Department of Physical Therapy, Neurology, Medical College of Georgia, Augusta, Georgia 30912, USA.
J Stroke Cerebrovasc Dis. 2012 Aug;21(6):478-86. doi: 10.1016/j.jstrokecerebrovasdis.2010.12.001. Epub 2011 Jan 14.
Driving is an important activity of daily living. Loss of driving privileges can lead to depression, decreased access to medical care, and increased healthcare costs. The ability to drive is often affected after stroke. In approximately 30% of stroke survivors, it is clear from the onset that driving will no longer be possible. Approximately 33% of survivors will be able to return to driving with little or no retraining, and 35% will require driving-related rehabilitation before they can resume safe driving again. The ability to drive is not routinely evaluated after stroke, and there is no established rehabilitation program for poststroke driving. When driving evaluation does occur, it is not always clear which tests are the most salient for accurately assessing poststroke driving ability. Investigators have examined the efficacy of various methodologies to predict driving performance after stroke and have found mixed results, with each method having unique weaknesses, including poor predictive ability, poor face validity, poor sensitivity or specificity, and limited reliability. Here we review common models of driving to gain insight into why single-construct visual or cognitive off-road measures are inadequate for evaluating driving, a complex and dynamic activity that involves timely interaction of multiple motor, visual, cognitive, and perceptual skills. We also examine the potential for driving simulators to overcome the problems currently faced in the evaluation and rehabilitation of driving after stroke. Finally, we offer suggestions for the future direction of simulator-based poststroke driving evaluation and training.
驾驶是日常生活中的一项重要活动。丧失驾驶资格可能导致抑郁、就医机会减少和医疗费用增加。中风后往往会影响驾驶能力。在大约 30%的中风幸存者中，从发病开始就很明显，他们将不再能够开车。大约 33%的幸存者只需进行少量或无需再培训即可恢复驾驶，而 35%的幸存者在能够再次安全驾驶之前需要进行与驾驶相关的康复。中风后通常不会对驾驶能力进行常规评估，也没有针对中风后驾驶的既定康复计划。当进行驾驶评估时，并不总是清楚哪些测试最能准确评估中风后驾驶能力。研究人员已经研究了各种方法来预测中风后的驾驶表现，结果喜忧参半，每种方法都有其独特的弱点，包括预测能力差、表面效度差、灵敏度或特异性差以及可靠性有限。在这里，我们回顾常见的驾驶模型，以深入了解为什么单一结构的视觉或认知场外测试不足以评估驾驶，这是一种复杂而动态的活动，需要及时互动多个运动、视觉、认知和感知技能。我们还研究了驾驶模拟器在克服当前中风后驾驶评估和康复所面临的问题方面的潜力。最后，我们为基于模拟器的中风后驾驶评估和培训的未来方向提出了建议。
