Original article
Retraining Visual Processing Skills To Improve Driving Ability After Stroke

Presented to Diff'rent Strokes, International Symposium on Stroke Rehabilitation, October 10–11, 2002, Adelaide, South Australia, and the State Congress of the Optometrists Association of Australia–South Australia, July 26–27, 2002, Adelaide, South Australia.
https://doi.org/10.1016/j.apmr.2009.08.143Get rights and content

Abstract

Crotty M, George S. Retraining visual processing skills to improve driving ability after stroke.

Objective

To evaluate the effectiveness of retraining using the Dynavision on driving performance of people with stroke.

Setting

Outpatient rehabilitation clinic in Australia.

Participants

People with stroke (N=26) referred for driving assessment.

Interventions

Eligible participants were randomized to either receive retraining with the Dynavision apparatus for 18 sessions or to receive no intervention and go onto a waitlist.

Main Outcome Measures

The primary outcome was an assessment of on-road ability. Secondary outcomes included measures of response speed, visual scanning, and self-efficacy. All assessments were conducted by assessors blinded to group assignment.

Results

No significant difference (P=.223) was found between the intervention and control groups in results of on-road assessment in terms of pass or fail; the primary outcome measure; or the results on the secondary outcome measures of response speed, visual scanning, and self-efficacy.

Conclusions

In this small trial, training underlying skills (such as executing a continuous wide scan, combining motor and visual processing into a motor response) using the Dynavision apparatus did not improve the outcomes of an on-road assessment for people after strokes. Larger trials are needed to evaluate devices that claim to retrain underlying skills related to driving.

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.

References (30)

  • J.A. Gresset et al.

    Risk of accidents among elderly car drivers with visual acuity equal to 6/12 or 6/15 and lack of binocular vision

    Ophthalmic Physiol Opt

    (1994)
  • R. Lister

    Loss of ability to drive following a stroke: the early experiences of three elderly people on discharge from hospital

    Br J Occ Ther

    (1999)
  • J. Legh-Smith et al.

    Driving after stroke

    J R Soc Med

    (1986)
  • B. Mazer et al.

    Evaluating and retraining driving performance in clients with disabilities

    Crit Rev Phys Rehabil Med

    (2004)
  • V.S. Pelak et al.

    Homonymous hemianopia: a critical analysis of optical devices, compensatory training and NovaVision

    Curr Treat Options Neurol

    (2007)
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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.

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