Effect of simulator training on driving after stroke: a randomized controlled trial.
BACKGROUND
Neurologically impaired persons seem to benefit from driving-training programs, but there is no convincing evidence to support this notion. The authors therefore investigated the effect of simulator-based training on driving after stroke.


METHODS
Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training program in which they were randomly allocated to either an experimental (simulator-based training) or control (driving-related cognitive tasks) group. Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training. Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered.


RESULTS
Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training. There were no significant differences between both groups in improvements from pre- to post-training except in the "road sign recognition test" in which the experimental subjects improved more. Significant improvements in the three-class decision ("fit to drive," "temporarily unfit to drive," and "unfit to drive") were found in favor of the experimental group post-training. Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training. Significantly more experimental subjects (73%) than control subjects (42%) passed the follow-up official predriving assessment and were legally allowed to resume driving.


CONCLUSIONS
Simulator-based driving training improved driving ability, especially for well educated and less disabled stroke patients. However, the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training.
Akinwuntan
A E
AE
Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, Belgium. aakinwuntan@mcg.edu
De Weerdt
W
W
Feys
H
H
Pauwels
J
J
Baten
G
G
Arno
P
P
Kiekens
C
C
D000063:Accidents, Traffic / Q000517:prevention & control*; D000328:Adult; D000368:Aged; D001334:Automobile Driving / Q000193:education*; D001925:Brain Damage, Chronic / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019957:Motor Skills Disorders / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010349:Patient Compliance; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000150:complications / Q000503:physiopathology; D000071939:Stroke Rehabilitation; D013663:Teaching / Q000379:methods / Q000639:trends; D016896:Treatment Outcome; D014584:User-Computer Interface