To drive or not to drive: Neuropsychological assessment for driver's license among stroke patients

Abstract

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception, (II) spatial attention, (III) visuospatial processing, and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.

Driving after cerebral ischemia – a driving simulator investigation

“…None of the investigated patients was severely physically disabled at the time of investigation. Driving performance is a complex task that requires multiple cognitive abilities located in both hemispheres, however [5,17,18]. Especially apraxia and attention deficits can be found following lesions in the left as well as in the right hemisphere.…”

“…Driving regulations do not list deficit patterns or response levels critical for physical, cognitive and emotional performance except that perception for both visual fields should be intact [17]. German traffic guidelines [3] allow driving after transient cerebral ischemia if no relapse is imminent.…”

Neurologic Conditions: Assessing Medical Fitness to Drive

“…8 There is often left-sided visual neglect with visuospatial and perceptual defects, poor insight regarding these defects and a prolonged reaction time. 17,18 These patients tend to have poorer driving skills, are more difficult to train and frequently do not pass their re-licensing examination. 3,19 Despite these deficiencies, with appropriate adaptations, patients with right hemispheric involvement can do as well as those with left hemispheric strokes.…”

Behavioural ratings of self-regulatory mechanisms and driving behaviour after an acquired brain injury

“…Some studies confirm this relationship [5,[20][21][22][23][24], whereas others fail to do so [25][26][27][28]. According to Pietrapiana et al [29], these mixed findings may be due to the variety of tests that are used, the different driving outcomes measured as criterion variables and an over-emphasis on perceptual-motor skills compared to higher order cognitions (e.g.…”