Clinical evaluation of the driving ability in stroke patients

OBJECTIVES: Stroke often causes physical, cognitive and psychomotor dysfunction, which markedly decreases the driving ability of stroke patients. The aim of this study was to evaluate the driving ability of stroke patients using multidisciplinary clinical evaluation and driving-related laboratory tests. MATERIALS AND METHODS: A neurologist evaluated the driving ability of 20 male stroke patients on the basis of his own clinical examination and the observations and measurements of a neurological multidisciplinary rehabilitation team. After that a traffic psychologist evaluated the patients' driving ability on the basis of the driving-related cognitive and psychomotor laboratory tests. The patients themselves also evaluated their driving ability, as did their spouses. All the evaluations were carried out independently using the same 10-point scale. The control group consisted of 20 healthy males, matched by age and driving experience, who went through the same laboratory test package as the patients did. RESULTS: The stroke patients had more deficiencies in all tested driving related cognitive and psychomotor functions than the controls. The neurologist and the psychologist together evaluated 12 (60%) of the 20 stroke patients being unable to drive; 8 patients out of 11 with non-dominant hemisphere lesion and 4 in the dominant group. The patients themselves and their spouses had a clear tendency to overestimate driving ability compared to the estimates of the neurologist and the psychologist. The hit-rate of the evaluations of the neurologist and traffic psychologist (75%) was high. CONCLUSION: Stroke patients form a risk group as drivers due to their decreased cognitive and psychomotor abilities, and driving ability should always be evaluated after stroke. The results suggest that multidisciplinary neurological teams are able to evaluate the driving ability of stroke patients reliably. A careful evaluation of driving ability without a driving test requires assessment of cognitive and psychomotor functions critical in driving, which is not feasible for physicians without the support of a multidisciplinary team and/or traffic-related laboratory tests.