title: Comparison of the effect of two driving retraining programs on on-road performance after stroke.
abstract: BACKGROUND
  Several driving retraining programs have been developed to improve driving skills after stroke. Those programs rely on different rehabilitation concepts.
  
  
  OBJECTIVE
  The current study sought to examine the specific carryover effect of driving skills of a comprehensive training program in a driving simulator when compared with a cognitive training program.
  
  
  METHODS
  Further analysis from a previous randomized controlled trial that investigated the effect of simulator training on driving after stroke. Forty-two participants received simulator-based driving training, whereas 41 participants received cognitive training for 15 hours. Overall performance in the on-road test and each of its 13 items were compared between groups immediately posttraining and at 6 months poststroke.
  
  
  RESULTS
  Generalized estimating equation analysis showed that the total score on the on-road test and each item score improved significantly over time for both groups. Those who received driving simulator training achieved better results when compared with the cognitive training group in the overall on-road score and the items of anticipation and perception of signs, visual behavior and communication, quality of traffic participation, and turning left. Most of the differences in improvement between the 2 interventions were observed at 6 months poststroke.
  
  
  CONCLUSIONS
  Contextual training in a driving simulator appeared to be superior to cognitive training to treat impaired on-road driving skills after stroke. The effects were primarily seen in visuointegrative driving skills. Our results favor the implementation of driving simulator therapy in the conventional rehabilitation program of subacute stroke patients with mild deficits.
authors.affiliation: Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, and Department of Physical Medicine and Rehabilitation, University Hospital Leuven Campus Pellenberg, Leuven, Belgium. Hannes.Devos@faber.kuleuven.be
authors.forename: Hannes
authors.initials: H
authors.lastname: Devos
authors.forename: Abiodun Emmanuel
authors.initials: AE
authors.lastname: Akinwuntan
authors.forename: Alice
authors.initials: A
authors.lastname: Nieuwboer
authors.forename: Mark
authors.initials: M
authors.lastname: Tant
authors.forename: Steven
authors.initials: S
authors.lastname: Truijen
authors.forename: Liesbet
authors.initials: L
authors.lastname: De Wit
authors.forename: Carlotte
authors.initials: C
authors.lastname: Kiekens
authors.forename: Willy
authors.initials: W
authors.lastname: De Weerdt
mesh_terms: D001334:Automobile Driving / Q000193:education*; D003071:Cognition; D003198:Computer Simulation; D006801:Humans; D008875:Middle Aged; D011597:Psychomotor Performance; D000071939:Stroke Rehabilitation; D013647:Task Performance and Analysis; D013997:Time Factors; D016896:Treatment Outcome