title: On-road driving impairments and associated cognitive deficits after stroke.
abstract: 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 (R(2) = 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 (R(2) = 0.65). Divided attention was the main determinant of on-road scores in the total group (R(2) = 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 (R(2) = 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 (R(2) = 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.
authors.affiliation: Department of Physical Therapy, College of Allied Health Sciences, Georgia Regents University, Augusta, Ga., USA.
authors.forename: Hannes
authors.initials: H
authors.lastname: Devos
authors.forename: Mark
authors.initials: M
authors.lastname: Tant
authors.forename: Abiodun E
authors.initials: AE
authors.lastname: Akinwuntan
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001288:Attention; D001334:Automobile Driving / Q000523:psychology*; D003072:Cognition Disorders / Q000503:physiopathology / Q000523:psychology*; D003430:Cross-Sectional Studies; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D010468:Perceptual Disorders / Q000503:physiopathology / Q000523:psychology; D020521:Stroke / Q000503:physiopathology / Q000523:psychology*; D000071939:Stroke Rehabilitation; D014794:Visual Fields