Understanding driving after stroke: safety outcomes and characteristics of those who return to driving

It is difficult to assess driving safety according to stroke sequelae, given that little attention has been given to the characteristics of post-stroke drivers. Therefore, the specific objective was to estimate the extent to which neurological and functional factors at 3 months predict driving resumption at 12 months post-stroke. A sub-cohort of drivers (n=290) were sampled from 678 Canadians who were participating in a longitudinal study of stroke outcomes. Of 290 participants (68% men; age: 64 years; CNS: 8.5), 177 (61%) returned to driving at one year. The relationships between the factors influencing driving status were modeled in a path analysis. Persons with higher scores on the combined SIS scales for strength and activity and MMSE, as well as those with ischemic stroke, will be more likely to return to driving. Fatigue, gender and stroke severity indirectly influence driving through strength and activity. Gender differences were also found in the level of fatigue. Future work that carefully incorporates more sensitive measures of function in a path model with contextual factors will confirm these results.Peu d'attention a été portée sur les caractéristiques des conducteurs suite à un ACV, alors il est très difficile de prendre en considération les risques d'accident associés aux séquelles d'un ACV. Par conséquent, l'objectif spécifique était d'estimer à quel point les facteurs neuraux et fonctionnels à 3 mois prédisent un retour à la conduite 12 mois suite à un ACV. Une sous-cohorte de conducteurs (n=290) a été sélectionnée de 678 canadiens qui ont participé à une étude longitudinale portant sur les variables reliés à un ACV. Des 290 participants (68% sont des hommes, âge 64 ans, CNS : 8.5), 177 (61%) reconduisaient après 12 mois. La relation entre les facteurs et le statut de conduite ont été modelé afin de faire une analyse des pistes causales (path analysis). Les personnes présentant un score élevé sur l'échelle SIS pour la force et l'activité combiné au MMSE, ainsi que les personnes ayant un ACV ischémique, sont plus enclin de conduire de nouveau. La fatigue, le genre ainsi que la sévérité de l'ACV influencent indirectement la conduite à travers force et l'activité. Les futures recherches intégrant des mesures plus sensibles. La prochaine direction à prendre est d'intégrer des mesures de la fonction plus sensible à l'analyse des causalités avec des facteurs contextuels

Psychosocial factors associated with physical activity in ambulatory and manual wheelchair users with spinal cord injury: a mixed-methods study

Purpose: To identify psychosocial factors which explain lower levels of leisure time physical activity (LTPA) in persons with spinal cord injury (SCI) who are ambulatory relative to those who use manual wheelchairs. Method: For the quantitative study component, 347 adults with SCI (78% male; M age = 47.7) completed baseline measures of LTPA attitudes, subjective norms, perceived behavioural control and intentions. Six months later, LTPA was assessed. The qualitative component involved semi-structured interviews with six ambulant adults with SCI (five male, M age = 52.8) addressing LTPA experiences with an emphasis on barriers and facilitators. Results: Ambulatory individuals had poorer attitudes towards LTPA than chair users (p = 0.004). Their attitudes had significant indirect effects on LTPA, through intentions. Perceived behavioural control was a significant negative predictor of LTPA. Qualitative analysis revealed three themes: an underestimated disability, low wheelchair skill self-efficacy and experiencing chronic pain. Conclusions: Poorer attitudes towards LTPA may partially explain why ambulatory individuals are less active. The qualitative and quantitative data suggest ambulators are an often-overlooked subgroup in need of targeted resources to enhance their attitudes, wheelchair skill self-efficacy and awareness of LTPA opportunities.Implications for RehabilitationRehabilitation practitioners must be sensitive to the unique needs of spinal cord injured individuals who are ambulatory, and tailor physical activity promotional strategies to suit the needs of this distinct group.Lack of wheelchair skills is a participation barrier for ambulators; ambulators should be introduced to activities that do not require wheelchair use, such as swimming, hand-cycling and adapted forms of circuit training.Strategies that encourage wheelchair skill development in non-wheelchair using ambulators, may increase physical activity opportunities for this segment of the spinal injured population