Abstract
Stroke can affect a variety of cognitive, perceptual, and motor abilities that are important for safe driving. Results of studies assessing post-stroke driving ability are quite variable in the areas and degree of driving impairment among patients. This highlights the need to consider clinical characteristics, including stroke subtype, when assessing driving performance. We compared the simulated driving performance of 30 chronic stroke patients (>3 months), including 15 patients with ischemic stroke (IS) and 15 patients with subarachnoid hemorrhage (SAH), and 20 age-matched controls. A preliminary analysis was performed, subdividing IS patients into right (n = 8) and left (n = 6) hemispheric lesions and SAH patients into middle cerebral artery (MCA, n = 5) and anterior communicating artery (n = 6) territory. A secondary analysis was conducted to investigate the cognitive correlates of driving. Nine patients (30%) exhibited impaired simulated driving performance, including four patients with IS (26.7%) and five patients with SAH (33.3%). Both patients with IS (2.3 vs. 0.3, U = 76, p < 0.05) and SAH (1.5 vs. 0.3, U = 45, p < 0.001) exhibited difficulty with lane maintenance (% distance out of lane) compared to controls. In addition, patients with IS exhibited difficulty with speed maintenance (% distance over speed limit; 8.9 vs. 4.1, U = 81, p < 0.05), whereas SAH patients exhibited difficulty with turning performance (total turning errors; 5.4 vs. 1.6, U = 39.5, p < 0.001). The Trail Making Test (TMT) and Useful Field of View test were significantly associated with lane maintenance among patients with IS (rs > 0.6, p < 0.05). No cognitive tests showed utility among patients with SAH. Both IS and SAH exhibited difficulty with lane maintenance. Patients with IS additionally exhibited difficulty with speed maintenance, whereas SAH patients exhibited difficulty with turning performance. Current results support the importance of differentiating between stroke subtypes and considering other important clinical characteristics (e.g., side of lesion, vascular territory) when assessing driving performance and reinforce the importance of physicians discussing driving safety with patients after stroke.
Highlights
Driving is a highly complex and important daily task
Patients with ischemic stroke (IS) and subarachnoid hemorrhage (SAH) scored significantly worse on the Montreal Cognitive Assessment (MoCA) and Trail Making Test Part A (TMT-A) compared to healthy controls (p < 0.01)
Values are reported in mean ± SD format. bolded values indicate analyses that are statistically significant. n, number of participants; SDLP, standard deviation in lane position. ap-values reported for all stroke patients vs. healthy control comparison (Mann–Whitney U test). bp-values reported from Kruskal–Wallis test analyses (IS stroke vs. SAH vs. healthy control comparison). cTotal errors include: sum of collisions, speed exceedances, centerline crossings, road edge excursions, stop signs missed. dTurning errors include collisions, centerline crossings, and road edge excursions. eKruskal–Wallis test was significant for left turns across stroke subtypes and controls, but results were no longer significant after the Bonferroni correction
Summary
Safe driving requires many abilities, including cognitive, perceptual, and motor function, all of which can be impacted to varying degrees following stroke. For patients who experience minor cognitive deficits, including mild attentional and executive dysfunction, that can be compensated for by other cognitive and behavioral functions, determining safe driving ability can be difficult [2]. Stroke can affect a variety of cognitive, perceptual, and motor abilities that are important for safe driving. Results of studies assessing post-stroke driving ability are quite variable in the areas and degree of driving impairment among patients. This highlights the need to consider clinical characteristics, including stroke subtype, when assessing driving performance
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