Stroke Driver Screening Assessment Research Articles

Usability of Norm Values on Results from a Simulator Device and Cognitive Tests in Traffic Medicine

IntroductionDriving is an essential everyday task for most adults, and fitness to continue car-driving after a brain injury/disease is a common issue in rehabilitation settings. There is no consensus on how this assessment should be performed and thus further research and development are of great value. The aim was to study the usability of cut-off values, based on recently developed norm values for a driving simulator device (CyberSiM), as well as cognitive tests, for patients already considered fit-to-drive after a standardized traffic medical investigation.MethodsThe study had a retrospective case-control design. Norm results (n = 129) were compared with patient results (n = 126) divided into two age groups (≤59 years and ≥60 years). Results from Useful Field of View, Trail Making Test, Nordic Stroke Driver Screening Assessment as well as a simulator device (CyberSiM) were compared.ResultsThe group of patients considered fit-to-drive after a traffic medicine assessment had worse results on all cognitive tests compared with norms. Results on CyberSiM subtests II and III did not differ from norms. The proportion of patients within suggested cut-off limits (mean±2SD norm) and considered fit to drive (mean±2SD norm) were highest (75–95%) for all three subtests of CyberSiM and for Useful Field of View in both age groups.ConclusionAvailability of norm values in decision on continued driving is of value when interpreting the results of cognitive assessments sensitive to age, but it must be handled with care because many factors are important for individuals’ ability to drive.

Fitness to drive after acquired brain injury: Results from patient cognitive screening and on-road assessment compared to age-adjusted norm values.

Fitness to drive after acquired brain injury or disease is a common question in rehabilitation settings. The aim of the study was to compare age-matched norms with patient cognitive test results used to predict fitness to drive. A second aim was to analyze the contribution from an on-road assessment to a final decision on resumption of driving after an acquired brain injury. Retrospective cognitive test results from four traffic medicine units (n = 333) were compared with results from a healthy norm population (n = 410) in Sweden. Patients were dichotomized according to the final decision as fit or unfit to drive made by the traffic medicine team. The norm group had significantly better results in all age groups for all cognitive tests compared with the patients considered unfit to drive and fit to drive. A binary regression analysis for the patient group showed an explained value for fit to drive/unfit to drive of 88%, including results for the Nordic Stroke Driver Screening Assessment total score, Useful Field of View total score and the final outcome from an on-road assessment. Results from the present study illustrate the importance of using several tests, methods and contexts for the final decision regarding fitness to drive.

Decisions on driving after brain injury/disease: Feasibility and construct validity of a new simulator assessment tool

Introduction Driving is a complex activity involving a high level of cognitive abilities and thus might be affected after a brain injury/disease. The aim of this research was to evaluate the feasibility and construct validity of a driving simulator tool as a complement to existing driving assessments of patients with cognitive dysfunctions after a brain injury/disease. Method A descriptive and prospective research design was achieved. For construct validation, decisions were based on results from the Useful Field of View, Nordic Stroke Driver Screening Assessment, Trail Making Test and, when necessary for the decision, an on-road observation. Results from the simulator tool were not included in the clinical decision process. Results A total of 129 patients from four different rehabilitation services were included. The results showed a significant difference in test results between those who were considered medically fit versus unfit to drive. A factor analysis revealed four components, all including attention in combination with processing speed, visuospatial function, simultaneous capacity and executive function; these are all represented in the simulator tool. A correlation analysis showed that simulator subtest 3 (response/divergent response to stimuli) had the strongest correlation with most of the other tests included. Conclusions The simulator was found to be feasible and valid and found to include components other than those measured in the other tests.

Cognitive prerequisites for fitness to drive: Norm values for the TMT, UFOV and NorSDSA tests

Background: Fitness-to-drive assessment is a growing area for occupational therapists. There are few off-road tests specially developed to assess fitness to drive, and several cognitive tests have no age-specific norms.Aims/objectives: The aim was to identify and describe age-related norm values for the Trail Making Test, Nordic Stroke Driver Screening Assessment and Useful Field of View test, and to study inter-correlation between test results.Materials and methods: The sample included 410 volunteers; 149 men and 261 women, mean age 52 ± 16.8 years. Commonly used off-road tests were used: TMT A and B, UFOV and NorSDSA.Results: Normative data for the specific subtests and total score for NorSDSA and UFOV are provided and presented in four age groups. Age correlated with the results for most of the subtests.Conclusions: Off-road cognitive test scores are necessary and valuable for occupational therapists in their contribution to the final decision on continued driving. In clinical practice, it can be difficult to interpret cognitive test results when working with driving assessments. Age-based norm values are suggested to be a way to provide clinicians with a benchmark against which scores can be compared.Significance: Age-based norms can guide occupational therapists working with fitness to drive.

Usefulness of the Stroke Drivers Screening Assessment (SDSA) in patients with Parkinson’s syndrome (P2.8-041)

Usefulness of the Stroke Drivers Screening Assessment (SDSA) in patients with Parkinson’s syndrome (P2.8-041)

Comparison of driving cognition on paretic side in drivers following stroke

Objective: The left and right sides of the brain has different roles. This study investigated the differences in cognitive driving ability between stroke survivors with damage to the left brain and right brain. Therefore, the purpose of this study was to compare the driving cognitive ability of left and right hemispheric drivers following stroke. Design: Cross-sectional study. Methods: The Stroke Drivers’ Screening Assessment (SDSA) from the UK was translated to the Korean Stroke Drivers’ Screening Assessment (K-SDSA) to meet the specific traffic environments of Korea. The SDSA is composed of 4 tasks :1) a dot cancellation task that measures concentration and visuospatial abilities necessary for driving, 2) a directional matrix task to measure spatio-temporal executive function required for driving, 3) a compass matrix task to measure accurate direction determination ability required for driving, and 4) recognition of traffic signs and reasoning ability to understanding traffic situation. The SDSA assessment time is about 30 minutes. The K-SDSA was used to compare the cognitive driving abilities between 15 stroke survivors with left and 15 stroke survivors with right brain damage. Results: There were significant differences between the persons with stroke patients with left brain lesions (right hemiplegia) compared to the persons with stroke with right brain lesions (left hemiplegia) (p<0.05). It was found that the cognitive driving ability of those with right brain damage was lower than that of the group of left brain damage. Conclusions: This research investigated the driving cognitive ability of persons with stroke. The therapists can use this information as basis for the driving test and training purposes. It could also be used as a basis to understanding if the cognitive ability of not only stroke survivors but also those with brain damage is adequate to actually drive.

Fitness to drive after acquired brain damage: Who should be assessed, and how?

Acquired brain damage such as stroke, traumatic brain injury (TBI), brain anoxia or encephalitis may impair fitness to drive in no less than 300,000 adults every year in France. Identifying peoples at risk and addressing the assessment methods were priority concerns in context of the guidelines developed on behalf of the French Rehabilitation Medicine Society SOFMER, the French Higher Health Authority (HHA) and other groups of interest. To draw from the literature guidelines regarding who should benefit from an assessment of fitness to drive, and how this assessment should be conducted. Two hundred and nine studies were analyzed among 326 references from the literature and discussed by a multidisciplinary work group. A preliminary draft was drawn, then submitted to a reviewing group and improved according to recommendations. Then guidelines were submitted to HHA. Peoples with mild TBI are advised not to drive again within 24 hours after their TBI. Three processes were defined: – process A: medical examination aiming at detecting mild motor and/or cognitive impairments (Montreal Cognitive Assessment was recommended), and ensuring visual acuity and visual field; – process B: comprehensive fitness to drive assessment including medical examination, cognitive tests (attention, visual scanning, memory and executive functions) and a standardized on road assessment (a least 45 minutes, with different driving situations); – process C: medical advice from a designed general practitioner before a revalidation of the driving license by authorities. Peoples with transient ischemic attack or mild impairment after stroke, brain anoxia or encephalitis: 2 weeks delay before driving again and process A + C. Peoples with moderate to severe TBI, stroke, brain anoxia or encephalitis with significant impairments needing rehabilitation: process B + C. Peoples with persistent neglect are urged to refrain from driving. Seizures and/or hemianopia are legal exclusions from driving. The committee emphasized the need for forthcoming studies providing French validated versions of international assessment battery such as: Stroke Driver Screening Assessment, as well as further information about driving simulators.

Cognitive, On-road, and Simulator-based Driving Assessment after Stroke

Driving is a complex activity that requires intact cognitive, behavioral, and motor function. Stroke is one of the most prevalent neurologic impairments and can affect all of these functions. However, diagnosis of stroke is not a definitive indicator of driving impairment. Determining fitness to drive after stroke is a very complex process and is typically based on cognitive assessments, on-road performance, simulator-based assessment, or a combination of the three. The aim of this review was to provide (1) a systematic review of the literature on cognitive, on-road, and simulator assessment after stroke, and (2) address the existing limitations and inconsistencies in stroke and driving research. Our results indicated that of 1413 total stroke patients, 748 definitively passed and 367 definitely failed an on-road assessment, with minimal information provided about clinical presentation. In addition, although the Stroke Driver Screening Assessment, the Useful Field of View Test, and the Rey-O Complex Figure test may have some utility in predicting driving performance, most cognitive measures have been inconsistently and minimally explored. Several limitations were observed across studies such as procedural inconsistencies, including outcome variables used (eg, driving cessation and pass/fail classification) and the heterogeneity of patient samples (eg, time since stroke and stroke location). Due, in part, to the larger variability in results of cognitive, on-road, and simulator-based assessment, there is no consensus regarding a valid and reliable driving assessment for physicians. Future studies should assess poststroke driving fitness by differentiating different stages, severities, and locations of stroke.

Rehabilitation for improving automobile driving after stroke

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. To determine whether any intervention, with the specific aim of maximising driving skills, improves the driving performance of people after stroke. We searched the Cochrane Stroke Group Trials register (August 2013), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2012, Issue 3), MEDLINE (1950 to October 2013), EMBASE (1980 to October 2013), and six additional databases. To identify further published, unpublished and ongoing trials, we handsearched relevant journals and conference proceedings, searched trials and research registers, checked reference lists and contacted key researchers in the area. Randomised controlled trials (RCTs), quasi-randomised trials and cluster studies of rehabilitation interventions, with the specific aim of maximising driving skills or with an outcome of assessing driving skills in adults after stroke. The primary outcome of interest was the performance in an on-road assessment after training. SECONDARY OUTCOMES included assessments of vision, cognition and driving behaviour. Two review authors independently selected trials based on pre-defined inclusion criteria, extracted the data and assessed risk of bias. A third review author moderated disagreements as required. The review authors contacted all investigators to obtain missing information. We included four trials involving 245 participants in the review. Study sample sizes were generally small, and interventions, controls and outcome measures varied, and thus it was inappropriate to pool studies. Included studies were at a low risk of bias for the majority of domains, with a high/unclear risk of bias identified in the areas of: performance (participants not blinded to allocation), and attrition (incomplete outcome data due to withdrawal) bias. Intervention approaches included the contextual approach of driving simulation and underlying skill development approach, including the retraining of speed of visual processing and visual motor skills. The studies were conducted with people who were relatively young and the timing after stroke was varied. there was no clear evidence of improved on-road scores immediately after training in any of the four studies, or at six months (mean difference 15 points on the Test Ride for Investigating Practical Fitness to Drive - Belgian version, 95% confidence intervals (CI) 4.56 to 34.56, P value = 0.15, one study, 83 participants). road sign recognition was better in people who underwent training compared with control (mean difference 1.69 points on the Road Sign Recognition Task of the Stroke Driver Screening Assessment, 95% CI 0.51 to 2.87, P value = 0.007, one study, 73 participants). Significant findings were in favour of a simulator-based driving rehabilitation programme (based on one study with 73 participants) but these results should be interpreted with caution as they were based on a single study. Adverse effects were not reported. There was insufficient evidence to draw conclusions on the effects on vision, other measures of cognition, motor and functional activities, and driving behaviour with the intervention. There was insufficient evidence to reach conclusions about the use of rehabilitation to improve on-road driving skills after stroke. We found limited evidence that the use of a driving simulator may be beneficial in improving visuocognitive abilities, such as road sign recognition that are related to driving. Moreover, we were unable to find any RCTs that evaluated on-road driving lessons as an intervention. At present, it is unclear which impairments that influence driving ability after stroke are amenable to rehabilitation, and whether the contextual or remedial approaches, or a combination of both, are more efficacious.

Improvement of Driving Skills in Persons With Relapsing-Remitting Multiple Sclerosis: A Pilot Study

ObjectiveTo determine the potential to improve driving-related skills using a simulator-based program in persons with relapsing-remitting multiple sclerosis (RRMS). DesignPre-post intervention. SettingA university driving simulator laboratory. ParticipantsParticipants (N=50) with RRMS and Expanded Disability Status Scale (EDSS) scores between 1 and 7 were enrolled. Pre- and posttraining data from 36 participants (mean age ± SD, 46±11y; 30 women) who received training and 6 participants (mean age ± SD, 48±13y; 5 women) who did not receive training (control group) were compared. InterventionsFive hours of driving training in a simulator. Main Outcome MeasuresPerformance on a road test at pre- and posttraining. Secondary outcome measures were performance on visual, physical, and cognitive tests. ResultsOverall, no significant differences were observed between the training and control groups before and after training. However, 4 of the 7 participants in the training group who failed the road test at pretraining passed posttraining, while the only participant in the control group who failed at pretraining still failed at posttraining. The training group also improved on perception of red and colored numbers, the Paced Auditory Serial Addition Test, and the dot cancellation test of the Stroke Driver Screening Assessment battery and reported less fatigue. These improvements were most pronounced among those with an EDSS score between 3 and 7. ConclusionsThis pilot study demonstrates the potential of using a simulator to improve driving-related visual, cognitive, and on-road skills in individuals with RRMS, particularly those with an EDSS score >3. Future randomized controlled trials with adequate power are needed to expand this field of study.

Cognitive and psychomotor tests as predictors of on-road driving ability in older primary care patients

This study examined the accuracy with which different cognitive and psychomotor assessment tools were able to predict driving ability among older primary care patients. A cross-sectional study of 50 older drivers (with an average age of 73.1±7.0years) was conducted. Participants who had been referred by their physicians for psychological assessment following a fitness-to-drive examination underwent both an on-road driving test and a cognitive assessment protocol that included the Senior Drivers Battery (SDB) that is currently administered at the Mobility and Land Transports Institute (MLTI) in Portugal, the Useful Field of View (UFOV) test, the Stroke Drivers Screening Assessment (SDSA), Addenbrooke’s Cognitive Examination Revised (ACE-R), the Trail Making Test, the Key Search test, and the Wechsler Adult Intelligence Scale (WAIS-III) Vocabulary and Block Design tests. Logistic regression analysis revealed that the performances of the participants on the SDSA, ACE-R, UFOV and SDB were the best predictors of on-road driving. Specific measures of processing speed and divided attention, visuospatial abilities, executive functions, psychomotor speed and global cognitive functioning may be useful for predicting unsafe driving. The practical implications of these findings are discussed with a view to developing new assessment models for determining driving fitness in older adults.

Predictors of driving in individuals with relapsing–remitting multiple sclerosis

Background: We previously reported that performance on the Stroke Driver Screening Assessment (SDSA), a battery of four cognitive tests that takes less than 30 min to administer, predicted the driving performance of participants with multiple sclerosis (MS) on a road test with 86% accuracy, 80% sensitivity, and 88% specificity. Objectives: In this study, we further investigated if the addition of driving-related physical and visual tests and other previously identified cognitive predictors, including performance on the Useful Field of View test, will result in a better accuracy of predicting participants’ on-road driving performance. Methods: Forty-four individuals with relapsing–remitting MS (age = 46 ± 11 years, 37 females) and Expanded Disability Status Scale values between 1 and 7 were administered selected physical, visual and cognitive tests including the SDSA. The model that explained the highest variance of participants’ performance on a standardized road test was identified using multiple regression analysis. A discriminant equation containing the tests included in the best model was used to predict pass or fail performance on the test. Results: Performance on 12 cognitive and three visual tests were significantly associated with performance on the road test. Five of the tests together explained 59% of the variance and predicted the pass or fail outcome of the road test with 91% accuracy, 70% sensitivity, and 97% specificity. Conclusion: Participants’ on-road performance was more accurately predicted by the model identified in this study than using only performance on the SDSA test battery. The five psychometric/off-road tests should be used as a screening battery, after which a follow-up road test should be conducted to finally decide the fitness to drive of individuals with relapsing–remitting MS. Future studies are needed to confirm and validate the findings in this study.

Prediction of Driving Ability in People with Relapsing-Remitting Multiple Sclerosis Using the Stroke Driver Screening Assessment

The ability to drive is often affected in individuals with multiple sclerosis (MS) because of the motor, visual, or cognitive deficits commonly associated with the condition. In this study, we investigated the accuracy with which the Stroke Driver Screening Assessment (SDSA), an established battery for the prediction of driving performance of stroke survivors, would predict driving performance of individuals with MS. Driving performance of 44 individuals with relapsing-remitting MS (mean ± SD age, 46 ± 11 years; 37 females and 7 males) who were currently driving at least once a month was predicted using their performance on the SDSA. Outcomes of a road test and the Useful Field of View (UFOV) test were used as measures of driving ability. Participants' performance on both the road and UFOV tests was predicted with more than 80% accuracy. The SDSA was more accurate in predicting who would pass the two tests than who would fail the tests. The SDSA battery appears to be a good predictor of driving performance of individuals with relapsing-remitting MS, especially those who have sufficient cognitive skills to continue driving. Larger studies are needed to definitively establish its predictive accuracy and confirm the validity of the predictions.

Older drivers: On-road and off-road test results

Eighty-five volunteer drivers, 65–85 years old, without cognitive impairments impacting on their driving were examined, in order to investigate driving errors characteristic for older drivers. In addition, any relationships between cognitive off-road and on-road tests results, the latter being the gold standard, were identified. Performance measurements included Trail Making Test (TMT), Nordic Stroke Driver Screening Assessment (NorSDSA), Useful Field of View (UFOV), self-rating driving performance and the two on-road protocols P-Drive and ROA. Some of the older drivers displayed questionable driving behaviour. In total, 21% of the participants failed the on-road assessment. Some of the specific errors were more serious than others. The most common driving errors embraced speed; exceeding the speed limit or not controlling the speed. Correlations with the P-Drive protocol were established for NorSDSA total score (weak), UFOV subtest 2 (weak), and UFOV subtest 3 (moderate). Correlations with the ROA protocol were established for UFOV subtest 2 (weak) and UFOV subtest 3 (weak). P-Drive and self ratings correlated weakly, whereas no correlation between self ratings and the ROA protocol was found. The results suggest that specific problems or errors seen in an older person's driving can actually be “normal driving behaviours”.

Establishing Criterion Validity of the Useful Field of View Assessment and Stroke Drivers’ Screening Assessment: Comparison to the Result of On-Road Assessment

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. This was a prospective study with people with stroke. Outcome measures used were UFOV, SDSA, and the results of on-road assessment. 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%). 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.

The Nordic Stroke Driver Screening Assessment as predictor for the outcome of an on-road test

The use of the cognitive test battery Nordic Stroke Driver Screening Assessment (NorSDSA) has increased, sometimes as a stand-alone test to evaluate fitness to drive, also for non-stroke patients such as patients suffering from cognitive deficits/dementia, approaches that may be questioned. The objective of the study was to determine whether the NorSDSA could predict an on-road test result, for large sets of stroke (n=74) and cognitive deficits/dementia participants (n=116), respectively. The percentage of correctly classified was 62% for the stroke group and 50% for the cognitive deficits/dementia group. A discriminant analysis with pass/fail on the on-road test as grouping variable could classify 62% of the stroke participants and the cognitive deficit/dementia participants. Hence, the NorSDSA could not predict the outcome of the on-road test. Therefore, NorSDSA should not be used as a stand-alone test to determine the fitness to drive of individual participants. Also, its use with participants suffering from cognitive deficits/dementia appears to be less successful than for clients with stroke.

The Nordic Stroke Driver Screening Assessment as predictor for the outcome of an on-road testThe Nordic Stroke Driver Screening Assessment as predictor for the outcome of an on-road test

The use of the cognitive test battery Nordic Stroke Driver Screening Assessment (NorSDSA) has increased, sometimes as a stand-alone test to evaluate fitness to drive, also for non-stroke patients such as patients suffering from cognitive deficits/dementia, approaches that may be questioned. The objective of the study was to determine whether the NorSDSA could predict an on-road test result, for large sets of stroke (n=74) and cognitive deficits/dementia participants (n=116), respectively. The percentage of correctly classified was 62% for the stroke group and 50% for the cognitive deficits/dementia group. A discriminant analysis with pass/fail on the on-road test as grouping variable could classify 62% of the stroke participants and the cognitive deficit/dementia participants. Hence, the NorSDSA could not predict the outcome of the on-road test. Therefore, NorSDSA should not be used as a stand-alone test to determine the fitness to drive of individual participants. Also, its use with participants suffering from cognitive deficits/dementia appears to be less successful than for clients with stroke. Language: en

P.8.a.008 The utility of structural neuroimaging in the psychiatric inpatients

Radford KA, Lincoln NB. Concurrent validity of the Stroke Drivers Screening Assessment. Arch Phys Med Rehabil 2004;85:324–8.To determine the concurrent validity of the Stroke Drivers Screening Assessment (SDSA).Comparison of the SDSA with criterion standards.Subjects’ homes in the community in the United Kingdom.Ninety-three stroke patients (age range, 22–83y) who were referred for assessment of fitness to drive or who had been driving before their stroke. Participants were assessed a median of 5 months poststroke.Not applicable.Patients were assessed on the SDSA and tests of visuospatial ability (Visual Object and Space Perception [VOSP] Battery), executive abilities (Stroop Neuropsychological Screening Test, Trail-Making Test [TMT], Cognitive Estimates Test [CET]), and visual memory (Recognition Memory Tests [RMT], Verbal Descriptions of Road Signs [VDRS]).The SDSA subtests all correlated significantly with the Stroop test (P<.001) and TMT (P<.001), which suggests that they measure executive abilities and attention. The SDSA Dot Cancellation (DC) also correlated significantly with the VDRS (P<.01). The SDSA Square Matrices (SM) test correlated significantly with the VOSP cube analysis (P≤.01) and the RMT faces subtest (P<.001), which suggests that the SM test also measures visuospatial abilities and visual memory. The SDSA Road Sign Recognition (RSR) test also correlated significantly with the VOSP cube analysis (P<.05), which suggests that the RSR test also measures visuospatial abilities. Factor analysis produced a 2-factor solution with DC time, SM compass, and RSR all loading on factor 1, together with the Stroop and TMT. This factor was interpreted as “executive abilities and attention.” The RMT faces subtest and CET loaded onto a second factor.The SDSA seems to measure predominantly attention and executive abilities, which have previously been shown to be important determinants of safety to drive. This may account for the high predictive validity of the SDSA.

The validity of a road test after stroke

Akinwuntan AE, De Weerdt W, Feys H, Baten G, Arno P, Kiekens C. The validity of a road test after stroke. ObjectivesTo determine the validity of a road test performed by stroke patients in Belgium and to reestablish its reliability. DesignProspective study of a predriving evaluation. SettingUniversity hospital in Belgium. ParticipantsThirty-eight patients with sequelae of first-ever stroke. InterventionsNot applicable. Main outcome measuresPerformance in the Stroke Driver Screening Assessment (SDSA) and on a road test. ResultsInterrater reliability of the road test subitems was moderate to substantial (weighted κ range, .44–.78). Item-per-item reliability varied from moderately high (intraclass correlation coefficient [ICC]=.63) to very high (ICC=.87). The reliability of the overall performance in the road test was very high (ICC=.83). For the criterion validity of the road test, 78.9% of the subjects were correctly classified when the judgments of the principal evaluator were compared with outcomes of the SDSA. Agreement in classification between the principal evaluator and a state-registered evaluator’s judgments was 81.6%. The sensitivity and specificity of the agreement were very high (80.6%) and perfect (100%), respectively. ConclusionsThe road test is a reliable and valid test of driving ability after stroke.

Preliminary evaluation of a desktop PC-based virtual reality driving assessment

This article describes the development and evaluation of a virtual reality (VR) based driving assessment, which runs on a desktop PC and is thus available in a variety of settings. The authors discuss the situations that may result in the need for an assessment of driving competence, including after rehabilitation from a stroke, or simply the effects of older age. The first stage of the evaluation was simply to determine whether the VR driving assessment could distinguish between the performance of drivers and non-drivers and to compare the results obtained across these two groups with their performance on the Stroke Drivers Screening Assessment (SDSA). The authors note that the VR driving assessment discriminated between drivers and non-drivers, which the SDSA did not. However, two measures on the VR driving assessment correlated with drivers' scores on the SDSA.