroke underwent a cognitive battery and a standardized road test that evaluated 13 specific on-road driving skills. These onroad driving skills were mapped onto an existing, theoretical framework that categorized the on-road items into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving skills. The total score on the road test and the on-road decision, made by a certified fitness-to-drive expert, decided the main outcome. The critical on-road driving skills predicting the on-road decision were identified using logistic regression analysis. Linear regression analysis was employed to determine the cognitive impairments leading to poor total on-road scores. Analyses were repeated for rightand left-sided strokes.Results: In all, 37 persons scored poorly on the road test. These participants performed worse in all hierarchic clusters of on-road driving. Performances on the operational cluster and the visuo-integrative cluster best predicted on-road decisions (R 2 = 0.60). 'Lane changing' and 'understanding, insight, and quality of traffic participation' were the critical skill deficits leading to poor performance on the road test (R2 = 0.65). Divided attention was the main determinant of on-road scores in the total group (R2 = 0.06). Participants with right-sided stroke performed worse on visual field, visual neglect, visual scanning, visuo-constructive skills, and divided attention compared with those with left-sided stroke. Divided attention was the main determinant of total on-road scores in the right-sided stroke group (R2 = 0.10). A combination of visual scanning, speed of processing, and executive dysfunction yielded the best model to predict on-road scores in left-sided strokes (R2 = 0.46).Conclusions: Poor performance in the road test after stroke is determined by critical operational and visuo-integrative driving impairments. Specific and different driving evaluation and training programs are needed for right- and leftsided strokes.",
keywords = "Activities of daily living, Neuropsychology, Neurorehabilitation, Occupational therapy, Physical therapy, Stroke, Stroke rehabilitation",
author = "Hannes Devos and Mark Tant and Akinwuntan, {Abiodun E.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1159/000368219",
language = "English (US)",
volume = "38",
pages = "226--232",
journal = "Cerebrovascular Diseases",
issn = "1015-9770",
publisher = "S. Karger AG",
number = "3",

}

TY - JOUR

T1 - On-road driving impairments and associated cognitive deficits after stroke

AU - Devos, Hannes

AU - Tant, Mark

AU - Akinwuntan, Abiodun E.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Little is known about the critical on-road driving skills that get affected after a stroke. The purpose of this study was to investigate the key on-road driving impairments and their associated cognitive deficits after a stroke. A second aim was to investigate if lateralization of stroke impacts results of the cognitive and on-road driving tests. Methods: In this cross-sectional study, 99 participants with a first-ever stroke who were actively driving prior to stroke underwent a cognitive battery and a standardized road test that evaluated 13 specific on-road driving skills. These onroad driving skills were mapped onto an existing, theoretical framework that categorized the on-road items into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving skills. The total score on the road test and the on-road decision, made by a certified fitness-to-drive expert, decided the main outcome. The critical on-road driving skills predicting the on-road decision were identified using logistic regression analysis. Linear regression analysis was employed to determine the cognitive impairments leading to poor total on-road scores. Analyses were repeated for rightand left-sided strokes.Results: In all, 37 persons scored poorly on the road test. These participants performed worse in all hierarchic clusters of on-road driving. Performances on the operational cluster and the visuo-integrative cluster best predicted on-road decisions (R 2 = 0.60). 'Lane changing' and 'understanding, insight, and quality of traffic participation' were the critical skill deficits leading to poor performance on the road test (R2 = 0.65). Divided attention was the main determinant of on-road scores in the total group (R2 = 0.06). Participants with right-sided stroke performed worse on visual field, visual neglect, visual scanning, visuo-constructive skills, and divided attention compared with those with left-sided stroke. Divided attention was the main determinant of total on-road scores in the right-sided stroke group (R2 = 0.10). A combination of visual scanning, speed of processing, and executive dysfunction yielded the best model to predict on-road scores in left-sided strokes (R2 = 0.46).Conclusions: Poor performance in the road test after stroke is determined by critical operational and visuo-integrative driving impairments. Specific and different driving evaluation and training programs are needed for right- and leftsided strokes.

AB - Background: Little is known about the critical on-road driving skills that get affected after a stroke. The purpose of this study was to investigate the key on-road driving impairments and their associated cognitive deficits after a stroke. A second aim was to investigate if lateralization of stroke impacts results of the cognitive and on-road driving tests. Methods: In this cross-sectional study, 99 participants with a first-ever stroke who were actively driving prior to stroke underwent a cognitive battery and a standardized road test that evaluated 13 specific on-road driving skills. These onroad driving skills were mapped onto an existing, theoretical framework that categorized the on-road items into hierarchic clusters of operational, tactical, visuo-integrative, and mixed driving skills. The total score on the road test and the on-road decision, made by a certified fitness-to-drive expert, decided the main outcome. The critical on-road driving skills predicting the on-road decision were identified using logistic regression analysis. Linear regression analysis was employed to determine the cognitive impairments leading to poor total on-road scores. Analyses were repeated for rightand left-sided strokes.Results: In all, 37 persons scored poorly on the road test. These participants performed worse in all hierarchic clusters of on-road driving. Performances on the operational cluster and the visuo-integrative cluster best predicted on-road decisions (R 2 = 0.60). 'Lane changing' and 'understanding, insight, and quality of traffic participation' were the critical skill deficits leading to poor performance on the road test (R2 = 0.65). Divided attention was the main determinant of on-road scores in the total group (R2 = 0.06). Participants with right-sided stroke performed worse on visual field, visual neglect, visual scanning, visuo-constructive skills, and divided attention compared with those with left-sided stroke. Divided attention was the main determinant of total on-road scores in the right-sided stroke group (R2 = 0.10). A combination of visual scanning, speed of processing, and executive dysfunction yielded the best model to predict on-road scores in left-sided strokes (R2 = 0.46).Conclusions: Poor performance in the road test after stroke is determined by critical operational and visuo-integrative driving impairments. Specific and different driving evaluation and training programs are needed for right- and leftsided strokes.

KW - Activities of daily living

KW - Neuropsychology

KW - Neurorehabilitation

KW - Occupational therapy

KW - Physical therapy

KW - Stroke

KW - Stroke rehabilitation

UR - http://www.scopus.com/inward/record.url?scp=84909983303&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84909983303&partnerID=8YFLogxK

U2 - 10.1159/000368219

DO - 10.1159/000368219

M3 - Article

C2 - 25359174

AN - SCOPUS:84909983303

VL - 38

SP - 226

EP - 232

JO - Cerebrovascular Diseases

JF - Cerebrovascular Diseases

SN - 1015-9770

IS - 3

ER -