Perceived confidence relates to driving habits post-stroke

Abstract

Purpose: Returning to driving post-stroke is a step towards independence. On return to driving following stroke, confidence is related to performance in on-road assessment and self-regulation of driving behaviours occurs. The aim of this study was to examine the relationship between driver’s confidence and driving habits post-stroke. Method: Structured telephone surveys were completed with 40 stroke survivors (62% men), of mean age 65 years SD 12.17 who returned to driving post-stroke within the previous 3 years. The survey included: (1) socio-demographics, (2) Adelaide Driving Self Efficacy Scale (ADSES) and (3) Driving Habits Questionnaire (DHQ). Results: Male stroke survivors were more likely to return to driving, drive further and more often. Stroke survivors under 65 years were likely to drive further. Driving confidence was significantly associated with kilometres driven (p?=?0.006), distance driven (p?=?0.027) and self-limiting driving (p?=?0.00). Conclusion: Findings indicate a relationship between confidence and driving behaviours post-stroke. Early recognition of driving confidence will help professionals target specific strategies, encouraging stroke survivors to return to full driving potential, access activities and positively influence quality of life.

• Implications for Rehabilitation

• Findings indicate a relationship between confidence and driving behaviours post-stroke.

• Early recognition of driving confidence will help professionals target specific strategies, encouraging stroke survivors to return to full driving potential, access activities and positively influence quality of life.

     

What contributes to driving ability in Parkinson's disease

Purpose.?To determine the most significant clinical predictors that influence driving ability in Parkinson disease (PD).

Methods.?National-multi-centre, cross-sectional study covering PD outpatients. Clinical assessment was based on the following questionnaires: cognition (SCOPA-Cog); motor impairment and disabilities (SCOPA motor); depression/anxiety; sleep (SCOPA-Sleep); psychosis and severity/global impairment (HY and CISI-PD). Driving status data was obtained using a standardized questionnaire. Comparisons between drivers and ex-drivers were calculated using χ² and Student t-tests as appropriate. Multi-variate logistic regression analysis was performed to identify independent driving ability clinical predictors.

Results.?Compared with the drivers, the ex-drivers were older (p?=?0.00005), had longer disease duration (p?=?0.03), had more overall cognitive dysfunction (p?=?0.004) and had greater motor impairment, as measured by the CISI (p?=?0.02), HY stage (p?=?0.034) and by the SCOPA-motor scale (p?=?0.002) and difficulty in activities of daily life (p?=?0.002). In the regression model analysis, aging and ADL impairment were the principal clinical predictors that differentiated drivers from ex-drivers.

Conclusions.?Although overall driving impairment in PD is associated with advancing disease severity, driving ability seems to be more strongly influenced by age and ADL impairment. Multi-disciplinary teams are required to assess driving ability in patients with PD and develop rehabilitation measures for safer driving.     

Predicting fitness-to-drive following stroke using the Occupational Therapy – Driver Off Road Assessment Battery

Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy – Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke.

Aim: Examine the predictive validity of the Occupational Therapy – Driver Off Road Assessment Battery for on-road performance among people with stroke.

Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive.

Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%).

Conclusion: The three cognitive subtests from the Occupational Therapy – Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke.

• Implications for Rehabilitation:

• Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving.

• The Occupational Therapy – Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment.

• Scores on four of the Occupational Therapy – Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.

     

On the road again after traumatic brain injury: driver safety and behaviour following on-road assessment and rehabilitation

Purpose: To examine pre- and post-injury self-reported driver behaviour and safety in individuals with traumatic brain injury (TBI) who returned to driving after occupational therapy driver assessment and on-road rehabilitation. Method: A self-report questionnaire, administered at an average of 4.5 years after completing an on-road driver assessment, documenting pre- and post-injury crash rates, near-crashes, frequency of driving, distances driven, driving conditions avoided and navigation skills, was completed by 106 participants, who had either passed the initial driver assessment (pass group n?=?74), or required driver rehabilitation, prior to subsequent assessments (rehabilitation group n?=?32). Results: No significant difference was found between pre- and post-injury crash rates. Compared to pre-injury, 36.8% of drivers reported limiting driving time, 40.6% drove more slowly, 41.5% reported greater difficulty with navigating and 20.0% reported more near-crashes. The rehabilitation group (with greater injury severity) was significantly more likely to drive less frequently, shorter distances, avoid: driving with passengers, busy traffic, night and freeway driving than the pass group. Conclusions: Many drivers with moderate/severe TBI who completed a driver assessment and rehabilitation program at least 3 months post-injury, reported modifying their driving behaviour, and did not report more crashes compared to pre-injury. On-road driver training and training in navigation may be important interventions in driver rehabilitation programs.

• Implications for Rehabilitation

• Driver assessment and on-road retraining are important aspects of rehabilitation following traumatic brain injury.

• Many drivers with moderate/severe TBI, reported modifying their driving behaviour to compensate for ongoing impairment and continued to drive safely in the longer term.

• Navigational difficulties were commonly experienced following TBI, suggesting that training in navigation may be an important aspect of driver rehabilitation.

     

脑卒中偏瘫上肢的作业治疗

脑卒中患者除了一侧肢体功能障碍外 ,还往往出现认知、言语、心理、社会等障碍。导致患者的ADL能力、家庭生活能力、学习、工作及娱乐活动能力下降。OT强调将患者视为一个整体 ,重视其各方面能力的改善与恢复。通过OT的干预、评估、制定目标、分析及选择活动、治疗 ,达到改善患者的身体机能、提高作业活动能力、调整心态、建立起与环境相适应的生活习惯的目的。     

语言疗法和作业疗法对脑卒中后运动性失语伴口颜面失用的作用

目的探讨语言疗法结合作业疗法对脑卒中致运动性失语伴口颜面失用的语言康复方法。方法 5 5名脑卒中致运动性失语伴口颜面失用患者随机分为训练组和对照组。用前瞻法对两组进行比较分析 ,训练组患者进行语言康复训练的同时 ,用作业疗法对其进行失用症康复训练 ;对照组只进行语言康复训练。分别于训练前后进行测评。结果训练组口颜面失用现象改善效果优于对照组 (P <0 0 5 ) ;语言表达能力 (复述、说、出声读 )训练组优于对照组 (P <0 .0 5 )。结论脑卒中致运动性失语伴口颜面失用患者在语言康复训练同时 ,运用作业疗法进行口颜面失用的康复训练 ,可明显改善口颜面失用 ,并提高语言表达能力     

Mobility scooter driving ability in visually impaired individuals

Purpose: To investigate how well visually impaired individuals can learn to use mobility scooters and which parts of the driving task deserve special attention.

Materials and methods: A mobility scooter driving skill test was developed to compare driving skills (e.g. reverse driving, turning) between 48 visually impaired (very low visual acuity?=?14, low visual acuity?=?10, peripheral field defects?=?11, multiple visual impairments?=?13) and 37 normal-sighted controls without any prior experience with mobility scooters. Performance on this test was rated on a three-point scale. Furthermore, the number of extra repetitions on the different elements were noted.

Results: Results showed that visually impaired participants were able to gain sufficient driving skills to be able to use mobility scooters. Participants with visual field defects combined with low visual acuity showed most problems learning different skills and needed more training. Reverse driving and stopping seemed to be most difficult.

Conclusions: The present findings suggest that visually impaired individuals are able to learn to drive mobility scooters. Mobility scooter allocators should be aware that these individuals might need more training on certain elements of the driving task.

• Implications for rehabilitation

• Visual impairments do not necessarily lead to an inability to acquire mobility scooter driving skills.

• Individuals with peripheral field defects (especially in combination with reduced visual acuity) need more driving ability training compared to normal-sighted people – especially to accomplish reversing.

• Individual assessment of visually impaired people is recommended, since participants in this study showed a wide variation in ability to learn driving a mobility scooter.

     

Evaluation of the driving ability in disabled persons: a practitioners' view

Purpose and methods. The purpose of this paper is to present, on the basis of four genuine cases from the Rehabilitation Research Unit of Oulu University, the theoretical frame in which evaluations of driving ability of disabled persons can be made.

Results. First, it is not the operations with the control devices but the correct mental actions which the driver carries out with the help of the control devices which are crucial for safe driving. Second, driving ability is only partly a biomedical object of research and one ought to avoid an excessive medicalisation of an evaluation of driving ability. Third, the driver meets traffic situations not by his or her separate biological or psychological functions, such as vision, attention, memory, thinking, motives, but as an integrated whole, as a personality.

Conclusions. By its complexity an evaluation of driving ability can be compared to an evaluation of working capacity where often a multidisciplinary team is needed. When evaluating driving ability we have to take a step from low-level motor operations towards high-level mental actions, from the measurement of acuity of eyesight towards the testing of the flexibility of perception, from the diagnosis-based evaluation to the patient-based evaluation, from using the common pencil - paper tests towards the traffic-related task-specific tests and from the testing of separate single general non-driving-related factors towards an evaluation of the theoretically based driving performance as whole.     

Evaluation of the driving ability in disabled persons: A practitioners' view

Purpose and methods.?The purpose of this paper is to present, on the basis of four genuine cases from the Rehabilitation Research Unit of Oulu University, the theoretical frame in which evaluations of driving ability of disabled persons can be made.

Results.?First, it is not the operations with the control devices but the correct mental actions which the driver carries out with the help of the control devices which are crucial for safe driving. Second, driving ability is only partly a biomedical object of research and one ought to avoid an excessive medicalisation of an evaluation of driving ability. Third, the driver meets traffic situations not by his or her separate biological or psychological functions, such as vision, attention, memory, thinking, motives, but as an integrated whole, as a personality.

Conclusions.?By its complexity an evaluation of driving ability can be compared to an evaluation of working capacity where often a multidisciplinary team is needed. When evaluating driving ability we have to take a step from low-level motor operations towards high-level mental actions, from the measurement of acuity of eyesight towards the testing of the flexibility of perception, from the diagnosis-based evaluation to the patient-based evaluation, from using the common pencil?–?paper tests towards the traffic-related task-specific tests and from the testing of separate single general non-driving-related factors towards an evaluation of the theoretically based driving performance as whole.     

早期介入作业疗法对脑卒中患者康复疗效的影响

目的 :探讨早期介入作业疗法(OT)对脑卒中患者康复疗效的影响。方法 :对30例脑卒中患者予以运动疗法(PT)治疗的同时进行系统的OT治疗 ,并与只进行PT治疗组进行对照。结果 :OT组的运动功能、ADL能力评分均高于PT组 ,在同一运动功能状态下作业疗法组的ADL能力高于运动疗法组 ,特别在运动功能积分(Fugl-Meyer肢体运动功能评价法)低于60分时 ,两组的ADL能力差异显著(P<0.001)。结论 :OT对提高脑卒中患者的ADL能力及肢体运动功能有重要意义。     

加拿大作业表现量表在偏瘫患者作业活动康复中的应用观察

目的:观察基于加拿大作业表现量表(COPM)评估结果开展的作业治疗对偏瘫患者作业活动和生活质量的影响。方法:将符合入选标准的脑卒中后偏瘫患者48例,随机分为观察组和对照组各24例。2组患者均接受为期3个月的常规康复治疗,对照组在此基础上接受常规日常生活活动训练,观察组在常规康复的基础上辅以COPM评估患者在日常生活活动、生产活动和休闲活动方面的功能障碍,并以COPM评估结果为依据实施针对性的作业活动康复。于治疗前和治疗3个月后分别采用改良Barthel指数(MBI)、世界卫生组织生活质量测定量表简表(WHOQOL-BREF)和COPM对2组患者进行评估。结果:治疗3个月后,2组MBI评分、WHOQOL前28项得分和第103项得分较治疗前均明显提高(均P<0.01),且观察组MBI评分、WHOQOL前28项得分和第103项得分均明显高于对照组(均P<0.05);观察组COPM表现得分和满意度得分较治疗前和对照组均明显提高(P<0.01,0.05),对照组治疗前后COPM表现得分和满意度得分比较差异均无统计学意义。结论:在脑卒中后偏瘫患者常规康复中辅以加拿大作业表现量表应用(评估和康复干预),可以明显改善患者的基础性日常生活活动能力,并提升患者的住院期间作业活动恢复的满意度。     

计算机辅助认知功能训练对脑卒中后认知功能障碍患者血清神经功能相关指标及生活能力的影响

目的：探讨计算机辅助认知功能训练（CACR）对脑卒中后认知功能障碍患者血清神经功能相关指标及生活能力的影响。方法：将80例脑卒中后认知功能障碍患者随机划分入对照组和观察组各40例,所有患者均接受常规治疗,在此基础上对照组实施作业疗法,观察组在对照组基础上开展CACR。于干预前、干预3个月后对2组采用简易精神状态评价量表（MMSE）评定认知功能,采用改良Barthel指数（MBI）评定生活能力,并检测2组血清视锥蛋白样蛋白-1（VILIP-1）、胶质纤维酸性蛋白（GFAP）、神经元特异性烯醇化酶（NSE）水平。结果：干预后,2组MMSE、MBI评分和干预前相比均明显增高（P＜0.05）,且观察组均明显高于照组（P＜0.05）;干预后2组血清视锥蛋白样蛋白-1（VILIP-1）、胶质纤维酸性蛋白（GFAP）、神经元特异性烯醇化酶（NSE）水平和干预前相比均明显降低（P＜0.05）,且观察组均明显低于对照组（P＜0.05）。结论：对脑卒中后认知障碍患者实施CACR结合作业疗法干预,可有效下调血清VILIP-1、GFAP、NSE表达,明显改善患者认知功能,显著提高生活能力。