Hird Megan A, Vetivelu Abeiramey, Saposnik Gustavo, Schweizer Tom A
Neuroscience Research, St. Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Canada.
Neuroscience Research, St. Michael's Hospital, Toronto, Ontario, Canada; Stroke Research Unit, Mobility Program, St. Michael's Hospital; Medicine, St. Michael's Hospital, University of Toronto.
J Stroke Cerebrovasc Dis. 2014 Nov-Dec;23(10):2654-2670. doi: 10.1016/j.jstrokecerebrovasdis.2014.06.010. Epub 2014 Oct 11.
Driving is a complex activity that requires intact cognitive, behavioral, and motor function. Stroke is one of the most prevalent neurologic impairments and can affect all of these functions. However, diagnosis of stroke is not a definitive indicator of driving impairment. Determining fitness to drive after stroke is a very complex process and is typically based on cognitive assessments, on-road performance, simulator-based assessment, or a combination of the three. The aim of this review was to provide (1) a systematic review of the literature on cognitive, on-road, and simulator assessment after stroke, and (2) address the existing limitations and inconsistencies in stroke and driving research. Our results indicated that of 1413 total stroke patients, 748 definitively passed and 367 definitely failed an on-road assessment, with minimal information provided about clinical presentation. In addition, although the Stroke Driver Screening Assessment, the Useful Field of View Test, and the Rey-O Complex Figure test may have some utility in predicting driving performance, most cognitive measures have been inconsistently and minimally explored. Several limitations were observed across studies such as procedural inconsistencies, including outcome variables used (eg, driving cessation and pass/fail classification) and the heterogeneity of patient samples (eg, time since stroke and stroke location). Due, in part, to the larger variability in results of cognitive, on-road, and simulator-based assessment, there is no consensus regarding a valid and reliable driving assessment for physicians. Future studies should assess poststroke driving fitness by differentiating different stages, severities, and locations of stroke.
驾驶是一项复杂的活动，需要完整的认知、行为和运动功能。中风是最常见的神经损伤之一，会影响所有这些功能。然而，中风的诊断并非驾驶能力受损的决定性指标。确定中风后是否适合驾驶是一个非常复杂的过程，通常基于认知评估、实际道路表现、基于模拟器的评估或三者的结合。本综述的目的是：（1）对有关中风后认知、实际道路和模拟器评估的文献进行系统综述；（2）解决中风与驾驶研究中现有的局限性和不一致性。我们的结果表明，在总共1413名中风患者中，748名在实际道路评估中明确通过，367名明确未通过，关于临床表现的信息极少。此外，尽管中风驾驶员筛查评估、有用视野测试和雷-奥复杂图形测试在预测驾驶表现方面可能有一定作用，但大多数认知测量方法的研究一直不一致且很少。在各项研究中观察到了一些局限性，如程序不一致，包括所使用的结果变量（如驾驶停止和通过/未通过分类）以及患者样本的异质性（如中风后的时间和中风部位）。部分由于认知、实际道路和基于模拟器的评估结果差异较大，对于医生而言，尚无关于有效且可靠的驾驶评估的共识。未来的研究应通过区分中风的不同阶段、严重程度和部位来评估中风后的驾驶适宜性。
