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

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

Better detection of reduced motor functioning in brain tumor survivors based on objective motor assessments:An incentive for improved standardized follow-up

Long-term sequelae are well-known in childhood brain tumor survivors, but motor functioning remains poorly described. This cross-sectional study aimed to assess objective motor functioning, patient-specific risk factors, and parental perceptions. Fifty-two childhood brain tumor patients (pilocytic astrocytoma, medulloblastoma, and other types) who were at least 6 months out of treatment were evaluated. Mean age at testing was 11.7 years. Objective motor functioning was assessed with the Movement Assessment Battery for Children (MABC-2-NL) and/or Bruininks-Oseretsky test of motor proficiency (BOT-2). Functional walking capacity was assessed with the 6-min walk test (6MWT). Parent-reported motor functioning was addressed using the ABILHAND-Kids, ABILOCO-Kids questionnaires, and a standardized anamnesis. Patients showed impaired motor functioning in all domains (p < 0.001). Regarding risk factors, younger age at diagnosis (< 5 year) was significantly associated with lower scores on body coordination (p = 0.006). Adjuvant treatment resulted in lower scores for fine manual control of the BOT-2 (p = 0.024) and balance of MABC-2-NL (p = 0.036). Finally, questionnaires revealed an underestimation of motor problems as perceived by the parents. In conclusion, many children who are in follow-up for a brain tumor show impaired motor functioning on multiple aspects, with younger age at diagnosis and adjuvant treatment as specific risk factors. Based on the questionnaires and anamnesis, motor problems appear to be underestimated by the parents. Conclusion: These findings point to the need for timely prospective screening of motor functioning. Based on a screening assessment, adequate rehabilitation programs can be applied in childhood brain tumor survivors, aiming to reduce the adverse impact on their daily lives, both for functional activities and cardiovascular fitness. What is Known: • A pediatric brain tumor and its treatment are associated with potential long-term motor sequelae. • Test assessments could enable us to objectify motor functioning of these patients. What is New: • Pediatric brain tumors survivors show lower motor performance compared to the norm, which is often underestimated by parents. • Younger age at diagnosis and adjuvant treatment could be specific risk factors

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

Internal Languages of Finitely Complete (∞,1)(\infty, 1)-categories

We prove that the homotopy theory of Joyal's tribes is equivalent to that of fibration categories. As a consequence, we deduce a variant of the conjecture asserting that Martin-L\"of Type Theory with dependent sums and intensional identity types is the internal language of $(\infty, 1)$-categories with finite limits.Comment: 41 pages, minor revision

Growth rate rather than growth duration drives growth heterosis in maize B104 hybrids

Research in maize is often performed using inbred lines that can be readily transformed, such as B104. However, because the B104 line flowers late, the kernels do not always mature before the end of the growing season, hampering routine seed yield evaluations of biotech traits introduced in B104 at many geographical locations. Therefore, we generated five hybrids by crossing B104 with the early-flowering inbred lines CML91, F7, H99, Mo17, and W153R and showed in three consecutive years that the hybrid lines proved to be suitable to evaluate seed yield under field conditions in a temperate climate. By assessing the two main processes driving maize leaf growth, being rate of growth (leaf elongation rate or LER) and the duration of growth (leaf elongation duration or LED) in this panel of hybrids, we showed that leaf growth heterosis was mainly the result of increased LER and not or to a lesser extent of LED. Ectopic expression of the transgenes GA20-oxidase (GA20-OX) and PLASTOCHRON1 (PLA1), known to stimulate the LER and LED, respectively, in the hybrids showed that leaf length heterosis can be stimulated by increased LER, but not by LED, indicating that LER rather than LED is the target for enhancing leaf growth heterosis. To enable transgenic maize research, hybrids between the inbred B104 that can be routinely transformed and early flowering inbreds were evaluated for yield components in three consecutive years. In addition, we show that leaf elongation rate is the main contributor to leaf growth heterosis in these hybrids, which can even be stimulated by overexpressing GA20OXIDASE, a known regulator of leaf elongation rate. Although leaf elongation duration has a limited contribution to the growth heterosis, the effect of the ectopic expression of PLASTOCHRON1, known to enhance leaf elongation duration and leaf growth, is still observed in the hybrids. This detailed understanding of the growth processes driving heterosis will be key to further breed for high yielding hybrids

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