Original articleRetraining Visual Processing Skills To Improve Driving Ability After Stroke
Section snippets
Participants
Participants were recruited from 4 rehabilitation sites in Adelaide, Australia, between February 2002 and June 2003. Inclusion criteria were as follows: patients had to have a desire to return to driving, they had to meet the medical guidelines by being a minimum of 1 month since their stroke and have binocular vision of at least 6 of 12 with normal visual field on confrontation18; they had to have practical driving assessment recommended by treating medical practitioner; held a car class
Results
A total of 37 potential participants were reviewed for eligibility; of the 11 excluded, the reasons were not meeting inclusion criteria (n=9) and refused to participate (n=2). Participants who consented to participate were randomized to either the retraining (n=13) or control group (n=13). Of those randomized to the intervention group, (n=13), 10 received the allocated intervention of 18 sessions. Of the 3 who did not, 1 died after 1 session from unrelated causes, 1 refused after 6 sessions,
Discussion
This is the first randomized controlled trial evaluating retraining with Dynavision, and we were unable to show significant improvements in driving ability after stroke, indicated by the pass or fail result on the on-road driving assessment. Furthermore, no improvement was found on the impairment level skills of response times and visual scanning or self-efficacy as a result of the Dynavision training. Although the small numbers limit the conclusions we can draw, the results raise issues for
Conclusions
This is the first randomized controlled trial, with the largest sample to date, evaluating the Dynavision, and we were unable to show an effect on on-road driving performance. The small size of the trial limits the conclusions that can be drawn but provides useful information for the design of future trials. Driving rehabilitation is an increasingly important area for stroke rehabilitation professionals, and expensive devices are currently being promoted as providing recovery via plasticity as
Acknowledgments
We thank the School of Psychology, Adelaide University, Guide Dogs of SA, and Ray Liddle, for loaning the equipment; the Department of Occupational Therapy, Repatriation General Hospital, and Royal Adelaide Hospital for support; the participants in the Steering Committee including Louise Rugari, Nicole Parsons, Michael Clark, Marisa Barbarioli, and Michelle Miller; and Jackie Stepien-Hulleman, Lynne Giles, and Simon Gunn for assistance with manuscript preparation and data analysis.
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Supported by the Motor Accident Commission and the Government of South Australia.
Australian clinical trials registry number 147.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
Reprints are not available from the author.