title: Post-stroke driving: examining the effect of executive dysfunction.
abstract: BACKGROUND
  Executive dysfunction can refer to both neurocognitive deficits and behavioral symptoms that include impaired judgment, slow decision making, disorganization, impulsiveness, and risk-taking behaviors. Executive dysfunction is relatively common in the post-stroke population but is often undetected. The impact of executive dysfunction on post-stroke driving is unclear but it may pose a risk to affected drivers and other road users.
  
  
  OBJECTIVE
  The aim of this study was to investigate the relationship between executive functioning following stroke and driving performance.
  
  
  METHODS
  A case-control study design was used. Purposive sampling was used to recruit stroke participants (n=19) and healthy controls (n=22). Participants were screened using a battery of psychometric assessments including the Montreal Cognitive Assessment and the Benton Judgment of Line Orientation. Driving performance was assessed using the STISIM driving simulator. Executive function was assessed using the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and the Trail Making Test Part B.
  
  
  RESULTS
  The control participants performed better than the stroke participants on the driving assessment and psychometric assessments. There was an association between the scores of the Trail Making Test Part B (Rho=0.34, p=0.034) and the Key Search Test of the BADS (Rho=-0.61, p=0.005), and the driving assessment scores. However, there was no association between the overall BADS scores and the driving assessment scores of the stroke participants.
  
  
  CONCLUSIONS
  The stroke participants underperformed in the driving assessment and the psychometric assessments that detected neurocognitive deficits, which included executive function. The Trail Making Test Part B and Key Search Test of the BADS were related to identify participants' deterioration in driving performance. Practical Applications: In clinical practice, the latter could be used as an indication of a post-stroke driver's performance.
authors.affiliation: School of Occupational Therapy and Social Work, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Motta
authors.affiliation: School of Occupational Therapy and Social Work, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia. Electronic address: Hoe.Lee@curtin.edu.au.
authors.forename: Hoe
authors.initials: H
authors.lastname: Lee
authors.affiliation: School of Occupational Therapy and Social Work, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia; Rehabilitation Medicine, Department of Medicine and Health Sciences (IMH), Faculty of Health Sciences, Linköping University & Pain and Rehabilitation Centre, UHL, County Council, Linköping, Sweden; School of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia.
authors.forename: Torbjorn
authors.initials: T
authors.lastname: Falkmer
mesh_terms: D000063:Accidents, Traffic; D000368:Aged; D001334:Automobile Driving / Q000523:psychology*; D016022:Case-Control Studies; D003071:Cognition; D003072:Cognition Disorders / Q000209:etiology*; D056344:Executive Function; D005260:Female; D006801:Humans; D007600:Judgment; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012309:Risk-Taking; D012449:Safety; D020521:Stroke / Q000150:complications / Q000523:psychology*; D013647:Task Performance and Analysis
keywords: Driving simulator; Executive dysfunction; Post-stroke driving