Making the evidence work for your patients and their families
Southampton Neurorehabilitation Conference edition:1 location:Southampton date:04-05 September 2008
BACKGROUND: Stroke patients may suffer from motor, visual and neuropsychological problems that interfere with safe driving. Driving retraining programs are therefore needed.
AIM: To investigate the effect of simulator therapy on driving ability after stroke
METHODS: In this randomized controlled trial (RCT), eighty-three subacute stroke patients entered a 15-hour training program spread over 5 weeks. Experimental subjects received driving simulator therapy. The driving scenarios aimed to train important on-road driving skills. Controls received standardized training by performing driving-related cognitive tasks.
Performance in off-road evaluations and an on-road test were used to assess the driving ability of subjects pre- and post-training, and at 3 months after training. The off-road evaluation involved descriptive measures, visual tests, and neuropsychological assessment. A standardized on-road test was performed in a car adapted to the subject’s needs. The official fitness to drive decision was the main outcome variable.
RESULTS: There were no significant differences between both groups in improvements from pre- to post-training except in the “road sign recognition test” and the fitness to drive decision in which the experimental subjects improved more.
Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training. Significantly more experimental (73%) than control subjects (42%) passed the follow-up official pre-driving assessment and were legally allowed to resume driving.
CONCLUSIONS: Simulator-based driving training improved driving ability, especially for the well-educated and less disabled stroke patients. However, the findings might be modified due to a large number of dropouts and the possibility of some neurologic recovery unrelated to training.
The goal of the study was to see if a specialized simulator-training program would improve driving performance after stroke. We divided 83 participants who had had a stroke into either a simulator training group or a mental training group.
Those who received driving simulator training tended to do better on tasks practiced during the simulation than those from the mental training program. People who received driving simulator therapy had also more chance to pass an official driving evaluation.
This study suggests that driving simulation may be helpful to individuals who have had a stroke and who want to resume driving.