Reliability of a Road Test After Stroke

Background: Despite physical, perceptual and cognitive impairments, amongst others, which might affect driving after stroke, some patients have demonstrated the ability to resume safe driving. Such patients are identified following strictly administered predriving evaluations. The road test is generally acclaimed to be the most valid test of driving performance. Aim: The purpose of this study was to determine the reliability of the road test when performed by stroke patients in Belgium. Method: This was a prospective study of a predriving evaluation at the Belgian Road Safety Institute. Thirty subjects with sequelae of stroke were included. Subjects were accompanied and evaluated during the road test by one of two assessors (A or B) from the road safety institute in an automatic car fitted with a video camera for recording driving performance. Inter-rater reliability was evaluated by comparing results from (1) real-life performance and video recording and (2) between-video judgements. Results: Most sub-items of the road test showed \u3e80% scoring agreement between the various evaluations. Intraclass correlation coefficient (ICC) of the items varied from -0.08 to 1.0. ICC of the overall performance was 0.62 when real-life scores were compared with video evaluations and 0.80 in video versus video comparison. Conclusion: Driving is important for optimal participation in daily and social activities. The reliability of assessing overall performance of the on-road test is moderately high and better when assessed using same evidence. Yet, the reliability of some items needs further attention

Reliability of a Road Test After Stroke

Background: Despite physical, perceptual and cognitive impairments, amongst others, which might affect driving after stroke, some patients have demonstrated the ability to resume safe driving. Such patients are identified following strictly administered predriving evaluations. The road test is generally acclaimed to be the most valid test of driving performance. Aim: The purpose of this study was to determine the reliability of the road test when performed by stroke patients in Belgium. Method: This was a prospective study of a predriving evaluation at the Belgian Road Safety Institute. Thirty subjects with sequelae of stroke were included. Subjects were accompanied and evaluated during the road test by one of two assessors (A or B) from the road safety institute in an automatic car fitted with a video camera for recording driving performance. Inter-rater reliability was evaluated by comparing results from (1) real-life performance and video recording and (2) between-video judgements. Results: Most sub-items of the road test showed >80% scoring agreement between the various evaluations. Intraclass correlation coefficient (ICC) of the items varied from -0.08 to 1.0. ICC of the overall performance was 0.62 when real-life scores were compared with video evaluations and 0.80 in video versus video comparison. Conclusion: Driving is important for optimal participation in daily and social activities. The reliability of assessing overall performance of the on-road test is moderately high and better when assessed using same evidence. Yet, the reliability of some items needs further attention

Determinants of Driving After Stroke

Objective: To identify from a predriving assessment the tests that best predict the driving ability of stroke patients. Design: Examination of records of 104 first ever stroke patients who visited the Belgian Institute for Road Safety in 1998 and 1999 and performed the medical, visual, perceptual and the ‘on the road’ assessments. Measures: Variables such as age, sex, side of lesion, driving experience, visual tests, neuropsychological assessments most of which are from the Test for Attentional Performance (TAP) battery and an ‘on the road’ test were considered. Based on performances of subjects on the tests, a suitable, not immediately suitable or not suitable to drive decision was jointly taken by the team of assessors. Results: Following a logistic regression analysis, a combination of side of lesion, kinetic vision, visual scanning and the ‘on the road’ tests led to the best model in predicting the final group decision (R2 =0.53). The ‘on the road’ test was the most important determinant (R2 =0.42). Conclusion: The predictive accuracy of the decision is moderate. Inclusion of assessments more closely related to real road situations should be considered

Effect of Simulator Training on Driving After Stroke: A Randomized Controlled Trial

Neurologically impaired persons seem to benefit from drivingtraining programs, but there is no convincing evidence to support this notion. Wetherefore investigated the effect of simulator-based training on driving afterstroke. Eighty-three first ever sub-acute stroke patients entered a 5-week, 15-hourtraining program in which they were randomly allocated to either an experimental(simulator-based training) or control (driving-related cognitive tasks) group.Performance in off-road evaluations and an on-road test were used to assess thedriving ability of subjects pre- and post-training. Outcome of an official predrivingassessment administered 6 to 9 months post stroke were also considered.Both groups significantly improved in a visual and many neuropsychologicalevaluations and in the on-road test after training. There were no significantdifferences between both groups in improvements from pre- to post-trainingexcept in the “road sign recognition test,” in which the experimental subjectsimproved more. Statistically significant improvements in the three-class decision(“fit to drive,” “temporarily unfit to drive” and “unfit to drive”) were found infavor of the experimental group. Academic qualification and overall disabilitytogether determined subjects who benefited most from the simulator-baseddriving training. Significantly more experimental subjects (73%) than controls(42%) passed the follow-up official pre-driving assessment and were legallyallowed to resume driving. We concluded that simulator-based driving trainingwas a better method, especially for well educated and less disabled stroke patients. However, the findings of the study may have been modified as a resultof the large number of dropouts and the possibility of some neurological recoveryunrelated to training

Training of Driving-Related Attentional Performance After Stroke Using a Driving Simulator

The objective of this study was to determine the effect of simulatorbased driving training on attentional performance after stroke. A further analysis of data was conducted from a randomized controlled trial in which the effect of simulator training and cognitive paper and pencil training to improve driving were compared. Performance in divided attention tasks before, during and after 15 hours of simulator-based training of general driving skills in 33 experimental participants were evaluated. Performance in divided attention tasks was assessed during navigation of a 5-km scenario with the divided attention tasks as the only event to respond to and another 13.5-km scenario that contained a good mixture of regular day to day traffic situations. There were significant improvements in mean response time to the divided attention tasks and time to complete the 5-km scenario. Significant decrease in mean response time, number of missed responses, collisions, pedestrians hit, total faults and run time and increase in number of correct responses were found in the 13.5-km scenario. Further analyses showed most improvements in the simulator assessments occurred between preand mid-training. Simulator-based training of driving skills positively impacted attentional performance. Findings in this study suggest that 10 hours of simulatorbased driving training after stroke is sufficient to realize meaningful benefits

Variations in follow-up services after inpatient stroke rehabilitation: A multicentre study

Background: Care after discharge from inpatient stroke rehabilitation units varies across Europe. The aim of this study was to compare service delivery after discharge. Methods: A total of 532 consecutive patients after stroke were recruited from 4 European rehabilitation centres in Germany, Switzerland, Belgium and the UK. At 2-month intervals, clinical assessments and structured interviews were carried out to document functional status and delivery of services after discharge. Significant factors for receiving follow-up services were analysed using a logistic generalized estimating equation model. Results: After controlling for case-mix, the results showed that Belgian patients were most likely to receive physical therapy but least likely to receive occupational therapy. German patients were least likely to receive nursing care. UK patients were less likely to receive medical care from their general practitioner compared with the other patient groups. Conclusion: Clinical characteristics did not explain the variations in service delivery after discharge from inpatient stroke rehabilitation. The decision-making processes involved in the provision of follow-up services need to be better documented. To improve our understanding of events post-discharge, the influence of non-clinical factors, such as healthcare regulations, should be explored further

Short and Predictive Assessment Battery of Fitness-to-Drive After Stroke

The objective of this study was to confirm the accuracy of a previously identified short assessment battery to predict fitness-to-drive after stroke in a new cohort of stroke survivors. This was a prospective study that included 43 (39 males and 4 females) participants who performed the pre-driving assessment that included a standardized on-road test at the Belgian Road Safety Institute in Brussels, Belgium. Participants were on average six months post stroke, not severely physically disabled, possessed valid drivers’ licenses and actively drove prior to stroke onset. Fitness-to-drive decisions made based on performance in 15 tests of a full scale assessment battery were predicted using only scores in three previously identified predictive tests. Performance in the three tests (figure of Rey, visual neglect (lateralized mean reaction time) and on-road test) was used to correctly predict 37 (86%) of the 43 participants’ driving fitness. The sensitivity and specificity of the predictions were 77% and 92% respectively. The outcome of this study shows that the short assessment battery is indeed a good predictor of fitness-to-drive in stroke survivors, especially those without severe deficits

The Discourse of Loss in Song Dynasty Private and Imperial Book Collecting

This article investigates the discourse of loss during the period between the pillaging of the Song Dynasty imperial libraries and the dispersal of private collections in north China in the late 1120s and the rebuilding of the Imperial Library and private collections through the 1140s. It contrasts the different strategies taken by the court and private collectors in managing loss, in developing acquisitions, and in remembering war and peace through collecting.published or submitted for publicatio

Continuities between Scribal and Print Publishing in Twelfth-Century Song China--The Case of Wang Mingqing's Serialized Notebooks

Asian Studie