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From the Departments of Rehabilitation Sciences (Drs. Akinwuntan, De Weerdt, and Feys) and Kinesiology (Dr. Pauwels), Faculty of Kinesiology and Rehabilitation Sciences, Katholieke Universiteit Leuven, CARA (Dr. Arno, G. Baten), Belgian Road Safety Institute, Brussels, and Department of Physical Medicine and Rehabilitation (Dr. Kiekens), University Hospital Pellenberg, Belgium.
Address correspondence and reprint requests to Dr Akinwuntan, Department of Physical Therapy, Medical College of Georgia, 1120 15 St., Augusta, GA 30912; e-mail: aakinwuntan{at}mcg.edu
Background: Neurologically impaired persons seem to benefit from driving-training programs, but there is no convincing evidence to support this notion. The authors therefore investigated the effect of simulator-based training on driving after stroke.
Methods: Eighty-three first-ever subacute stroke patients entered a 5-week 15-hour training 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 the driving ability of subjects pre- and post-training. Outcome of an official predriving assessment administered 6 to 9 months poststroke was also considered.
Results: Both groups significantly improved in a visual and many neuropsychological evaluations and in the on-road test after training. There were no significant differences between both groups in improvements from pre- to post-training except in the "road sign recognition test" in which the experimental subjects improved more. Significant improvements in the three-class decision ("fit to drive," "temporarily unfit to drive," and "unfit to drive") were found in favor of the experimental group post-training. Academic qualification and overall disability together determined subjects that benefited most from the simulator-based driving training. Significantly more experimental subjects (73%) than control subjects (42%) passed the follow-up official predriving assessment and were legally allowed to resume driving.
Conclusions: Simulator-based driving training improved driving ability, especially for well educated and less disabled stroke patients. However, the findings of the study may have been modified as a result of the large number of dropouts and the possibility of some neurologic recovery unrelated to training.
Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the September 27 issue to find the title link for this article.
Supported by Stichting Van Goethem Brichant (funding support) and Interfaculty Office for Development Cooperation of the Katholieke Universiteit Leuven, Belgium (funding of the doctoral study).
The authors report no conflicts of interest.
Received August 16, 2004. Accepted in final form April 29, 2005.
Related Article
Neurology 2005 65: 786-787.
This article has been cited by other articles:
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  Driving Simulator Training Helps Stroke Patients Journal Watch Neurology, February 9, 2006; 2006(209): 9 - 9. [Full Text]
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 E. Roaf and J. Jankowiak Driving after a stroke: What helps Grandma drive safely? Neurology, September 27, 2005; 65(6): E13 - E14. [Full Text] [PDF]
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