Retraining Visual Processing Skills To Improve Driving Ability After Stroke

Crotty, Maria; George, Stacey

doi:10.1016/j.apmr.2009.08.143

Cited by 36 publications

(21 citation statements)

References 39 publications

(20 reference statements)

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“…938,941 One study showed that visual training with the Dynavision system (Dynavision LLC, West Chester, OH) did not result in increased driving ability. 943 Unfortunately, other studies that investigated vision training and showed improved driving-related visual skills did not include measures of actual driving ability. 944 Thus, the evidence is insufficient to determine whether visual training improves driving performance in those individuals with insufficient visual skills.…”

Section: Winstein Et Al Guidelines For Adult Stroke Rehabilitation Anmentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,055

840

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e98Purpose-The aim of this guideline is to provide a synopsis of best clinical practices in the rehabilitative care of adults recovering from stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council's Scientific Statement Oversight Committee and the AHA's Manuscript Oversight Committee. The panel reviewed relevant articles on adults using computerized searches of the medical literature through 2014. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA methods of classifying the level of certainty and the class and level of evidence. The document underwent extensive AHA internal and external peer review, Stroke Council Leadership review, and Scientific Statements Oversight Committee review before consideration and approval by the AHA Science Advisory and Coordinating Committee. Results-Stroke rehabilitation requires a sustained and coordinated effort from a large team, including the patient and his or her goals, family and friends, other caregivers (eg, personal care attendants), physicians, nurses, physical and occupational therapists, speech-language pathologists, recreation therapists, psychologists, nutritionists, social workers, and others. Communication and coordination among these team members are paramount in maximizing the effectiveness

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Section: Winstein Et Al Guidelines For Adult Stroke Rehabilitation Anmentioning

confidence: 99%

Guidelines for Adult Stroke Rehabilitation and Recovery

Winstein¹,

Stein²,

Arena

et al. 2016

Stroke

2,055

840

View full text Add to dashboard Cite

show abstract

“…The review rendered a total of 6 studies: 5 Level I randomized controlled trials (RCTs), 3 from the same group of researchers (Akinwuntan et al, 2005;Devos et al, 2010Devos et al, , 2009) and 2 from independent researchers (Crotty & George, 2009;Mazer et al, 2003); and 1 Level II nonrandomized two-group study (Söderström, Pettersson, & Leppert, 2006).…”

Section: Stroke Studiesmentioning

confidence: 99%

“…Given the longitudinal nature of three stroke studies (Akinwuntan et al, 2005;Devos et al, 2009Devos et al, , 2010, Level I evidence, with a high level of certainty, exists to support the effectiveness of task-specific training in a driving simulator versus cognitive training to improve on-road driving skills in clients with mild stroke. The remaining Level I RCTs displayed a lack of carryover effects by training driving skills through a cognitive (Mazer et al, 2003) or a visual attention (Crotty & George, 2009) component. However, a Level II study (Söderström et al, 2006), with moderate level of certainty, indicates that drivers with stroke who failed a driving test improved their driving ability with interventions consisting of traffic theory knowledge tests (TTKTs) and on-road training interventions.…”

Section: Stroke Studiesmentioning

confidence: 99%

“…Limitations of this review include heterogeneity among the primary studies, such as variability in age of study participants (Bowers et al, 2005;Szlyk et al, 2000), population size (Crotty & George, 2009;Szlyk et al, 2005), and gender composition, because some studies included only men (Crotty & George, 2009;Söderström et al, 2006). We reviewed only studies published in the English literature and within a specific time frame.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

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Evidence-Based Review of Interventions for Medically At-Risk Older Drivers

Classen

Monahan

Auten

et al. 2014

The American Journal of Occupational Therapy

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OBJECTIVE. To conduct an evidence-based review of intervention studies of older drivers with medical conditions. METHOD. We used the American Occupational Therapy Association’s classification criteria (Levels I–V, I = highest level of evidence) to identify driving interventions. We classified studies using letters to represent the strength of recommendations: A = strongly recommend the intervention; B = recommend intervention is provided routinely; C = weak evidence that the intervention can improve outcomes; D = recommend not to provide the intervention; I = insufficient evidence to recommend for or against the intervention. RESULTS. For clients with stroke, we recommend a graded simulator intervention (A) and multimodal training in traffic theory knowledge and on-road interventions (B); we make no recommendation for or against Dynavision, Useful Field of View, or visual–perceptual interventions (I). For clients with visual deficits, we recommend educational intervention (A) and bioptic training (B); we make no recommendation for or against prism lenses (I). For clients with dementia, we recommend driving restriction interventions (C) and make no recommendation for or against use of compensatory driving strategies (I). CONCLUSION. Level I studies are needed to identify effective interventions for medically at-risk older drivers.

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“…Driving rehabilitation has shown promising effects on fitness-to-drive, on-road driving performance, and cognitive functions after stroke [6]. These driving interventions used a standard set of simulator scenarios, off-the-shelf cognitive games, or computerized training programs [7,8,9]. Mazer et al compared the effect of 20 sessions of Useful Field Of View (UFOV) training with traditional visuo-perceptual training in 84 drivers with stroke [7].…”

Section: Introductionmentioning

confidence: 99%

On-Road Driving Impairments and Associated Cognitive Deficits After Stroke

2014

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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 on-road 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 right- and 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 (R² = 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 left-sided strokes.

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Retraining Visual Processing Skills To Improve Driving Ability After Stroke

Cited by 36 publications

References 39 publications

Guidelines for Adult Stroke Rehabilitation and Recovery

Guidelines for Adult Stroke Rehabilitation and Recovery

Evidence-Based Review of Interventions for Medically At-Risk Older Drivers

On-Road Driving Impairments and Associated Cognitive Deficits After Stroke

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